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Low sperm count: everything you need to know

By Dr. Jesús Alberto Félix Atondo

Approximately 30% of couples have an infertility problem. Of that percentage, 30% are due to some male factor, 20% due to a female factor and the rest are due to unknown causes. Low sperm count is one of the main causes of male infertility, and below we will tell you everything you need to know.

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What is low sperm count?

Oligospermia or low sperm count means that the semen a man ejaculates during an orgasm contains fewer sperm than normal. It is important to differentiate oligospermia from azoospermia, in which there is a total absence of sperm.

A man is considered to have oligospermia when there are less than 15 million sperm per millimeter of semen. Although a low sperm count reduces the chances of fertilizing the couple’s egg to have a pregnancy, this does not mean that they will not achieve their dream of becoming parents: there are alternatives to make these dreams come true.


If you have been having unprotected sex with your partner for more than a year and there has been no pregnancy, there is an alert that one or both have some condition that prevents them from achieving fertilization.

In general, men with low sperm count have no visible signs unless there is an underlying problem, such as a hormonal imbalance, dilated testicular veins, inherited chromosomal abnormalities, or a condition that blocks the passage of sperm, in which case, the symptoms are:

  • Sexual dysfunction. Either low sexual desire or difficulty keeping an erection long enough to have intercourse (erectile dysfunction).
  • Pain, swelling, or a lump in the testicular area.
  • Decrease in facial or body hair.



Sperm production is a very complex process that involves the normal functioning of the testicles, as well as the hypothalamus and pituitary gland, organs that are located in the brain and regulate hormones. When sperm are produced in the testicles, they are transported through the ducts where they mix with semen and are ejaculated through the penis, so any problem in any of the systems will affect the production and quality of sperm.

Low sperm count causes are divided into:

  • Medical causes. Infections such as epididymitis, orchitis, gonorrhea, HIV, as well as varicocele (the main cause of male infertility), retrograde ejaculation, ejaculation absence, alpha blocker drugs consumption, antifungals and antibiotics, antisperm antibodies, benign tumors, cancer (whether in progress or as a result of having received treatments such as chemotherapy, radiation therapy or surgery to remove tumors), undescended testicles, hormonal imbalances or imbalances of the thyroid, pituitary and adrenal glands, defects or blockages in the tubules that transport sperm, chromosomal defects, disease celiac disease, long term use of anabolic steroids, diabetes, spinal injuries, having had surgery on the bladder, prostate, scrotum, testicles, or urethra.
  • Environmental causes. Prolonged exposure to some elements present in the environment or work environment can affect sperm production, such as industrial chemicals: solvents, pesticides, herbicides, pesticides, toluene, xylene, paints, heavy metals such as lead, exposure to radiation (with high doses of radiation, sperm production can permanently decrease), elevated temperatures in the testicles.
  • Lifestyle causes. Sitting for a long time, wearing clothes that squeeze the testicles, drug use such as anabolic steroids, marijuana or cocaine, alcoholism, smoking, severe or prolonged emotional stress, obesity, depression, playing sports or activities with risk of blows or injuries to the testicles.

In addition, it is important to consider that there may be problems related to alterations in the shape (morphology), movement (motility) or function of the sperm.


In order to diagnose a low sperm count, the doctor will perform a general physical exam, medical history about family members, injuries, surgeries, chronic health problems, and sexual habits. Subsequently, a semen analysis under the microscope is indicated to analyze the sperm quality and take the count by computer.

Semen samples are obtained by masturbation and ejaculation in a special container at the doctor’s office, which is the most recommended way, although it can also be taken during intercourse using a special condom. In addition, the doctor will recommend that you refrain from ejaculating for two to seven days before collecting the sample and make sure that all the semen obtained is deposited in the container.

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Sperm are constantly produced in the testicles, with a maturation period of between 42 and 76 days, so semen samples reflect the environment of the last three months, and positive changes will not be seen for another three months.

The normal density of sperm is from 15 million to more than 200 million per milliliter of semen, so samples with less than 15 million are considered to have a low sperm count.

To find the cause of low sperm count, your doctor may prescribe other tests such as:

  • Scrotum Ultrasound.
  • Hormone analysis.
  • Post ejaculate urine analysis.
  • Chromosome analysis.
  • Testicular biopsy.
  • Antisperm antibody tests.
  • Sperm function tests.
  • Transrectal ultrasound.

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Whether to correct a varicocele, repair a blocked vas deferens, reverse a vasectomy, or retrieve sperm from the testicles or epididymis if there are no sperm in the ejaculation.


Reproductive tract infections are treated with antibiotics, but they do not always help restore fertility.

Psychological therapy

Sexual problems such as erectile dysfunction or premature ejaculation usually have a psychological origin, so individual or couples therapy is recommended, in addition to helping them reduce tension, depression and other emotional conditions associated with infertility.

Hormone therapy

Hormone replacement for low levels of hormones like testosterone is one of the most common treatments for infertility.

Assisted Reproduction Techniques

On some cases, male infertility due to oligospermia cannot be treated, so Assisted Reproduction treatments such as In Vitro Fertilization (IVF) are recommended, where sperm are obtained through normal ejaculation or surgical extraction, to subsequently give them a treatment prior to fertilization and subsequently implant it in the female genital tract.

This means that you and your partner can fulfill your dream of achieving a pregnancy and becoming parents, without the use of donor sperm or resorting to adoption.

Prevention measures

Avoid the consumption of substances harmful to health such as drugs, alcohol and tobacco, which have a high impact on your reproductive health:

  • Use your personal protective equipment during work, especially if you are at risk of vapor inhalation or injury.
  • Do not put your computer or cell phone near your testicles to prevent the heat they generate from affecting your sexual health.
  • Take care of any type of infection or disease.
  • Increase your sexual activity frequency so that there are sperm present when ovulation occurs and the probability that an egg will be fertilized will increase as well.
  • Avoid vaginal lubricants and lotions, which can harm sperm function and movement.


Schedule your appointment at The Fertility Center

If more than a year has passed since you and your partner had unprotected sexual intercourse looking for a pregnancy and you still haven’t achieved it, schedule your appointment with our fertility specialist Tijuana at The Fertility Center where, in addition to Assisted Reproduction treatments such as IVF in Mexico, we have andrology services. These are focused on the sexual and reproductive health of men in order to determine male infertility causes and provide timely treatment to help you fulfill your dream of being a father.

Schedule your appointment through our contact form. We will gladly assist you!

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Dr. Jesús Alberto Félix Atondo

Gynecology, Obstetrics and Biology of Human Reproduction Surgeon at the Autonomous University of Guadalajara, specialist Biologist of Human Reproduction by the Mexican Institute of Infertility.

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