Low Sperm Count: Meaning, 21 Causes, Tests and Treatments That Work

A low sperm count (oligospermia) means fewer than 16 million sperm in each ml of semen, or fewer than 39 million in the whole sample. These are the WHO 2021 values. Most causes can be found with simple tests, and most are treatable.

Written and medically reviewed by Dr Shah Dupesh, MBBS, DCE, FASM, Consultant Andrologist, Chennai · First published 12 December 2019 · Last reviewed: 3 November 2026

Hello! Vanakkam and Namaste.

This is Dr Shah Dupesh, consultant andrologist in Chennai. My work is male infertility and men’s sexual health.

A semen report that says “low count” can feel like a blow. Please take a breath. A low count is not the same as infertile.

In my clinic, most men with a low count feel completely healthy. So the report comes as a shock. But once we find the cause, the plan usually becomes clear.

Patients often ask me, “Doctor, how do I increase my sperm count?” (in Hindi, “sperm count kaise badhaye?”). So I answered that in a short video first.

A note on the video: I recorded it in 2019. Where my advice has changed since then, this page gives you the current version, with the studies.

This page is my complete guide. It covers what the numbers mean, the 21 causes, the 5 tests and the treatments that actually work. First, here is the whole story in one minute.

That is the short version. Now let me take each part slowly, starting with what the report actually says.

What does low sperm count mean?

Low sperm count means your semen carries fewer sperm than the WHO lower limit. Doctors call it oligospermia, or oligozoospermia. Also, both words mean the same thing.

The limit is 16 million sperm per ml of semen. Also, the whole sample should hold at least 39 million sperm. When you fall below either number, the report reads “low”.

But here is the key point. These numbers are not a pass or fail line for fertility. Instead, they simply mark the lowest counts seen in fertile men.

What is a sperm? A one-minute biology lesson

A sperm, or spermatozoon, is the male cell that fertilises the egg. Each one is tiny, but it is complex. It has four working parts, and each part has one job.

• Head: carries DNA. This is half of your baby’s genes.
• Acrosome: opens the egg. It is a cap of enzymes on the head.
• Midpiece: energy. It powers the swim.
• Tail: swims. It beats to push the sperm forward.

Millions are needed for one to reach the egg. That is why the count matters at all.

What is the normal sperm count for a male?

On the WHO 2021 values, a normal sperm count is 16 million per ml or more. Also, the total sperm count should be 39 million or more. Many fertile men have far higher numbers than that.

Your report checks more than the count, as the table shows. Here is the same information as a single card.

Below these? Repeat the test.

One low result is a reason to look closer, not a diagnosis. To read every line of your report, see my guide on how to read a semen analysis report.

Why do some reports still say 15 million?

Before 2021, the older WHO manual used 15 million per ml. Many labs still print that number. So you may see 15 on one report and 16 on another.

The sixth WHO manual came out in July 2021 (Boitrelle, 2021). Its reference values came from 3,589 fertile men in 12 countries (Paffoni, 2022). For this reason, I use the 2021 values throughout this page.

In practice, the difference between 15 and 16 changes little. So a man at 15.5 million is not suddenly infertile. Instead, I look at the whole report and the whole couple.

What are the WHO criteria for semen analysis in 2026?

In 2026, labs still follow the sixth WHO manual from 2021. Its limits are the ones in the table above. Also, the 2021 manual moved away from treating them as strict pass-or-fail thresholds (Boitrelle, 2021).

WHO also issued a wider infertility guideline in 2025. It notes that one in six people face infertility in their lifetime (Mburu, 2026). It also advises when a semen test should be repeated (Mburu, 2026).

Is 20 or 30 million per ml a normal sperm count?

Yes. A sperm count of 20 million per ml is normal on the WHO 2021 values, and so is 30 million. Both are higher than the 16 million limit.

However, “normal” is not the same as “ideal”. In a study of 6,061 men, values well above the WHO limits went with a faster time to conception (Keihani, 2021). So at 20 or 30 million, pregnancy is fully possible, but it may take a little longer.

Sperm concentration vs total sperm count: what is the difference?

Sperm concentration is the number of sperm in one ml. Total sperm count, on the other hand, is the concentration multiplied by the volume. So a man with 12 million per ml and 4 ml of semen has 48 million in total.

That man has a low concentration, but a normal total count. Both numbers matter, and I always read them together. You can check yours with my semen analysis calculator.

Under the microscope, the difference looks like the picture above. On the left, a normal field holds 16 million or more per ml.

On the right, a low field holds under 16 million per ml. Only a semen test can tell.

Is 1 ml of semen too little?

A little, yes. The WHO 2021 lower limit for semen volume is 1.4 ml. But low volume is not the same as a low sperm count.

In fact, many men with 1 ml of semen have plenty of sperm in it. Then again, a short abstinence or a spilled sample often explains a low volume. I explain this fully in my page on semen volume.

What does “occasional sperm seen” mean?

“Occasional sperm seen” means the lab found only a few sperm, often after spinning the sample down. Sometimes it reads “occasional motile sperm”, which means a few of them were moving. The medical name is cryptozoospermia.

So it is a severe form of low sperm count. Yet it is not azoospermia, because sperm are present. And those few sperm can often be used for ICSI.

My sperm quantity is low: what happens now?

First, do not panic, and do not buy pills online. Instead, follow three simple steps.

• Repeat the semen analysis after 2 to 7 days of abstinence, a few weeks later.
• See an andrologist for an examination and hormone tests.
• Treat the cause that the tests find, then re-test after three months.

If sperm count is less, will anything bad happen to your health? Usually not. Still, male infertility can be a marker of other health problems, so a proper check is worth it (Schlegel, 2021a).

Why is my sperm count so low?

Usually there is a reason. It may be low testosterone or another hormone problem, a testicle problem, a blockage, or a lifestyle habit or medicine. The 21 causes follow below, grouped in that order, so you can find yours.

Types of oligospermia: how low is low?

Doctors grade a low sperm count as mild, moderate or severe. However, these grades are a clinical convention, not WHO values. Still, they help me plan treatment.

The ladder above runs from mild to none at all. Here are the same five grades, with what each one means for you.

Most low counts are treatable. Also, a mild count often needs nothing more than fixing the cause and waiting three months.

Cryptozoospermia and azoospermia: what do they mean?

Cryptozoospermia means sperm are so rare that the lab finds them only after spinning the sample. Azoospermia means no sperm at all in the semen.

Azoospermia is a different problem, so it has its own tests. Sometimes sperm can still be found inside the testis. Read my full guide on azoospermia if your report says “no sperm seen”.

How common is low sperm count?

Low sperm count is far more common than most men think. One in six people face infertility at some point (Mburu, 2026). Also, a male factor plays a part in about half of infertile couples (Du, 2024).

Counts have also fallen worldwide. The largest analysis, of 223 studies, tracked semen samples from 1973 to 2018 (Levine, 2023).

Over those 45 years, average sperm concentration fell by 51.6% (Levine, 2023). Total sperm count fell further than that, by 62.3%.

Then the pace picked up after 2000. The yearly fall doubled, from 1.16% to 2.64% (Levine, 2023). Importantly, this included men from Asia, not only the West.

What about men in India?

Indian data are mixed. A review of 37 years of Indian studies found a decline in sperm concentration (Mishra, 2018). It also put the average for fertile Indian men at about 81 million per ml.

On the other hand, one large south Indian lab found no decline over 17 years in 12,151 men (Yaiphaba Meitei, 2025). So the trend is real worldwide, but your own report matters far more than any trend.

Planning to marry and want children soon? Then a premarital fertility test is a sensible early step.

21 causes of low sperm count

Here are the 21 causes of low sperm count that I look for. Sperm production needs the brain, the hormones, the testicles and open tubes. So a problem anywhere along that chain can lower the count.

I group the causes into four families, exactly as on the card above:

• Hormones: Low testosterone, pituitary, thyroid.
• Testicles: Genes, injury, infection.
• Blockage: Ducts and ejaculation.
• Lifestyle and Medicines: Heat, weight, steroids, smoking.

Find the cause before treating. For the wider picture of fertility problems in men, see my page on male infertility causes.

1. Low testosterone

In my practice, low testosterone explains many low sperm counts. So it is the hormone cause I look for first.

Your testes need their own testosterone, made inside them, to make sperm. So when that testosterone runs low, the count often falls with it.

In men with a very low count, low testosterone also raised the risk of the count falling to zero (Karavani, 2024). The signs are on my page on low testosterone.

The fix is to raise your own testosterone, under an andrologist. For selected men, after tests, I use letrozole for this. Never start it on your own.

Testosterone injections, gels and “boosters” do the opposite. They switch off your own supply and make sperm production worse, as cause 3 explains.

2. A pituitary or brain hormone problem

The pituitary gland in the brain sends two signals to the testes, called LH and FSH. When those signals are weak, the testes make little sperm. Doctors call this hypogonadotropic hypogonadism.

It is rare, and it shows up on blood tests. Then the andrologist treats it with hormone therapy.

3. Testosterone injections, gels and anabolic steroids

This is also the most avoidable cause. Testosterone from outside switches off the brain’s signals to the testes (McBride, 2016). So sperm production falls, sometimes to zero.

In one old contraceptive trial, healthy men had weekly testosterone injections. After six months, 17 of 28 had no sperm at all, and the rest had very low counts (Wallace, 1993).

I often meet gym-going men who never linked their injections or “boosters” with their report. Recovery after stopping can take many months, and it is not always complete (Kumar, 2025).

Low energy and low drive are real problems, too. But outside testosterone is the wrong fix for a man trying for a baby. Instead, raise your own, as in cause 1.

4. High prolactin and thyroid problems

Prolactin is a pituitary hormone. When it runs high, it can suppress sperm production and sex drive. An underactive or overactive thyroid can also upset the hormones behind sperm.

Both are simple blood tests. Also, both are treatable once found.

5. An undescended or injured testis

An undescended testis affects up to 6% of newborn boys (Ghanem, 2024). Bringing it down early protects later sperm production (Ghanem, 2024). Even so, men treated in childhood may still have lower counts.

A badly injured or twisted testis can also lose its sperm-making tissue. Tell me about any such history, even from childhood.

6. Infections, including mumps

Infections of the testis, epididymis or prostate can lower the count. On average, genital tract infections cut sperm concentration by about 6.65 million per ml (Campbell, 2026).

Mumps after puberty can inflame the testes, too. Also, untreated epididymitis and chronic prostatitis are both worth treating properly.

7. Klinefelter syndrome

Klinefelter syndrome means an extra X chromosome (47,XXY). It is the most common genetic cause of male infertility (Chebihi, 2026). Also, the testes are usually small and firm.

It is found more often with no sperm at all. But it also appears in men with a low count (Chebihi, 2026).

8. Y-chromosome microdeletions

Tiny missing pieces of the Y chromosome can stop sperm production. They turned up in 14.1% of men with 5 million per ml or less (Lee, 2024).

That is why genetic tests are advised for severe low counts (Krausz, 2024). The result also matters for any son born through ICSI.

9. Cancer and its treatment

Cancer itself can lower the count, even before treatment (Vogt, 2026). Then chemotherapy and radiation can harm sperm production further.

So every man facing cancer treatment should be offered sperm freezing first. It takes a day, and it can preserve the chance of a family.

10. Retrograde ejaculation

In retrograde ejaculation, semen flows backwards into the bladder. So very little comes out, and the count looks low. Diabetes, some prostate medicines and some operations can cause it.

A urine test after ejaculation confirms it. Read more in my page on what to do if you can’t ejaculate.

11. A partial blockage in the ducts

Sperm travel through fine tubes to leave the body. A partial block, for example near the prostate, lets only a few sperm through. Then the semen volume is often low as well.

An examination and a scan usually find it. However, surgery to open a block does not work well.

So I do not send men for it. Instead, sperm can usually be collected directly for ICSI.

12. Obesity and diabetes

Extra body fat changes hormones and heats the scrotum. Obese men had 1.28 times the odds of a low or zero count (Sermondade, 2013). For morbidly obese men, the odds doubled.

The good news is that weight loss raised sperm concentration in a recent analysis (Santi, 2025).

Poorly controlled diabetes also affects sperm. In one study, diabetic men had lower testosterone and more sperm damage than men without diabetes (Haffez, 2026). So good sugar control is part of fertility treatment.

13. Smoking and chewing tobacco

Smoking was linked with a lower sperm count in a review of 5,865 men (Sharma, 2016). The harm was greater in moderate and heavy smokers. I cover this in detail in how smoking affects sperm.

Chewing tobacco is no safer than smoking. In Indian men, sperm quality fell as the habit rose, from mild to severe use (Said, 2005).

14. Alcohol

Heavy drinking harms sperm in a dose-dependent way: the more you drink, the worse the semen (Jagadesh, 2026). Even long-term mild drinking raised oxidative stress in that study.

15. Cannabis and other recreational drugs

Cannabis is often blamed. But in a large study of 921 men, it was not clearly linked with sperm quality (Joseph, 2026). Still, I ask men to stop all recreational drugs while trying, because their wider effects are real.

However, strong painkillers called opioids are different. They can suppress the hormones behind sperm, so tell me if you take them.

16. Heat: saunas, hot baths and laptops

The testes work best a little cooler than the body. Twice-weekly saunas for three months sharply cut sperm count in healthy men (Garolla, 2013). Happily, the effect reversed six months after stopping.

A laptop on the lap raised scrotal temperature by about 2.8°C in an hour (Sheynkin, 2005). Long hours of sitting or driving add heat, too.

17. A recent fever

A high fever can crash the count for weeks, because sperm-making cells are sensitive to heat. After a fever of 39°C or more for three days, sperm concentration dropped sharply 3 to 6 weeks later (Jung, 2001). Then it recovered within 4 to 6 months.

So always tell me about any fever, dengue, typhoid or COVID in the three months before your test.

18. Medicines

Some long-term medicines can lower the count or weaken ejaculation. Besides testosterone, these include some medicines for the prostate, hair loss, stomach, bowel, mood and cancer. Never stop a prescribed medicine on your own, though.

Instead, bring every tablet and supplement you take to the consultation. A simple switch often solves it.

19. Chemicals and air pollution

Pesticides, solvents and heavy metals at work can harm sperm. Air pollution matters, too. Men exposed to more fine particle pollution had lower sperm counts and motility (Gago, 2026).

You cannot move the city. But you can use protective gear at work, and avoid smoke where you can.

20. Age

Men keep making sperm until old age. But quality slowly falls. In IVF, live birth rates dropped when the man was 40 or older and his partner was 35 to 39 (Datta, 2024).

So age matters for men as well, though much less than for women.

21. Stress and poor sleep

Psychological stress was linked with lower sperm concentration in about half of the studies reviewed (Costa, 2026). Also, poor sleep quality went with a lower total sperm count (Coleman, 2026).

Neither is a sole cause in most men. However, both are worth fixing, because they make every other cause worse.

What about varicocele?

A varicocele is a cluster of swollen veins above the testis. It is a common finding in men with subfertility. But it is not the cause of a low sperm count, or of low testosterone.

Here is why I say that. Varicoceles are found in 12% of men whose semen is completely normal (Chiba, 2016). Only about one in five men with a varicocele has any fertility problem (Chiba, 2016).

So I never recommend varicocele surgery. There is no good evidence that the surgery brings more babies (Persad, 2021). Instead, I look for the real cause of the low count, and treat that.

Does masturbation cause low sperm count?

No. Masturbation does not damage sperm production.

Frequent ejaculation lowers the count in that one sample, but not your fertility (Clay, 2026). I bust this and six other myths further down.

Finally, here is what I have noticed over the years, beyond the studies.

In short, a low count is a clue, not a final answer. Next, let us look at the signs, and why most men have none.

Signs of low sperm count: what most men notice

Most men with a low sperm count notice nothing at all. Erections, desire and semen look normal. Instead, the usual first sign is that a pregnancy is not happening.

Sometimes, though, the cause leaves clues. Look out for these signs of weak or unhealthy sperm production:

• Small, soft or painful testes, or a lump in the scrotum.
• Low sex drive, or trouble with erections.
• Less facial or body hair, or breast swelling.
• Very little semen, or none at ejaculation.
• A history of undescended testis, mumps, cancer treatment or steroid use.

If you have erection problems as well, they need their own care. See my page on erectile dysfunction treatment.

I cover each clue in detail in my page on how to know if you have a low sperm count. Still, only a semen test can give the answer.

How sperm are made: the 74-day journey

Sperm are not stored for years. Instead, your testes make them nonstop, millions every day. Each sperm takes about 74 days to mature, and then a little longer to travel out.

The four stages on the diagram are simple:

1. Stem Cell: the starting cell in the testis.
2. Dividing Cell: it splits and halves its genes.
3. Young Sperm: a round cell grows a head and a tail.
4. Mature Sperm: it learns to swim on the way out.

So the semen you give today reflects your health about three months ago. That is why a fever shows up weeks later (Jung, 2001). It is also why the harm from a sauna took six months to reverse (Garolla, 2013).

The practical rule follows. Re-test 3 months after any change, whether it is a new habit or a new treatment. So when you book your next semen analysis, count three months from the change.

5 tests that find the cause of a low sperm count

A low count is a finding, not a diagnosis. That is why a thorough andrological evaluation is always necessary. It finds out why the count is low, and whether it is still falling.

I use five tests, but not every man needs all five.

The card shows them in the order we use them:

1. Semen Analysis: Done twice.
2. Hormone Tests: FSH, LH, testosterone.
3. Scrotal Ultrasound: When needed.
4. Genetic Tests: For very low counts.
5. DNA Fragmentation: Selected cases.

Treat the cause, not the number. Before any test, though, I take a full history and examine the testes. My page on male infertility assessment explains that visit step by step.

1. Semen analysis, done twice

The semen analysis is the cornerstone. I ask for two tests, a few weeks apart, because counts swing naturally. Then one bad day does not decide your treatment.

Collect the whole sample into the lab container, by masturbation, at the lab if possible. Also, do not use a condom or lubricant. For the details, see my page on the semen analysis test.

Why 2 to 7 days of abstinence before a semen analysis? (And why 2.5 days?)

The WHO manual asks for 2 to 7 days without ejaculation before the test. Too short a gap lowers the count. In men with a low count, a second sample within four hours had a lower volume and total count (Poopaibool, 2023).

Too long a gap hurts, too. In men with a low count, longer abstinence led to a fall in moving sperm (Badreddine, 2023). So many labs ask for about 2 to 3 days, often written as 2.5 days, because it sits safely inside the window.

For infertile men, shorter abstinence within the first 4 days may even give better samples (Du, 2024). Either way, keep the gap similar for both tests, so the results compare fairly.

Can I test my sperm count at home?

Yes, as a first screen. In a study of 3,469 samples, mail-in semen kits changed with abstinence just as lab tests do (Badreddine, 2023). Validated at-home kits are now used even in research studies (Coleman, 2026).

However, a home kit cannot do the full analysis. For example, it does not check shape, vitality or infection. So a low home result still needs a proper lab test.

2. Hormone tests: FSH, LH, testosterone and prolactin

A morning blood test checks FSH, LH, testosterone and prolactin. Sometimes I add thyroid tests as well. These hormones show where the problem lies, so they guide treatment.

Testosterone is worth checking in every man, whatever his count. In one study, almost half of men with a normal count still had low testosterone (Greenberg, 2023).

For example, a low FSH and LH points to the pituitary. And a low testosterone with a high oestrogen balance may suit letrozole, as I explain below. Never take it on your own.

A high FSH and LH tells a different story. It can mean the sperm-making tubes in the testes are failing (seminiferous tubule failure, or Sertoli cell dysfunction). This failure may be ongoing, or it may have just begun.

Sertoli cells are the nurse cells in these tubes that feed developing sperm (Iliadou, 2015). On average, FSH also runs higher in men with a low count (Greenberg, 2023).

In these men, I expect the count to keep falling, and it may reach zero in the future. So I start medical treatment early. I also advise sperm freezing while sperm are still there.

3. Scrotal ultrasound, when needed

An ultrasound is not needed for everyone. I order it when the examination is unclear, the testes feel small or lumpy, or I suspect a blockage. It is painless and quick.

If the scan shows a varicocele, remember what I said above. It is a common finding, not the cause of the low count.

4. Genetic tests for very low counts

For a severe low count, under 5 million per ml, I advise two genetic tests. These are a karyotype for chromosome problems and a Y-chromosome microdeletion test (Krausz, 2024).

The lower the count, the more often these tests find something. Here is how often chromosome problems turned up in one study.

Chromosome problems were found in 18.4% of men with a severe low count, against 1.1% of men with a normal count (Pylyp, 2013). A result matters for treatment, and for any son born after ICSI.

5. DNA fragmentation, in selected cases

Sperm DNA fragmentation measures breaks in the sperm’s genetic material. However, it is not a routine test. Experts now advise testing selectively, in the men most likely to benefit (Esteves, 2026).

I consider it after repeated miscarriages, failed IVF, or when the count is normal but pregnancy is not happening.

Where can I get a sperm test in Chennai, and what does it cost?

Every test on this list is available in Chennai. My page on sperm testing in Chennai explains how testing works at the clinic in T Nagar.

The cost depends on the lab and on which tests you need. So I do not quote fees online. Please call the clinic on 97907 83856 for the current fee.

Low sperm count treatment: 9 options, matched to the cause

Low sperm count treatment depends on two things: the cause, and how low the count is. So there is no single pill for everyone. Instead, I match the treatment to the tests.

The ladder on the card runs from the simplest step to the most advanced:

1. Fix Lifestyle: Weight, heat, smoking.
2. Treat the Cause: Infection, hormones, medicines.
3. Doctor-Led Medicines: Letrozole, when suitable.
4. IUI: Mild to moderate.
5. IVF or ICSI: Severe low count.

Never self-prescribe. Here are the nine options in detail. For every fertility treatment in one place, see my male infertility treatment guide.

1. Treat the cause first

This is the most powerful step. A thyroid or prolactin problem gets corrected. A medicine gets switched.

An infection gets cleared. Then the testes can recover on their own.

2. Stop testosterone and steroids, under supervision

If you use testosterone or anabolic steroids, stopping is the treatment. Many men then recover sperm production with time (McBride, 2016). But the time it takes varies widely, from months to longer (Desai, 2022).

Do not stop suddenly on your own, though. Your andrologist plans the stop, and tracks your hormones and semen.

3. Treat any infection properly

An infection in the prostate or epididymis needs the right antibiotic, for the right length of time. Infection is linked with a lower sperm concentration (Campbell, 2026), so clearing it properly matters. Your partner may need checking as well as you.

4. Repair your lifestyle

Weight, tobacco, alcohol, heat and sleep all matter. In fact, for a mild low count, lifestyle repair alone is often enough. I list the ten habits that help in the section below.

5. Letrozole, for selected men after tests

Letrozole is the one fertility medicine I use. I prescribe it only for selected men, after hormone tests. It lowers oestrogen, so the brain sends stronger signals to the testes.

The studies were mostly in men whose testosterone ran low compared with oestrogen. In those men, letrozole and similar drugs raised sperm concentration and total count (Guo, 2022). Across trials, these drugs improved hormone and semen results, though bigger trials are still needed (Del Giudice, 2020).

Letrozole is not for every man with a low count. So never take it on your own, and never copy a friend’s prescription.

6. Lyon bean extract, my only supplement

The only supplement I use is Lyon bean extract. It is my clinical preference, as one part of a plan after tests. Also, I do not give it to every man.

Please do not start it on your own. Like every supplement, it belongs inside a treatment plan, never in place of one.

7. IUI for mild to moderate counts

In IUI, the lab washes the sperm and places the best ones inside the womb at ovulation. It suits mild to moderate low counts, when her tubes are open. Read my full page on IUI.

Most IUI pregnancies come in the first few attempts. In one clinic study, no pregnancies occurred after the fifth attempt (Findeklee, 2020). So I do not keep repeating IUI endlessly.

8. IVF and ICSI for severe counts

In ICSI, a single sperm is injected into each egg. So even a very low count can be enough. Men with a severe low count had similar first-transfer results to men with normal semen in one large study (Quintana-Vehí, 2026).

Assisted reproduction works well for male factor infertility (Schlegel, 2021b). If the semen has no sperm at all, sperm can sometimes be taken directly from the testis for ICSI. My page on IVF explains the steps.

9. Sperm freezing (cryopreservation) when FSH and LH are high or the count is falling

Sperm freezing stores your sperm safely for later IUI, IVF or ICSI. It matters most when FSH and LH are high, or when the count keeps falling on repeat tests. Then the sperm you freeze today may be the best you will have.

In a study of 1,056 men with a low count, about a third of those at 1 million per ml or less had no sperm at all after five years (Karavani, 2024). Men with higher counts rarely did, and the authors advise sperm banking for the lowest counts (Karavani, 2024).

For these men, I combine early medical treatment with sperm freezing. Freezing protects the chance of a child with your own sperm, even if the count later reaches zero.

When the semen holds only rare sperm, the lab can collect and freeze them over several samples. My page on fertility preservation explains how sperm freezing works.

Why I do not prescribe antioxidant cocktails

Antioxidant cocktails are pills that mix vitamins, zinc, selenium and similar ingredients. They are sold everywhere as sperm boosters.

In a controlled trial of antioxidant pills for men, fewer couples had a baby on the antioxidants than on dummy pills: 15 in 100 versus 24 in 100 (Steiner, 2020). The trial was small, so that gap may be chance. What it clearly did not show is any benefit.

In the largest zinc and folic acid trial, there were no extra babies, and sperm DNA damage went up (Schisterman, 2020). That is why I do not prescribe antioxidant cocktails.

What I do not use: clomiphene and varicocele surgery

I do not use clomiphene in my practice, although you will read about it online. Letrozole is the only fertility medicine I prescribe.

I also never recommend varicocele surgery, for the reasons I gave earlier. There is no good evidence that the surgery brings more babies (Persad, 2021).

One rule runs through every option on this list.

If your report is low, the right next step is a proper assessment, not a pharmacy visit.

Dr Shah Dupesh

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Now to the question every couple asks next: can it actually be fixed?

Can low sperm count be cured?

Often, yes. When the cause is reversible, the count usually recovers. Stopping steroids, clearing an infection, losing weight or getting over a fever are all good examples.

Some causes cannot be reversed, such as Klinefelter syndrome or a Y-chromosome microdeletion. Even then, ICSI can often give you a child with your own sperm. My page on IVF and ICSI explains how.

Can oligospermia be corrected?

Oligospermia can often be corrected when its cause is found and treated. When it cannot be fully corrected, the goal changes. We then aim for a pregnancy, through IUI, IVF or ICSI, rather than a perfect number.

How long does it take to increase sperm count?

It takes about three months. That is the time new sperm need to mature and travel out. So I re-test the semen three months after any change.

Recovery after testosterone or steroids can take longer, sometimes much longer (Desai, 2022). Then patience, and regular tests, matter most.

How can I increase my sperm count fast?

There is no seven-day fix, whatever an advertisement says. Sperm simply take about three months to make. But some changes start helping at once.

Stop tobacco and steroids. Keep the testes cool.

Treat any fever or infection quickly. Then give it three months, and re-test.

How to increase sperm count naturally: 10 habits that help

These ten habits help almost every man with a low sperm count. They are not a substitute for tests.

But they support every treatment. For a long list of foods, see my page on how to increase sperm quality.

1. Lose the extra weight

Obesity raises the odds of a low count (Sermondade, 2013). On the other hand, weight loss raised sperm concentration and progressive motility (Santi, 2025). Even a modest loss helps.

2. Stop smoking and chewing tobacco

Both lower sperm quality, and the harm grows with the dose (Sharma, 2016; Said, 2005). Stopping is one of the best things you can do for your sperm, and for your partner.

3. Cut alcohol right down

Keep alcohol to an occasional drink, or none, while you are trying. Heavier drinking means worse semen (Jagadesh, 2026).

4. Keep the testes cool

Skip saunas and long hot baths. Also, keep the laptop off your lap, and take breaks on long drives. Loose underwear helps a little, too: boxer wearers had a 25% higher sperm concentration (Mínguez-Alarcón, 2018).

Keep your phone out of your front pocket as well. Mobile phone exposure was linked with lower sperm motility and concentration (Kim, 2021).

5. Move every day

Exercise improves fertility in men as well as women. In men, exercise went with higher pregnancy rates in their partners (Lam, 2026). Aim for brisk walking or a sport most days.

6. Eat a simple, healthy diet: which foods improve sperm?

Fish, poultry, vegetables, fruits, whole grains and low-fat dairy are linked with better sperm (Salas-Huetos, 2017). By contrast, processed meat, sugary drinks and sweets are linked with worse semen.

You do not need exotic foods. A plain Indian home meal, with more vegetables and less fried food, does the job.

7. Sleep seven to eight hours

Poor sleep quality went with a lower total sperm count (Coleman, 2026). So protect your sleep, especially if you work night shifts.

8. Bring stress down

Stress is often linked with lower sperm concentration (Costa, 2026). Trying for a baby is itself stressful, too. A daily walk, regular sleep and talking it through all help.

9. Check every medicine and supplement

Show your andrologist every tablet, powder and “booster” you take. Testosterone and steroids are the worst offenders (McBride, 2016). Never stop a prescribed medicine on your own, though.

10. Have sex every 1 to 2 days around ovulation

Regular sex keeps sperm fresh. In fact, current evidence supports ejaculation every 1 to 2 days for men trying to conceive (Clay, 2026). Read my male fertility tips for timing.

Is 12 hours enough to refill sperm?

Partly. Your testes make sperm nonstop, so the next sample always has some.

But a quick second sample holds fewer sperm. In men with a low count, a sample within four hours had a lower total count (Poopaibool, 2023).

So for trying to conceive, every 1 to 2 days is the sweet spot. For a semen test, wait 2 to 7 days.

Can you get pregnant with a low sperm count?

Yes, very often. A low count lowers the chance each month, but it rarely makes it zero. In a study of 6,061 subfertile couples, 65% conceived within five years (Keihani, 2021).

The usual path depends on the severity, as the card below shows.

• Mild: Natural, then IUI.
• Moderate: IUI or IVF.
• Severe: ICSI.

Her age matters as much as his count. A couple with a mild low count and a partner under 30 can often wait and try. But if she is 35 or older, I move faster.

Can a man with a low sperm count impregnate a woman naturally?

Yes. Many men with a mild or moderate low count father children naturally.

Only one sperm is needed to fertilise the egg. The catch is time, because fewer sperm means lower odds each month.

The median time to conception in subfertile couples was 22 months (Keihani, 2021). So if you are under pressure of time, do not just wait. Get tested, and treat the cause.

Can 1 ml of sperm cause pregnancy?

Yes. One ml of semen can cause pregnancy if it holds enough healthy sperm.

Volume is only the carrier. What matters is the number of moving sperm inside it.

Can watery sperm get a woman pregnant?

Yes. Watery semen is common, and it often holds a normal count.

Semen naturally turns runny within about half an hour. Thickness tells you nothing about the count; only a semen test does.

What percent of sperm lives for 5 days?

Only a very small share. Most sperm die within hours of ejaculation. A few survive in fertile cervical mucus for up to five days, and nobody can put an exact percentage on it.

That is why sex in the few days before ovulation works so well. The sperm are already waiting when the egg arrives.

How can we get pregnant fast with a low sperm count?

Have sex every one to two days through her fertile window. Avoid lubricants, unless they are sperm-friendly. Also, she should have her own fertility check, so no time is lost.

Meanwhile, treat his cause, and re-test after three months. My tips to get pregnant fast cover the timing in detail.

When do we need IUI, IVF or ICSI?

I decide using two things: the total motile sperm count, and her age. Higher counts went with faster conception, so the count guides the choice (Keihani, 2021). Then her age decides how long we can wait.

Low sperm count vs low motility vs morphology vs azoospermia

A semen report can be low in different ways. Because the words sound alike, they are easy to mix up, so here they are side by side.

These problems often travel together, and the same causes drive them. So the same tests apply. For the full picture, see my main page on male infertility.

7 myths about low sperm count

Myths about sperm cost couples months. Here are seven common ones, and the facts behind each one.

In short, a low count is a medical finding with medical causes. Guilt, rumours and shop-bought pills do not change it, but proper tests do.

When should you see an andrologist for a low sperm count?

See an andrologist if you have tried for 12 months without a pregnancy. If she is 35 or older, see one after 6 months. A thorough andrological evaluation is always necessary, because the cause decides the treatment.

Do not wait at all in these situations:

• Your semen report already says low count, or no sperm.
• Your FSH or LH is high, or your count is falling on repeat tests. Ask about sperm freezing, too.
• You had an undescended testis, mumps after puberty, or cancer treatment.
• You use, or used, testosterone or anabolic steroids.
• Your testes feel small, soft or different from each other.
• You notice a lump, swelling or ache in a testis. Get this checked the same week.
• You have very little semen, or none, at orgasm.

The first visit is a full male infertility assessment. Bring every semen report you have, and a list of your medicines.

Bring your wife, too, if she is willing. Fertility is a couple’s journey, and two heads plan better than one.

Low sperm count: your questions answered

Here are quick answers to the questions people search most, each in a few lines.

What supplements can improve sperm quality?

The only supplement I use is Lyon bean extract, and only as part of a plan after tests. Antioxidant pills did not improve semen results in a large trial (Steiner, 2020). Never self-prescribe any fertility supplement.

What are the top 10 male fertility supplements?

I do not recommend a top-10 list. Most such lists are antioxidant blends, and the big trials found no benefit to sperm (Steiner, 2020; Schisterman, 2020). I use only Lyon bean extract, after tests.

Do antioxidants increase sperm count?

No, not in the big trials. Antioxidant pills, and zinc with folic acid, did not improve sperm counts (Steiner, 2020; Schisterman, 2020). That is why I do not prescribe antioxidant cocktails.

What medication is used to increase sperm count?

Letrozole is the only fertility medicine I use, for selected men after hormone tests. I do not use clomiphene in my practice. Never self-prescribe any medicine for sperm count.

What is the best treatment for low sperm count?

The best treatment is the one that fixes your cause. That may mean stopping steroids, treating an infection, losing weight, letrozole for selected men, or IUI, IVF or ICSI. Never self-prescribe.

What are the treatment options for male infertility?

Options include treating the cause, lifestyle repair and letrozole for selected men. Then come IUI, IVF and ICSI, and sperm retrieval for the severest cases (Schlegel, 2021b).

How can I boost a low sperm count?

Find and fix the cause first. Then lose extra weight, stop tobacco, cut alcohol, keep the testes cool, sleep well and stay active. Re-test after three months.

How can I improve sperm quality?

The habits that raise the count also improve quality: a healthy weight, no tobacco, little alcohol, cool testes, good sleep and daily exercise. Then re-test after three months.

How do I make sperm stronger for pregnancy?

Strong sperm come from a healthy body: normal weight, no tobacco, little alcohol, cool testes and good sleep. Also, have sex every one to two days around ovulation, which keeps sperm fresh (Clay, 2026).

What sperm count do you need to get pregnant?

There is no single cut-off, and natural pregnancies happen below 16 million per ml. Still, higher counts went with faster conception, and a total progressive motile count of 50 million or more did best (Keihani, 2021).

Does a low sperm count mean I am infertile?

No, a low count means lower odds each month, not zero. In one study of subfertile couples, 65% conceived within five years (Keihani, 2021). Finding the cause can shorten the wait.

My sperm count is zero. Can it be increased?

Zero sperm is azoospermia, a different problem from a low count. Some causes, such as steroid use, are treatable. With a blockage, sperm can often be collected directly for ICSI, as my azoospermia page explains.

Should I freeze my sperm if my count is low?

Not every man needs to. I advise sperm freezing when FSH and LH are high, or when the count keeps falling on repeat tests, because the count may later reach zero. Freezing early keeps your options open.

How do you know if a man is fertile?

Only a semen analysis, read with an examination, gives a real answer. Erections, desire and semen appearance do not. Even then, the result is a guide, not a guarantee (Keihani, 2021).

Is oligospermia the same as oligozoospermia?

Yes. Both mean a low sperm count: under 16 million sperm per ml, or under 39 million in total, on the WHO 2021 values. Oligozoospermia is simply the more formal term.

What is oligospermia and azoospermia?

Oligospermia is a low sperm count: under 16 million per ml on the WHO 2021 values. Azoospermia means no sperm at all in the semen, even after spinning the sample.

What is the main cause of oligospermia?

There is no single main cause. Hormone problems, testicle problems, blockages, and lifestyle and medicines all play a part. Testosterone or steroid use is the most avoidable one, and tests find yours.

Can I get pregnant with oligospermia?

Yes. Many couples with mild or moderate oligospermia conceive naturally, though it takes longer. In one study, 65% of subfertile couples conceived within five years (Keihani, 2021).

Is healthy sperm thick or runny?

Either can be normal. Semen is thick at first and turns runny within about 30 minutes. Thickness does not show the count; only a semen test does.

What are the symptoms of low sperm volume?

The main sign is very little semen, under about 1.4 ml, or a dry orgasm. A short abstinence, a spilled sample, retrograde ejaculation or a blockage can cause it.

Is a sperm motility of 20% normal?

No. On the WHO 2021 values, at least 42% of sperm should be moving, and 30% moving forward. So 20% motility is low, but pregnancy is still possible, as my low sperm motility page explains.

Can I get pregnant with 30% sperm motility?

Yes. If 30% of sperm swim forward, that meets the WHO 2021 limit for progressive motility. If 30% is the total motility, it is low, but natural pregnancy is still possible.

What is progressive motility in sperm?

Progressive motility is the share of sperm swimming forward, in a line or a large circle. The WHO 2021 lower limit is 30%. These are the sperm that can reach the egg.

Can low sperm motility be cured?

Often, yes, once the cause is found, such as heat, smoking, infection or long gaps between ejaculations. Then re-test after three months.

Is 7% normal sperm good?

Yes. On the WHO 2021 values, 4% or more normal forms is normal, so 7% is a good result. Shape is judged very strictly, so low-looking numbers are expected.

How do you get pregnant with poor sperm morphology?

First rule out a cause such as heat, smoking or infection. Many couples still conceive naturally. If not, IUI or ICSI helps, and my sperm morphology page explains the report.

Can releasing sperm every day cause low sperm count?

No. Daily ejaculation lowers that one sample, but your testes keep making sperm. In fact, ejaculation every one to two days is advised for couples trying (Clay, 2026).

Does sperm count decrease with age?

Slowly, yes. Men make sperm for life, but quality falls with age. In IVF, live births fell when the man was 40 or older and his partner was 35 to 39 (Datta, 2024).

Does tight underwear reduce sperm count?

It may, a little. Men who mostly wore boxers had 25% higher sperm concentration than other men (Mínguez-Alarcón, 2018). Loose underwear is a sensible habit, though not a cure.

Can alcohol affect sperm count?

Yes. Alcohol harmed semen in a dose-dependent way: the more men drank, the worse the results (Jagadesh, 2026). While trying for a baby, keep it to an occasional drink, or none.

Can stress cause low sperm count?

Stress can contribute. In a review of 34 studies, stress was often linked with lower sperm concentration and motility (Costa, 2026). It is rarely the only cause, so tests still matter.

Is low sperm count genetic?

Sometimes. Klinefelter syndrome and Y-chromosome microdeletions are the main genetic causes. Chromosome problems turned up in 18.4% of men with a severe low count (Pylyp, 2013).

What is the average sperm count in Indian men?

A review of Indian studies put the average for fertile men at about 81 million per ml (Mishra, 2018). For infertile men, it was about 38 million per ml.

Does a low sperm count cause semen leakage?

No. Fluid with urine, or a wet dream at night, is usually normal prostate or semen fluid. It does not cause, or signal, a low sperm count.

Do home remedies work for low sperm count?

Healthy habits work, and they are the real home remedy. Untested herbal pills and powders are a different matter, so skip them. My home remedies page explains what helps.

The bottom line

A low sperm count means fewer than 16 million sperm per ml, or under 39 million in total, on the WHO 2021 values. It is common, and it is usually silent. But it is rarely the end of the road.

Repeat the test, ideally a proper lab sperm test. Find the cause with the right tests.

Then treat that cause, fix your habits, and re-test after three months. Many couples conceive naturally, and IUI, IVF and ICSI cover the rest.

Above all, never self-prescribe. Bring your report to me at the clinic in T Nagar, Chennai. Call 97907 83856 or message me on WhatsApp.

This is Dr Shah, Consultant Andrologist. Please do ask your questions below.

References

WHO 2021 lower reference limits on this page (16 million/ml, 39 million, 1.4 ml, 42%, 30%, 4%, 54%) are quoted from the WHO laboratory manual, sixth edition (2021); the papers below discuss it.

Semen analysis and the WHO 2021 manual

1. Boitrelle F, et al., 2021: The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis (PMID 34947899).
2. Paffoni A, et al., 2022: The statistical foundation of the reference population for semen analysis included in the sixth edition of the WHO manual: a critical reappraisal of the evidence (PMID 35849333).
3. Mburu G, et al., 2026: Recommendations from the WHO guideline for the prevention, diagnosis, and treatment of infertility (PMID 41387135).
4. Schlegel PN, et al., 2021a: Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (PMID 33309062).

How common low sperm count is

5. Levine H, et al., 2023: Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries (PMID 36377604).
6. Mishra P, et al., 2018: Decline in seminal quality in Indian men over the last 37 years (PMID 30352581).
7. Yaiphaba Meitei H, et al., 2025: No Evidence of Temporal Decline in Semen Parameters Over 17 Years Among Men Who Underwent Fertility Evaluation from Indian Southern States (PMID 41117704).
8. Du C, et al., 2024: Association of abstinence time with semen quality and fertility outcomes: a systematic review and dose-response meta-analysis (PMID 38197853).

Hormone, genetic and testicular causes

9. McBride JA, et al., 2016: Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use (PMID 26908067).
10. Wallace EM, et al., 1993: Comparison between testosterone enanthate-induced azoospermia and oligozoospermia in a male contraceptive study. I: Plasma luteinizing hormone, follicle stimulating hormone, testosterone, estradiol, and inhibin concentrations (PMID 8325955).
11. Kumar N, et al., 2025: Pandemic of testosterone abuse: Considerations for male fertility (PMID 40747477).
12. Desai A, et al., 2022: Understanding and managing the suppression of spermatogenesis caused by testosterone replacement therapy (TRT) and anabolic-androgenic steroids (AAS) (PMID 35783920).
13. Haffez H, et al., 2026: The link between diabetes and male infertility: mechanisms and implications (PMID 42498725).
14. Ghanem MA, et al., 2024: Long-term outcomes of erectile function in adult orchidopexy patients (PMID 39533990).
15. Campbell KJ, et al., 2026: Impact of male genital tract infections on semen quality: a systematic review and meta-analysis (PMID 41825760).
16. Chebihi ZT, et al., 2026: Prevalence of Klinefelter syndrome among infertile men with spermogram abnormalities: a cross-sectional study at a referral laboratory in Rabat, Morocco (PMID 42952821).
17. Lee TH, et al., 2024: An analysis of Y-chromosome microdeletion in infertile Korean men with severe oligozoospermia or azoospermia (PMID 38197754).
18. Krausz C, et al., 2024: EAA/EMQN best practice guidelines for molecular diagnosis of Y-chromosomal microdeletions: State of the art 2023 (PMID 37674303).
19. Pylyp LY, et al., 2013: Chromosomal abnormalities in patients with oligozoospermia and non-obstructive azoospermia (PMID 23575767).
20. Vogt M, et al., 2026: Semen quality in men with cancer: comparison with a healthy Swiss reference population (PMID 42814001).

Lifestyle and environmental causes

21. Sermondade N, et al., 2013: BMI in relation to sperm count: an updated systematic review and collaborative meta-analysis (PMID 23242914).
22. Santi D, et al., 2025: Weight Loss as Therapeutic Option to Restore Fertility in Obese Men: A Meta-Analytic Study (PMID 39344112).
23. Sharma R, et al., 2016: Cigarette Smoking and Semen Quality: A New Meta-analysis Examining the Effect of the 2010 World Health Organization Laboratory Methods for the Examination of Human Semen (PMID 27113031).
24. Said TM, et al., 2005: Relationship between semen quality and tobacco chewing in men undergoing infertility evaluation (PMID 16169398).
25. Jagadesh P, et al., 2026: Alcohol and male infertility: is there a safe dose? Evidence of accessory gland dysfunction, oxidative stress, and sperm DNA damage (PMID 42871238).
26. Joseph MD, et al., 2026: A North American preconception cohort study of cannabis use and semen quality (PMID 40326424).
27. Garolla A, et al., 2013: Seminal and molecular evidence that sauna exposure affects human spermatogenesis (PMID 23411620).
28. Sheynkin Y, et al., 2005: Increase in scrotal temperature in laptop computer users (PMID 15591087).
29. Mínguez-Alarcón L, et al., 2018: Type of underwear worn and markers of testicular function among men attending a fertility center (PMID 30102388).
30. Jung A, et al., 2001: [Fever as etiology of temporary infertility in the man] (PMID 11910858).
31. Gago LC, et al., 2026: Environmental PM2.5 Exposure and Socioeconomic Deprivation Are Independent Risk Factors for Impaired Semen Parameters (PMID 40846186).
32. Datta AK, et al., 2024: Livebirth rates are influenced by an interaction between male and female partners’ age: analysis of 59 951 fresh IVF/ICSI cycles with and without male infertility (PMID 39241250).
33. Costa AF, et al., 2026: Psychological stress and semen quality impairment: A systematic review (PMID 42441879).
34. Coleman CM, et al., 2026: A North American preconception study of sleep health and semen quality (PMID 41330355).
35. Kim S, et al., 2021: Effects of mobile phone usage on sperm quality – No time-dependent relationship on usage: A systematic review and updated meta-analysis (PMID 34333014).

Low testosterone, high FSH and sperm freezing

36. Greenberg DR, et al., 2023: Assessing the Prevalence of Low Testosterone and Elevated Follicle Stimulating Hormone Among Men Presenting for Fertility Evaluation Without Oligospermia (PMID 37482101).
37. Karavani G, et al., 2024: Idiopathic secondary azoospermia occurrence in men with oligospermia over time (PMID 38941005).
38. Iliadou PK, et al., 2015: The Sertoli cell: Novel clinical potentiality (PMID 26859601).

Varicocele

39. Chiba K, et al., 2016: Clinical Outcomes of Varicocele Repair in Infertile Men: A Review (PMID 27574593).
40. Persad E, et al., 2021: Surgical or radiological treatment for varicoceles in subfertile men (PMID 33890288).

Tests and timing

41. Poopaibool N, et al., 2023: Effects of a short abstinence period on sperm quality in oligozoospermic men (PMID 37995754).
42. Badreddine J, et al., 2023: The Variability of Semen Parameters With Sexual Abstinence Using Mail-in Sperm Testing Is Similar to That Seen With Traditional In-Office Semen Analysis (PMID 37771162).
43. Clay N, et al., 2026: Ejaculatory frequency and male fertility: a literature review of evidence-based recommendations (PMID 41809803).
44. Esteves SC, et al., 2026: Sperm DNA fragmentation: how to test, when to test, and what to do with abnormal results-a pragmatic mini-review for clinical practice (PMID 42049202).

Treatment and supplements

45. Del Giudice F, et al., 2020: A systematic review and meta-analysis of clinical trials implementing aromatase inhibitors to treat male infertility (PMID 31621654).
46. Guo B, et al., 2022: Efficacy and safety of letrozole or anastrozole in the treatment of male infertility with low testosterone-estradiol ratio: A meta-analysis and systematic review (PMID 35438843).
47. Steiner AZ, et al., 2020: The effect of antioxidants on male factor infertility: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial (PMID 32111479).
48. Schisterman EF, et al., 2020: Effect of Folic Acid and Zinc Supplementation in Men on Semen Quality and Live Birth Among Couples Undergoing Infertility Treatment: A Randomized Clinical Trial (PMID 31910279).
49. Schlegel PN, et al., 2021b: Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II (PMID 33309061).
50. Salas-Huetos A, et al., 2017: Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies (PMID 28333357).
51. Lam LK, et al., 2026: Exercise intervention improves fertility outcomes in females and males: an umbrella review of meta-analyses (PMID 42661515).

Pregnancy with a low count

52. Keihani S, et al., 2021: Semen parameter thresholds and time-to-conception in subfertile couples: how high is high enough? (PMID 34097024).
53. Findeklee S, et al., 2020: Correlation between total sperm count and sperm motility and pregnancy rate in couples undergoing intrauterine insemination (PMID 32371917).
54. Quintana-Vehí A, et al., 2026: Effect of abnormal semen parameters on ICSI: morphokinetics and cumulative clinical outcomes of 10,623 embryos (PMID 41720045).