Medicines for Low sperm count

What it is

A low sperm count (oligospermia) means that the semen a man ejaculates contains a lower number of sperm than normal. It is a common factor in difficulties conceiving — male factors contribute to a significant proportion of fertility problems, either alone or alongside female factors. A low sperm count reduces the chance of natural conception, but it does not necessarily mean a man cannot father a child, as conception may still be possible (sometimes taking longer), and treatments and options are available. A low sperm count usually causes no obvious symptoms — men are typically healthy and have normal sexual function — and it is often only discovered when a couple has difficulty conceiving and fertility tests are done, which include a semen analysis (a test of the semen). There are many possible causes of a low sperm count, and in some cases no cause is found. Possible causes and contributing factors include: certain medical conditions (such as hormonal problems, infections, or problems affecting the testicles); physical problems (such as a varicocele — enlarged veins in the scrotum — or blockages, or previous surgery or injury); genetic factors; certain medicines or treatments; lifestyle and environmental factors (such as smoking, heavy alcohol use, drug use including anabolic steroids, being significantly overweight, heat exposure to the testicles, and possibly others); and undescended testicles in the past. Some of these are treatable or modifiable. Because a low sperm count often has no symptoms, it is usually identified through fertility assessment when a couple is trying to conceive; assessment can look for a cause, and, depending on the situation, various options may help — including treating an underlying cause, lifestyle changes, and assisted conception techniques (such as IVF or related treatments), which can help many couples conceive even when the sperm count is low. The key messages are that a low sperm count is a common and often symptomless factor in fertility difficulties, that assessment can find causes (some treatable), and that a range of options can help couples trying to conceive.

How it is treated

A low sperm count is assessed as part of investigating fertility difficulties, and management involves looking for a cause, addressing modifiable factors, and considering the options available for conceiving. When a couple has difficulty conceiving (usually defined as not conceiving after about a year of regular unprotected sex, or sooner in certain circumstances), both partners are assessed, and for the man this includes a semen analysis (which measures the number, movement, and shape of the sperm), sometimes repeated, along with a history, examination, and further tests (such as hormone or other tests) where indicated. This can identify a low sperm count and, in some cases, a cause. Management then depends on the findings and the couple’s situation, and may include: treating an identified, treatable underlying cause (for example a hormonal problem, an infection, or, in some cases, a varicocele or a blockage, where treatment may help); addressing modifiable lifestyle factors, which can support sperm health — such as stopping smoking, moderating alcohol, avoiding recreational drugs and anabolic steroids, achieving a healthy weight, and other general health measures; and reviewing any medicines that may be contributing. Where natural conception is unlikely or not occurring, assisted conception techniques can help many couples — including intrauterine insemination (IUI) in some cases, and in vitro fertilisation (IVF), often with a technique called ICSI (where a single sperm is injected into an egg), which can achieve conception even with a low sperm count; the appropriate option depends on the specific situation and is discussed with a fertility specialist. Where a man produces no sperm in the ejaculate, further assessment can determine whether sperm can be retrieved directly for use in treatment. Support for the emotional impact of fertility difficulties is also important, as they can be stressful. The reassuring messages are that a low sperm count is common and often symptomless, that assessment can identify causes (some of which are treatable) and guide options, that lifestyle measures can support sperm health, and that a range of treatments — including assisted conception — can help many couples conceive even when the sperm count is low. Couples with difficulty conceiving are encouraged to seek assessment and advice.