Low sperm count

Low sperm count — medically called oligospermia — is when the semen contains fewer sperm than normal. Normal is about 15 million or more per millilitre; below that is considered low, and azoospermia means no sperm at all. Sperm count is one of several factors in male fertility; even men with normal counts can have fertility problems if sperm motility (movement) or morphology (shape) is abnormal.

Male-factor issues are involved in roughly 40-50% of infertility cases — often overlooked in a cultural context where infertility is frequently assumed to be a female problem.

Causes

Medical:

• Varicocele — enlarged veins in the scrotum; a common and treatable cause
• Infections — past mumps, STIs, prostatitis
• Hormonal problems — testosterone deficiency, thyroid disorders
• Genetic conditions — Klinefelter syndrome, Y-chromosome microdeletions, cystic fibrosis
• Undescended testicles in childhood
• Tumours — of the testes, pituitary, or elsewhere
• Blockages — of the ducts that carry sperm
• Previous surgery (including vasectomy)
• Cancer treatment — chemotherapy, radiotherapy

Lifestyle and environmental:

• Smoking, alcohol, recreational drugs (cannabis, anabolic steroids)
• Obesity
• Heat — frequent saunas, tight clothing, laptop on lap (modest effect)
• Exposure to pesticides, heavy metals, radiation, industrial chemicals — relevant in some Indian occupational settings
• Stress
• Certain medicines (some testosterone products paradoxically reduce sperm count; some anti-seizure and chemotherapy drugs also affect sperm)

Diagnosis

• Semen analysis — the key test. Usually 2 samples a few weeks apart, after 2-5 days of abstinence
• Physical examination
• Hormone tests (testosterone, FSH, LH, prolactin)
• Genetic tests in severe cases
• Scrotal ultrasound — to look for varicocele or other structural issues
• Post-ejaculation urine analysis — for retrograde ejaculation
• Testicular biopsy — in selected cases

Treatment

Treatment depends on the cause:

• Treating the underlying cause — varicocele repair, hormone therapy for hormonal deficiencies, antibiotics for infection, stopping causative medicines
• Lifestyle changes — stop smoking, limit alcohol, achieve healthy weight, avoid heat exposure, reduce stress
• Assisted reproduction — intrauterine insemination (IUI), in-vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI) where even very few sperm can achieve pregnancy
• Surgical sperm retrieval — for azoospermia, sperm can sometimes be retrieved directly from the testis

If a couple has been trying to conceive for more than a year (or 6 months if the woman is over 35) without success, both partners should be evaluated. Fertility specialists and IVF clinics are widely available; government hospitals also provide initial evaluation.