Low sperm count: causes, treatment and how to improve it

The NHS explains that a common cause of infertility in men is poor-quality semen, the fluid containing sperm that is ejaculated during sex. This can mean a lack of sperm (a very low sperm count, or no sperm at all), sperm that are not moving properly, which makes it harder for them to swim to the egg, or abnormal sperm, whose shape can make it harder for them to move and fertilise an egg.

A fertility centre in Shropshire says the problem can range from minor to major. An example of a major problem would be a complete absence of sperm (azoospermia), whereas a minor one is a slightly below average count. Many of the more minor problems are not a bar to pregnancy but reduce the chance of it happening.

A low sperm count usually causes no symptoms of its own. The usual first sign is difficulty conceiving. The NHS says infertility means a couple cannot get pregnant despite regular unprotected sex, around 1 in 7 couples may have difficulty conceiving, and more than 8 out of 10 couples where the woman is under 40 will conceive naturally within a year if they have regular unprotected sex (every 2 or 3 days).

Some causes do have signs. The NHS lists problems with the testicles, such as an infection, testicular cancer, surgery, injury or testicles that did not descend into the scrotum, and ejaculation problems that make it difficult to release semen during sex. A GP will examine your testicles for lumps or deformities.

The NHS says many cases of abnormal semen are unexplained. When a cause is found, it falls into several groups.

The NHS says to see your GP if you have not conceived after a year of regular unprotected sex. You should go sooner if the woman is 36 or over, or if you have any other reason to be concerned, for example cancer treatment or a possible sexually transmitted infection. It is best for both partners to visit the GP because fertility problems can affect either or both.

The GP asks about your medical and sexual history, medicines (including herbal remedies and supplements), smoking, weight, alcohol, drugs and stress, and may examine your testicles and penis. After that you may be referred to a specialist infertility team. The tests for men are a semen analysis, to check for problems with sperm such as a low count or sperm that are not moving properly, and a urine test for chlamydia, which can affect fertility; antibiotics are prescribed if it is found.

The NHS says the treatment offered depends on the cause and on what is available from your local integrated care board (ICB). Infertility is usually only diagnosed and treated when a couple have not conceived after 2 years of regular unprotected sex.

A Worcestershire NHS trust leaflet and the Shropshire fertility centre give practical advice. The evidence for some steps is stronger than others.

• Alcohol: heavy drinking is associated with reduced testosterone and low sperm quality and quantity. The leaflet says NHS England recommends men drink no more than 14 units a week, spread over 3 days or more.

• Smoking and vaping: for men there is a link between smoking and poorer semen quality, and passive smoking is also likely to affect chances of conceiving.

• Weight and exercise: men with a BMI of 29 or over are likely to have reduced fertility; regular moderate exercise is associated with healthier sperm (30 minutes, 4 to 5 times a week).

• Heat: avoid tight underwear, hot baths, saunas, hot tubs, laptops directly on the lap and long periods of sitting. The NHS notes it is uncertain whether loose underwear improves fertility.

• Drugs: avoid cannabis, cocaine, anabolic steroids and testosterone.

• Caffeine: large amounts can decrease sperm motility; the leaflet suggests limiting to around 200 mg a day.

• Illness and stress: a flu-type illness can affect sperm production; stress affects hormones and libido.

• Sex: the leaflet suggests regular intercourse, 3 to 4 times a week, to optimise the chance of conception.

The Shropshire centre says vitamin and mineral supplements, especially vitamins A, C and E and zinc and selenium, can be beneficial, but warns that some vitamins and minerals can be harmful in large quantities. The NHS says there is no evidence that complementary therapies for fertility problems are effective, and that NICE says further research is needed before they can be recommended. Some herbal remedies, such as extracts of the Chinese herb Tripterygium wilfordii, can affect sperm production or reduce testicle size.

The sources used here do not give a time scale for sperm to recover after lifestyle change, so ask your GP or fertility clinic. The NHS does say that the effect of sulfasalazine on sperm is temporary and sperm count should return to normal when you stop taking it, and the Worcestershire leaflet notes that long-term anabolic steroid misuse can reduce sperm count and mobility. The NHS says that of couples who do not conceive in the first year, about half will conceive in the second year.

Low sperm count is not an emergency, but see a GP promptly if you notice a lump or deformity in a testicle, because the NHS lists testicular cancer among the causes. See a GP after a year of trying without success, or sooner if the woman is 36 or over, you have had cancer treatment or you think you may have had a sexually transmitted infection.

The NHS pays for referral to a specialist team for initial investigation, and all patients have the right to be referred to an NHS clinic for the initial investigation. Fertility treatment funded by the NHS varies across the UK, waiting lists can be long and eligibility criteria can vary, so a GP or your local ICB can advise.

Private treatment is also available, but the NHS says it can be expensive, there is no guarantee of success and it is important to choose a clinic licensed by the Human Fertilisation and Embryology Authority (HFEA). Ask for a personalised, fully costed treatment plan. The NHS says complementary therapies have no proven benefit.