Low Sperm Count (Oligospermia): Signs, Symptoms, Causes, Treatment & Diagnosis

Millions of couples are affected by infertility and low sperm count signs. Low sperm count, or oligospermia, is one of the most frequent issues in men’s fertility. Many males believe that fertility issues are just for women, but sperm health is also significant in the conception process.

According to WHO, male factor contributes to 20 to 30% overall. If a man’s sperm count is low, it does not mean that he cannot father a child. Even if a man has a low sperm count, he may be able to conceive naturally or through medical intervention. The secret is early detection: recognising the symptoms of low sperm count, understanding what causes low sperm count, and receiving prompt treatment.

Here in this extensive guide, we’ll talk about what exactly constitutes low sperm count, reasons for low sperm count, low sperm count signs, causes of low sperm count, treatment for low sperm count, and things that you can do naturally to boost your sperm health.

What is Low Sperm Count (Oligospermia)?

Low sperm count is a decrease in the number of sperm in semen, below the normal level. The World Health Organisation (WHO) considers a normal sperm count to be 15 million sperm/mL of semen or more. Any sperm count below this rate is considered a low sperm count (oligospermia).

The severity can be categorised as:

• Mild: 10–15 million sperm/mL
• Moderate: 5–10 million sperm/mL
• Severe: < 5 million sperm/mL

Low sperm count means lower chances of sperm reaching and fertilising the egg naturally; it doesn’t mean it is a cause of infertility.

What are the Signs and Symptoms of Low Sperm Count (Oligospermia)?

Low sperm count signs & symptoms are not noticeable to many men, since the sperm count cannot be determined just by looking or by measuring the volume of their ejaculation. Indeed, some men will have no symptoms until they find themselves facing difficulties when they are trying to conceive.

Here are the reasons for low sperm count:

1. Difficulty Conceiving

The most common symptom of low sperm count is not being able to conceive after 12 months or more of regular unprotected sexual relations.

2. Reduced Sexual Desire

Low levels of the hormone testosterone can cause low sex drive.

3. Erectile Dysfunction

Men may be unable to get and keep an erection because of other hormone or health issues.

4. Pain or Swelling of Testicles

Varicocele, infection and injury can cause discomfort and decrease sperm production.

5. Small or Soft Testicles 

Testicular abnormalities may indicate reduced sperm-producing capacity. 

6. Decreased Facial or Body Hair 

Abnormalities in the testicles can be a sign of lower levels of sperm production.

7. Low Semen Volume

Although not always related, unusually low semen volume may indicate reproductive tract issues.

8. Thinning of facial or body hair

Male hormone levels can also be low, which can impact on secondary sexual traits.

7. Low Semen Volume

A decreased semen volume is not necessarily associated with decreased motility but can be a sign of problems within the reproductive tract.

8. Hormonal Symptoms

These may include:

• Fatigue
• Reduced muscle mass
• Mood changes
• Weight gain

9. Previous Reproductive Problems

Prior history of undescended testes, mumps orchitis, or surgery of the reproductive organs may indicate fertility issues.

10. No Symptoms at All

Many men will find they have a low sperm count only after undergoing investigations into their fertility.

What Does Low Sperm Count Look Like?

One of the most prevalent misconceptions about male fertility is what a low sperm count entails. In reality, it is impossible to tell if the individual’s sperm count is low by examining their semen. The colour, quantity, texture or appearance of semen is not an accurate reflection of the number of sperm. Semen can appear perfectly normal and healthy, but still have a poor sperm count; on the other hand, semen can be abnormal and have a normal sperm count.

Normal semen should be whitish-grey or slightly off-white. Sometimes it might be slightly yellowish as a result of diet, vitamin consumption or the interval between ejaculations (which should not be a cause for concern). The same applies to thick semen or thin semen – it does not necessarily indicate the concentration of sperm or fertility.

There are no obvious indicators or low sperm count color, so the only sure method is to seek a semen analysis conducted in a lab. This test is used to determine the concentration, total count, motility (the ability to move), morphology (shapes) and other important factors affecting fertility.

When the couple has not been able to conceive after 12 months (or 6 months if the partner is over 35 years), it is advisable to seek advice from a fertility specialist. With early evaluation, you can find out the cause and receive appropriate treatment, which will increase your chances of having a healthy pregnancy.

What Causes Low Sperm Count?

Multiple factors, including medical, lifestyle, environmental and genetic issues, can contribute to low sperm count. Some causes are temporary and can be treated, while others might need specialist fertility treatment. Once the cause is determined, the next step is to take steps to enhance sperm output and boost chances of conception.

Medical Conditions

Several medical conditions can directly impact the production, development or transport of sperm. A very common cause is varicocele, which is when the veins within the scrotum become enlarged. This raises the temperature in the area of the testicles, which hinders normal sperm production and diminishes sperm quality. Fortunately, in many men, varicocele can be corrected by surgery to improve their fertility.

Low sperm count can also be caused by hormonal imbalance. The production of sperm is controlled by hormones, including testosterone, follicle-stimulating hormone (FSH), luteinising hormone (LH) and prolactin. If these hormones are not balanced because of problems with the pituitary gland, disorders of the thyroid or inadequate testosterone, the sperm production can be substantially reduced.

Disease of the reproductive organs may also affect the quality of the sperm or obstruct its movement. 

Conditions such as 

• sexually transmitted infections (STIs)
• epididymitis
• Orchitis
• mumps after puberty 
• If not treated, may affect fertility.

Other medical conditions such as:

• undescended testicles
• diabetes
• autoimmune disorders
• kidney disease
• liver disease
• genetic abnormalities

can have an impact on sperm production or sperm transportation. 

In some men, blocked reproductive ducts may also cause sperm not to be ejected during an ejaculation.  Many of these conditions are medically treatable, which is why timely medical assessment is key to enhancing fertility outcomes.

Lifestyle Factors

The daily choices that men make have a significant impact on their reproductive health. Unhealthy habits can lower semen production, affect the motility of sperm, damage the DNA of the sperm, and influence the production of hormones.

While smoking introduces damaging chemicals into the body that can decrease the number of sperm, excessive alcohol use can diminish the level of testosterone and disrupt the production of sperm. Marijuana, cocaine and anabolic steroids are recreational drugs that can adversely affect fertility, disrupting normal hormone function.

Another common cause of low sperm count is obesity. Body fat, in excess, can lead to a rise in oestrogen, a drop in testosterone and an elevation in scrotal temperature, all of which hurt sperm production. All these effects are exacerbated by a sedentary lifestyle.

Unhealthy eating patterns can result in a lack of zinc, selenium, folic acid, vitamin C, vitamin E and omega-3 fatty acids, all of which are essential for healthy sperm development. A chronic stress response can raise cortisol levels, impacting sex hormones and libido. Likewise, poor sleep can be associated with decreased testosterone levels and sperm count.

The great news is that many lifestyle risks are preventable. A healthy sperm count within a few months can be achieved by quitting smoking, reducing alcohol consumption, maintaining a healthy weight, eating a well-balanced diet, exercising regularly, managing stress and getting adequate sleep.

Environmental Factors

There has been an increasing awareness of the role of environmental exposures in male infertility. A variety of chemicals and pollutants may disrupt the production of hormones or disrupt the cells that make sperm.

Frequent exposure to pesticides, herbicides, industrial chemicals, lead and mercury, solvents and toxic fumes can lead to decreased sperm count and quality in men. If you work in an occupation with agricultural, manufacturing, mining, painting, or chemical industries, there is a greater risk of exposure.

Another common environmental risk is an excess amount of heat. Hot tubs, saunas, steam rooms, heated car seats, or placing laptops on the lap for extended periods of time can sometimes lessen sperm production, though only for a brief period of time.

Sperm-producing cells can be damaged by exposure to radiation, such as from cancer treatment and some industrial settings. Long-term exposure to air pollution has also been linked to decreased sperm concentration, motility and DNA fragmentation.

While it may not always be possible to eliminate all the risks in the environment, wearing protective clothing, minimising unnecessary chemical exposure and avoiding prolonged heat around the testicles can help to protect male fertility.

Medications & Medical Treatments

Some drugs and medical treatments can affect your ability to make sperm, either temporarily or permanently. Chemotherapy and radiation therapy used to treat cancer are one of the biggest contributing factors. These treatments may affect the rapidly growing cells that make sperm. Men who are going to receive cancer treatment are sometimes told to freeze their sperm before starting their treatment to keep their fertility in the future.

Though Testosterone Replacement Therapy (TRT) can alleviate the signs and symptoms of low testosterone, it can actually lead to a decrease in sperm production because the body’s normal hormone signals for sperm production are suppressed. In the same way, the abuse of anabolic steroids for bodybuilding may also cause the testicles to shrink and cause a significant drop in sperm count.

Some prescription drugs, such as certain antibiotics, antifungal medications, anti-androgens, medications for autoimmune diseases, chemotherapy drugs, and antihistamines for high blood pressure and depression, may also impact fertility in some men.

Don’t discontinue medication without consulting a health care provider. A fertility specialist can determine if there is another option for treatment or fertility preservation measures should be discussed.

Age and Genetic Factors

Men produce sperm for the rest of their lives, but fertility does tend to decrease as they get older. Sperm count, motility, morphology and DNA quality decrease as men get older, especially after 40 years of age. Sperm DNA fragmentation is also more likely to occur in older men and could lead to poor fertilisation, impaired embryo development and miscarriage.

Low sperm count is also due to genetic causes. Sperm production may be reduced or blocked due to conditions like Klinefelter syndrome, Y chromosome abnormalities, or abnormalities in the reproductive system caused by cystic fibrosis. Infertility may be congenital or may involve a lack of the tube through which sperm passes (vas) in the testicle, even though the testicle produces sperm.

A male with a family history of low sperm count or inherited reproductive conditions also may be at a higher risk of low sperm count. Genetic testing is usually ordered by fertility specialists when male infertility is unexplained and/or severe.

Although age and genetic issues are factors that cannot be changed, many men can become the fathers of biological children through early evaluation and treatment, including assisted reproductive technologies like IUI, IVF or ICSI.

Can a Man Recover from Low Sperm Count?

One of the frequently asked questions is, can a guy regain his normal sperm count?

It will depend on the cause of the problem.

Yes, in many cases, a man may be able to improve his sperm count, depending on the cause. Sometimes the condition can be linked to lifestyle habits, like smoking, overindulgence in alcoholic beverages, obesity, an unhealthy diet, stress, and inadequate sleep; changes to a healthier lifestyle will greatly benefit sperm production. Medications or surgery may be able to treat some medical conditions, such as infections, hormonal imbalance or varicocele. Spermatogenesis is approximately 74 days, and the improvements will be noticeable within two to three months. In cases where the low sperm count is due to genetic issues or extensive damage to the testicles, however, IUI, IVF, or ICSI might be recommended as assisted methods of reproduction.

How is Low Sperm Count Diagnosed?

Accurate diagnosis will allow for a correct diagnosis and appropriate treatment.

Medical History

The fertility specialist checks your medical history, your lifestyle habits, medication use, your past surgeries, your sexual health and your fertility history to see what may be causing low sperm count and male infertility.

Physical Examination

A physical exam evaluates the testicles, penis, scrotum and reproductive organs for any abnormal condition, including varicocele, swelling, undescended testicles, and other conditions that might affect sperm production.

Semen Analysis

The main diagnostic test used for determining low sperm count is a semen analysis, which will assess the levels of sperm count, concentration, motility, morphology, semen volume and sperm overall health.

Hormone Testing

Blood tests are used to measure hormone levels such as testosterone, FSH, LH and prolactin, to see if the hormones are in balance and thus that sperm production is not being impacted.

Ultrasound & Additional Investigations

Special tests, such as scrotal ultrasound, genetic tests, DNA fragmentation tests, or other specialised tests may be suggested to determine if there is a structural problem, genetic cause or other hidden cause for low sperm count.

Can You Check Low Sperm Count at Home?

So many people are concerned about how to check low sperm count at home. You can order home sperm testing kits, which will give a rough idea of sperm concentration.

But they come with some drawbacks:

• Has difficulty evaluating the shape of the sperm cells
• The motility of some sperm was only briefly evaluated.
• Cannot diagnose infections
• Cannot identify hormonal problems
• A semen analysis is still the best way to test for fertility.

After one year of trying (or six months if the female partner is over 35 years of age), it is better to see a fertility specialist than take a home pregnancy test alone.

What are the Low Sperm Count Treatment Options

The appropriate low sperm count treatment depends on the underlying cause.

Lifestyle Modifications

Adopting healthy habits can make a big difference in improving sperm count and fertility. Avoiding excessive heat exposure, reducing stress, get adequate sleep, eat a balanced diet, limiting alcohol, exercising regularly and quitting smoking are all factors that can help produce healthier sperm.

Medications

Medications, such as anti-inflammatory drugs and antibiotics or fertility drugs, may be prescribed, depending on the cause of low sperm count, which may be due to infections or some medical conditions. These treatments address the root cause and promote better production, quality and reproductive health.

Hormonal Treatment

If low sperm count is due to hormonal imbalance, hormonal therapy is recommended. With the guidance of a fertility expert, gonadotropins (hormone-regulating medications) or other hormone-regulating medications may be prescribed to help restore normal hormone levels, stimulate sperm production and enhance fertility.

Surgery (such as Varicocele Repair)

Conditions that can affect sperm production, like varicocele, may require surgery to correct. Varicocele surgery restores the passage of blood around the testicles, allowing more sperm to be produced, better quality sperm and increasing the likelihood of a spontaneous pregnancy.

Assisted Reproductive (ART) Treatment: IUI, IVF, ICSI

If, despite treatment, natural conception is difficult, assisted reproductive techniques may be recommended, for example, IUI, IVF or ICSI. These high-tech fertility treatments make it possible for couples to become pregnant even when sperm counts are low or sperm quality is poor.

What are the Tips to Improve Sperm Count Naturally?

Some causes are not preventable, but healthy habits will help to support good sperm production.

Some practice tips could be:

• Include antioxidant foods in the diet, such as fruit and vegetables.
• Eat food rich in zinc like pumpkin seeds, nuts, beans and seafood.
• Eat foods rich in selenium, such as Brazil nuts and fish.
• Eat more foods containing omega-3 fatty acids.
• Keep a healthy body mass index (BMI).
• Exercise regularly but avoid overtraining.
• Relieve stress with yoga or meditation.
• Get adequate rest at night.
• Steer clear of smoking and recreational drugs.
• Limit alcohol consumption.
• Stay hydrated.
• If exposed to heat often, wear loose-fitting underwear.
• Do not use a laptop directly on the lap for extended periods of time.

 

Men may benefit from supplements of zinc, Coenzyme Q10, vitamin C, vitamin E, folic acid and L-carnitine, but should always ask their doctor before taking them.

When Should You See a Fertility Specialist?

If you and your partner have been trying to get pregnant for 12 months without success or 6 months if your partner is over 35 years old, it is best to see a fertility specialist. If you have a family history of undescended testicles, varicocele, genital surgery, sexually transmitted infections, chemotherapy or a history of hormonal disorders, seek medical advice sooner. Men with ED, sperm dysfunction, or with a painful, enlarged or abnormally analysed semen should also be evaluated. Prompt diagnosis can help find out what’s causing low sperm counts and enable treatment at an early stage, so that the chances of a successful pregnancy are increased.

Conclusion

One of the most common causes of male infertility is low sperm count, which is treatable. Knowledge of what is low sperm count,  low sperm count symptoms, signs of low sperm count, causes of low sperm count and prompt medical evaluation can go a long way in enhancing fertility.

In some cases, lifestyle changes will improve the health of the sperm; in other cases, medication or surgery may be indicated, or assisted reproductive methods like IUI, IVF or ICSI may be necessary. The health of sperm depends on several factors, and therefore, personalised treatment from the fertility specialist will have the best chance at pregnancy.

Remember that low sperm count doesn’t mean that you cannot conceive. Many couples conceive and create families with the proper diagnosis and treatment plan.

Take the First Step Towards Better Male Fertility

At Femcare Fertility, our experienced fertility specialists treat low sperm count symptoms, comprehensive male fertility assessments, conduct advanced semen analysis, hormonal evaluation, and offer personalised treatment plans tailored to your needs.

Book your consultation

FAQs

1. What is considered a low sperm count?

According to WHO guidelines, a sperm count less than 15 million sperm per mL of semen is considered to be a low sperm count.

2. What are some of the early warning signs of low sperm count?

Early low sperm count symptoms of low sperm count include conceiving problem, reduced libido, erectile dysfunction and discomfort in the testicles. But many men don’t have any apparent symptoms.

3. What could be the reason for low sperm count?

Sperm count is affected by varicocele, hormonal imbalance, infections, obesity, smoking, alcohol abuse, heat exposure, genetic abnormalities and age.

4. Can semen color indicate low sperm count?

No, it doesn’t. However, there are common searches for low sperm count colour, semen colour has nothing to do with sperm count. The only way to measure sperm concentration is by making a semen analysis.

5. Is it possible to fix low sperm count?

Yes, you can. Treatment depends on the cause and can involve lifestyle changes, medication, hormone therapy, surgery or assisted reproductive techniques.

6. Can Men Recover from low sperm count?

Yes, it is possible. If a man’s sperm count is low, it may be possible to improve it by treating the cause of the low count and by making some lifestyle changes. It usually takes about 3 months to improve.

7. What is the diagnosis for low sperm count?

Diagnosis consists of medical history, physical examination, semen analysis, hormone testing, and imaging and genetic testing if needed.

8. How to check low sperm count at home? 

A basic estimate is available with home sperm testing kits, but a laboratory semen analysis is the most accurate method to determine fertility.

9. What is the best food for men to boost their sperm count?

Antioxidant foods, zinc, selenium, omega-3 fatty acids, lean protein, fruits, vegetables, whole grains, eggs, fish and nuts are important foods for healthy sperm production.

10. Is low sperm count a bad thing and always a cause of infertility?

No. While some men with low sperm count may still be able to conceive naturally, it may take a bit longer.

11. Is there a permanent cure if you have a low sperm count?

If the cause can be reversed, like smoking, obesity, infections or varicocele, there is a chance of a very high chance of a great improvement in sperm count. The underlying cause is the determinant of permanent recovery.

12. Does the number of sperm and fertility decrease as age increases?

Yes. A gradual decline in sperm count, motility, DNA, and fertility potential may occur with age.

13. What is the best treatment possible for very low sperm count?

Treatment will vary depending on the diagnosis. In severe cases, ICSI along with IVF may be beneficial, especially in cases of very low sperm count.

14. Are there any nutritional supplements that can help you boost sperm count?

Some supplements can also help improve sperm health in some men, but should only be taken with the assistance of a fertility specialist.

15. How many months should it take to grow the sperm count naturally?

It takes about 74 days to produce sperm, so it takes 2-3 months for noticeable improvement after making lifestyle changes or from treatment.