Low sperm count

Low sperm count means that the fluid (semen) you ejaculate during an orgasm contains fewer sperm than normal. A low sperm count is also called oligospermia. A complete absence of sperm is called azoospermia. Your sperm count is considered lower than normal if you have fewer than 15 million sperm per milliliter of semen.

Having a low sperm count decreases the odds that one of your sperm will fertilize your partner's egg, resulting in pregnancy. Nonetheless, many men who have a low sperm count are still able to father a child.

SYMPTOMS
The main sign of low sperm count is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, an underlying problem such as an inherited hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause signs and symptoms. Low sperm count symptoms may include:

Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)Pain, swelling or a lump in the testicle areaDecreased facial or body hair or other signs of a chromosome or hormone abnormality

See a doctor if you:

Are unable to conceive a child after a year of regular, unprotected sexual intercourse with your partnerHave erection or ejaculation problems, low sex drive or other problems with sexual functionHave pain, discomfort, a lump or swelling in the testicular areaHave a history of testicle, prostate or sexual problemsHave had groin, testicle, penis or scrotum surgery

CAUSES
The production of sperm is a complex process and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in your brain that produce hormones that trigger sperm production. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these systems can affect sperm production. Also, there may be problems of abnormal sperm shape (morphology), movement (motility) or function. Often the cause of low sperm count isn't ever identified.

Medical causes

Low sperm count can be caused by a number of health issues and medical treatments. Some of these include:

Varicocele. A varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. It's a common cause of male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm. The treatment of a varicocele often improves sperm quality and overall fertility.Infection. Some infections can interfere with sperm production and sperm health or can cause scarring that blocks the passage of sperm. These include some sexually transmitted infections, such as chlamydia and gonorrhea; inflammation of the prostate (prostatitis); inflamed testicles; and other infections of the urinary tract or reproductive organs.Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra. Certain medications also may result in retrograde ejaculation, such as blood pressure medications known as alpha blockers. Some men with spinal cord injuries or certain diseases can't ejaculate semen at all, though they still can produce sperm.Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, or can affect the glands that release hormones related to reproduction (such as the pituitary gland). Surgery, radiation or chemotherapy to treat tumors can also affect male fertility.Undescended testicles. During fetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.Hormone imbalances. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal, may impair sperm production.Sperm duct defects. The tubes that carry sperm can be damaged by illness or injury. Some men are born with a blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one of the tubes that carry sperm out of the testicles (vas deferens). Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether.Chromosome defects. Inherited disorders such as Klinefelter's syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann's syndrome and Kartagener syndrome.Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal and antibiotic medications, some ulcer medications and some other medications can impair sperm production and decrease male fertility.

Environmental causes

Overexposure to certain environmental elements can affect sperm production or function. Specific causes include:

Industrial chemicals. Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead may contribute to low sperm counts.Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.Radiation or X-rays. Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced.Overheating the testicles. Frequent use of saunas or hot tubs may temporarily lower your sperm count. Sitting for long periods, wearing tight clothing or using a laptop on your lap for long periods of time also may increase the temperature in your scrotum and reduce sperm production. The type of underwear you choose to wear is unlikely to significantly impact your sperm count.Prolonged bicycling. Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles.

Health, lifestyle and other causes

Other causes of low sperm count include:

Illegal drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.Occupation. Certain occupations may increase your risk of infertility, including those associated with extended use of computers or video display monitors, shift work and work-related stress. Tobacco smoking. Men who smoke may have a lower sperm count than do those who don't smoke.Emotional stress. Severe or prolonged emotional stress, including stress about fertility itself, may interfere with certain hormones needed to produce sperm.Weight. Obesity can cause hormone changes that reduce male fertility.Sperm testing issues. Lower than normal sperm counts can result from testing a sperm sample that was taken too soon after your last ejaculation; was taken too soon after an illness or stressful event; or didn't contain all of the semen you ejaculated because some was spilled during collection. For this reason, results are generally based on several samples taken over a period of time.

COMPLICATIONS
Infertility caused by low sperm count can be stressful for both you and your partner. Complications can include:

Surgery or other treatments for an underlying cause of low sperm count Expensive and involved assisted reproductive techniques, such as in vitro fertilization Stress related to the inability to have a child

DIAGNOSIS
When you see a doctor because you're having trouble getting your partner pregnant, he or she will try to determine the underlying cause. Even if your doctor thinks low sperm count is the problem, you and your partner may both need tests to rule out other causes of infertility and to look for any underlying health problems. Testing and diagnosis may involve the following:

General physical examination and medical history

This includes examination of your genitals and questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor may also ask about your sexual habits and your sexual development.

Semen analysis

A low sperm count is diagnosed as part of a semen analysis test. Sperm count is generally determined by examining semen under a microscope to see how many sperm appear within squares on a grid pattern. In some cases, a computer may be used to measure sperm count.

To collect a semen sample, your doctor will have you masturbate and ejaculate into a special container. It's also possible to collect sperm for examination during intercourse, using a special condom. Sperm counts often fluctuate. In most cases, several semen analysis tests are done over a period of time to ensure accurate results.

New sperm are produced continually in the testicles and take about 40 to 76 days to mature. So, a current semen analysis reflects your environment over the past 2.5 months. Any positive changes you've made won't show up for a period of several months.

One of the most common causes of low sperm count is incomplete or improper collection of a sperm sample. Most doctors will check two or more semen samples over time to ensure consistency between samples. To ensure accuracy in a collection, your doctor will want to:

Ensure all of your semen makes it into the collection cup or collection condom when you ejaculateWait at least three months after you've recovered from an illness or stressful event to collect a sperm sampleHave you abstain from ejaculating for at least two but no longer than seven days before collecting a sampleMake sure a second sample is collected at least seven days after the firstHave you avoid the use of lubricants because these products can affect sperm motility

Semen analysis results

Normal sperm densities range from 15 million to greater than 200 million sperm per milliliter of semen. You are considered to have a low sperm count if you have fewer than 15 million sperm per milliliter or less than 39 million sperm total per ejaculate. Your chance of getting your partner pregnant decreases with decreasing sperm counts. Some men have no sperm in their semen at all. This is known as azoospermia (ay-zoh-uh-SPUR-me-uh).

There are many factors involved in reproduction, and the number of sperm in your semen is only one. Some men with low sperm counts successfully father children. Likewise, some men with normal sperm counts are unable to father children. Even if you have enough sperm, you're much more likely to get your partner pregnant if at least half of your sperm have normal forward movement (motility).

Other tests

Depending on initial findings, your doctor may recommend additional tests to look for the cause of your low sperm count and other possible causes of male infertility. These can include:

Scrotal ultrasound. This test uses high-frequency sound waves to look at the testicles and supporting structures.Transrectal ultrasound. A small lubricated wand is inserted into your rectum to check your prostate, and for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).Hormone testing. Your doctor may recommend a blood test to determine the level of hormones produced by the pituitary, hypothalamus and testicles, which play a key role in sexual development and sperm production.Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).Genetic tests. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing may also be ordered to diagnose various congenital or inherited syndromes.Testicular biopsy. This test involves removing samples from the testicle. It may be used if your semen analysis shows no sperm at all. The results of the testicular biopsy will tell if sperm production is normal. If it is, your problem may be caused by a blockage or another problem with sperm transport.Anti-sperm antibody tests. These tests are used to check for immune cells (antibodies) that attack sperm and affect their ability to function.Specialized sperm function tests. A number of tests can be used to evaluate how well your sperm survive after ejaculation, how well they can penetrate an egg and whether there's any problem attaching to the egg. If you do have a low sperm count, having healthy sperm can be an important factor in male fertility.

TREATMENT
Treatments for low sperm count include:

Surgery. For example, a swelling of the veins that drain the testicle (varicocele) can often be surgically fixed or an obstructed vas deferens tube repaired. Treating infections. Antibiotics can cure an infection of the reproductive tract, but this doesn't always restore fertility. Hormone treatments and medications. Hormone replacement or medications may be prescribed to change hormone levels. It can take between three and six months before you'll notice any effects on your semen analysis. Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used for in vitro fertilization or intracytoplasmic sperm injection.

When treatment doesn't work

Sometimes male fertility problems can't be treated, and it's impossible for a man to father a child. If this is the case, you and your partner can consider either using sperm from a donor or adopting a child.