Low Sperm Count

Symptoms

Not being able to conceive is the primary indication of low sperm count, and there aren’t any other apparent symptoms or signs. But in some cases, an underlying condition like genetic chromosomal abnormality, enlarged testicular veins, hormonal imbalance, or a blockage in the sperm passage can lead to the symptoms.

The common symptoms of low sperm count may include:

• Sexual function problems, such as reduced sex drive or erectile dysfunction (difficulty maintaining an erection)
• Pain, lump, or swelling in the testicular area
• Reduced facial or body hair or other symptoms indicating a chromosomal or hormonal abnormality

Causes

Sperm production is an intricate process. Hence, it needs proper functioning testes (testicles) along with pituitary glands and hypothalamus, which are brain organs producing hormones essential for sperm production.

After the testicles produce sperm, delicate tubes carry them, and it is here that they combine with semen. They are eventually ejaculated through the penis.

Any issue with one of the systems could impact sperm production. Moreover, abnormalities in the shape of the sperm (morphology), movement (motility), or function can occur. Nonetheless, the actual causes of low sperm count remain unidentified.

Medical causes

Low sperm count can result from various health problems as well as medical therapies. The common causes include:

• Varicocele: This is the inflammation of the veins draining the testicle. It is the most prevalent reversible male infertility cause. While the actual reason as to why varicoceles lead to infertility is unclear, it may be linked to abnormal regulation of testicle temperature. Generally, this condition reduces sperm quality.
• Infection: Certain infections can alter sperm production and health, or result in scarring that hinders sperm passage. Examples of these infections are inflammation of the epididymis (epididymitis) or testicles (orchitis), along with particular sexually transmitted diseases like gonorrhoea and HIV. While some infections could cause irreversible damage to the testicle, sperm may still be retrievable.
• Ejaculation problems: This is known as retrograde ejaculation, and arises when semen gets into the bladder rather than exiting through the penis tip during orgasm. Certain medical conditions such as diabetes, spinal injuries, and surgeries involving the prostate, bladder, or urethra can cause ejaculation disorders.
  In addition, some medications, especially blood pressure drugs called alpha blockers, can lead to ejaculatory issues. Some of these problems are reversible, whereas others may be permanent. For most permanent ejaculation cases, sperm could directly be retrieved from the testicles.
• Antibodies attacking sperm: Immune system cells called anti-sperm antibodies can accidentally detect sperm as dangerous intruders, hence attempting to destroy them.
• Tumors: Both cancerous and noncancerous tumors can directly impact male reproductive organs through hormone-releasing glands associated with reproduction like the pituitary gland or through some unidentified causes. Tumors treatment, including surgery, radiation therapy, or chemotherapy, can as well interfere with male fertility.
• Undescended testicles: As the foetus develops, sometimes one or both testicles may not descend into the scrotum (the sac containing testicles) from the abdomen. Men with this condition are more likely to have reduced fertility.
• Hormone imbalances: The hypothalamus, pituitary gland, and testicles release hormones essential for sperm production. Therefore, any changes in these hormones including the hormones from other systems like the adrenal and thyroid glands, can affect sperm creation.
• Defects of tubules transporting sperm: Various tubes transport sperm. Sometimes, factors such as accidental injury due to surgery, trauma, previous infections, or abnormal growth, like cystic fibrosis or related genetic conditions, can cause the tubes to block.
  Tubule blockages can happen anywhere in the tubes draining the testicle, within the testicle, in the epididymis, around the ejaculatory ducts, in the vas deferens, or within the urethra.
• Chromosomal defects: Genetic conditions, including Klinefelter’s syndrome, where a male child has two X and one Y chromosomes rather than one X and one Y chromosome at birth, lead to abnormal growth of male reproductive organs. Other inherited syndromes related to infertility are Kallmann’s syndrome, cystic fibrosis, and Kartagener’s syndrome.
• Celiac disease: This digestive disorder that results from sensitivity to gluten can lead to male infertility. However, fertility can start improving once you adjust to a gluten-free diet.
• Certain drugs: Prolonged use of anabolic steroids, testosterone replacement therapy, cancer medicines (chemotherapy), some antifungal and antibiotic drugs, and ulcer treatments, among other types of medications, are likely to affect sperm production and lower male fertility.
• Previous surgeries: Some surgeries can cause the absence of sperm in the ejaculate. They include vasectomy, scrotal or testicular procedures, inguinal hernia repairs, prostate operation, and large abdominal surgeries done to treat cancers of the testicle and rectum. Mostly, surgical procedures can be conducted to reverse these obstructions or directly retrieve sperm from the testicles and epididymis.

Environmental causes

Too much exposure to some environmental factors can affect the production or function of the sperm. They include:

• Industrial chemicals: Prolonged exposure to industrial chemicals such as benzenes, xylene, toluene, herbicides, pesticides, painting materials, organic solvents, and lead could cause low sperm count.
• Heavy metal exposure: Being exposed to lead and other heavy metals can lead to male infertility.
• Radiation or X-rays: Radiation exposure is likely to lower sperm production, and it may take a few years for sperm creation to be normal again. Higher radiation doses can permanently reduce sperm production.
• Overheating the testicles: High temperatures can impair the function and production of sperm. While research is limited and not conclusive, regularly being in hot tubs or saunas can temporarily affect sperm count.

Furthermore, putting on tight clothing, sitting for extended periods, or placing a laptop on your lap for long can increase scrotal temperature and slightly lower sperm production.

Health, lifestyle, and other causes

Other factors that can contribute to low sperm count are:

• Drug use: Anabolic steroids used to boost muscle growth and strength can make the testicles shrink and reduce sperm production. Cocaine and marijuana use may also decrease the number and quality of the sperm.
• Alcohol intake: Consuming alcohol is likely to reduce testosterone levels and lead to reduced sperm production.
• Occupation: Some occupations, such as welding and those involving prolonged sitting, like truck driving, could be associated with male infertility. Nonetheless, the evidence backing these claims is unreliable.
• Smoking tobacco: Those who smoke tobacco may have reduced sperm count compared to men who don’t.
• Emotional stress: Persistent or severe emotional stress, such as stress regarding fertility can disrupt the hormones necessary for sperm production.
• Depression: Depression can adversely impair sperm concentration.
• Weight: Excessive weight can affect fertility in many ways, such as directly impairing sperm and triggering hormonal changes that lower fertility.
• Sperm testing problems: Low sperm counts can be detected if the sperm sample test is done too soon following the past ejaculation, shortly after a disease or stressful occasion, or if the sample didn’t have all the ejaculated semen due to spillage during collection. Therefore, results usually depend on the number of samples obtained over time.

Risk factors

Various risk factors are associated with low sperm count and related problems. They are:

• Smoking tobacco
• Alcohol consumption
• Use of illegal drugs
• Obesity
• Having severe depression or stress
• Particular present or previous infections
• Toxins exposure
• Overheating the testicles
• History of trauma to the testicles
• Congenital fertility condition or having a close family member (father or brother) with the disorder
• Having health conditions such as chronic diseases and tumors
• Receiving cancer treatments like radiation therapy
• Using certain medicines
• Previous vasectomy or major pelvic or abdominal surgery
• A history of undescended testicles

Complications

Infertility resulting from low sperm count could be distressing for you and your partner. Some of the possible complications are:

• Surgical procedures or other treatment options for low sperm count underlying causes.
• Costly and complex assisted reproductive methods, including in vitro fertilization (IVF).
• Stress associated with the inability to conceive a child.

Prevention

You can safeguard your fertility by avoiding the known contributing factors that could impact sperm quality and count. These include:

• Not smoking
• Limiting or abstaining from alcohol consumption
• Avoiding illicit drugs
• Consulting your doctor regarding medicines that may impact sperm count
• Maintaining a healthy body weight
• Avoiding too much heat
• Managing stress
• Avoiding heavy metals, pesticides, or other toxins exposure

Diagnosis

Upon consulting a doctor due to difficulties in having a child, they will attempt to find out the underlying cause. Whereas low sperm count is suspected, it is advisable that your partner also undergo an examination. This helps rule out possible contributing reasons and decide if assisted reproductive methods are necessary.

General physical examination and medical history

This involves assessing the genitals and inquiring about any hereditary conditions, diseases, chronic medical problems, injuries, or surgeries likely to affect fertility. Moreover, the doctor may want to know about your sexual behaviours and development.

Semen analysis

Doctors use semen analysis tests to diagnose low sperm count. Generally, sperm count is detected through semen examination under a microscope to check the number of sperm appearing in squares on the grid pattern. Sometimes, a computer is used to determine sperm count levels.

There are a number of methods of obtaining semen samples. First, the sample can be collected in a container by masturbating and ejaculating in the provider’s office. However, due to some cultural or religious beliefs, some opt for alternative ways of collecting semen, such as using a special condom during sexual intercourse.

The testicles are constantly producing new sperm, which takes 42 to 76 days to reach maturity. Therefore, the current semen analysis is a reflection of your surroundings within the previous 3 months. For a few months, you won’t notice any positive adjustments that you have made.

Improper or incomplete sperm sample collection is among the most prevalent reasons for low sperm count. Moreover, sperm count frequently tends to fluctuate. Due to such factors, the majority of medical providers will evaluate two or even more semen samples with time to make sure they are consistent.

The doctor will mostly recommend the following steps to guarantee accuracy when obtaining the sample:

• Ensure that all the semen gets into the collection container or condom during ejaculation.
• Avoid ejaculating for at least 2 to 7 days before sample collection.
• Obtain the second sample after about two weeks from the first collection.
• Avoid using lubricant products as they can impair sperm motility.

Semen analysis results

The normal density of sperm ranges between 15 million to over 200 million sperm per milliliter of semen. If you have below 15 million sperm per milliliter or a total of fewer than 39 million sperm per ejaculate, then you are deemed to have a low sperm count.

The odds of getting your partner pregnant reduce with declining sperm counts. Also, some men do not have any sperm in their semen (azoospermia).

While various factors are involved when it comes to reproduction, the amount of sperm in the semen is one of them. Other men with low sperm count are still able to successfully conceive a child. Similarly, some with normal sperm counts may not father a child. This means that even though you have sufficient sperm, additional factors are essential in achieving a pregnancy. An example is normal sperm movement or motility.

Other diagnostic tests

• Based on the initial results, the medical provider can suggest more diagnostic tests to identify the cause of low sperm count as well as other potential reasons for male infertility. Examples of these tests are:
• Scrotal ultrasound: Utilizes high-frequency sound waves to examine the testicles along with the supporting structures.
• Hormonal testing: A blood test can be used to assess hormone levels the pituitary gland and testicles release, which are crucial for sperm production and sexual development.
• Post-ejaculation urinalysis: Detects the presence of sperm in the urine, which can mean that sperm are moving backward into the bladder rather than exiting the penis during ejaculation (retrograde ejaculation).
• Inherited tests: Very low sperm concentration can be linked to genetic causes. Therefore, a blood test can identify any subtle alterations in the Y chromosome, which may indicate an inherited defect. Genetic testing can also help diagnose different congenital or hereditary syndromes.
• Testicular biopsy: Involves using a needle to obtain samples from the testicle. The findings from this test determine if the production of sperm is normal. If normal, the issue is probably due to blockage or a different problem with sperm transportation. Testicular biopsy is, however, only recommended under particular situations and isn’t mostly used to detect male infertility causes.
• Anti-sperm antibody tests: This looks for immune cells (antibodies) attacking sperm and affecting their functioning capacity. These tests are, however, uncommon.
• Specialized sperm function tests: Evaluate how well the sperm can remain alive after ejaculation, their ability to penetrate an egg, and if there are attachment problems to the egg. However, these tests are not commonly done and don’t significantly alter treatment choices.
• Transrectal ultrasound: Involves inserting a small, lubricated wand into the rectum to examine the prostate and look for obstructions in the tubes transporting semen (ejaculatory ducts and seminal vesicles).

Treatments

Treatmentoptions for low sperm count are:

• Surgery: A varicocele is mostly corrected through surgery, and a blocked vas deferens can as well be repaired. Previous vasectomies may also be reversed. In situations where sperm is absent in the ejaculate, it is often directly obtained from the epididymis or testicles through sperm retrieval methods.
• Treating infections: Doctors can prescribe antibiotics to treat reproductive tract infections, although this doesn’t often restore male fertility.
• Treatments for sexual intercourse disorders: Taking medication or seeking counselling may be helpful in improving fertility for problems like premature ejaculation or erectile dysfunction.
• Hormone treatments and medications: Hormonal replacement or medicines may be recommended if infertility is due to high or reduced levels of particular hormones or issues with how these hormones are used in the body.
• Assisted reproductive technology (ART): This treatment entails sperm collection through normal ejaculation, surgical removal, or from donors based on a person’s particular situation and preferences. After that, the obtained sperm will be injected into the female vaginal canal or used for in vitro fertilization (IVF) or intracytoplasmic sperm injection.

How should I care for myself to optimize my sperm count?

The doctor can recommend the following lifestyle adjustments to improve fertility in men with a low sperm count:

• Attaining and maintaining a healthy weight through regular exercise and a balanced diet.
• Avoiding smoking and use of tobacco products.
• Limiting intake of alcoholic beverages.
• Stop using marijuana and other substances.

While there are available helpful mineral, herbal, or vitamin supplements, it’s always important to talk with your doctor before using them to ensure they are safe and appropriate.

How can I lower my risk of having a low sperm count?

By leading a healthy lifestyle that involves adequate sleep, exercise, food, and alcohol use, you can benefit in every aspect, along with your sperm count.

Outlook/Prognosis

How long does oligospermia last?

The duration of the oligospermia condition is determined by the underlying cause. Low sperm count can be reversed if the reason behind this problem is stoppable, such as overheating the testicles or using certain drugs.

Changing certain causes of low sperm count, like those related to genetic problems, might be impossible.

Overall, oligospermia is not a life-threatening illness and is unlikely to come between work or school.

Living With

When should I see my doctor about a low sperm count?

Most likely, you won’t immediately be aware that you have oligospermia since you can’t feel it. The first indicator is usually being unable to get your partner pregnant, especially when trying to conceive.

At this period, many people will probably see a doctor to understand the reason you and your partner can’t get a child. After undergoing tests, you will discover that you have a low sperm count.

In such cases, it’s important to ask your doctor these questions:

• What is the cause of my low sperm count?
• What can I do to increase my sperm count?
• Is my low sperm count associated with a serious health problem?
• Should I consult another specialist for more assistance?