Signs of low sperm count and how it can affect fertility

Nothing in this article is or should be construed as medical advice; for any medical questions, consult your healthcare professional.

If “low sperm count” has entered the conversation, you and your partner are likely wondering: What now? Low sperm count, one of the common causes of infertility in men, can make it challenging for couples to conceive naturally. However, a successful pregnancy is possible. Better understanding the many factors surrounding low sperm count may help ease some of your worries and concerns as you work with a healthcare professional.

What are the chances of getting pregnant with low sperm count?

While this is likely your most pressing question, the answer is unique for every situation. As sperm count decreases, so do chances of pregnancy.¹ However, pregnancy with low sperm count is possible.¹ Percentages are difficult to provide because of the many factors involved when dealing with low sperm count and fertility. For example, did you know that sperm count, motility and shape (morphology) are all important factors in male fertility?² Additionally, there are many different reasons for low sperm count and some are more easily remedied than others. Additional fertility issues (such as problems with ovulation) may also exist. If you’re wondering what you and your partner’s chances of pregnancy are with low sperm count, make an appointment with a healthcare professional who can put you on a path to painting a clearer picture of your fertility future.

What are some low sperm count signs?

Many men don’t realize they have low sperm count until they and their partner have trouble getting pregnant.¹ Often, infertility is the first sign of low sperm count. Additional signs and symptoms could include:

• Erectile dysfunction
• Low libido
• Testicular pain or swelling
• Testicular veins that are dilated
• Pain during or after sex
• Reduced body or facial hair¹

You should always talk to a healthcare professional if you and your partner have been trying to conceive for one year without success. Also talk to your healthcare professional if you or your partner are experiencing any of the following:

• Problems with ejaculation
• Erectile dysfunction
• Low libido
• Testicular pain or swelling
• A history of problems or surgeries to the male reproductive organs¹

What is low sperm count and why does it happen?

Fewer than 15 million sperm in 1 mL of semen is considered low sperm count.³ According to the Urology Care Foundation, sperm problems, including how they grow, how they’re shaped, how they move and how many (if any) exist, can result from congenital issues, lifestyle choices, childhood infections, long-term health conditions, certain medications, problems with hormones or chromosomes, or damage to or blockage within the reproductive system.⁴ If you suspect you (or your partner) have any of the above, speak to your healthcare professional.

Some causes of low sperm count include:

• Varicoceles: Found in 16% of men (and in 40% of infertile men), these swollen scrotal veins disrupt blood flow and can overheat the testes, lowering sperm production.⁴
• Hormones: Low hormone levels in the pituitary gland can lead to poor sperm growth.⁴
• Medications: According to the Urology Care Foundation, some medications used to treat anxiety, depression, infection, arthritis, issues with digestion, high blood pressure and cancer can interfere with sperm production, as well as function and delivery.⁴ Talk to your healthcare professional for more information.
• Infections: Some sexually transmitted infections (e.g., gonorrhea) and/or inflammation of the testicles or epididymis can result in damage that leads to low sperm count.¹
• Chromosome anomalies: These can include inherited disorders such as cystic fibrosis or Klinefelter’s syndrome (in which men have an extra X chromosome).¹
• Injury to the testicle: Testicles hang outside the body, so they can be damaged more easily than internal organs.⁵ Testicular trauma can create blockages and issues in how sperm are transported, lowering sperm count.¹
• Thyroid problems: Hyperthyroidism is associated with low sperm count.⁶
• Lifestyle factors: According to Mayo Clinic, smoking, drug and alcohol use, stress, depression, obesity, and even what someone does for a living (for example, if they sit in one place for long periods of time) can all affect sperm count.¹
• Environmental toxins: Exposure to certain industrial chemicals and some heavy metals have been associated with low sperm count.¹
• Radiation therapy: Cancer treatments that require radiation therapy to reproductive organs, the pelvis, or the spine or abdomen can lower sperm count.⁷ Those who are undergoing cancer treatments should talk to their healthcare professional about fertility.

While this list may feel daunting, there are solutions and workarounds to many of these causes. If you are concerned about any of the factors above, talk to your healthcare professional, who can provide specific advice for your health and well-being.

How does low sperm count affect fertility?

Fewer sperm decreases the chances of pregnancy.¹ While getting pregnant with low sperm count can be more difficult, it’s important to note that sperm count is only one factor in male fertility.⁴ According to the Urology Care Foundation, “Male fertility depends on your body making normal sperm and delivering them.”⁴ Many factors can affect the normal production and delivery of sperm, making pregnancy more difficult.

Tips for getting pregnant with low sperm count

Although you may feel uncomfortable discussing low sperm count, talking to a healthcare professional is key for optimizing male fertility and sperm count. A semen analysis often provides a goldmine of information. If an analysis reveals low sperm count, a healthcare provider may suggest checking hormone levels in the blood, genetic testing, ultrasounds, sperm function testing, a urinalysis or a biopsy.³

Some treatment options for low sperm count include*:

• Lifestyle changes: Eat nutritious foods, exercise and try to lose some weight if obese. Stop smoking. Prevent STIs. Take steps to manage stress. Limit alcohol intake and don’t binge drink. Avoid environmental toxins. Also, heat can affect testicle sperm production, so avoid hot tubs and tight-fitting underwear.²
• Medication or counseling for sexual disorders: For pregnancy to occur, it’s important to have sex during the fertile window.³ An ovulation test can help identifying your most fertile days. Treating sexual disorders such as erectile dysfunction and premature ejaculation can positively impact low sperm count and fertility generally.³
• Surgery: These may include a varicocelectomy (treating swollen varicoceles), a microsurgical vasovasostomy (to reverse a vasectomy), a vasoepididymostomy (which treats epididymal blocks), and transurethral resection of the ejaculatory duct (TURED) to treat an ejaculatory duct blockage.⁴
• Assisted reproductive techniques (ART): This may include IUI (intrauterine insemination), IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection).⁴ There are several ways to retrieve sperm for ART; talk to your healthcare professional for more information.⁴
• Additional therapies: Your healthcare professional may recommend medications or treatments that affect your hormones.³

Talk to your healthcare professional about the full list of options and what may be right for your circumstances.

My partner has no sperm: How can I get pregnant?

When ejaculation occurs with no sperm, it is called azoospermia.⁸ According to Cleveland Clinic, azoospermia is the cause of infertility in about 10% of men who are infertile.⁸ A diagnosis of azoospermia doesn’t mean pregnancy is impossible.⁸ Many treatment options for low sperm count are the same as or similar to treatments for no sperm count. Talk to your healthcare professional about testing and treatment options.

Learning that low sperm count is affecting your chances of getting pregnant can feel frustrating, uncomfortable and disheartening. However, keep in mind that many people experience infertility, whether from low sperm count or another reason — meaning that you’re not alone. And while low sperm count can be caused by varying factors, remember that for many of those causes, there is hope – treatment options do exist. Talk to your healthcare professional for advice. A better understanding of your situation and the available options may help point you in the direction of a successful pregnancy.

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