The treatment of low sperm count depends on the underlying cause, the severity of the condition, and the couple’s overall fertility goals.
Some men may only need lifestyle changes, while others may require medical or surgical treatment. Today, advances in reproductive medicine make it possible for many men with low sperm count — even those with severe fertility problems — to father biological children through different therapies and assisted reproductive technologies (ART).
Lifestyle Changes for Better Sperm Health
A good plan for the treatment of low sperm count often starts with lifestyle changes. These are usually the first step and can improve both sperm count and quality. Key changes include:
- Quitting smoking and limiting alcohol, as both reduce sperm number and movement.
- Avoiding recreational drugs like anabolic steroids, marijuana, and cocaine, which affect hormones and sperm production.
- Keeping a healthy weight to prevent hormonal imbalance and inflammation.
- Eating a nutrient-rich diet with zinc, selenium, folic acid, and antioxidants such as vitamins C and E.
- Reducing stress through mindfulness, counselling, or exercise.
- Avoiding heat exposure from saunas, hot tubs, or tight underwear, which can raise scrotal temperature and harm sperm production.
Medical Treatments for Low Sperm Count
When lifestyle changes are not enough, medical options may help. Hormone treatments are useful when the cause is linked to hormone problems. Depending on the case, doctors may prescribe:
- Clomiphene citrate to boost FSH and LH, which stimulate sperm production.
- Human chorionic gonadotropin (hCG) to increase testosterone in men with secondary hypogonadism.
- Recombinant FSH, often combined with hCG, to further support sperm growth.
- Aromatase inhibitors like anastrozole to lower excess oestrogen and restore a healthy testosterone-to-oestrogen balance.
If infections in the reproductive tract reduce sperm production or block sperm flow, antibiotics can treat the infection. Early treatment of conditions like epididymitis or prostatitis may prevent lasting harm, though it cannot repair damage already done to sperm-producing tissue.
Surgical Options and Sperm Retrieval
Some men need surgery to correct structural problems. One common procedure is:
- Varicocelectomy — surgery to repair a swollen vein in the scrotum that can reduce sperm quality. This can improve count and movement in certain patients.
Other surgical methods include:
- Vasovasostomy or vasoepididymostomy — reconnecting the sperm pathway after a vasectomy or clearing a blockage.
- Transurethral resection of the ejaculatory ducts (TURED) — to fix blockages that lower semen volume and sperm count.
When no sperm are found in the ejaculate (azoospermia), sperm retrieval techniques may be used for ART:
- Testicular sperm aspiration (TESA)
- Testicular sperm extraction (TESE)
- Microdissection TESE (micro-TESE)
These methods take sperm directly from the testes for use in IVF with intracytoplasmic sperm injection (ICSI).
Assisted Reproductive Technologies (ART)
For many couples, ART gives the best chance of success. Options include:
- Intrauterine insemination (IUI) — placing concentrated sperm directly into the uterus, best for mild to moderate low sperm count when movement is good.
- In vitro fertilisation (IVF) — fertilising eggs in a lab before placing embryos into the uterus, requiring higher sperm quality than ICSI.
- Intracytoplasmic sperm injection (ICSI) — injecting a single sperm into an egg, highly effective for very low sperm count or poor sperm movement.
When sperm quality or count is extremely low, or when genetic risks are high, donor sperm may be considered. This is a personal choice that often involves counselling and legal advice to ensure both partners agree emotionally and ethically.
Genetic Causes and Counselling
If the low sperm count comes from a genetic condition like Y chromosome microdeletion or Klinefelter syndrome, treatment options are fewer. ART with sperm retrieval may still be possible, but genetic counselling is important to understand risks to future children.
Emotional Support and Mental Health
Throughout the treatment of low sperm count, mental health care is essential. The diagnosis can cause embarrassment, low self-worth, or depression. Stress from fertility problems can strain relationships. Counsellors or therapists can help couples handle the emotional pressure and make informed decisions.
Final Thoughts on the Treatment of Low Sperm Count
Treatment of low sperm count is personal and depends on the cause, level of sperm problem, couple’s goals, age, and readiness for advanced fertility options. Many men once thought infertile have become fathers with the right mix of care, persistence, and medical help.
