What Causes Oligospermia (Low Sperm Count), What Are Its Symptoms, and How Is It Treated?

Infertility is a prevalent concern affecting a substantial global population, with both men and women sharing equal contributions to its prevalence. 

The underlying causes of male infertility are diverse, encompassing a range of factors. 

Oligospermia, characterized by a low sperm count, stands as one such significant factor. 

Notably, it’s essential to recognize that men diagnosed with oligospermia are not inherently rendered infertile. 

In this article, we present a comprehensive guide elucidating the causes, symptoms, and treatment modalities associated with this condition. 

What is Oligospermia?

Oligospermia, alternatively known as oligozoospermia, is a male fertility issue characterized by a lower-than-normal sperm count within the semen during orgasm. 

This condition is quantified by having fewer than 15 million sperm present in 1 millilitre of semen. 

The diminished sperm count associated with oligospermia reduces the likelihood of successful fertilization of the egg. 

Oligospermia is categorized into various degrees based on the severity of sperm depletion: 

• Mild oligospermia, with sperm counts ranging from 10 to 15 million sperm per millilitre;
• Moderate oligospermia, where counts fall between 5 and 10 million sperm per millilitre; and 
• Severe oligospermia, where the count is between 0 and 5 million sperm per millilitre. 

To diagnose this condition, a semen analysis is typically conducted, offering valuable insights into the individual’s reproductive health.

Causes of Oligospermia

The underlying cause of oligospermia, a condition characterized by a low sperm count, often remains unidentified. 

Medical causes

Infections

Infections can serve as significant medical causes of oligospermia, exerting their influence through disruptions in sperm production or by inducing scarring within the sperm’s transport pathways. 

This disruption and scarring ultimately culminate in the condition of oligospermia. 

Notable infections contributing to this condition include sexually transmitted infections such as gonorrhoea and HIV. 

Moreover, inflammation affecting critical reproductive structures like the testicles (orchitis), epididymis (epididymitis), or the prostate gland (prostatitis) can also be implicated. 

Additionally, infections extending to the urinary tract, including conditions like urethritis, cystitis, pyelonephritis, and even mumps, can contribute to the development of oligospermia.

Hormonal Imbalances

Organs such as the hypothalamus, pituitary gland, testicles, thyroid, and adrenal glands play a role in secreting hormones essential for reproductive functions.

Any aberrations in the levels of these hormones can exert a detrimental effect on sperm production. 

Notably, a decrease in the ratio of estrogen to testosterone can lead to a reduction in the production of LH and FSH hormones, altering spermatogenesis.  

Moreover, alterations in prolactin levels can also influence sperm production adversely.

Blockages 

Blockages within crucial reproductive structures, including the testicles, epididymis, vas deferens, ejaculatory ducts, or urethra, can serve as medical origins of oligospermia. 

Such blockages disrupt the seamless transport of sperm, thereby contributing to the emergence of oligospermia. 

These obstructions can stem from a range of factors, including inadvertent injuries sustained during surgical procedures, trauma, previous infections, or irregular developmental patterns.

Genetic Conditions 

Genetic conditions wield considerable influence as medical triggers for oligospermia, underpinning the compromised development and function of reproductive systems. 

Klinefelter’s syndrome, characterized by the presence of extra X chromosomes in males, impairs the testicles’ development and functionality, leading to reduced sperm production.

Similarly, cystic fibrosis, marked by the production of thick mucus, can obstruct the sperm canal, often causing underdevelopment or absence of the vas deferens, which disrupts sperm transport.

Kallmann’s syndrome, involving deficient gonadotropin-releasing hormone (GnRH) release, cascades into a disturbance in sex hormone production, ultimately affecting sperm production.

Kartagener’s syndrome, a rare genetic disorder of cilia, undermines cilia movement, resulting in diminished sperm motility.

Varicocele

Varicocele is a medical condition characterized by the enlargement of veins within the scrotum, which can also result in the twisting of these veins. 

This condition disrupts the typical blood flow from the testicles, consequently causing an elevation in testicular temperature. 

The increased temperature adversely affects testicular function, leading to impaired sperm production, and thus contributes to oligospermia.

Undescended Testicles

Undescended testicles, a medical condition in which the testicles do not descend into the scrotum, can lead to oligospermia due to the vital temperature requirements for sperm production. 

Sperm production necessitates a lower temperature than that of the body, which is why testicles are located in the scrotum. 

However, in cases of undescended testicles, they remain within the body at a higher temperature. 

This elevated heat level adversely affects testicular function, resulting in diminished sperm count and compromised sperm quality.

Ejaculation Problems 

Ejaculation problems, including conditions like retrograde ejaculation, can contribute to oligospermia by causing the semen to travel in a reverse direction, entering the bladder instead of being expelled through the urethra. 

This occurrence prevents the semen from being properly ejected out of the penis, leading to reduced sperm count or a decreased volume of ejaculation.

Medications

Medications can contribute to oligospermia by adversely affecting sperm production. 

Specifically, medications such as testosterone therapy or anabolic steroids have the potential to completely halt sperm production. 

Chemotherapy drugs used for cancer treatment, due to their targeting of rapidly dividing cells, can also impact sperm count. 

Blood pressure medications might lead to low libido, erectile dysfunction, and subsequently reduced sperm count. 

Additionally, certain antifungal, antibiotic, and ulcer medications can create problems in sperm production.

The impact of these medications on sperm count underscores the importance of considering potential side effects when assessing factors contributing to oligospermia.

Previous Surgeries 

Previous surgeries can be a cause of oligospermia due to their potential impact on sperm production. 

Surgical procedures like vasectomy initially intended for birth control, can occasionally result in oligospermia through partial sperm production.

In some cases, inguinal hernia repairs can also interfere with sperm production. 

Surgeries involving the scrotum, testicles, or prostate may similarly lead to reduced sperm count, highlighting the need to consider surgical history when investigating potential causes of oligospermia.

Tumours

Tumours, whether cancerous or non-malignant, can contribute to oligospermia by affecting sperm count. 

The impact can occur either directly on the reproductive system or indirectly through glands releasing hormones associated with reproduction. 

Beyond the tumour’s effect itself, cancer treatments like surgery, radiation, or chemotherapy can further harm fertility by influencing sperm count. 

The interplay between tumours, their effects on hormonal systems, and the subsequent impact on sperm production underscores the complex relationship between medical conditions and oligospermia.

Environmental Causes

Excessive exposure to certain environmental factors has been linked to impaired fertility, resulting in a reduction in sperm count.

Industrial Chemicals

Exposure to hazardous industrial chemicals in the workplace can have detrimental effects on men’s reproductive health. 

Chemicals such as benzenes, toluene, organic solvents, xylene, pesticides, herbicides, painting materials, and cleaning agents are among the culprits. 

These substances can lead to issues with sperm production and function, ultimately resulting in lowered sperm counts. 

One of the mechanisms behind this decline is the impact of these chemicals on the immune system, contributing to the overall reduction in fertility among men exposed to them.

Heavy Metal Exposure

Heavy metal exposure has emerged as a significant environmental factor contributing to oligospermia. 

Certain heavy metals act as endocrine disruptors, leading to disruptions in reproductive processes. 

The functioning of crucial cells like Sertoli and Leydig cells can be inhibited, leading to issues with sperm count and quality. 

Additionally, interference with spermatogenesis and the induction of oxidative stress are common consequences of heavy metal exposure, further compounding the problem.

Notably, heavy metals such as lead, arsenic, cadmium, and mercury have been identified as key contributors to oligospermia due to their disruptive effects on male reproductive health.

Radiation

Radiation exposure, whether stemming from medical procedures or environmental sources, has the potential to profoundly impact male fertility. 

Oligospermia, characterized by reduced sperm count, is a notable consequence of such exposure. 

The deleterious effects manifest as a reduction in sperm production, leading to challenges in achieving successful fertilization. 

The extent of the damage is closely linked to both the duration and intensity of the radiation exposure, emphasizing the critical role these factors play in determining the impact on male reproductive health.

Overheating of the testicles

Excessive heat affecting the testicles, stemming from factors such as hot baths, tight clothing, saunas, fever, or prolonged sitting, can have a significant impact on male fertility. 

This overheating phenomenon can lead to impairments in both sperm production and function. 

The delicate balance required for optimal sperm development and performance can be disrupted when the testicles are subjected to elevated temperatures. 

As a result, maintaining an appropriate testicular temperature is crucial for safeguarding the health of sperm and promoting healthy reproductive outcomes.

Lifestyle causes

Drugs and Alcohol use

Drugs and alcohol use can serve as lifestyle causes of oligospermia, a condition characterized by a low sperm count. 

Drugs, such as narcotics, have been linked to disruptions in testosterone production, leading to a decreased sperm count. 

Additionally, substances like tobacco, marijuana, and smoking have shown detrimental impacts on sperm production, contributing to reduced sperm counts. 

Moreover, consistent and heavy alcohol consumption can disturb the hormonal equilibrium, further impacting the body’s ability to produce an adequate amount of sperm.

Weight 

Weight can play a significant role as a lifestyle factor contributing to oligospermia. 

The presence of excess body weight has been shown to influence sperm production adversely. 

This effect is attributed to hormonal fluctuations resulting from the accumulation of a substantial amount of adipose tissue. 

Consequently, individuals with excessive body weight may face an elevated risk of developing oligospermia due to the disruption in sperm production caused by these hormonal changes.

Stress 

Stress can serve as a lifestyle-related factor contributing to oligospermia, a condition characterized by a low sperm count. 

Research has explored the connection between psychological stress and male infertility, highlighting its potential impact on reproductive health. 

High levels of stress can lead to a decrease in testosterone levels in men, which in turn can disrupt the normal production of sperm. 

Consequently, the culmination of these factors can contribute to the development of oligospermia, further emphasizing the role of stress in affecting sperm quantity and quality.

Symptoms of Oligospermia

The primary symptom of oligospermia is the inability to conceive with a partner after one year of regular unprotected sexual intercourse. 

Diagnosis often occurs after failed attempts to conceive. 

Additional signs of oligospermia differ based on the underlying cause. 

For instance, if the low sperm count stems from a disease, individuals might experience burning during urination, along with testicular pain and thick discharge. 

Other possible symptoms include sexual function issues, testicular pain, hormonal abnormalities, or reduced hair—a sign of hormonal imbalance. 

Treatment for Oligospermia

When addressing oligospermia, an array of treatment options becomes accessible, with the ultimate choice contingent upon the underlying cause of the condition.

Surgery

Surgery stands as a viable treatment for oligospermia, particularly when addressing specific underlying causes. 

For instance, when the cause is a varicocele, opting for varicocelectomy surgery proves advantageous. 

This surgical intervention involves the meticulous sealing of the problematic vein, effectively rerouting blood flow to healthier veins and subsequently enhancing sperm production. 

Similarly, obstructions within the ejaculatory duct can be rectified through duct resection surgery, thereby potentially alleviating the oligospermic condition. 

Men who have undergone a vasectomy but wish to conceive can consider vasectomy reversal surgery as a plausible option. 

In cases where sperm is absent in the ejaculate, sperm retrieval techniques enable the direct extraction of sperm from the testicles or epididymis, offering a potential pathway to overcome the challenges of oligospermia.

Medications

Medications play a pivotal role in addressing oligospermia, particularly when its origins are rooted in specific causes. 

In instances where infection underlies the condition, targeted administration of appropriate antibiotics emerges as an effective approach for resolution. 

Additionally, medicinal interventions hold the capacity to mitigate inflammation, further contributing to the amelioration of oligospermic manifestations. 

Moreover, medications extend their utility beyond infection and inflammation, as they can be harnessed to tackle associated sexual problems like erectile dysfunction, thereby fostering comprehensive treatment strategies for individuals grappling with oligospermia.

Hormonal Treatments  

Hormonal treatments present a viable avenue for addressing oligospermia, particularly in cases where specific hormonal imbalances are at the core of the condition. 

For individuals exhibiting hypogonadism marked by low gonadotropin levels, the consideration of gonadotropin therapy holds promise in enhancing sperm count. 

It’s paramount, however, to consult with a qualified physician to determine the optimal hormones and dosages tailored to individual needs. 

Additionally, hormonal interventions extend their utility to encompass the management of elevated prolactin levels, a contributing factor to reduced sperm counts. 

In such instances, hormonal therapy emerges as a strategic approach to mitigate the impact of elevated prolactin levels on sperm production and overall fertility.

Assisted Reproductive Technology (ART)

Assisted Reproductive Technology (ART) stands as a compelling option for individuals seeking to overcome the challenges of oligospermia and achieve conception. 

Depending on the underlying cause, viable sperm can be obtained from the male partner through regular ejaculation, surgical extraction, or, when necessary, from a donor. 

These collected sperm are then harnessed for techniques like Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF), employing either conventional fertilization methods or Intracytoplasmic Sperm Injection (ICSI). 

Each of these procedures facilitates the proximity of sperm to the egg, optimizing the conditions for successful fertilization and ultimately enhancing the prospects of achieving pregnancy.

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