Low sperm count

What people mean by it

“Low sperm count” is not one laboratory field. If the report says 12 million/ml, that is a low concentration. If it says 20 million per ejaculate, that is a low total sperm number. Oligospermia is the usual clinical word for a low concentration. Azoospermia means none were found, which is a different situation and is repeated sooner.

What the NHS describes

The NHS says you usually discover a low count during fertility tests. The main test is a semen analysis, which also looks at movement and shape. If the first test suggests a problem, another is usually done about three months later. If the second also shows a problem, referral for further tests may follow, such as blood tests, an ultrasound of the testes, or a urine test. If pregnancy has not happened after a year of regular sex without contraception — or six months if the partner is 36 or over — the NHS says to see a GP. Treatment, when it is offered, may include IVF or ICSI. Those are clinical decisions.

Causes clinicians look for

• A problem with sperm production, sometimes with abnormal hormones.
• A blockage, previous infection, or vasectomy.
• A varicocele felt on examination.
• Medicines and hormones, especially testosterone therapy and anabolic steroids.
• Heat, smoking, heavy alcohol intake, and a high BMI, which NICE links to reduced fertility risk in men with a BMI of 30 or over.
• An incomplete or poorly timed sample, which can imitate a low count.

This list is why a repeat and an examination come before a product. NICE’s committee treats examination of the scrotum and testes as part of assessing male infertility after repeated abnormal analyses, including to look for varicocele and, importantly, testicular cancer.