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Last updated: May 17, 2022
5 min read

Sperm count: what’s considered ‘normal’?

 

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

It’s not uncommon for couples to experience fertility problems. There are many factors that can affect fertility, including sperm count.  

If you and your partner are having trouble getting pregnant, it’s likely both of you need to be evaluated so your healthcare provider can figure out the root cause and recommend treatment. Read on to learn more about sperm count and how it factors into male fertility

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What is sperm count?

Sperm count refers to the total number of sperm in your ejaculate, which is the fluid you release during an orgasm (Cooper, 2010). 

Low sperm count means you have fewer sperm than what’s considered normal. The technical term for low sperm count is oligospermia, and having no sperm in semen is called azoospermia (Kumar, 2015). 

A low sperm count makes it more difficult to get pregnant since fewer sperm mean chances are lower for sperm to reach and fertilize an egg. In a lot of cases, low sperm count may account for male infertility issues, however, many men with low sperm count go on to have successful pregnancies (Leaver, 2016; Leslie-a, 2022). 

At the same time, it’s important to keep in mind that sperm count is just one measure of male fertility. Having a normal or high sperm count on its own doesn’t say a lot about how fertile you are; other sperm measurements have to be considered. For example, if you have a normal sperm count but none of the sperm are moving (sperm motility), it won’t be possible to conceive naturally.   

What’s considered a ‘normal’ sperm count?

Your count is considered low if there are less than 39 million total sperm in your ejaculate (or less than 15 million per milliliter of semen). 

More than 200 million sperm per milliliter of semen indicates a high sperm count, although researchers don’t believe that affects fertility. Anything between those numbers is considered normal (Cooper, 2010). 

How can I find out my sperm count?

Sperm count is determined through semen analysis. These tests can be performed at a doctor’s office, fertility clinic, or your home. 

To collect a sample, you’ll need to ejaculate into a special container. Whether done at home or in-office, your semen sample is then sent to a lab to be analyzed. To find out your sperm count, the sample is reviewed under a microscope with a grid-like pattern and the number of sperm per square is added up (Kumar, 2015; Leslie-a, 2022).

What causes low sperm count?

Environmental factors, medical conditions, or blockages that prevent sperm from passing can all cause low sperm count. Here are some common causes (Leslie-a, 2022; Barak, 2016):

  • Hormonal imbalances
  • Infections, including sexually transmitted infections (STIs) 
  • Ejaculation issues like retrograde ejaculation (when semen goes into the bladder instead of the penis during orgasm)
  • Lifestyle factors, such as drug or alcohol use, smoking tobacco, and chronic stress
  • Medications like opioids or testosterone replacement therapy can affect sperm production 
  • Physical abnormalities that block the passage of sperm. This includes undescended testicles or the obstruction of the vas deferens or epididymis (the tubes sperm pass through on their way to the vas deferens)
  • Surgeries that affect the male reproductive tract like a vasectomy
  • Tumors that affect male reproductive organs (can be cancerous or benign)
  • Varicocele, swelling of the veins inside your scrotum
  • Exposure to industrial chemicals, including heavy metals, insecticides, fungicides, and pesticides
  • Genetic factors or chromosomal abnormalities, such as Klinefelter syndrome

Healthcare professionals aren’t always able to determine the cause of a low sperm count. Many factors are involved in sperm production and transportation, including your reproductive organs and parts of the brain that regulate hormone levels (Leslie-a, 2022). 

Besides low sperm count, other factors like reduced sperm motility (movement) or abnormal sperm morphology (shape), can impact the ability to reach and fertilize an egg (Kumar, 2015).

Signs of low sperm count

It’s possible to have a low sperm count and not know it. For some men, difficulty conceiving is the first sign. Other indicators of low sperm count include (Leslie-a, 2022):

  • Low libido (sex drive)
  • Erectile dysfunction
  • Reduced facial or body hair
  • Pain, swelling, or lumps around testicles

Diagnosing low sperm count

If you notice one of the signs above or haven’t been able to conceive after six to 12 months of having unprotected intercourse, contact your healthcare provider (Barak, 2016). 

They’ll begin by reviewing your personal medical history, asking about your sexual habits, and performing a physical exam. If they suspect low sperm count, the next step is semen analysis which also evaluates sperm morphology and movement.

Due to the variability of semen samples, doctors typically order two samples a week apart to ensure the most accurate results. It’s possible other tests may be needed to see if other causes are behind it including hormone testing, genetic testing, or an ultrasound of your testicle area (Kumar, 2015; Leslie-a, 2022).

Treatment for low sperm count

Treatment for low sperm count depends on the cause. For example, antibiotics may be prescribed if an infection is contributing to low sperm count. 

Other treatments may include (Leslie-a, 2022):

  • Surgery: Sometimes surgery is needed to clear an obstructed vas deferens and correct conditions like varicocele. For example, studies have shown that roughly 70% of men who underwent a varicocelectomy had improved semen quality within six months of the procedure (Leslie-b, 2022). 
  • Medications: A medley of meds can be prescribed to treat hormonal imbalances and infections.
  • Assisted reproductive technologies: When other treatments don’t work, other fertility treatment options like in vitro fertilization (IVF) and intrauterine insemination (IUI) can help facilitate pregnancy.
  • Counseling and therapy: This can be useful for individuals or couples to work through any distress they’re experiencing due to infertility. 

Lifestyle changes may also be recommended to support sperm health including (Leslie-a, 2022; Ferlin, 2021):

  • Avoid drugs and alcohol
  • Quit cigarette smoking 
  • Review any medications you take with your doctor in case it’s affecting your sperm count 
  • Maintain a healthy body weight through a balanced diet and regular exercise 
  • Avoid prolonged exposure to heat, heavy metals, chemicals, and pesticides
  • Reduce stress through wellness practices like meditation and yoga

Some dietary supplements may also help with fertility, according to small research trials. To avoid any side effects it’s wise to consult a health professional before starting any supplements (Yao, 2016):

In lots of cases, low sperm count and male fertility are treatable. For others, it’s not and assisted reproductive technologies may be required to get pregnant. If you have concerns about your sperm count, schedule an appointment with a provider. 

Prepare for your appointment by writing down symptoms you’re experiencing, your personal and family medical history (especially as it relates to fertility), and a list of medications. Think of any questions you want to ask, and if you have a partner, consider bringing them along for support.

References

  1. Barak, S. & Baker, H. (2016). Clinical Management of Male Infertility. Endotext. Retrieved May 2, 2022 from https://pubmed.ncbi.nlm.nih.gov/25905383/ 
  2. Cooper, T. G., Noonan, E., von Eckardstein, S., et al. (2010). World Health Organization reference values for human semen characteristics. Human Reproduction Update, 16(3), 231–245. doi:10.1093/humupd/dmp048. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19934213/
  3. Ferlin, A., Garolla, A., Ghezzi, M., et al. (2021). Sperm Count and Hypogonadism as Markers of General Male Health. European Urology Focus, 7(1), 205–213. doi:10.1016/j.euf.2019.08.001. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31427194/
  4. Kumar, N. & Singh, A. K. (2015). Trends of male factor infertility, an important cause of infertility: A review of literature. Journal of Human Reproductive Sciences, 8(4), 191–196. doi:10.4103/0974-1208.170370. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26752853/
  5. Leaver, R. B. (2016). Male infertility: an overview of causes and treatment options. British Journal of Nursing, 25(18), S35–S40. doi:10.12968/bjon.2016.25.18.S35. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27734725/
  6. Leslie-a, S. W., Siref, L. E., Soon-Sutton, T. L., & Khan, M. (2022). Male Infertility. StatPearls. Retrieved May 2, 2022 from https://pubmed.ncbi.nlm.nih.gov/32965929/ 
  7. Leslie-b, S. W., Sajjad, H., & Siref, L. E. (2022). Varicocele. StatPearls. Retrieved May 2, 2022 from https://pubmed.ncbi.nlm.nih.gov/28846314/ 
  8. Yao, D. F. & Mills, J. N. (2016). Male infertility: lifestyle factors and holistic, complementary, and alternative therapies. Asian Journal of Andrology, 18(3), 410–418. doi:10.4103/1008-682X.175779. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26952957/