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Getting Pregnant

What to Do About Low Sperm Count when You’re Trying to Conceive

low sperm count

You probably know that all it takes to make a baby is one egg and one sperm. But in order for a single sperm to make it all the way to the egg, you actually need quite a lot—we’re talking millions—to begin with. That’s why low sperm count may decrease the chances of conceiving naturally.

Maybe your partner has done a semen analysis, and your report indicates a low sperm count. Read on to understand what a low sperm count means, why it might be happening, and what you can do about it at home—or at your doctor’s office.

Sperm basics

Sperm is the male sex cell, also known as a “gamete,” that carries half of the genetic material for a new baby. Sperm are produced in the testicles in a process called spermatogenesis; in a healthy reproductive system, approximately 50 – 100 million viable sperm are produced each day. Spermatogenesis begins at puberty and typically continues until death, but some of the sperm health parameters are negatively affected with aging.

Sperm count

Sperm count refers to the total number of sperm in the “ejaculate” (the semen that’s released from the penis during ejaculation). Sperm concentration, on the other hand, is the density of the sperm within the semen—in other words, it’s the number of sperm per milliliter of semen. For example, a sample may include 3 milliliters of semen (also known as semen volume) and a total sperm count of 45 million; that would be a concentration of 15 million sperm per mL.

Though they’re not exactly the same value, both sperm count and sperm concentration measures test the same basic idea: if there are enough sperm being produced and ejaculated to make a natural pregnancy likely.

Normal sperm count vs. low sperm count

What’s a normal sperm count? Technically, 15 million sperm per mL of semen is considered a normal sperm concentration according to the World Health Organization 5th Edition, and anything under that threshold would be considered a low sperm count. But some researchers argue that concentrations under 40 million/mL may impede chances of pregnancy.

woman in bed

Low sperm count/concentration is known as oligospermia, while having no sperm in your semen at all is known as azoospermia.

What a low sperm count means for your fertility

The natural conception process begins with ejaculation, when sperm (floating within semen) are released from the penis into the female reproductive system, in hopes of making it to the egg. There are many obstacles along the way, including the acidic vagina, the cervical mucus (which can sometimes be helpful to sperm, but if abnormal, can destroy sperm), and the possibility that sperm will move toward the wrong fallopian tube (in a normal cycle, only one fallopian tube, either the left or the right, will hold an egg at the time of ovulation). Most abnormal sperm will fall prey to these dangers, along with a good percentage of healthy sperm.

While approximately 80 million sperm are typically released in one ejaculate, only about 400 make it to the egg. When you consider that failure ratio, it makes sense that having a lower sperm count would make it less likely that one sperm will be able to fertilize the egg and result in pregnancy.

While low sperm count may indicate that natural conception might be more challenging, it doesn’t mean that a couple is infertile, or can’t get pregnant without reproductive assistance.

Measuring sperm count (and other sperm health parameters)

The test to measure sperm count is called a semen analysis. During this test, a sample of semen—typically produced via masturbation—is examined under a microscope to determine sperm count along with motility (how well sperm are moving) and morphology (how many sperm are the proper shape and size).

Traditionally, a semen analysis is performed at a fertility clinic, urologist’s office, or a lab.

Can I check my sperm count at home?

Yes! There are several options for sperm analysis tests that don’t require a visit to a doctor’s office. Some test only for sperm count, while others—like Legacy’s at-home sperm testing kit—evaluate many factors to provide a more comprehensive picture of male fertility.

What can cause low sperm count?

There are many lifestyle factors and medical conditions that can be associated with low sperm count. These are just a few.

Medical causes

  • Fever: Fever increases the temperature of the testicles above the ideal for sperm production. This can cause a temporary but significant decrease in sperm count. In one case study, sperm count, motility, and genetic health was decreased for over two months after the patient’s fever resolved.
  • Varicocele: Varicocele, the term for a swollen vein or veins within the scrotum, can contribute to low sperm production. Experts believe that the swelling causes an increase in the temperature and oxidative stress within the scrotum, once again impeding sperm production.
  • Congenital absence of the vas deferens: The vas deferens is the duct through which sperm pass on their way from the testicles to the urethra in the penis. It’s rare, but some people are born without this duct; they may orgasm and ejaculate normally, but their sperm never make it into their semen, resulting in azoospermia.
  • Chemotherapy: Chemotherapy works by using medications called “cytostatics” and “cytotoxins” to attack fast-dividing cancer cells. But because the medication is usually administered through the bloodstream to the entire body, it can also kill or damage other cells. High doses of chemotherapy can temporarily or even permanently impair sperm production. (That’s why doctors often recommend sperm freezing prior to chemotherapy treatment.)

Lifestyle factors

  • Diet: An extensive body of research tells us that diet has a significant impact on sperm health. The common “Western” diet—high in fried foods, refined grains, added sugars, and red meat—can be associated with lower sperm counts as well as poorer sperm motility and morphology.
  • Exercise and body weight: Higher levels of physical activity are associated with higher sperm counts, as well as improved sperm motility and morphology. On the other hand, being overweight or obese has been associated in research with lower sperm counts and decreased motility.
  • Smoking: Cigarette smoking has long been considered a risk factor for male infertility. A 2016 review examined 20 different studies of tobacco use and found that sperm count and motility were both significantly reduced by smoking—and that the more someone smokes, the stronger these effects are.
  • Boxers or briefs: One study found that loose-fitting underwear may be related to higher sperm concentration, total sperm count, and total motile count, compared with those who regularly wore tight-fitting briefs. This is likely because tight underwear holds the scrotum closer to the body, raising the temperature of the testes and hindering sperm production.

Getting pregnant with low sperm count

What is the treatment for low sperm count? That really depends on what’s causing it in the first place. For some people, simple lifestyle changes might be enough to increase sperm count and achieve pregnancy, while others might need intervention from a urologist or reproductive endocrinologist.

The Legacy sperm analysis report

One of the advantages of testing sperm count with a Legacy at-home kit is that, in addition to a comprehensive evaluation of all sperm parameters, the Legacy report includes customized recommendations for improving sperm count and sperm health, based on the subject’s lifestyle and results.

Changes associated with improved sperm count

Improving diet, upping exercise, and quitting smoking are associated with improved sperm count. One study demonstrated that a 16-week aerobic training program, consisting of hour-long workouts on a treadmill three times a week, improved the sperm count, motility, and normal morphology of obese patients.

If a smoker quits, there’s evidence that their sperm count and health can improve fairly quickly. In one follow-up study of men who quit smoking, sperm motility and morphology began to return to normal within six months, and research shows that former smokers who quit more than six months ago have similar semen parameters to non-smokers.

Which foods may boost sperm count? Fruits and vegetables are an excellent source of many of the vitamins and nutrients required for the body to create healthy sperm, such as folic acid, vitamin C, and antioxidants. The best diet for sperm count and sperm health is high in fruits and vegetables (specifically leafy greens and cruciferous vegetables like broccoli and Brussels sprouts); nuts and seeds such as walnuts, Brazil nuts, and pumpkin seeds; and fatty fish such as salmon.

There are also a number of nutritional and herbal supplements that are associated with increased sperm count, including D-aspartic acid, ashwagandha, omega-3 fatty acids, and fenugreek. (Always talk to a doctor before incorporating any new supplements into your diet.)

Remember that spermatogenesis—the process of making sperm—takes around 74–90 days. So if you or your partner have made lifestyle changes, it won’t be an immediate improvement; it’ll take about 3 months to see those changes reflected in their semen analysis results or your real-life attempts at pregnancy.

How often to have sex when you’re trying to conceive

If you’re trying to conceive and your partner has a low sperm count, you may be wondering how often you should have sex to get pregnant. If your partner goes more than a day or two without ejaculating, his sperm count will rise—but so will the proportion of dead, immotile, or abnormal sperm.

A study of about 6,000 men found that for men whose sperm counts were already low, sperm motility decreased after one day of abstinence, and sperm quality decreased after two days of abstinence.

So contrary to outdated recommendations that men avoid ejaculating for several days in order to “save up” sperm, it’s now believed that having sex every day during the fertile window may increase pregnancy rates for couples dealing with low sperm count. The fertile window is about 5 days; it’s best to have sex about 2 days before ovulation (since sperm can live up to 5 days in the uterus) as well as the day following.

Fertility treatments for couples trying to conceive with low sperm count

In most cases, having a low sperm count doesn’t mean you can’t get pregnant naturally. But some male-factor infertility cases might require assisted reproductive technology to boost chances of conception.

Intrauterine insemination (IUI)

IUI is a procedure in which a healthcare provider places washed sperm directly into a female patient’s uterus. Because this procedure bypasses the vagina and cervix to place the sperm closer to the egg, it can slightly increase chances of pregnancy for couples diagnosed with low sperm count. The chance of pregnancy with IUI is around 20%.

Intracytoplasmic sperm injection (ICSI) during IVF

During an in vitro fertilization (IVF) cycle, the female partner’s eggs are retrieved from the ovaries and fertilized in an embryology lab. In traditional IVF, the embryologist places the egg and sperm together in a dish for natural fertilization. When the ICSI technique is used, the embryologist uses a needle to inject a single sperm directly into the egg.

ICSI is an option for those to produce too few sperm to result in natural fertilization, as well as for those sperm motility and morphology issues that make it difficult for sperm to penetrate the egg on their own. It can also be used alongside sperm extraction (see below) for those with azoospermia.

IVF and ICSI is the most successful reproductive treatment option; the chance of pregnancy is around 40–45%, depending on the age of the female partner and other factors.

Sperm retrieval or extraction

There are several techniques—including TESE (testicular sperm extraction), TESA (testicular sperm aspiration), PESA (percutaneous sperm aspiration), and micro or microdissection TESE —that can be used to surgically retrieve sperm directly from the testes. These techniques may be used in the rare case that a patient has an anatomical issue, such as absence of the vas deferens, that prevents sperm from reaching the ejaculate, resulting in azoospermia.

Sperm freezing to proactively manage male factor infertility

The process of sperm freezing doesn’t elevate a low sperm count. But, younger men do generally have higher concentrations of sperm, plus better sperm morphology, motility, and genetic health. Freezing sperm at its youngest and healthiest can help increase your chances of pregnancy using IUI or IVF later on, and protect your fertility in the case of injury or illness.

While sperm preservation is traditionally done at a fertility clinic or sperm bank facility, some sperm freezing kits, like Legacy’s, allow you to preserve your sample from the comfort of your own home.


View sources

Victor M. Brugh 3rd and Larry I. Lipshultz. “Male factor infertility: evaluation and management.” Medical Clinics of North America, March 2004.

Trevor G. Cooper and Elizabeth Noonan, et al. “World Health Organization reference values for human semen characteristics.” Human Reproduction, November 2009.

Niels E. Skakkebaek. “Normal reference ranges for semen quality and their relations to fecundity,” January 2010.

Feiby L. Nassan, ScD, MBBCh, MSc, and Tina K. Jensen, PhD, et al. “Association of Dietary Patterns With Testicular Function in Young Danish Men.” JAMA Network Open, February 2021.

Diana Vaamonde and Marzo Edir Da Silva-Grigoletto, et al. “Physically active men show better semen parameters and hormone values than sedentary men.” European Journal of Applied Physiology, September 2012.

En-Yin Wang and Yan Huang, et al. “Body mass index effects sperm quality: a retrospective study in Northern China.” Asian Journal of Andrology, March 2017.

Reecha Sharma and Avi Harlev, et al. “Cigarette Smoking and Semen Quality: A New Meta-analysis Examining the Effect of the 2010 World Health Organization Laboratory Methods for the Examination of Human Semen.” European Urology, September 2016.

Lidia Mínguez-Alarcón and Audrey J. Gaskins, et al. “Type of underwear worn and markers of testicular function among men attending a fertility center.” Human Reproduction, September 2018.

Martin Sergerie and Roger Mieusset, et al. “High risk of temporary alteration of semen parameters after recent acute febrile illness.” Fertility & Sterility, October 2007.

Ashok Agarwal and Reecha Sharma, et al. “Effect of varicocele on semen characteristics according to the new 2010 World Health Organization criteria: a systematic review and meta-analysis.” Asian Journal of Andrology, March 2016.

Keisuke Okada and Masato Fujisawa. “Recovery of Spermatogenesis Following Cancer Treatment with Cytotoxic Chemotherapy and Radiotherapy.” World Journal of Men’s Health, May 2019.

Miguel Ángel Rosety and Antonio Jesus Díaz, et al. “Exercise improved semen quality and reproductive hormone levels in sedentary obese adults.” Nutrición Hospitalaria, June 2017.

Albert Salas-Huetos and Mònica Bulló, et al. “Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies.” Human Reproduction Update, July 2017.

Eliahu Levitas, MD, and Eitan Lunenfeld, MD, et al. “Relationship between the duration of sexual abstinence and semen quality: analysis of 9,489 semen samples.” Fertility & Sterility, June 2005.

Dr. Ramy Abou Ghayda

As a dual fellowship trained urologist, Dr. Ramy Abou Ghayda aspires to contribute and advance the field of Men’s Health and Male Infertility. Dr. Ghayda graduated as a general urologist from of Medicine the American University of Beirut Medical Center. Following his training, he completed two fellowships at The University of Illinois at Chicago in Chicago and at Brigham and Women’s Hospital in Boston. In addition, Dr. Ghayda has a Master degree of Public Health from the Harvard T H Chan School of Public Health and a Master of Health Administration from École des Hautes Etudes En Santé Publique and Paris Diderot University-Paris 7, Paris, France. Dr. Ghayda recently joined University Hospitals and Case Western Reserve University as an assistant professor in Urology. He is currently the Head of research and Chief Medical Officer at Legacy, a Harvard-incubated company. Dr. Ghayda is married with 2 kids. He enjoys travel, having visited over 40 countries already.

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