Low Sperm Count: Causes, Signs, Treatment, Pregnancy Chances

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What Causes Low Sperm Count and How Is It Treated?

Medically reviewed by Meera Patel, PA-C — Written by Ashley Marcin — Updated on July 1, 2025

Causes
Signs
Diagnosis
Treatment
Infertility
Medically assisted reproduction
Takeaway

An underlying health condition, such as varicocele, environmental stress, and taking steroids may cause low sperm count. Surgery, medications, lifestyle interventions, and counseling may help treat low counts.

If you want to start a pregnancy, sperm count and quality may be foremost on your mind.

While it only takes one sperm to fertilize an egg, the journey getting there can be challenging. The more sperm you have, the better your chances.

Causes of low sperm count

Low sperm count, also called oligospermia, is a major cause of male infertility. Sperm count is considered low if it dips below 15 million sperm per milliliter (mL) of semen.

The average is around 39 million sperm per mL, but even this number can vary based on the individual.

Risk factors include having obesity, having experienced trauma or surgery in or around the testicles, and taking certain medications.

Beyond that, various causes of low sperm quality can be attributed to three factors: medical, environmental, and lifestyle.

Medical

A history of testicular symptoms, injury, or surgeries, or genetic conditions like Klinefelter syndrome, may increase your chances of having a low sperm count.

Other possible causes include:

swelling in the veins that drain the testicle (varicocele), which is the most common correctable cause of male infertility
previous infections or sexually transmitted infections (STIs)
issues with erections or ejaculation
issues with the immune system
cystic fibrosis or being a genetic carrier of cystic fibrosis
medical procedures, treatments, or medications for a range of conditions, including some cancer, antifungal, antibiotic, and ulcer drugs
cancer treatments, including chemotherapy, radiation, surgery, or hormone therapy
previous surgery to the male reproductive system, such as testicular surgery, bladder surgery, surgery for undescended testicles, inguinal hernia repair, and vasectomy

Environmental

Ideal sperm conditions are slightly less than body temperature, which is why the testicles are positioned outside of the abdominal cavity.

Heat stress on the testicles can lower sperm production. Likewise, exposure to cold temperatures may also impact sperm quantity and quality.

Other possible environmental causes include occupational exposure to:

herbicides
pesticides
solvents
other industrial chemicals or heavy metals

Exposure to radiation from X-rays or other sources may harm sperm production.

Lifestyle

Excessive drug use (nicotine, tobacco, vapes, cannabis, and other recreational drugs) and alcohol consumption may lower sperm count.

Anabolic steroids, which are usually taken to increase muscle mass, will almost always shrink testicles and decrease sperm production. However, most regain sperm production after stopping usage.

Other possible causes include:

testosterone boosters, and pre-workout supplements marketed toward a workout crowd may contain small amounts of anabolic steroids
vitamin deficiency
jobs that require long periods of sitting, such as truck driving
mental health conditions such as stress and depression, particularly if they’re long-term and severe
body weight, particularly if you have obesity

What about masturbation?
You may have heard that masturbating too frequently can lower sperm count.
However, this 2022 study indicates that daily ejaculation does not typically affect fertility in healthy males.

Signs of low sperm count

The main symptom of low sperm count is infertility.

If your low sperm count is caused by an underlying condition, you may experience symptoms related to that condition. But this isn’t the same as having symptoms of low sperm count.

Symptoms or health conditions related to decreased sperm count may include:

low sex drive
erectile dysfunction (ED)
swelling or pain in or around the testicles
less facial or body hair

Diagnosing low sperm count

If you’ve been having sex without a condom or other birth control regularly for the past year and haven’t gotten someone pregnant, you may want to speak with your doctor.

You may want to speak with a health expert even sooner if you have difficulty ejaculating or pain in the testicles, or have had previous surgeries.

Diagnosis can usually be determined through laboratory tests and clinically. It may include:

a physical exam
review of your medical history
semen analysis
blood tests to check hormones or chromosomes
ultrasound to visualize the testicles or prostate
biopsy to evaluate sperm production in the case of blockages (uncommon)

Semen analysis

A semen analysis may be particularly helpful in receiving a diagnosis, as your sperm can be counted under a microscope and checked for motility (movement) and morphology (shape).

Your doctor may even want to repeat the analysis to ensure consistent results because of high variability between samples.

You’ll likely be provided with a container at your doctor’s office. You’ll be asked to ejaculate into the container either at the clinic or at home.

If you opt to collect the sample at home, you’ll be instructed on how to care for the specimen until you can get it back to the lab within an hour.

Treatment for low sperm count

The treatment you receive for low sperm count will depend on the cause. You can also change up your trying to conceive (TTC) routine that may make pregnancy more possible, if you’re looking to start a pregnancy.

Surgery

Surgery is an option for cases involving:

large varicoceles
blockages
issues with sperm leaving the body

For example, a varicocele can be corrected with a minor outpatient surgery, and previous vasectomies are sometimes reversible.

In other cases, sperm can be directly obtained for assisted reproduction procedures like in vitro fertilization (IVF) by surgically retrieving it from the testicle or epididymis.

Medications

Medications can treat infections in the reproductive tract.

It’s important to treat infections promptly. Even if an infection is properly treated, sperm count may not always return to normal if permanent tissue scarring has occurred.

Counseling

Issues with sexual intercourse, including ED or premature ejaculation, may respond to a combination of medication and counseling.

»Moreo on this:12 Best Home Remedies for Premature Ejaculation

Hormonal treatments

Since testosterone and other hormone levels that are either too high or too low may cause low sperm count, addressing the levels with hormonal treatments may help restore fertility.

Remember that the use of anabolic steroids, testosterone, or even most over-the-counter testosterone boosters can cause infertility, so avoid these.

Lifestyle modifications

To increase the odds of pregnancy with low sperm count at home, have sexual intercourse more frequently and time it with ovulation to help ensure that the sperm will fertilize the egg at the right time.

Some lubricants may slow sperm travel, so you may want to avoid using lubricants if you’re trying to start a pregnancy.

Avoid:

activities that raise the temperature of the testicles, such as frequent hot tub dips, saunas, or steam rooms
excessive drug and alcohol use
workout supplements that are known to lower sperm quality

Alternative medicine

Although a variety of vitamin supplements have been studied, antioxidants or vitamins may have a minimal effect unless you have a true dietary deficiency.

Speak with your doctor before taking supplements, as some may interact with other medications you’re taking.

Give it time

It’s important to note that any treatments or lifestyle changes may not be reflected in your sperm count right away, as the time frame of sperm production and transit is up to 2 to 3 months. You may not see an increase for 3 months, on average.

»Learn more:10 Ways to Boost Male Fertility and Increase Sperm Count

Low sperm count and infertility

Having fewer sperm doesn’t mean it’s impossible to become pregnant — it may just take a bit longer.

Unless your sperm count is zero, you may still be able to get your partner pregnant with time.

However, just how long it takes depends on a number of factors that are individual to you and your partner, if you have one, including how low your sperm count is and how healthy your sperm are.

Your partner’s fertility affects the equation as well, as does your ability to time sex with the ovulation window.

Medically assisted reproduction (MAR)

In some cases of low semen quality, your doctor may suggest intrauterine insemination (IUI). At the time of ovulation, you supply purified sperm that’s placed in the uterus.

If your sperm count is very low, IVF may be a better option. Sperm can be collected ahead of time and frozen, or supplied fresh the day of fertilization.

Your doctor fertilizes the eggs in a lab and then transfers healthy embryos into the uterus. This whole process takes around 3 weeks to complete.

While MAR is an often effective fertility treatment, it can also be invasive and expensive. Costs vary by clinic location and depend on insurance coverage.

The takeaway

It’s possible to start a pregnancy with a low sperm count. It may take more time than expected, and it may require speaking with a fertility specialist to see how you can improve your sperm quality.

Speaking with a doctor can help you get a better picture of just how low your count might be, what treatments are available, and whether you want to explore options like IUI or IVF.

If an underlying health condition may be causing your low sperm count, your doctor can also help you get the treatment you need to relieve other symptoms you’re experiencing.

Parenthood
Infertility

How we reviewed this article:

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Anawalt BD. (2019). Diagnosis and management of anabolic androgenic steroid use.https://pmc.ncbi.nlm.nih.gov/articles/PMC6517163/
Leslie SW, et al. (2024). Male infertility.https://www.ncbi.nlm.nih.gov/books/NBK562258/
Penzias A, et al. (2022). Optimizing natural fertility: A committee opinion.https://www.fertstert.org/article/S0015-0282(21)02130-0/fulltext
Sunder M, et al. (2022). Semen analysis.https://www.ncbi.nlm.nih.gov/books/NBK564369/
Xiao L, et al. (2024). Effects of temperature anomaly on sperm quality: A multi-center study of 33,234 men.https://pmc.ncbi.nlm.nih.gov/articles/PMC10907732/

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Medically reviewed by Meera Patel, PA-C — Written by Ashley Marcin — Updated on July 1, 2025

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