Low Sperm Count: Symptoms, Causes & Diagnosis

Did you know that on an average, there is a 51.6% decline in the sperm count in the last 50 years. Quite alerting right? As per a research conducted in 2022, the sperm count has declined across the continents at the rate of  0.87 million/ml/year and the declining percentage has doubled after 2000s.¹ Yes, you read it right. Due the continuous decline in the sperm count, males are sole contributor for nearly 20% and contributing factor for nearly 30-40% cases of infertility.²  Overall, males contribute in about 50% cases of infertility. It is not a fact to scare rather it is an alarming call for males if your partner is unable to conceive even after trying unprotected, frequent sex for one year or more. Low sperm count might be the reason for it. It makes conceiving difficult naturally. But, on the brighter side, low sperm count is treatable with timely diagnosis and treatment.

Let's understand what low sperm count is and how it can impact men’s fertility.

Low Sperm Count And Infertility

As per WHO, infertility is usually defined as a disease of male reproductive system leading to the failure to achieve pregnancy after 12 or more months of regular unprotected sexual intercourse. As infertility can affect both males and females, it is important that both partners are accurately investigated. But, if you are wondering why infertility occurs in men, then let know about the factors that can lead to infertility.

Sperm quantity often comes under the spotlight when a couple desires to start or expand their family. If they have trouble conceiving, sperm count is the initial test prescribed by the doctor. Although only one sperm fertilizes the egg, the more healthy and viable sperm, higher the chances of pregnancy. Hence, a lower sperm count is not desirable.

Factors Leading To Infertility In Men

Infertility in males is caused by various factors like obstruction in the reproductive tract leading to ejection dysfunctionality, absence or low sperm count, hormonal disorders (eg testosterone which regulate the sperm production), testicular failure to produce sperm, abnormal sperm function and quality.⁵ Additionally, environmental and lifestyle factors like excessive smoking, alcohol intake, obesity contribute to deteriorating reproductive health in males.⁵

Now, let’s understand what sperm count is and why it is necessary to talk about it.

What Is Low Sperm Count?

Sperm count is the 'measure of the number of spermatozoa (the male sex cells) per ejaculation or per measured amount of semen, used as an indication of a man's fertility.' In simple terms, sperm count refers to laboratory evaluation of male semen to assess male fertility.

As per WHO updates (2021), the normal sperm count per ejaculation is 39 million.7 A low sperm count is below 15 million, and anything above 200 million is considered high. The condition of having a low sperm count is referred to as 'oligozoospermia.

Why Is Sperm Count Important?

The question of sperm quantity generally arises when a couple decides to start or expand their family. If they have trouble conceiving, sperm count is the initial test prescribed by the doctor.⁹ Although only one sperm fertilizes the egg. However, the more healthy and viable sperm, the higher the chances of pregnancy. Hence, a lower sperm count is not desirable.

Let's Talk About The Symptoms of Low Sperm Count

The most obvious and direct indicator of low sperm count is infertility.¹⁰ The inability to conceive a child is the main sign of oligospermia or low sperm count. Usually, there are no other direct symptoms of low sperm count. However, inherited chromosomal abnormality, dilated testicular veins, hormonal imbalance or medical condition that blocks the passage of sperm may cause some signs and symptoms.²

Such low sperm count signs Include-

• Difficulty to maintain erection known as erectile dysfunction or low sex drive.
• Swelling or lump and pain in the testicle area.
• Decreased facial or body hair or other signs of a chromosome or hormone abnormality.

What Causes Low Sperm Count?

While understanding the concept of sperm count, the most obvious question is- What causes a low sperm count?

The answer is very explicit. The most important risk factors include being overweight or obese, having had a medical history of injury in or around the testicles, and taking certain medications (eg. medications used in treatment of peptic ulcer disease and for HIV/AIDS).¹¹ Other things that may lead to a low sperm count include exposure to too much heat or different medical situations.

Besides these, there are various causes of low sperm quality, which can be divided into three main categories: medical, environmental, and lifestyle.

1. Medical: Any history of testicular injury or medical condition, as well as genetic disorders, increases the probability of a person having a low sperm count.2 Medical treatments and therapies such as chemotherapy, radiation, or surgery may also impact the sperm count in men. Other factors which may affect the concentration of sperm in men are immune system disorders, erectile dysfunction, or previous STIs like HIV.^12,13

2. Direct Exposure To Heat:

What is truly astonishing is that the ideal temperature for sperm is slightly lower than the body temperature. This is the reason why testicles are positioned outside the abdominal cavity. Hence, any external condition that causes an increase in temperature around the testicles can affect the sperm count adversely. Examples include exposure to heat, long hot baths, etc. Other environmental causes include exposure to chemicals like fertilizers and radiation like X-rays.¹⁵

3. Obesity & Poor Diet:

A significant contributor to low sperm count is unhealthy diet. Countless studies have suggested that a healthy diet promotes better semen parameters. On the other hand, being overweight or obese has been directly associated with reduced testosterone and semen parameters.

Another study demonstrated that men who consumed a highly processed diet had poor sperm count. In comparison, groups of men who consumed relatively healthier food consisting of fresh vegetables, fish, chicken, etc. showed the highest levels of sperm count.¹⁵

4. Air Pollution: 

Yes, you read that right! Air pollution too can negatively impact male fertility. Air contains pollutants such as nitrogen dioxide, ozone, sulphur dioxide and carbon monoxide. These pollutants have been found to impact male fertility by increasing sperm DNA fragmentation, chromosomal abnormalities, impaired spermatogenesis, abnormal sperm morphology and decreased sperm motility. Besides these, exposure to fine particulate matter and heavy metals through air pollution has been associated with testicular cancer.

5. Cigarettes & Alcohol:

The most ‘usual suspect’ in almost every reproductive health problem. Many studies have demonstrated that the tobacco in cigarettes is directly linked to decrease in sperm count, sperm motility, and semen volume. It is also a known culprit of male factor infertility that causes impaired assisted reproduction technique (ART). In fact, male factor infertility was attributed to cigarette smoking in over 5,000 male candidates with reduced sperm count & motility.

Whereas recent studies have shown that chronic alcoholism negatively impacted all sperm parameters, including significantly reduced testosterone levels. Previous studies on alcoholism and its impact on male fertility have also highlighted spermatogenesis and hypogonadism among those men who binged on alcohol.¹⁵

6. Recreational Drugs, Steroids:

While few studies have been done on the effect of recreational drugs on male fertility, some studies on the effects of marijuana reveal that its usage can directly impact semen parameters & sperm function. Additionally, regular intake of pre-workout supplements containing anabolic steroids, can shrink the testicles and result in lower sperm count ¹⁶

Let us now understand the signs of low sperm count.

How To Diagnose Low Sperm Count?

Diagnosis of a low sperm count can be done by undertaking semen analysis test.⁶ A person experiencing the symptoms of low sperm count must reach out to a professional immediately or take an at-home self-collection test with Lifecell’s SpermScore kit. It is a comprehensive sperm analysis solution as it tests for 14 sperm health conditions along with 11 sperm health parameters from the comfort of your home. Moreover, there is no need to visit the laboratory to get your results as you get smart reports on your personalized dashboard within a few days. 

Treatment For Low Sperm Count

Treatment for low sperm count, depending on the severity, usually includes the following:

1. Lifestyle Changes 

Changing your lifestyle for the better can help reverse low sperm count problems. Regular exercise coupled with healthy diet choices are recommended to boost male fertility. Likewise, getting 7-8 hours of good sleep, avoiding stress, alcohol, cigarettes and drugs can also have a positive impact on male fertility.¹⁷

2. Surgical Intervention: 

If the low sperm count is due to an obstructed vas deferens or a varicocele, it can be fixed with a surgery. The effect of a past vasectomy can also be surgically reversed. In case sperm is absent in semen, it can also be surgically collected from the testicles or epididymis.¹⁷

3. Medical Intervention:

Conditions like premature ejaculation or erectile dysfunction can also cause low sperm count. For such conditions, medicines or counseling is provided to help improve fertility.¹⁷

4. Assisted Reproductive Technology

This treatment usually involves collection of healthy sperm through ejaculation or surgery, depending on the situation. To help a couple conceive through ART, the collected sperm can either be directly placed into the uterus (intrauterine insemination) or the sperm & egg can be fertilized in the lab and then placed in the uterus (in vitro fertilization). These procedures can help couples overcome the effects of low sperm count. However, thorough discussion with the doctor is necessary to understand individual-based scenarios and related outcomes.

Conclusion

In conclusion, having a low sperm count is not a chronic or rare medical condition. Testing sperm count can help assess a man's fertility potential and identify potential health issues. It can also help men make lifestyle changes to improve their fertility potential. Also, if you are experiencing difficulty conceiving, a semen analysis may be one of the first tests recommended by a fertility specialist. So, stop accepting low sperm count as normal. It is time to get your semen sample checked with LifeCell’s at-home sperm test kit-SpermScore.

Don’t wait. Get your semen analyzed within 24 hours!