Low sperm count

About low sperm count

Problems with sperm, including a low sperm count and problems with sperm quality, are quite common. They're a factor in around one in three couples who are struggling to get pregnant.

There are treatments available on the health service or privately that can help you become a dad if you have a low sperm count.

A low sperm count is also called oligozoospermia.

Getting your sperm count checked

See your GP if you have not been able to conceive after one year of trying for a baby.

It's a good idea for both you and your partner to get advice, as fertility problems can affect men and women. Often it's a combination of both. It's important to understand what the issue is before you decide on your next steps.

One of the tests your GP can arrange is a semen analysis.

This is where a sample of your semen is analysed in a laboratory. This is to check the quality and quantity of the sperm.

If the results are not normal, the test should be repeated to make sure it was accurate. This will normally be carried out after three months.

Your GP can refer you to a specialist in male infertility at your local hospital or fertility clinic if any problems are found.

Home sperm count testing kits

There are several male fertility home-testing kits available to buy from pharmacies. These tests claim to show whether your sperm count is low.

You should be aware that although research by the manufacturers suggests these tests can give an accurate indication of sperm count, they haven't been extensively studied.

Some kits only check the number of sperm, and not other things that can affect fertility, such as how well the sperm are able to move (motility). Some kits use 20 million sperm per millilitre of semen as being the measure of normal, instead of 15 million. They may you false reassurance, or may suggest your sperm count is low when it's normal.

It's better to see your GP for a proper semen analysis if you're concerned about your fertility. See how to use self-test kits safely for more about the issues of home-testing.

Causes of a low sperm count

In many cases, it's not obvious what causes a low sperm count.

Sometimes problems with sperm count and quality are linked with:

• a hormone imbalance, such as hypogonadism (reduced hormone production)
• a genetic problem such as Klinefelter syndrome
• having had undescended testicles as a baby
• a structural problem – for example, the tubes that carry sperm being damaged and blocked by illness or injury, or being absent from birth
• a genital infection such as chlamydia, gonorrhoea or prostatitis (infection of the prostate gland)
• varicoceles (enlarged veins in the testicles)
• previous surgery to the testicles or hernia repairs 
• the testicles becoming overheated
• drinking too much alcohol, smoking and using drugs such as marijuana or cocaine
• certain medications, including testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some antibiotics and some antidepressants

Treatments for low sperm count

If you or your partner has been diagnosed with a low sperm count, there are several options available.

Keep trying

Your doctor may first of all suggest trying to conceive naturally for a little longer. Many couples conceive within the second year of trying.

You can help maximise your chances of conceiving by:

• having sex every two or three days
• moderating your alcohol intake and stopping smoking
• staying in good shape, exercising regularly and having a healthy, balanced diet

• How to improve your chances of becoming a dad.

IVF

In vitro fertilisation (IVF) may be an option if you have a slightly low sperm count and you've been trying to conceive naturally with your partner for at least two years.

During IVF, an egg is removed from the woman's ovaries and fertilised with sperm in a laboratory. The fertilised egg is then returned to the woman's womb to grow and develop.

Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is a type of IVF technique, in which a single sperm is injected directly into an egg to fertilise it. The fertilised egg is then transferred to the woman's womb.

ICSI may be offered if you've been trying to conceive naturally with your partner for at least two years and you have either:

• few or no sperm in your semen
• poor quality sperm

Before having ICSI, you and your partner will need to have an assessment to make sure the treatment is suitable.

Donor insemination

Donor insemination means using sperm donated by another man.

You may want to consider using donor insemination as an alternative to ICSI. This is particularly if the man has a genetic disorder that could be passed on to any children. It can be used as part of IVF if necessary.

If you're considering donor insemination, you should be offered counselling as a couple about the implications for you and your children.

Gonadotrophin medication

If you have very low levels of gonadotrophin hormones (which stimulate the production of sperm), you should be offered treatment with gonadotrophin medication to improve your fertility.

But if no cause has been found for your sperm count not being normal, you will not be offered hormone-based medicines as they are not known to improve fertility in these cases.

More useful links

• How to use your health services