When is sperm count said to be low? – Normal sperm count is 15 million cells or more per milliliter of semen. The sperm count is said to be low when there are fewer than 15 million sperm cells in one milliliter of semen. This is very important for fertility, as the chances of pregnancy reduces as the sperm count decreases. At less than 5 million sperm cells per milliliter of semen (severe oligospermia), fertilization is very difficult to achieve.

What are the causes of low sperm count?

The possible causes of low sperm count include:

1. Genetic conditions – These are conditions that affect the formation of the parent (bigger) cells from which sperm cells are produced. It is a problem that originated from the mother’s gene (egg). One of such conditions is Klinefelter syndrome. This refers to a genetic abnormality in which a male has an extra X chromosome (having XXY instead of XY). One of the numerous problems encountered by the affected persons is infertility because of the abnormality in sperm production.
2. Infections – These include sexually transmitted infections, urinary tract infection, mumps orchitis etc, which may affect either sperm production by the testes directly or cause injury along the tubes that carry sperm, with subsequent healing by fibrosis, leading to obstruction to sperm delivery.
3. Blockage along sperm passage – This prevents sperm cells from mixing with other components of semen. There may still be ejaculation but with few or no sperm cells in the semen.
4. Hormonal abnormality – Low level of testosterone (male hormone responsible for male sexual characteristics, including sperm production) results in low sperm production.
5. Toxins – Some environmental toxins such as heavy metals (e.g. mercury, lead, arsenic, cadmium etc) have negative impacts on sperm production.
6. Drugs – Some medications taken for other medical conditions may negatively affect sperm production. It is therefore necessary to disclose all medical conditions for which you are being managed and the medications being given.
7. Heat – The testes work best at a temperature range slightly lower than the core body temperature. This is the reason they are suspended outside the body. The following factors may raise the temperature around the testes:

1. 1.  Undescended testes – If the testes hang near the body or do not come out of the groin to be suspended outside the body, the heat of the body will destroy the parent sperm cells and impair their ability to produce sperm cells necessary for fertilization. This underscores the need to critically examine male children at birth to make sure that the testes are in the scrotal sac.
   2. Tight underwear – Wearing tight underwear that hold the testes near the body for the greater part of the day may affect sperm production. The body heat impairs the ability of the testes to produce sperm cells.
   3. Hot water bath – Spending a long time in hot tubs may affect sperm count by reducing sperm cell production.
   4. Varicocoele – These are coiled and distended veins around the testes. They retain blood longer than necessary around the testes and thereby raise the temperature around the testes. This negatively impacts sperm production by the testes.

How is low sperm count treated?

The treatment for low sperm count depends on the cause. The following steps may be helpful in correction of low sperm count:

1. Discontinuation of certain medications associated with low sperm count
2. Change of tight-fitting underwear to loose ones
3. Hormone supplements for those with low hormone levels
4. Antibiotics to treat infections
5. Surgery for varicocoele or blockage along the pathway for sperm passage may be necessary

How can low sperm count be prevented?

Some causes of low sperm count are preventable by:

1. Adopt healthy lifestyle – By taking balanced diets, regular exercise and having adequate sleep 
2. Stop smoking
3. Reduce alcohol consumption
4. Avoid medications that reduce sperm count
5. Discontinue the use of hard drugs