Introduction
Low sperm count means that the fluid (semen) in ejaculation during an orgasm contains fewer sperm than normal. A complete absence of sperm is called azoospermia. A low sperm count is also called oligospermia. The sperm count is considered lower than normal if fewer than 15 million sperm per millilitre of semen.
Signs & symptoms
The main sign of low sperm count is the inability to conceive a child. There might be no other obvious signs or symptoms. In some men, an underlying problem such as an inherited chromosomal abnormality, a hormonal imbalance, dilated testicular veins or a condition that blocks the passage of sperm may cause signs and symptoms.
Low sperm count symptoms might include:
- Problems with sexual function — for example, low sex drive or difficulty maintaining an erection (erectile dysfunction)
- Pain, swelling or a lump in the testicle area
- Decreased facial or body hair or other signs of a chromosome or hormone abnormality
- Low sex drive
Causes
The production of sperm is a complex process and requires normal functioning of the testicles (testes) as well as the hypothalamus and pituitary glands — organs in the brain that produce hormones that trigger sperm production. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis. Problems with any of these systems can affect sperm production.
Also, there can be problems of abnormal sperm shape (morphology), movement (motility) or function.
However, often the cause of low sperm count isn’t identified.
Medical causes
- Varicocele. A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. Varicoceles result in reduced quality of the sperm.
- Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhoea or HIV.
- Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde ejaculation or lack of ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra.
Certain medications also might result in ejaculatory problems, such as blood pressure medications known as alpha blockers. Some ejaculatory problems can be reversed, while others are permanent. In most cases of permanent ejaculation problems, sperm can still be retrieved directly from the testicles.
- Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.
- Tumours. Cancers and non-malignant tumours can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. Surgery, radiation or chemotherapy to treat tumours also can affect male fertility.
- Undescended testicles. During foetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.
- Hormone imbalances. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal gland, may impair sperm production.
- Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.
Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
- Chromosome defects. Inherited disorders such as Klinefelter’s syndrome.
- Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
- Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal and antibiotic medications, some ulcer medications, and other medications can impair sperm production and decrease male fertility.
- Prior surgeries. Certain surgeries might prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockages or to retrieve sperm directly from the epididymis and testicles.
Environmental causes
Sperm production or function can be affected by overexposure to certain environmental elements, including:
- Industrial chemicals. Extended exposure to benzenes, toluene, xylene, herbicides, pesticides, organic solvents, painting materials and lead might contribute to low sperm counts.
- Heavy metal exposure. Exposure to lead or other heavy metals also can cause infertility.
- Radiation or X-rays. Exposure to radiation can reduce sperm production. It can take several years for sperm production to return to normal. With high doses of radiation, sperm production can be permanently reduced.
- Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs might temporarily impair sperm count.
Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also might increase the temperature in your scrotum and slightly reduce sperm production.
Health, lifestyle and other causes
Other causes of low sperm count include:
- Drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana might reduce the number and quality of your sperm as well.
- Alcohol use. Drinking alcohol can lower testosterone levels and cause decreased sperm production.
- Occupation. Certain occupations might be linked with a risk of infertility, including welding or those associated with prolonged sitting, such as truck driving. However, the data to support these associations is inconsistent.
- Tobacco smoking. Men who smoke might have a lower sperm count than do those who don’t smoke.
- Emotional stress. Severe or prolonged emotional stress, including stress about fertility, might interfere with hormones needed to produce sperm.
- Depression. Being depressed may negatively affect sperm concentration.
- Weight. Obesity can impair fertility in several ways, including directly impacting sperm and by causing hormone changes that reduce male fertility.
- Sperm testing issues. Lower than normal sperm counts can result from testing a sperm sample that was taken too soon after your last ejaculation; was taken too soon after an illness or stressful event; or didn’t contain all of the semen you ejaculated because some was spilled during collection. For this reason, results are generally based on several samples taken over a period of time.
A number of risk factors are linked to low sperm count and other problems that can cause low sperm count. They include:
- Smoking tobacco
- Drinking alcohol
- Using certain illicit drugs/narcotics
- Being overweight
- Being severely depressed or stressed
- Having certain past or present infections
- Being exposed to toxins
- Overheating the testicles
- Having experienced trauma to the testicles
- Being born with a fertility disorder or having a blood relative, such as your brother or father, with a fertility disorder
- Having certain medical conditions, including tumors and chronic illnesses
- Undergoing cancer treatments, such as radiation
- Having a prior vasectomy or major abdominal or pelvic surgery
- Having a history of undescended testicles
Diagnosis
General physical examination and medical history
Semen analysis
Sperm count – examining semen under a microscope to see how many sperm appear within squares on a grid pattern.
Normal sperm densities range from 15 million to greater than 200 million sperm per millilitre of semen.
Chance of fertility decreases with decreasing sperm counts.
Other tests
These can include:
- Scrotal ultrasound. This test uses high-frequency sound waves to look at the testicles and supporting structures.
- Hormone testing. Blood tests to determine the level of hormones produced by the pituitary gland and testicles, which play a key role in sexual development and sperm production.
- Post-ejaculation urinalysis. Sperm in the urine can indicate that sperm are traveling backward into the bladder instead of out the penis during ejaculation (retrograde ejaculation).
- Genetic tests. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might also be ordered to diagnose various congenital or inherited syndromes.
- Testicular biopsy. This test involves removing samples from the testicle with a needle.
- Anti-sperm antibody tests. These tests, which are used to check for immune cells (antibodies) that attack sperm and affect their ability to function.
- Specialized sperm function tests. A number of tests can be used to check how well the sperm survive after ejaculation, how well they can penetrate an egg and whether there’s any problem attaching to the egg. These tests are rarely performed and often do not significantly change treatment recommendations.
- Transrectal ultrasound. A small lubricated wand is inserted into your rectum to check your prostate and check for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).
Treatments for low sperm count include:
- Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens can be repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
- Treating infections. Antibiotics can cure an infection of the reproductive tract, but this doesn’t always restore fertility.
- Treatments for sexual intercourse problems. Medication or counselling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
- Hormone treatments and medications. Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
- Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on the specific situation and wishes. The sperm are then inserted into the female genital tract, or used for IVF or intracytoplasmic sperm injection.
Prognosis
Usually, the low sperm count is difficult to treat.
Complications
- · Infertility
- Surgery or other treatments for an underlying cause of low sperm count
- Expensive and involved assisted reproductive techniques, such as in vitro fertilization (IVF)
- Stress and depression related with infertility
Disease & Ayurveda
Ksheenasukra
Nidana
Ativyavaya – Excessive sexual intercourse
Akaalamaithuna – Untimely inercourse
Ayonimaithuna – Sex with orifices other than vagina of woman
Amaithuna Complete abstinence from sexual act
Rooksha-Tikta_kashaya-lavana-amla-ushna – Intake of excess dry, bitter, astringent, salt, sour and hot food items
Jara – Old age
Paternal ageing – Congenital issues because of old father
Bhaya-Krodha-Soka-Lobha-Moha-Aayasa – Psychological factors like fera, anger, grief, greed, delusion, and excess emotional stress or thoughts
Sastrakarma – Surgical invasions
Kshara-agnikarmas- Kshara & agni procedures
Vyadhikarsita – emaciated/malnourished due to a chronic disease
Vegaghata – Suppression of natural urges
Kshata – Injury
Purvaaroopa
Not mentioned
Samprapti
Excessive indulgence in causative factors for the vitiation of Vaata, will lead to either aavarana (obstruction to channels) or dhaatukshaya (depletion of tissues) and result in vitiation of Vaata. When it is affecting the shukravahasrotas and gets lodged there, leads to Shukrakshaya/ksheenasukra resulting in deficient structure and functioning of shukra(semen/spem)
Lakshana
Dourballyam – weakness of body/weak erectile power
Mukhasosha – dryness of mouth
Pandutwa – pallor
Sadana – Malaise
Bhrama – Giddiness
Klaibya – Loss of libido
Sukraavisarga – No ejaculation of semen/ very little sperm in semen
Divisions
Not mentioned
Prognosis
Ksheenasukra is kricchrasadhya
Chikithsa
Samana
Amapachana
Agnideepana
Rasayana
Vaajeekarana
Sodhana
Snehana
Swedana
Vamana
Virechana
Asthapanavasti
Anuvasanavasti
Uttaravasti
Commonly used medicines
Sukumaram kashayam
Chyavanaprasam
Brahmarasayanam
Narasimharasayam
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Lifestyle changes
There are measures that can be taken at home to increase the chances of fertility, including:
- Increasing the frequency of sex. Having sexual intercourse every day or every other day beginning at least four days before ovulation increases the chances of pregnancy.
- Having sex when fertilization is possible. A woman is likely to become pregnant during ovulation — which occurs in the middle of the menstrual cycle, between periods. This will ensure that sperm, which can live several days, are present when conception is possible.
- Avoiding lubricants. Some products such as Astroglide or K-Y jelly, lotions, and saliva might impair sperm movement and function.
To protect your fertility, avoid known factors that can affect sperm count and quality. For example:
- Don’t smoke.
- Limit or abstain from alcohol.
- Steer clear of illicit drugs.
- Talk to your doctor about medications that can affect sperm count.
- Maintain a healthy weight.
- Avoid heat.
- Manage stress.
- Avoid wearing tight jeans or undergarments.
- Minimise riding bikes
- Avoid exposure to pesticides, heavy metals and other toxins.
Diet
- To be avoided
Very hot, spicy, salty and pungent foods like pickles
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, ghee, milk, soups, etc
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from very hot climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
For improving sperm count and removing obstructions in channels, regular stretching and mild cardio exercises are advised. Also, specific yogacharya including suryanamaskara, meditation, naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Surya Namaskar
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
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