Low Sperm Count: Symptoms, Types, Causes and Treatment

Low sperm count—also known as oligospermia—can be a significant challenge for many men hoping to start a family. It not only impacts fertility but can also carry broader health implications and emotional stress. Understanding the symptoms, different types, causes, and treatment options is essential for anyone facing this condition or supporting someone who is.

Symptoms of Low Sperm Count

Low sperm count often goes unnoticed until a couple experiences difficulty conceiving. Most men do not have obvious physical symptoms, but subtle signs may point toward underlying fertility issues. Recognizing these can guide timely medical consultation and intervention.

Symptom	Description	Impact	Source
Infertility	Inability to conceive after a year of regular unprotected sex	Most common sign	1 3 5
Sexual Issues	Low libido, erectile dysfunction	May hint at hormonal imbalances	3 5
Hormonal Signs	Decreased facial/body hair, other signs of chromosome or hormone abnormality	May signal underlying genetic or endocrine disorders	5
Testicular Pain/Swelling	Localized discomfort or masses	Can indicate infection or obstruction	1 8

Table 1: Key Symptoms

Infertility as the Main Indicator

The most consistent and telling symptom of low sperm count is the inability to achieve pregnancy despite regular, unprotected sexual intercourse over a period of 12 months. Unlike other health conditions, low sperm count rarely causes symptoms that are immediately obvious without medical testing, making infertility the primary red flag for most men and couples 1 3.

Other Signs and Associated Conditions

• Sexual Dysfunction: Some men may experience decreased libido or difficulty with erections, which can accompany low sperm count, especially if related to hormonal imbalances 3.
• Hormonal Abnormalities: Reduced facial or body hair, breast enlargement, or other changes can suggest a hormonal or chromosomal issue contributing to low sperm production 5.
• Testicular Symptoms: Pain, swelling, or the presence of a lump in the testicles might indicate infections (such as Chlamydia trachomatis or other sexually transmitted infections), varicoceles, or other structural problems that may impact sperm production 1 8.

When to Seek Help

If you and your partner have been trying to conceive for over a year without success, or if you notice any of the above symptoms, it’s advisable to seek medical evaluation—both partners should be assessed to identify the root cause and receive appropriate care 3.

Types of Low Sperm Count

Low sperm count isn’t a one-size-fits-all diagnosis. Different types are classified based on sperm concentration and associated abnormalities in motility and morphology. Understanding these distinctions is crucial for personalized management and treatment.

Type	Sperm Count (per mL)	Main Characteristic	Source
Normospermia	≥20 million	Normal sperm count	1 3
Oligospermia	<20 million	Low sperm count	1 3 5
Severe Oligospermia	<5 million	Markedly low count	7 9
Azoospermia	0	No sperm in semen	1 3 5
Asthenozoospermia	Normal/Low count	Poor motility	1 5
Teratozoospermia	Normal/Low count	Abnormal morphology	1 5
Oligoasthenoteratospermia	<20 million	Low count, poor motility & abnormal shape	1 5

Table 2: Main Types of Low Sperm Count

Oligospermia

Oligospermia is defined as a sperm count below 20 million per milliliter. This is the most common category and is further divided by severity:

• Mild: 10–20 million/mL
• Moderate: 5–10 million/mL
• Severe: <5 million/mL 3 7

Azoospermia

This is the complete absence of sperm in the ejaculate, accounting for a substantial share of male infertility cases. Azoospermia may have obstructive or non-obstructive causes and requires specialized evaluation 1 3 5.

Asthenozoospermia and Teratozoospermia

• Asthenozoospermia: Refers to reduced sperm motility, meaning sperm are present but do not move efficiently—a crucial factor for fertilization 1 5.
• Teratozoospermia: Indicates a high proportion of abnormally shaped sperm, which can impair their function 1 5.

Mixed Types

Some men may have more than one abnormality, such as oligoasthenoteratospermia (low count, poor motility, and abnormal morphology), which significantly reduces the chances of natural conception 1.

Causes of Low Sperm Count

Low sperm count can arise from a wide range of causes, spanning genetic, environmental, lifestyle, and medical factors. Identifying the root cause is key to effective management and improving fertility outcomes.

Cause Type	Example/Details	Effect on Sperm	Source
Genetic	Mutations, chromosomal defects, lncRNA dysregulation	Disrupted spermatogenesis	4 5 7
Infections	Chlamydia trachomatis, STDs	Inflammation, blockages	8 9
Lifestyle	Smoking, excess soda, environmental toxins	Epigenetic changes, oxidative stress	6 11
Medical	Cancer, hormonal imbalances, varicocele	Direct sperm damage or impaired production	2 5 6
Environmental	Pollutants (PCBs), heat, radiation	DNA damage, hormonal disruption	6 11

Table 3: Main Causes of Low Sperm Count

Genetic and Epigenetic Factors

A significant proportion of male infertility has a genetic basis, including:

• Chromosomal abnormalities (e.g., Klinefelter syndrome)
• Mutations in genes essential for spermatogenesis
• Dysregulation of long non-coding RNAs (lncRNAs), which play critical roles in sperm development 4 5
• Post-transcriptional mRNA defects, such as those in the UBE2B gene, can interfere with sperm production 7

Infections

• Sexually Transmitted Infections: Chlamydia trachomatis is a leading infectious cause of low sperm count, particularly in developing countries. It causes inflammation and obstruction in the male reproductive tract 8.
• Other infections: Genital tract inflammation from other pathogens can also reduce sperm production and quality 9.

Lifestyle and Environmental Factors

• Smoking and Diet: Smoking and excessive consumption of carbonated drinks have been linked to epigenetic changes that impair sperm production. Pollutants like PCBs accumulate over time, especially with advancing age, further degrading sperm quality 6.
• Oxidative Stress: Poor diet, lack of exercise, and exposure to environmental toxins increase oxidative stress, damaging sperm DNA and reducing count and motility 11.

Medical Conditions and Treatments

• Cancer: Certain cancers, particularly testicular malignancies and hematological malignancies, are associated with lower sperm counts even before treatment. Cancer therapies can further exacerbate the problem 2.
• Hormonal Imbalances: Disorders affecting testosterone or other reproductive hormones, as well as conditions like undescended testicles or varicoceles, can lower sperm production 5.
• Aging: While not always a direct cause, advancing age contributes to the accumulation of environmental toxins and may indirectly affect sperm count through epigenetic changes 6.

Treatment of Low Sperm Count

The management of low sperm count is multifaceted, ranging from lifestyle interventions and medications to assisted reproductive technologies. Treatment depends on the underlying cause, the degree of sperm reduction, and the couple’s reproductive goals.

Treatment Type	Approach/Example	Main Benefit	Source
Lifestyle Changes	Quit smoking, reduce toxins, improve diet	Addresses modifiable risks	6 11
Medical Therapy	Hormones, antibiotics, antioxidants	Treats infections, optimizes sperm health	8 11
Alternative Medicine	Ayurveda, herbal remedies, acupuncture	May improve sperm count and quality	9 10 12
ART	IVF, ICSI, sperm banking	Enables conception despite low count	2 11

Table 4: Main Treatment Strategies

Lifestyle and Dietary Modifications

• Smoking cessation, reduced alcohol intake, healthy diet, and regular exercise can improve sperm parameters in many men 6 11.
• Antioxidant supplementation (e.g., myo-inositol, coenzyme Q10, zinc, selenium, vitamins) has shown significant improvements in sperm concentration, motility, and DNA integrity, thereby increasing pregnancy rates in assisted reproduction 11.

Medical and Surgical Treatments

• Antibiotics: Used to treat infections like Chlamydia trachomatis, which can restore sperm count if the infection is the underlying cause 8.
• Hormonal Treatments: For cases caused by hormonal imbalances, specific medications may be prescribed to stimulate sperm production 5.
• Surgical Interventions: In conditions like varicocele or obstructive azoospermia, surgical correction can improve sperm parameters 5.

Complementary and Alternative Medicine

• Ayurvedic Medicine: Certain herbal formulations have been observed to increase sperm concentration, motility, and morphology over several months of use 10 12.
• Acupuncture: Particularly in men with severe oligospermia or azoospermia, acupuncture has shown promising results in increasing sperm counts, especially in those with past genital tract inflammation 9.
• Homeopathy: Some practitioners report success in treating various sperm abnormalities, though more scientific validation is needed 3.

Assisted Reproductive Technologies (ART)

• In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI): These advanced techniques can help men with very low or absent sperm counts achieve biological parenthood 2 11.
• Sperm Banking: Recommended prior to gonadotoxic treatments (e.g., chemotherapy), sperm banking preserves fertility options for the future, although the usage rate is relatively low 2.

Conclusion

Low sperm count is a complex issue with significant implications for male fertility and overall well-being. Understanding its symptoms, the different types, underlying causes, and available treatments empowers men and couples to seek effective solutions and make informed decisions.

Key Takeaways:

• Subtle Symptoms: Infertility is the most common, often only sign of low sperm count; other symptoms may suggest underlying causes 1 3 5.
• Multiple Types: Oligospermia, azoospermia, and associated motility or morphology disorders require precise diagnosis 1 3 5.
• Diverse Causes: Genetics, infections (notably Chlamydia), lifestyle, environmental exposures, and medical conditions all play roles 4 5 6 7 8.
• Wide Range of Treatments: From lifestyle changes and medical management to alternative therapies and ART, options are varied and must be tailored 2 8 9 10 11 12.

Early diagnosis and a comprehensive, individualized approach offer the best chances for overcoming low sperm count and achieving successful conception. If you suspect a problem, consult a healthcare provider—timely action can make all the difference.