Male Infertility
(Low Sperm Count)

Male Infertility (Low Sperm Count): Overview

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.

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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.

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

Signs, symptoms & indicators of Male Infertility (Low Sperm Count):

Lab Values - Cells

Risk factors for Male Infertility (Low Sperm Count):


Vegan Diet Consequences

Various theories have been proposed to explain reduced fertility among vegetarians and vegans: possible vitamin deficiencies (such as vitamin B12); increased use of soy (contains phyto-estrogens); increased pesticide consumption through a diet high in fruits and vegetables.

Vegetarian Diet Consequences

October 2014: A study at Loma Linda University Medical School in southern California has found that men who do not eat meat have significantly reduced sperm counts.  Comparing 443 omnivores with 26 vegetarians and five vegans, they found that vegetarians and vegans had significantly lower sperm counts compared with meat eaters – 50 million sperm per ml compared with 70 million per ml.  Average sperm motility (the percentage that are active) was lower too: only one-third of sperm were active for vegetarians and vegans compared with nearly 60% for omnivores.

Various theories have been proposed to explain this reduced fertility: possible vitamin deficiencies (such as vitamin B12); increased use of soy (contains phyto-estrogens); increased pesticide consumption through a diet high in fruits and vegetables.

Another study at the Massachusetts General Fertility Centre looked at the sperm quality of 155 men.  It confirmed that those with the highest intake of fruit and vegetables had 70% lower quality and 68% lower sperm motility.



The thyroid gland is responsible for balancing cell metabolism, so when the thyroid gland is not functioning properly, cell metabolism suffers.  This causes changes in the production of sperm.


Symptoms - Muscular

Being lean or underweight or being very skinny

Being too skinny increases the risk of male infertility due to low sperm count.  A Danish study that found sperm counts are more than one-third lower in underweight men, and so is the concentration.

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Male Infertility (Low Sperm Count) suggests the following may be present:


Zinc Requirement

Zinc increases sperm count and motility as well as raising testosterone levels when low.

Recommendations for Male Infertility (Low Sperm Count):

Botanical / Herbal


Tribestan, an extract of tribulus, administered to males with reduced sperm count of unknown cause or with sperm disturbances due to varicocele, has been shown to result in increased concentration of sperm, increased percentage of motile sperm and, in some cases, an increase in the volume of ejaculate by 1-2ml.


Caffeine/Coffee Avoidance

Research has indicated that men who drank two to three cups of coffee a day had an increased incidence of abnormally formed sperm.  Having five cups a day appears to make sperm sluggish as well.


Not recommended

Testosterone causes suppression of spermatogenesis and can lead to infertility.

Laboratory Testing

Test Zinc Levels

Zinc is concentrated in ejaculate, and important for prostate health.  Zinc stores can be reduced by frequent ejaculation.  Marginal zinc status is associated with poor sperm count and motility (especially if testosterone levels are low).



A study performed in India showed that lycopene supplementation proved to be beneficial to couples who try for the first time to conceive but are not successful due to unspecified male infertility problems.  In this study, 50 men with low sperm counts were selected to receive lycopene supplements twice per day for three months.  Within nine months after starting the lycopene supplements, 36% of the couples were successful.  Amongst the 50 men, 70% had an increase in sperm concentration and 58% had an increase in sperm motility.

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