Low sperm count

Diagnosis

You may learn that you have a low sperm count if you get a healthcare checkup because you're having trouble getting your partner pregnant. At your appointment, your healthcare professional works to find out the cause of your fertility troubles. Even if your healthcare professional thinks you have a low sperm count, your partner's fertility also may need to be checked. This can help guide fertility treatment options for you and your partner.

General physical exam and health history

This includes an exam of your genitals. Your healthcare professional also asks questions about any inherited conditions, long-term health problems, illnesses, injuries or surgeries that could affect fertility. You also may be asked about your sexual habits and your sexual development.

Semen analysis

A sample of your semen is collected for testing as well. This is called a semen analysis. Your semen is checked under a microscope to see how many sperm are present. Sometimes, a computer helps measure sperm count.

Semen samples can be collected in a couple of ways. You can provide a sample by masturbating and ejaculating into a special container at the healthcare professional's office. Or you could use a special condom that collects your semen during sex.

New sperm are regularly made in the testicles. The sperm take about 42 to 76 days to mature. So a semen analysis reflects your environment over the past three months. The results of any lifestyle changes you've made won't show up for several months.

One of the most common causes of low sperm count is incomplete or improper collection of a semen sample. Sperm counts also often change on their own. Because of these factors, most healthcare professionals check two or more semen samples over time.

To help you collect an accurate sample, your healthcare professional likely will:

• Ask you to make sure that all of your semen goes into the collection cup or collection condom when you ejaculate.
• Ask you not to have sex or masturbate for 2 to 7 days before you collect a sample.
• Collect a second sample at least two weeks after the first.
• Tell you not to use lubricants while collecting your sample. These products can affect sperm movement.

Semen analysis results

If you have a low sperm count, your semen contains fewer than 15 million sperm in each milliliter or less than 39 million sperm total for the entire sample.

Your chance of getting your partner pregnant drops with lower sperm counts. Some people have no sperm in their semen at all. This is known as azoospermia.

Many factors are involved in pregnancy. The number of sperm in the semen is only one. Many people with low sperm counts are able to get their partners pregnant. Likewise, some people with typical sperm counts are not able to start pregnancies. Even if you have enough sperm, other factors are important to start a pregnancy. These factors include healthy sperm movement, also called motility.

Other tests

Depending on your semen analysis results, your healthcare professional might recommend more tests. Tests to look for the cause of your low sperm count and other possible causes of male infertility can include:

• Scrotal ultrasound. This test uses high-frequency sound waves to look at the testicles and supporting structures.
• Hormone testing. Your healthcare professional may recommend a blood test to check the levels of hormones made by the pituitary gland and testicles. These hormones play a key role in sexual development and in how much sperm the body makes.
• Post-ejaculation urinalysis. This urine test is done after you ejaculate. Sperm in your urine can mean that your sperm travel backward into the bladder instead of out of your penis during ejaculation. This is a condition called retrograde ejaculation.
• Genetic tests. When semen contains extremely low levels of sperm, certain genetic causes may be involved. A blood test can find out if you have symptoms of a genetic condition. Some people with genetic conditions decide not to get fertility treatment. That's because the gene changes that cause such conditions can be passed from parent to child.
• Testicle biopsy. This test involves removing small tissue samples from the testicles with a needle. It's not commonly used to find the cause of infertility.
• Transrectal ultrasound. A small, lubricated wand is placed into the rectum to check the prostate and look for blockages in the tubes that carry semen.

Treatment

Treatments for low sperm count include:

• Surgery. For example, a varicocele can often be fixed with surgery. Or an obstructed vas deferens can be repaired. Past vasectomies can be reversed. If no sperm are present in the semen, sperm often can be collected directly from the testicles or epididymis.
• Treatments for infections. Antibiotics can cure an infection of the reproductive tract caused by germs. But this doesn't always restore fertility. And it's rare for genital tract infections to be linked with infertility.
• Treatments for sexual conditions. Medicine or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
• Hormone treatments and medications. These treatments can help if you have infertility caused by high or low levels of certain hormones. These treatments also may help if you have issues with the way your body uses hormones.
• Assisted reproductive technology (ART). Some couples have trouble becoming pregnant despite frequent sex. ART refers to treatments that can help couples become pregnant without sex. ART treatments involve collecting sperm through ejaculation or surgery or from donors. The way sperm is collected depends on your situation and wishes. Various types of ART are available. The sperm can be placed in the uterus through a tube, a process called intrauterine insemination. Or the sperm and eggs can be mixed together in a lab and placed in the uterus, a process called in vitro fertilization. Or a single healthy sperm can be injected into each mature egg before placement in the uterus. This is called intracytoplasmic sperm injection.

When treatment doesn't work

Rarely, male fertility problems can't be treated, and the affected person's sperm can't be used to start a pregnancy. If this happens to you, it's still possible to have a child. You and your partner can think about using sperm from a donor or adopting a child.

Lifestyle and home remedies

You can take steps at home to raise your chances of getting your partner pregnant, such as:

• Have sex more often. Have sex every day or every other day. Start 5 to 7 days before one of your partner's ovaries releases an egg, called ovulation. Keep having sex until two days after ovulation.
• Don't use certain lubricants during sex. Products such as Astroglide and K-Y Jelly, lotions, and saliva might affect sperm movement and function. Ask your healthcare professional about sperm-safe lubricants.
• Get regular exercise and eat a balanced diet.
• Aim to get at least seven hours of sleep a night.
• Take charge of stress.
• If you smoke tobacco or take illicit drugs, quit as soon as possible.
• Try not to become overheated.

Alternative medicine

If you have a low sperm count, you can take a multivitamin. But talk with your healthcare professional before you try any other supplement or type of alternative medicine. It's unclear whether supplements can help treat male infertility. And some supplements may affect medicines that you take or health conditions that you have.

Preparing for your appointment

For low sperm count, you can start by seeing your family healthcare professional. Then you might be referred to an infertility specialist.

Here's some information to help you get ready for your appointment, and what to expect.

What you can do

• Be aware of any restrictions before your appointment. When you make the appointment, ask if there's anything you need to do in advance. For instance, you may be told not to have sex or masturbate for a certain amount of time.
• Write down any symptoms you've had. Include any symptoms that might not seem related to the reason for which you made the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Find out whether you have a family history of fertility problems. Having a male blood relative, such as a brother or father, with fertility trouble or other reproductive conditions may give your healthcare professional clues to the cause of low sperm count.
• Find out from your parents if you had undescended testes or other conditions at birth or in early childhood.
• Make a list of all medicines, vitamins and supplements that you take. Include the amounts that you take.
• Take your partner along. Even if you have a low sperm count, your partner also may need tests. These tests can help find out whether your partner has a condition that could be preventing pregnancy. It's also good to have your partner with you to help keep track of any instructions your healthcare professional gives you. Your partner also can ask questions you may not think of.
• Write down questions to ask your healthcare professional.

Some basic questions to ask your healthcare professional include:

• What do you think may be causing my low sperm count?
• Other than the most likely cause, what are other possible reasons my partner and I haven't been able to become pregnant?
• What kinds of tests do I need?
• Will my partner also need tests?
• What treatments are available to raise my sperm count? Which do you recommend?
• Are there any restrictions that I need to follow?
• At what point should we think about trying options such as a sperm donor or adoption?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

Feel free to ask any other questions that you think of during your appointment.

What to expect from your doctor

Some questions that your healthcare professional may ask you include:

• At what age did you start puberty?
• Have you had a vasectomy or a vasectomy reversal?
• Do you use drugs such as marijuana, cocaine or anabolic steroids?
• Have you been exposed to toxins such as chemicals, pesticides, radiation or lead, especially on a regular basis?
• Are you taking any medicines, including dietary supplements?
• Do you have a history of undescended testicles?