Low Sperm Count: Causes, symptoms, diagnosis & treatment
Vanakkam, Namaste, and Welcome to Dr. Shah’s Clinic. My name is Dr. Shah Dupesh, I am a full time practicing andrologist in Chennai. In this post, I am going to tell you everything under the sun about low sperm count. Do read the article till the very end, since I have included a tonne of information for your personal benefit.
Okay, let’s begin!
A patient is said to have low sperm count if his sperm concentration is <15 million/ml. Patients with low sperm counts are diagnosed to have Oligozoospermia (the medical term for low sperm count issues)
The normal sperm count to father a child in the 1st year of marriage is usually 15 million/ml and above. Check out the image below
However, an important point to bear in mind is that the total number of sperms in the ejaculate is usually a more important metric than sperm count.
You can calculate the total sperm count of your ejaculate as follows—->
Total sperm in ejaculate = semen volume x sperm concentration/ml
This is were an expert interpretation of a semen analysis report becomes highly necessary. Let me explain with an example!.
Now a man who has a semen volume of 1.0 ml and a sperm concentration of 10 million/ml is truly suffering from low sperm count. This is is because as per the WHO 2010 manual the normal semen volume is 1.5 ml and the normal count is 15 million/ml
In the above example, both the man’s semen volume and the count is less, as compared to the WHO 2010 reference ranges.
Now, lets look at another example. Suppose another gave a semen test and his semen volume is 3.0 ml, and his sperm concentration is 10 million/ml, most doctors will label this man to have low sperm count. However, this is not right!. Its absurd!
Multiply 10 million/ml by 3.0 ml, what do you get?
30 million/ml!!. Thats right!. 30 million/ml. This is way higher than the WHO’s recommended guideline values. As per the WHO 2010 guideline values, the calculated total sperm count is
1.5 ml x 15 million/ml which equals 22.5 million!.
Now, which is higher? 30 million or 22.5 million/ml?. You get the picture right?
Consequently, a large number of men are being labeled to have low sperm count, without a proper work up of their sperm test reports
What causes low sperm count in men?
A man is said to suffer from low sperm count if a semen test indicates a sperm concentration <15 million/ml. The reference of 15 million/ml is based on the recent WHO 2010 Andrology Laboratory Manual.
Men usually father children in less than a year when the sperm count is 15 million/ml and above.
Some common causes of low sperm count that are well proven medically include conditions like
- Hypogonadotrophic hypogonadism (Kallman Syndrome)
- Hypergonodotrophic hypogonadism (Testicular failure)
- Undescended testis
- Klinefelter’s Syndrome (Here there is an extra X-chromosome)
- Obstructions in the male reproductive tract
- Y-Chromosome Microdeletions
- Testicular Infections
- Past surgeries done to the testis, prostate, and associated structures
- Certain medications taken for blood pressure, gastric ulcers and certain antibiotics and/or antifungals
- Problems with erection
- Problems with ejaculation
- Past Chemotherapy & radiotherapy
Let us briefly go through some of these causes.
A. Hypogonadotropic Hypogonadism –
In this condition, the patient’s reproductive hormones of FSH (the hormones that drives sperm production) and LH (the hormones for Testosterone production) are low. Testis size is also very small. Sperm production will usually be completely absent (azoospermia) or will be very very low. These patients also have difficulties in achieving an erection and will also have low libido.
B. Testicular Failure
Patients with testicular failure, show high levels of reproductive hormones, i.e high FSH and LH. Testis size is usually smaller than what normal. These patients may also have problems with erection and interest.
C. Klinefelters Syndrome
The normal karyotype is XY. However, in patients with Klinefelter’s syndrome, an extra X chromosome is present which impairs development. These patients are tall with long extremities, small firm testis, and very sparse hair distribution. These patients also have problems with erection and overall mood. Learning difficulties is also frequently present.
D. Undescended testis
In some men, both the testis does not descend into the scrotal sac. Sometimes one testis may descend, while the other may remain up in the abdomen. In these scenarios, low sperm count can result. In patients were both testis are completely abdominal in position, the sperm count is usually zero
E. Y-Chromosome Microdeletions
The interesting thing to know is that its the Y chromosome that determines ‘maleness’. Over 2500 genes have to function in harmony for normal sperm production. Close to over 300 of these genes are located in the Y-Chromosome. If anyone of these genes do not function or are deleted during development, very low sperm count ultimately results.
F. Obstructions in the Male Reproductive Tract
A very common cause of low sperm count issues is blocks anywhere in the sperm transport pathways. Moreover, in some scenarios, the pathways are underdeveloped. In all these cases, sperm count will be low and imaging studies are usually required to find out the site of block or obstruction. Surgical recorrection though works for some patients.
G. Testicular Infections
Common sexually transmitted diseases that have been associated with low sperm count include infections like Chlamydia and Gonorrhea. However, when diagnosed and treated properly, most of the time, sperm counts return back to normal
H. Past Surgeries
Surgeries that cause low sperm count include surgeries done to the prostate, hernia repair, failed vasectomy reversals, large abdominal surgeries and in some cases surgeries done to the testis itself.
I. Medications that lead to low sperm count
Numerous medications cause low sperm count. Common medications include medicines taken for infections, ulcers, fungal infections, steroids, and range of drugs. Moreover, chemotherapy and radiotherapy also lower the sperm count in men.
J. Problems with Erection
Men with erectile dysfunction frequently present to a clinic with a low sperm count report. Treating the erectile dysfunction with a sexologist frequently resolves the issue
K. Problems with ejaculation
Low sperm count can result from a condition called retrograde ejaculation. In this condition, the semen instead of coming through the urethral tip goes backward into the urinary bladder. In the same vein, surgeries done to the prostate and certain medications called alpha-blockers can lead to problems with ejaculation.
How common is low sperm count?
Male infertility affects close to over 50% of couples trying for a child naturally. Low sperm count alone contributes to over 25% of the male factor infertility burden. Low sperm count and problems with sperm motility are among the top causes of male infertility.
How do you check sperm count?
Sperm count assessment or an assessment of male infertility is best done by a semen analysis.
A sperm count <15 million/ml is called as oligozoospermia. In individuals where the sperm count is less than 5 million/ml, the patient is said to have severe oligozoospermia.
In all individuals suspected to have male infertility, at least 2 semen analysis is definitely recommended. This is because sperm counts are extremely variable, and furthermore for a single fertile male, the sperm count can range from anywhere from 0 (zero) all the way upto 160 million per ml.
Home-based sperm kit tests are not adequately sensitive to detect very low sperm counts. Home-based sperm kit tests are not recommended as they are misleading.
Furthermore, in some individuals, the sperm count can be so low that the semen sample has to be centrifuged to do a proper sperm test. In these patients, a thorough evaluation with an extended semen analysis is definitely required.
In the same vein in patients whose sperm tests show only an occasional motile sperm cell in the semen are said to have a count <20,000 cells/ml and suffer from severe male infertility.
What are the signs of low sperm count in man?
In men suffering from low sperm count, symptoms of male infertility commonly seen are
- Problems with erection
- Low volume ejaculate
- Decreased sex interest
- Pain during ejaculation
- Some lump in the testicle
- Sparse body hair distribution
The main symptom of low sperm count though, is that the patient will be unable to father a child. In some instances, the man may not present with any symptoms at all.
Can low sperm count be cured?
To tell you the truth, low sperm count can be cured but that purely depends on the cause. Moreover, finding out the cause of low sperm count is the 1st step before deciding on a mode male infertility treatment. Low sperm count that results from genetic causes cannot be improved successfully.
How can I increase my sperm count naturally?
There are numerous strategies to improve sperm count naturally. I have made a short video below, were I share quick tips that you can follow on improving your sperm count. While these strategies definitely work, please remember that, making a diagnosis and finding out why your sperm count is low is important.
Can you get a girl pregnant with low sperm count?
Pregnancies happen all the time!. What’s more important is the time to pregnancy rates. In men with low sperm count, time to pregnancy is delayed especially in individuals where the sperm count is less than 15 million/ml. Taking active medical therapy along with proper evaluation can help improve sperm count significantly.
Can a man with zero sperm count get a women pregnant?
In some patients, sperm count = zero. Consequently, in this condition called Azoospermia, finding out the cause of azoospermia is key before proceeding with any treatment. In some patients recovery of sperm count is possible. However, recovery purely and I mean purely depends on the cause.
So, that concludes this article on low sperm count. I hope you enjoyed it! Do share it with all your friends and loved ones. Feel free to get in touch with us below. Always happy to help.
Stay healthy and stay happy!