The diagnosis of low sperm count is an essential step in checking male fertility. It is especially important when a couple has been trying to conceive for at least a year without success. Many men with low sperm count show no clear signs. This makes medical tests the only dependable way to find it. A full diagnosis also helps uncover the cause, so treatment can start in the right way.
Medical History and Lifestyle Check
The first step is a detailed medical and reproductive history. The doctor will ask about:
- Past illnesses or infections
- Any surgery, especially on the testicles or groin
- Puberty and sexual health
- Family history of infertility or genetic problems
- Lifestyle habits such as smoking, alcohol use, recreational drugs, work exposures, diet, exercise, and stress
These questions help point to possible factors that affect sperm production.
Physical Examination
Next, the doctor does a physical check of the genital area. They look for:
- Undescended testicles
- Small testicular size
- Varicocele (enlarged veins in the scrotum)
- Swelling, lumps, or tenderness
- Signs of hormonal issues, such as less body hair, larger breast tissue, or lower muscle mass
These signs can suggest conditions like Klinefelter syndrome or hypogonadism.
Semen Analysis
The main test for low sperm count is a semen analysis. It measures the number and quality of sperm in the semen.
How it works:
- The man gives a semen sample, usually through masturbation into a clean container
- To get the best results, doctors ask for no ejaculation for 2–7 days before the test
The test looks at:
- Sperm concentration (per millilitre)
- Total sperm count in the sample
- Sperm movement (motility)
- Sperm shape (morphology)
- Semen volume
- pH and thickness
- Signs of infection or immune problems, such as white blood cells or anti-sperm antibodies
To be sure of the results, doctors often check at least two samples, taken weeks apart. A sperm count below 15 million per millilitre is low (oligospermia). No sperm means azoospermia.
Extra Tests for Cause
If the count is low, more tests help find the reason.
Hormone tests check testosterone, LH, FSH, prolactin, and thyroid hormones. These can show if there are hormone problems affecting sperm.
Scans such as scrotal ultrasound can spot varicocele, blockages, tumours, or other changes in the reproductive organs. A transrectal ultrasound (TRUS) can look for blockages in the seminal vesicles or ejaculatory ducts.
Genetic tests may be used for very low counts or azoospermia. These can include:
- Karyotype testing (to look for chromosome changes)
- Y chromosome microdeletion testing
- CFTR gene testing (linked to missing parts of the reproductive tract)
Other special tests can include:
- Anti-sperm antibody testing
- Sperm DNA damage testing, which may be useful for IVF cases
Testicular biopsy may be needed if other tests cannot give answers. In this, a small tissue sample is taken to check sperm production and, if possible, collect sperm for assisted reproduction.
Partner Assessment
Often, fertility problems come from both partners. Because of this, doctors usually check the female partner at the same time. This gives a full picture and avoids delays in starting treatment.
Final Thoughts
Diagnosing low sperm count is a step-by-step process. It starts with questions and a physical check. Then, it moves to semen testing and sometimes hormone, scan, or genetic tests. The sooner this is done, the better the chance of finding and fixing the cause. For couples facing fertility struggles, this careful approach offers answers, a plan, and hope.
