Oligospermia is a male fertility condition where semen contains fewer sperm than normal, reducing the chance of fertilising an egg naturally. It is a common cause of male infertility, but many cases are treatable.
What counts as a low sperm count
A typical semen sample should contain at least 15 million sperm per millilitre. Oligospermia is classified by severity:
- Mild: 10–15 million sperm/mL
- Moderate: 5–10 million sperm/mL
- Severe: Less than 5 million sperm/mL
The lower the count, the harder natural conception becomes.
Symptoms
Oligospermia usually has no obvious symptoms. Many people only discover it during fertility testing. Possible related signs include difficulty conceiving after 12 months of trying, sexual dysfunction in some cases, pain, swelling or lumps in the testicles, and reduced facial or body hair attributed to hormonal imbalance.
Causes
Low sperm count can result from many factors affecting sperm production, function or delivery.
Medical causes:
- Varicocele: enlarged veins in the scrotum that affect temperature and sperm production
- Infections: STIs, prostatitis, epididymitis
- Hormonal imbalances: low testosterone or pituitary problems
- Genetic conditions: e.g., Klinefelter syndrome
- Tumours or cancer treatments: chemotherapy/radiation
- Undescended testicles
- Ejaculation problems: retrograde ejaculation
- Antibodies attacking sperm
Lifestyle causes:
- Smoking and recreational drugs
- Heavy alcohol use
- Obesity
- Stress and poor sleep
- Exposure to heat (hot tubs, saunas, laptops on lap)
- Poor diet and nutrient deficiencies
Environmental causes: often, multiple factors contribute.
- Exposure to pesticides, heavy metals, toxins
- Radiation or industrial chemicals
Diagnosis
Diagnosis starts with semen analysis, which measures sperm count, movement (motility), shape (morphology), and semen volume. Because sperm levels fluctuate, multiple tests are usually required.
Additional testing may include blood tests for hormones, genetic testing, scrotal ultrasound, post-ejaculation urine test to test for retrograde ejaculation.
Treatment
Treatment depends on the underlying cause and severity.
Medical and surgical treatments include varicocele repair surgery, hormone therapy for endocrine issues, antibiotics for infections and medications to improve ejaculation.
There are also assisted reproductive techniques or fertility treatments that are used when natural conception is difficult, which include ovulation induction and timed intercourse (OI/TI), intrauterine insemination (IUI), in vitro fertilisation (IVF) and, as part of the IVF treatment, injecting one sperm directly into the egg, known as intracytoplasmic sperm injection (ICSI).
Even severe oligospermia can sometimes achieve pregnancy with assisted reproduction.
Through lifestyle improvements, many men can improve sperm count by quitting smoking and drugs, limiting alcohol, maintaining a healthy weight, eating a nutrient-rich diet, managing stress, avoiding excessive heat to the testes, and exercising regularly. The sperm production cycle takes about 2 to 3 months, so improvements can be realised in this timeframe.
Key takeaways
Oligospermia does not always mean infertility. Many people can conceive naturally through some lifestyle adjustments, or through interventional treatments or assisted reproduction. Early testing and medical guidance greatly improve the chances of a successful pregnancy.
Read more about oligospermia in this article by the Cleveland Clinic.
