Male Infertility
(Low Sperm Count)

Alternative Names: Oligozoospermia, Male Infertility

Low sperm count is one of the main causes of male infertility.  It is considered that a man has low sperm count when he has less than 20 million spermatozoa per one ml of ejaculate. The term sperm count can be confusing.  More correctly called sperm concentration, it measures the concentration of sperm in a man's ejaculate; total sperm count is the sperm concentration multiplied by the volume.

The average sperm count today is around 60 million per milliliter in the Western world, having decreased by 1-2% per year from a substantially higher number decades ago.

Causes and Development; Contributing Risk Factors

A great number of medical conditions as well as many biologic and environmental factors can cause low sperm count temporarily or permanently.

Here are some of the possible causes of low sperm count:

• Problems with sperm production, which may be genetic (for example Klinefelter's syndrome) or based on a hormonal disorder
• Testicular injury and disease; injuries that affect the testicles may affect sperm production and cause low sperm count
• Malnutrition and nutrient deficiencies - deficiency of some nutrients (for example Zinc, Selenium, vitamin C, etc.) may also lead to low sperm count
• Overheating - excessive heat from saunas, hot tubs, very hot baths etc.  may hasten the death of sperm and lower sperm count
• Tight-fitting jeans and underwear that heat the scrotum and testes, thereby inhibiting sperm production
• Smoking - smoking cigarettes may impair male fertility since it is known to reduce sperm count and sperm lifespan
• Drugs - the use of cocaine and heavy marijuana is known to reduce sperm count by 50%
• Excessive alcohol consumption - alcohol is toxic to sperm and may reduce sperm count and quality
• Prescribed medications - many prescription medications are known to reduce sperm count and decrease fertility
• Environmental toxins, radiation and heavy metals - a number of environmental factors, such as exposure to toxins or chemicals, cigarette smoke, heavy metals (lead, mercury, arsenic), pesticides, solvents, toxic chemicals, aflatoxin (a fungus found on peanuts and grains), and synthetic estrogens in poultry and dairy feed can reduce sperm count either by affecting testicular function directly or by affecting the hormone system; all interfere with sperm formation and protection.  In a study of 100 males, aflatoxin levels in infertile men were 60% higher than in fertile men.
• Obesity - many studies find association between low sperm count and obesity in men
• Stress and excessive physical or mental exertion - these can cause some hormonal changes in the body that can affect sperm count and fertility
• Varicocele - it is not clear how exactly this condition causes infertility in men
• Bicycling - blood vessels and nerves may be damaged due to the pressure from the bike seat

Marginal zinc status is associated with poor sperm count and motility (especially if testosterone levels are low).

Diagnosis and Tests

A semen analysis evaluates certain characteristics of a male's semen and the sperm contained within.  It may be done while investigating a couple's infertility problem or after a vasectomy to verify that the procedure was successful.

The characteristics measured by semen analysis are only some of the factors in semen quality.  It is estimated that some 30% of men with a normal semen analysis actually have abnormal sperm function.  Conversely, men with poor semen analysis results may still go on to father children.

The characteristics measured include sperm concentration, total sperm count, motility (what percentage of the sperm show good forward movement), morphology (shape and form), volume, fructose level, pH, liquefaction, MOT (how many sperm per ml are highly motile), total motile spermatozoa, presence of white blood cells.

Treatment and Prevention

Sometimes the real cause of low sperm count is never found.  Additionally, many disorders affecting sperm production cannot be cured at all or do not respond well to treatment.

Some commonly used medications and supplements for increasing sperm count are testosterone, certain vitamins, high-protein diets, anti-oxidants, and herbal semen enhancement pills.  The effectiveness of most of these has not been clinically tested; yet, there are some quality semen enhancement pills that show significant results in improving both sperm count and quality.

Zinc supplementation improves both sperm count and testosterone levels.

Prevention
There are a lot of things you can do to reduce the risk of low sperm count.

• Switch to a healthier, balanced diet, rich in vegetables and whole grains
• Exercise regularly
• Try to reduce stress
• Maintain a healthy weight; if you are overweight, lose the excess weight
• Don't smoke
• Reduce or eliminate alcohol consumption
• Don't use recreational drugs
• Ejaculate less often; maintain a gap of three days between ejaculations
• Avoid tight underwear, saunas, hot tubs and anything else that may increase the temperature of the testicles