Low sperm count – Causes, diagnosis and treatment

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Low sperm count is a common problem related to male infertility. The sperm count is said to be low (oligozoospermia) when there are less than 150 million sperms per ml of semen.

Low sperm count – Causes, diagnosis and treatmentComplete absence of sperm in the semen is called azoospermia. Low sperm count may not be detected until the couple want to have a baby and are unable to do so and seek medical help.

Causes of low sperm count

  1. Varicocele: In this condition there is swelling of the veins associated with the testes. It may affect the scrotal temperature leading to low sperm count.
  2. Infections: Sexually transmitted diseases like Chlamydia and gonorrhoea if ignored and untreated could potentially affect sperm count.
  3. Quality of Lifestyle: Lifestyle factors like excessive alcohol intake, sedentary lifestyle, unhealthy eating habits and smoking regularly can affect sperm count and quality.
  4. Drugs: Narcotic drug abuse or even certain medications like anti-hypertensive drugs can affect sperm count.
  5. Prior surgery: Surgery done on testicles, prostate or urinary bladder can lead to low sperm count as a consequence. One instance is vasectomy in which the tubes transporting the sperm are tied and cut off at the top of the scrotum.
  6. Illnesses: Chronic illnesses like diabetes, hypertension and obesity etc can cause oligozoospermia. Cancers can affect sperm negatively. Radiation used in cancer treatment may also lead to this problem.
  7. Hormonal factors: Two glands in the brain namely hypothalamus and pituitary gland as well as testicular hormones are important for forming and releasing sperm during ejaculation. Any such hormonal disturbances may affect the production of sperm.
  8. Anti sperm antibodies may mistakenly turn on the body’s immune system to attack the sperm and kill it thinking it to be foreign.
  9. Genetic conditions: Disorders like Kleinfelter’s syndrome and cystic fibrosis can lead to infertility in these patients due to abnormal chromosomes.
  10. Defects in the transporting ducts: Blockages in the ducts that carry the sperm from the testes into the urethra may be present. In cystic fibrosis these ducts may be absent.
  11. Ejaculation problems: In a condition known as retrograde ejaculation, the semen enters the urinary bladder instead of the penis. This can lead to low sperm count.
  12. Coeliac disease is a condition when a person cannot digest gluten which is present in wheat products. Cutting off gluten from the diet can reverse male infertility.
  13. Exposure to chemicals like lead, heavy metals and paints can cause sperm counts to plummet.

Symptoms and signs of low sperm count

In most cases there are no symptoms that can be noticed.

The only sign is the inability to conceive after having unprotected sex with the partner for at least one year.

If there is an infection, there may be swelling, redness and increased temperature.

Risk factors

Sportsmen like cyclists or jockeys may have perpetual elevation of scrotal temperature which may lead to oligozoospermia.

Wearing ill-fitting underwear may play a role.

Inadequate sleep, stress and other factors also contribute.

Diagnosis of low sperm count

When a couple seeks infertility treatment, the problem comes to light. The tests are done on the man to check sperm count and quality. For this he is asked to masturbate and ejaculate in a cup or special condoms can be usedand the semen collected in that. Then the sperm is checked for motility, quality and counts.

Several such tests are done at intervals of a week after the first test and then few months later as if the person has changed his lifestyle and adopted a healthier lifestyle, the change will be reflected in the sperm two and a half months later.

Treatment of low sperm count

If the sperm count is low, it may still be possible to impregnate the partner using advanced methods of fertility treatment like intracycloplasmic injection or in vitro fertilisation.

However, if there is azoospermia or complete absence of sperm, then using donor sperm or adoption are the only available options.

Photograph via sxc.hu

Written by Dr Nisreen Nakhoda, General Physician

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