What a low sperm count means
A low sperm count, called oligospermia, means fewer sperm than normal in the semen. It is one of the most common reasons for male infertility. It does not always mean a man cannot father a child.
Doctors also look at motility, which is how well sperm swim, and morphology, which is their shape. These three together give a fuller picture than count alone.
Male factors contribute to many cases of infertility. That is why both partners should be tested at the start.
First step: confirm with tests
One semen report is not enough to decide treatment. Sperm counts vary from week to week. Doctors usually repeat the semen analysis after a few weeks.
- Semen analysis checks count, motility, shape and volume.
- Hormone tests such as FSH, LH and testosterone look for hormonal causes.
- Scrotal ultrasound can detect a varicocele or other problems.
- Genetic tests may be advised when the count is very low.
Many of these tests can be done in your own city. Reports can be reviewed on WhatsApp before you plan a visit to Delhi.
Common causes
Finding the cause helps choose treatment. Sometimes no clear cause is found, and that is common too.
- Varicocele, which is swollen veins around the testicle
- Hormonal imbalance
- Past infections or mumps affecting the testicles
- Smoking, heavy alcohol use and some recreational drugs
- Obesity, heat exposure and some medicines
- Genetic conditions or blockages in the sperm ducts
Treatment options
Treatment moves from simple to advanced depending on the count, the cause and the female partner's age and fertility.
Lifestyle changes
For a mildly low count, lifestyle changes can help. Stop smoking, cut alcohol, aim for a healthy weight and avoid long exposure to heat. Sperm take around three months to develop, so changes need time to show.
Medicines
If tests find a hormonal problem or infection, medicines may help. Antioxidant supplements are sometimes suggested, but take them only on a doctor's advice. Avoid testosterone supplements unless prescribed, as they can lower sperm production.
Surgery for varicocele
Some men with a varicocele benefit from repair. Whether it helps depends on the size of the varicocele and the semen results. Your urologist and fertility doctor can advise together.
IUI
In IUI, washed sperm are placed directly in the uterus around ovulation. It suits a mildly low count with good motility. Our IUI page explains when it is used.
IVF with ICSI
When the count or motility is moderately or severely low, IVF with ICSI is usually advised. In ICSI, a single sperm is injected directly into each egg. This means only a few healthy sperm are needed. An IVF cycle with ICSI typically costs ₹1,80,000 – ₹4,06,000.
Surgical sperm retrieval
If there are no sperm in the semen, sperm may still be found in the testicle. A procedure called TESA collects sperm with a fine needle. These sperm are then used with ICSI. TESA typically costs ₹30,000 – ₹60,000.
Matching treatment to the situation
| Situation | Usual first approach |
|---|---|
| Mildly low count, cause unclear | Lifestyle changes, timed intercourse, possibly IUI |
| Hormonal cause found | Medicines to correct hormones |
| Significant varicocele | Assessment for repair |
| Moderate or severe low count | IVF with ICSI |
| No sperm in semen | Further tests, then TESA with ICSI if sperm are found |
The female partner's age also matters. If she is older or has her own fertility issues, the doctor may suggest moving to IVF sooner rather than waiting.
How to give a good semen sample
An accurate report depends on how the sample is collected. Small mistakes can make the count look lower than it really is.
- Follow the abstinence period the lab gives, usually two to seven days.
- Collect the full sample in the sterile container provided. Losing the first part can lower the count.
- Avoid lubricants, as many harm sperm.
- If collecting at home, bring the sample to the lab within the time they advise, kept at body temperature.
Tell the lab if you had a fever or illness in the past three months. A recent fever can lower sperm count for a while.
Looking after the emotional side
Many men feel embarrassed or upset by a low count. This is a medical finding, not a measure of masculinity. Talking openly with your partner and doctor makes planning easier.
When donor sperm is discussed
If no sperm can be found even after retrieval, donor sperm is an option some couples consider. Under the ART (Regulation) Act, 2021, donor gametes can only come through registered ART banks. Your doctor will discuss this sensitively if it becomes relevant.
What you can do now
- Repeat the semen analysis after 2 to 7 days of abstinence, as the lab advises
- Stop smoking and limit alcohol
- Avoid hot baths, saunas and laptops on the lap
- Bring all past reports to your consultation
Read more on our male infertility treatment page. Success with any treatment depends mainly on age, egg reserve, sperm quality and embryo quality. The doctor explains realistic chances after tests.