A low sperm count doesn’t give any symptoms, it’s usually found in fertility investigations when a couple is finding it difficult to conceive naturally. A semen analysis reveals the low sperm count number, which is classed as fewer than 15 million sperm per millilitre of semen. It's found in one in three couples who are struggling to conceive. Depending on any other results from fertility tests, may guide potential fertility treatments.
We can pinpoint some causes of a low sperm count, but much of the time there is no obvious cause. Sexually transmitted infections such as chlamydia and gonorrhoea, need to be excluded with simple tests – if found, they need to be treated. Prostatitis, which is diagnosed more on symptoms than any specific test, should also be treated with antibiotics. Some medications may be responsible, including certain antibiotics, antidepressants and cancer medication. There has been much media focus on testicles overheating and the importance of loose underwear, and there is truth to this. Other conditions outside your control include if you had an undescended testis as a baby, hormonal imbalance that leads to reduced testosterone production and genetic conditions such as Klinefelter syndrome. Some lifestyle concerns can affect the sperm count, including smoking, alcohol, obesity, regular use of anabolic steroids and taking street or party drugs, so you should take steps to cut these out, and reduce weight if this applies.
Your GP can arrange a semen analysis on your behalf. This can be organised if you and your partner have had difficulty conceiving after one year of trying. Fertility problems can affect both individuals so usually tests will be arranged for both. The semen analysis will inform you of the quantity and quality of your sperm count. If there are any abnormalities, it is advised to repeat the test after 3 months. For consistent abnormalities in your sperm analysis, your GP will refer you to a specialist called a urologist or to a fertility clinic at your local hospital. Home sperm count test kits are available to buy but they may not be as accurate and the information they give may be limited.
Some couples can conceive naturally within the second year of trying, so doctors may encourage couples to continue having regular sex (at least 3 times a week), even whilst awaiting further review by a specialist. IVF (In vitro fertilisation) is one option for addressing low sperm count, where an egg and sperm are collected and then fertilised in a laboratory. The fertilised embryo is transferred back to the woman, in the hope it implants in the uterus and the pregnancy continues. If your sperm is very scarce or of poor quality, a single functioning sperm may be injected into an egg to fertilise it and then transferred to the womb, in a procedure called ISCI (intracytoplasmic sperm injection). If they are unable to isolate a single good sperm, donor insemination is an option, where sperm is donated by another man.