Low Sperm Count: What It Means and What Can Be Done

A low or poor-quality sperm result is not the end of the road, and on its own it does not mean you cannot father a child. The first step is a proper semen analysis to establish what is actually low, because "weak sperm" covers several different findings with different implications. From there the options run from lifestyle change, which works over months rather than weeks, through to ICSI, where a single sperm is injected directly into an egg, and to surgical retrieval where there is no sperm in the ejaculate at all.

What counts as a low sperm count?

A semen analysis measures several things separately: the volume of the sample, the concentration of sperm, the total number, how many are moving and how well, how many are normally formed, and how many are alive. A result can be low on one of these and normal on the others, which is why "weak sperm" is not a diagnosis by itself.

The reference values come from the WHO laboratory manual for the examination and processing of human semen, now in its sixth edition. Two things about them are commonly misunderstood. They are drawn from the fifth percentile of men known to be fertile, so a man scoring below them is in the lowest 5 percent of that group, not outside the range of men who conceive. And the sixth edition deliberately moved away from treating these values as fixed thresholds, stating that they are one way of interpreting a result and are not sufficient on their own to diagnose male infertility.

In practice this means a single below-range result needs repeating and interpreting alongside everything else, not treating as a verdict. The current sixth edition sets the lower reference limits at 1.4 mL for volume, 16 million per mL for concentration, 39 million for total sperm number, 42 percent total motility, 30 percent progressive motility and 4 percent normal morphology. Our article on what a semen analysis measures sets these out in full.

What causes a low sperm count?

• Structural problems, such as undescended testicles, a varicocele, or inflammation affecting the testes.
• Hormonal disorders affecting the signals that drive sperm production.
• Medical treatment, particularly chemotherapy and radiotherapy, and some medications.
• Genetic causes, which is why genetic testing is offered where no sperm is found in the semen.
• Lifestyle factors, including smoking, alcohol and heat exposure.
• Infection, past or present, which can cause blockages.

What can you change yourself?

These are worth doing, and they are worth doing early, because a full cycle of sperm production takes roughly two to three months. Nothing you change this week will show on a test next week.

• Stop smoking. The clearest of the modifiable factors. See our article on smoking, vaping and fertility.
• Reduce alcohol. The American Society for Reproductive Medicine advises reducing alcohol and caffeine while trying to conceive.
• Eat a healthy overall diet. A systematic review in Human Reproduction Update linked healthy dietary patterns to better semen quality. Our article on foods that nourish sperm covers what it found, including which foods were associated with worse results.
• Avoid sustained heat to the testes, such as hot baths and saunas.
• Review your medications with your doctor rather than stopping anything on your own.

Be realistic about what this achieves. Lifestyle change can improve a borderline result. It does not resolve a structural, genetic or obstructive cause, and time spent on it is time not spent on investigation.

What treatments are available?

ICSI

Where the count or motility is low but sperm is present, ICSI sidesteps the problem: a single sperm is selected and injected directly into an egg, so the number of sperm available matters far less than it would in natural conception or IUI.

Surgical sperm retrieval

Where there is no sperm in the ejaculate at all, it can often be collected directly. PESA draws from the epididymis and TESA or TESE from the testicle itself. These are covered in our article on TESA and PESA and on our surgical sperm retrieval page. Sperm collected this way is used with ICSI, not with IUI, because the numbers retrieved are small.

We at Millennium IVF Clinic assess both partners and will go through which of these applies to your results. You can arrange a consultation with our team.

Frequently asked questions

Does a low sperm count mean I cannot have children?

No. It means conception is less likely per cycle, not that it is impossible, and treatments such as ICSI are designed for exactly this situation.

How long should I try lifestyle changes before seeking treatment?

Sperm production takes roughly two to three months, so that is the minimum period before a repeat test would show anything. Discuss the timescale with your specialist rather than deferring investigation indefinitely.

Should the test be repeated?

Semen results vary considerably between samples, so a single below-range result is usually repeated before conclusions are drawn.

Can IUI work with a low sperm count?

It depends how low. IUI relies on enough motile sperm reaching the uterus, so where the count or motility is very low, ICSI is generally the route. Your specialist will advise based on your numbers.