Low sperm count means that the fluid (semen) you ejaculate during an orgasm contains fewer sperm than normal.
A
low sperm count is also called oligospermia. A complete absence of
sperm is called azoospermia. Your sperm count is considered lower than
normal if you have fewer than 15 million sperm per milliliter of semen.
Having
a low sperm count decreases the odds that one of your sperm will
fertilize your partner's egg, resulting in pregnancy. Nonetheless, many
men who have a low sperm count are still able to father children.
Symptoms
The
main sign of low sperm count is the inability to conceive a child.
There might be no other obvious signs or symptoms. In some men, an
underlying problem such as an inherited chromosomal abnormality, a
hormonal imbalance, dilated testicular veins or a condition that blocks
the passage of sperm may cause signs and symptoms.
Low sperm count symptoms might include:
. Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
. Pain, swelling or a lump in the testicle area
. Decreased facial or body hair or other signs of a chromosome or hormone abnormality
When to see a doctor
See
a doctor if you have been unable to conceive a child after a year of
regular, unprotected intercourse or sooner if you have any of the
following:
. Erection or ejaculation problems, low sex drive, or other problems with sexual function
. Pain, discomfort, a lump or swelling in the testicle area
. A history of testicle, prostate or sexual problems
. A groin, testicle, penis or scrotum surgery
Causes
The
production of sperm is a complex process and requires normal
functioning of the testicles (testes) as well as the hypothalamus and
pituitary glands — organs in your brain that produce hormones that
trigger sperm production. Once sperm are produced in the testicles,
delicate tubes transport them until they mix with semen and are
ejaculated out of the penis. Problems with any of these systems can
affect sperm production.
Also, there can be problems of abnormal sperm shape (morphology), movement (motility) or function.
However, often the cause of low sperm count isn't identified.
Medical causes
Low sperm count can be caused by a number of health issues and medical treatments. Some of these include:
. Varicocele.
A varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain
the testicle. It's the most common reversible cause of male infertility.
Although the exact reason that varicoceles cause infertility is
unknown, it might be related to abnormal testicular temperature
regulation. Varicoceles result in reduced quality of the sperm.
. Infection.
Some infections can interfere with sperm production or sperm health or
can cause scarring that blocks the passage of sperm. These include
inflammation of the epididymis (epididymitis) or testicles (orchitis)
and some sexually transmitted infections, including gonorrhea or HIV.
Although some infections can result in permanent testicular damage, most
often sperm can still be retrieved.
. Ejaculation problems.
Retrograde ejaculation occurs when semen enters the bladder during
orgasm instead of emerging out of the tip of the penis. Various health
conditions can cause retrograde ejaculation or lack of ejaculation,
including diabetes, spinal injuries, and surgery of the bladder,
prostate or urethra.
. Certain medications also might result in ejaculatory problems, such as blood pressure medications known as alpha blockers. Some
ejaculatory problems can be reversed, while others are permanent. In
most cases of permanent ejaculation problems, sperm can still be
retrieved directly from the testicles.
. Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.
. Tumors.
Cancers and nonmalignant tumors can affect the male reproductive organs
directly, through the glands that release hormones related to
reproduction, such as the pituitary gland, or through unknown causes.
Surgery, radiation or chemotherapy to treat tumors also can affect male
fertility.
. Undescended testicles. During
fetal development one or both testicles sometimes fail to descend from
the abdomen into the sac that normally contains the testicles (scrotum).
Decreased fertility is more likely in men with this condition.
. Hormone imbalances. The
hypothalamus, pituitary and testicles produce hormones that are
necessary to create sperm. Alterations in these hormones, as well as
from other systems such as the thyroid and adrenal gland, may impair
sperm production.
. Defects of tubules that transport sperm. Many
different tubes carry sperm. They can be blocked due to various causes,
including inadvertent injury from surgery, prior infections, trauma or
abnormal development, such as with cystic fibrosis or similar inherited
conditions.
. Blockage can occur at any level,
including within the testicle, in the tubes that drain the testicle, in
the epididymis, in the vas deferens, near the ejaculatory ducts or in
the urethra.
. Chromosome defects. Inherited
disorders such as Klinefelter's syndrome — in which a male is born with
two X chromosomes and one Y chromosome instead of one X and one Y —
cause abnormal development of the male reproductive organs. Other
genetic syndromes associated with infertility include cystic fibrosis,
Kallmann's syndrome and Kartagener's syndrome.
. Celiac disease. A
digestive disorder caused by sensitivity to gluten, celiac disease can
cause male infertility. Fertility may improve after adopting a
gluten-free diet.
. Certain medications.
Testosterone replacement therapy, long-term anabolic steroid use, cancer
medications (chemotherapy), certain antifungal and antibiotic
medications, some ulcer medications, and other medications can impair
sperm production and decrease male fertility.
. Prior surgeries. Certain
surgeries might prevent you from having sperm in your ejaculate,
including vasectomy, inguinal hernia repairs, scrotal or testicular
surgeries, prostate surgeries, and large abdominal surgeries performed
for testicular and rectal cancers, among others. In most cases, surgery
can be performed to either reverse these blockages or to retrieve sperm
directly from the epididymis and testicles.
Environmental causes
Sperm production or function can be affected by overexposure to certain environmental elements, including:
. Extended exposure to benzenes, toluene, xylene, herbicides, pesticides,
organic solvents, painting materials and lead might contribute to low
sperm counts.
. Heavy metal exposure. Exposure to lead or other heavy metals also can cause infertility.
.
Radiation or X-rays. Exposure to radiation can reduce sperm production.
It can take several years for sperm production to return to normal.
With high doses of radiation, sperm production can be permanently
reduced.
. Overheating the testicles. Elevated
temperatures impair sperm production and function.Although studies are
limited and are inconclusive, frequent use of saunas or hot tubs might
temporarily impair sperm count.
. Sitting for long
periods, wearing tight clothing or working on a laptop computer for long
stretches of time also might increase the temperature in your scrotum
and slightly reduce sperm production.
Health, lifestyle and other causes
Other causes of low sperm count include:
.
Drug use. Anabolic steroids taken to stimulate muscle strength and
growth can cause the testicles to shrink and sperm production to
decrease. Use of cocaine or marijuana might reduce the number and
quality of your sperm as well.
. Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.
. Occupation. Certain occupations might be linked with a risk of infertility, including welding or those associated with prolonged sitting, such as truck driving. However, the data to support these associations is inconsistent.
. Tobacco smoking. Men who smoke might have a lower sperm count than do those who don't smoke.
.
Emotional stress. Severe or prolonged emotional stress, including
stress about fertility, might interfere with hormones needed to produce
sperm.
. Depression. Being depressed may negatively affect sperm concentration.
.
Weight. Obesity can impair fertility in several ways, including
directly impacting sperm and by causing hormone changes that reduce male
fertility.
. Sperm testing issues. Lower than
normal sperm counts can result from testing a sperm sample that was
taken too soon after your last ejaculation; was taken too soon after an
illness or stressful event; or didn't contain all of the semen you
ejaculated because some was spilled during collection. For this reason,
results are generally based on several samples taken over a period of
time.
Risk factors
A number of risk factors are linked to low sperm count and other problems that can cause low sperm count. They include:
. Smoking tobacco
. Drinking alcohol
. Using certain illicit drugs
. Being overweight
. Being severely depressed or stressed
. Having certain past or present infections
. Being exposed to toxins
. Overheating the testicles
. Having experienced trauma to the testicles
. Being born with a fertility disorder or having a blood relative, such as your brother or father, with a fertility disorder
. Having certain medical conditions, including tumors and chronic illnesses
. Undergoing cancer treatments, such as radiation
. Taking certain medications
. Having a prior vasectomy or major abdominal or pelvic surgery
. Having a history of undescended testicles.
Complications
Infertility caused by low sperm count can be stressful for both you and your partner. Complications can include:
. Surgery or other treatments for an underlying cause of low sperm count
. Expensive and involved assisted reproductive techniques, such as in vitro fertilization (IVF)
. Stress related to the inability to have a child
Prevention
To protect your fertility, avoid known factors that can affect sperm count and quality. For example:
. Don't smoke.
. Limit or abstain from alcohol.
. Steer clear of illicit drugs.
. Talk to your doctor about medications that can affect sperm count.
. Maintain a healthy weight.
. Avoid heat.
. Manage stress.
. Avoid exposure to pesticides, heavy metals and other toxins.
