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Written by: Favour Francis | Reviewed by: Dr Ortega Ogomigo
INTRODUCTION
Low sperm count, also called Oligospermia, has increasingly become one of the major factors of infertility in couples trying to conceive. Infertility affects about 1 in 6 people globally, according to WHO, and male-related factors, such as low sperm count, contribute to nearly half of infertility cases.
In Nigeria, the conversation around male fertility is still underprioritised, and many men only begin to pay attention when they begin to experience conception issues in marriage. Even then, the focus is sometimes placed more on the woman, while underlying male fertility issues go unchecked for longer than necessary.
For many men, this can feel confusing, especially because topics like sperm health are not widely discussed in the country. While low sperm count does not automatically mean permanent infertility, it is a leading cause of difficulty in achieving pregnancy. Fortunately, in many cases, it can be improved or treated depending on the cause.
The challenge is that most men do not know what could be affecting their fertility or what treatment options are actually available.
So, in this article, we’ll break down:
- what low sperm count means
- what causes low sperm count
- 5 treatment options to improve sperm health
What is Low Sperm Count?
Low sperm count is a condition that affects a man’s ability to father a child. It simply means that when a man ejaculates, the semen contains fewer sperm cells than what is considered normal for fertilisation. Doctors usually describe it as having fewer than 15 million sperm per milliliter of semen, based on World Health Organization guidelines
Sperm plays an important role in pregnancy because it is what fertilises the woman’s egg. So, when the number is lower than normal, it reduces the chances of the sperm reaching and successfully fertilising the egg, which can make conception take longer or become difficult.
In some cases, low sperm count may also come alongside other signs like reduced sexual drive (low libido), difficulty maintaining an erection (erectile dysfunction), or changes in ejaculation.
If you notice any of these changes, it’s important to speak to a doctor early so you can understand what might be going on. However, some men may not notice any obvious symptoms at all and only discover the issue when they go for fertility tests after trying to conceive.
What Causes Low Sperm Count?
Low sperm count doesn’t just happen without a reason. Most times, there is an underlying reason affecting how sperm is produced, transported, or released in the body. These causes can range from lifestyle habits to medical conditions.
1. Hormonal imbalance
Sperm production is controlled by hormones in the body, especially testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). When these hormones are not balanced, the body may not produce enough sperm.
This can happen when there is a problem with the brain areas that control these hormones, like the pituitary gland or hypothalamus. When this system is affected, it can slow down or reduce sperm production without any obvious warning signs.
2. Medical conditions and immune-related issues
Some long-term health conditions can also affect fertility. Illnesses like tuberculosis, sarcoidosis, or iron overload (hemochromatosis) may interfere with how the reproductive system or hormone glands function.
In some cases, the body’s immune system may mistakenly attack healthy tissues involved in sperm production. This can slowly reduce sperm quality or count over time.
3. Infections in the reproductive system
Infections such as gonorrhea, chlamydia, syphilis, or inflammation of the prostate (prostatitis) can affect male fertility.
If these infections are not treated early, they may cause swelling, scarring, or blockages in the reproductive tract. This can make it harder for sperm to pass through or affect how well they are produced.
4. Medications and drug use
Certain medications and substances can interfere with sperm production. For example, long-term use of strong pain medications like opioids, chemotherapy drugs used for cancer treatment, or hormone-related drugs like testosterone supplements can reduce natural sperm production.
Even some recreational drugs, such as cannabis, have been linked in some studies to changes in sperm quality when used frequently.
5. Physical or structural problems
Some men may have a condition called varicocele, which is when the veins inside the scrotum become enlarged. This can raise the temperature around the testicles and affect sperm production.
Other physical issues, like injury or blockages in the reproductive tract, can also prevent sperm from being released properly.
6. Ejaculation and sexual function issues
Even when sperm production is normal, problems with sexual function can still affect fertility. Conditions like erectile dysfunction, premature ejaculation, or infrequent ejaculation can reduce the chances of conception.
In more severe cases, a condition called anejaculation (no ejaculation at all) may prevent sperm from being released completely
5 Treatment Options to Improve Low Sperm Count
Low sperm count is not always a permanent situation. In many cases, once the cause is found, there are different ways to improve it and increase the chances of conception. The treatment usually depends on what is affecting sperm production in the first place, so there’s no one-size-fits-all solution.
1. Lifestyle changes and daily habits
For a lot of men, the first thing doctors look at is lifestyle. This is because everyday habits can affect sperm production over time.
Things like smoking, drinking too much alcohol, poor sleep, constant stress, and lack of exercise can reduce testosterone levels and affect sperm quality. Even something as simple as carrying excess weight can interfere with hormone balance.
On the positive side, small changes can help. Regular exercise, better sleep, staying hydrated, and eating more natural foods like fruits, vegetables, eggs, fish, and nuts can support sperm health. Also, reducing heat around the testicles (like avoiding very tight underwear or long exposure to hot baths) may help improve sperm production gradually.
2. Treating infections
Sometimes the issue is not lifestyle but an underlying infection. Infections like gonorrhea, chlamydia, syphilis, or inflammation of the prostate gland (prostatitis) can affect how sperm is produced.
The challenge is that some of these infections may not show strong symptoms at first, so they go unnoticed for a while. If detected early and treated properly with antibiotics or prescribed medication, sperm health can improve over time.
It is important not to self-medicate but to get proper medical testing so the right treatment is given.
3. Hormonal treatment
Sperm production is strongly controlled by hormones like testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). When these hormones are low or not balanced, the body may reduce sperm production.
In such cases, doctors may prescribe hormone therapy to correct the imbalance. But this has to be done carefully because using external testosterone (testosterone replacement therapy) without guidance can actually reduce sperm production instead of improving it.
This is why proper diagnosis and blood tests are very important before starting any hormonal treatment.
4. Surgery for physical issues
In some men, the problem is structural rather than hormonal or lifestyle-related. A common example is varicocele, which is the enlargement of veins in the scrotum.
This condition increases heat around the testicles, and that heat can affect sperm production. A simple surgical procedure can sometimes correct it by improving blood flow and reducing that heat effect.
Surgery may also be needed if there is a blockage in the reproductive tract that is stopping sperm from being released properly.
5. Assisted reproductive techniques
When other treatments are not enough, assisted fertility options can help couples still achieve pregnancy.
Procedures like intrauterine insemination (IUI) involve placing processed sperm directly into the uterus to increase the chance of fertilisation. In-vitro fertilisation (IVF) takes it a step further by fertilising the egg outside the body before transferring it back into the womb.
In more advanced cases, a method called intracytoplasmic sperm injection (ICSI) may be used, where a single healthy sperm is directly injected into an egg.
These options don’t necessarily increase sperm count, but they help bypass the challenge of low numbers and improve the chance of conception.
From the Desk of Koyo Doctors
Low sperm count can feel like a heavy topic, especially when you are trying to understand what it means for your chances of becoming a father. In Nigeria, many men tend to only think about their fertility when they start experiencing difficulty in conceiving a child. At that point, it can feel confusing and even overwhelming to figure out which step to take next.
In the case of low sperm count, it is important to remember that it is a medical condition that can oftentimes be improved once the cause is identified. What matters most is early search for the right medical guidance.
If you are unsure about your symptoms, your test results, or just what steps to take next, you don’t have to figure it out alone. You can ask questions and speak with a Koyo doctor online, who can guide you through your situation.
At Koyo, we believe everyone should be able to get honest answers about their health without confusion or delay, especially when it comes to reproductive care.
References
Leslie, S. W., Siref, L. E., & Khan, M. A. (2023). Male Infertility. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562258/
Sahakian, V. (2024, August 23). 5 treatment options for men with low sperm count. Www.pfcla.com. https://www.pfcla.com/blog/low-sperm-count-treatment
World Health Organization. (2024, May 22). Infertility. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/infertility
