Male Fertility Clinic in Chennai: 5 Common Reasons for Low Sperm Count and What You Can Do

Low sperm count — quick answers

What is a low sperm count?

A sperm count below 15 million sperm per millilitre of semen (or under 39 million in the whole sample) is classed as low, a condition doctors call oligospermia. It is diagnosed with a simple semen analysis.

Can a man with a low sperm count still have a child?

Yes. Many couples conceive naturally with a mildly low count, and treatments such as IUI, IVF and ICSI are designed for exactly this situation. Even very low counts can often be helped.

What are the most common causes of low sperm count?

Varicocele (swollen veins in the scrotum), hormonal imbalance, infections, heat and toxin exposure, and lifestyle factors such as smoking, alcohol, obesity and stress.

How is low sperm count treated?

It depends on the cause: surgery for varicocele, medicines for hormonal problems or infection, lifestyle changes for heat and habit-related causes, and assisted reproduction (IUI, IVF or ICSI) when the count does not improve enough on its own.

Which test checks male fertility?

A semen analysis measures sperm count, movement (motility) and shape (morphology). Blood tests for hormones and a scrotal ultrasound are added when needed.

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Around 40 to 50 percent of infertility in couples involves a male factor, and low sperm count is the most frequent finding. The good news is that most causes are identifiable and many are treatable. Here are the five we see most often at our male fertility clinic in Chennai, and what can be done about each.

1. Varicocele

A varicocele is an enlargement of the veins that drain the testicle, much like a varicose vein in the leg. It raises the temperature of the testicle and impairs sperm production. It is the single most common correctable cause of male infertility, found in roughly 40 percent of men evaluated for it.

What you can do: A varicocele is diagnosed by examination and scrotal ultrasound. When it is causing a low count, a short microsurgical repair (varicocelectomy) improves semen quality in most men over the following six to twelve months.

2. Hormonal imbalance

Sperm production is driven by hormones from the brain (FSH and LH) and the testicle (testosterone). Low testosterone, high prolactin, thyroid disorders and, importantly, anabolic steroid or testosterone supplement use can all switch sperm production down. Men who take testosterone for muscle gain or "low T" often have a dramatically reduced count.

What you can do: A blood hormone panel identifies the problem. Stopping external testosterone, treating thyroid or prolactin problems, and in selected cases medicines that stimulate the testicle can restore production.

3. Infection and inflammation

Past or current infections of the reproductive tract, including sexually transmitted infections, mumps orchitis in adolescence, and prostatitis, can damage sperm production or block the tubes that carry sperm.

What you can do: Infections are treated with antibiotics. If a blockage has already formed, sperm can often be retrieved directly from the testicle for use in ICSI.

4. Heat, toxins and medicines

The testicles sit outside the body because sperm production needs a temperature about two degrees below core body heat. Long hours in a hot kitchen or vehicle, laptops on the lap, tight underwear, saunas and frequent hot baths all push the count down. Occupational exposure to pesticides, solvents and heavy metals, and medicines such as some antibiotics, antifungals, chemotherapy and blood pressure drugs have the same effect.

What you can do: Reduce heat exposure and switch to loose cotton underwear. Tell your doctor every medicine and supplement you take. Sperm takes about 74 days to mature, so improvements show in the semen analysis after roughly three months.

5. Lifestyle: smoking, alcohol, weight and stress

Smoking lowers count and motility and damages sperm DNA. Heavy alcohol reduces testosterone. Obesity changes hormone balance and increases scrotal temperature. Chronic stress and poor sleep affect the hormones that drive sperm production.

What you can do: Stop smoking, keep alcohol to a minimum, aim for a healthy weight through diet and regular exercise, and protect your sleep. These changes are free, and they improve both natural conception and the success of fertility treatment.

When to see a male fertility specialist

See a specialist if you have been trying to conceive for a year without success (six months if your partner is over 35), or sooner if you have a known risk such as undescended testicles in childhood, previous chemotherapy, or a history of testicular injury or surgery.

At Iswarya Hospital's fertility centre in OMR, Chennai, male fertility evaluation starts with a semen analysis and a consultation with a reproductive medicine specialist. Treatment ranges from medicines and lifestyle guidance to varicocele repair, IUI, IVF and ICSI, all under one roof.