Wondering how age of the mom and dad affects fertility? Trying to conceive in your 30s, 40s, or 50s? We created this guide to explain how age affects your chances of pregnancy.

 

By Dr. Andrew Y. Sun

Let’s talk about sperm count. It’s a little counterintuitive. It might seem like the amount of ejaculate a man produces is directly proportional to sperm count—i.e. bigger ejaculations equal more sperm. But that’s not actually true. Just because there’s more liquid, doesn’t necessarily mean that liquid is full of fertile swimmers. And, unfortunately, sperm aren’t visible to the naked eye, so it’s not obvious how many recruits are in your army.

It’s important to know that semen and sperm are two different things. Semen is the fluid that is emitted from the male reproductive tract during ejaculation. Semen contains fructose, citric acid, and sperm (spermatozoa), among other things. Sperm usually makes up only about 2 to 5 percent of the total semen volume, and sometimes it’s lower. The amount of sperm in semen is called sperm count (we’ll get into how this is measured later).

Some men have normal amounts of ejaculate (volume), but zero sperm, which usually indicates a genetic or hormonal issue. Other men have no sperm in the analysis because their volume is super low; essentially they are making sperm, but the pipes are blocked or not letting the fluid through. This is why it’s important to look at both the concentration of sperm (“sperm count”) and volume, which gives us a clearer picture of what’s going on. 

Many men who are diagnosed with low sperm count don’t experience any symptoms related to the issue, so they don’t find out until they’ve been unsuccessfully trying to conceive with a partner for a while. Even if you have been trying for a few months, there’s no need to jump to worrying about sperm count too quickly. But it can still be helpful to get a feel for what those terms mean and what you might do to improve sperm count. So, we’ve summed it up for you here. 

Backing up—why does sperm count matter?

As we’ve explained elsewhere, pregnancy begins when a sperm fertilizes an egg—but while there’s just one egg present at a time when that happens, there are many sperm vying to fertilize it. Like, many, many sperm. On average, about 200 million sperm cells are present in every ejaculation. 

Why so many? Because the race from the vagina to the uterus to fallopian tube to finally, the egg is a true survival-of-the-fittest, perhaps the most severe selection processes designed by evolution

The fewer sperm present in the semen, the lower the chances of conception. In medical parlance, we call low sperm count “oligospermia” and the complete absence of sperm “azoospermia.” Keep in mind that sperm count is just one factor of male fertility (see our other post, A Urologist's Guide to Male Fertility). 

Why do some men have low sperm count?

That’s a complicated question with a complicated answer. There are some medical reasons why men can have low sperm count, some environmental factors, and some health and lifestyle reasons. 

  • Varicocele, an abnormal dilation of the veins of the testis, is the most common reversible factor in male infertility. It is the most common thing that a urologist can help treat to improve semen parameters. 
  • Past medical history including hormone imbalances, tumors, radiation, and chemotherapy can also play a role. There are many other possible medical reasons for decreased sperm count; your doctor can help you sort through if any of them might apply to you.
  • Current and past infections, including STIs like gonorrhea or HIV. If you have a history of STIs, that’s something to bring up with your doctor as a possible cause. 
  • Environmental causes can be exposure to toxins, like chemicals that you might encounter if you work in a job like farming or construction—herbicides, pesticides, chemicals used for painting, and lead can all harm sperm. So can exposure to heavy metals or radiation. Heat is also generally not great for your sperm (more on that below). 
  • Smoking tobacco causes a 13-17% decrease in sperm concentration per recent meta-analysis. So does excessive drinking and drug use. 

How to Know if You Have Low Sperm Count (“Oligospermia”)

There are often no signs or symptoms of low sperm count until a man tries, and fails, to conceive. If the underlying cause of low sperm count is a varicocele or blockage to the sperm pathway, this may present as pain or swelling in the testicle area. If a hormonal imbalance is the issue, then symptoms could include sexual dysfunction such as low sex drive or erectile dysfunction.

To evaluate sperm count (and other aspects of sperm health), a doctor will generally recommend a semen analysis. To provide a sample, you’ll either ejaculate into a sterile container, or, you might be instructed to acquire a sample at home, using a special condom. Be aware: you’ll have to abstain from sex for two to five days before the sample is collected. This is to ensure there is enough semen to analyze. 

A “normal” sperm count range is 40 million to 300 million sperm per milliliter of semen. Counts below 15 million are considered poor (“oligospermia”). Anything from 20-40 million may still be fine if other factors (like motility and morphology) are normal.  

The good news

This mission might seem a little daunting, but one good thing is that your sperm count doesn’t have to be perfect for your partner and you to conceive. You don’t need to bat 1,000 to hit a home run. But it’ll increase your chances of getting pregnant sooner if you can increase sperm count, so we’re going to take you through how to do it. And the good news is that most methods aren’t too difficult or expensive.

And another good thing: men’s bodies continually make new sperm over time (unlike women, who are born with all the eggs they’ll ovulate in a lifetime), and it takes about 72 days for a sperm to fully develop. So if you make lifestyle changes, they’ll affect the new sperm that your body’s working on producing. In summary, it is not too late to grow some healthy sperm!

How to improve sperm count

It turns out that your sperm’s wellness and your own wellness have a lot in common. To make both you and your sperm healthier, you should:

  • Eat a balanced diet
  • Get plenty of sleep
  • Exercise regularly
  • Avoid too much stress
  • Avoid excessive alcohol and drug use
  • Don’t smoke cigarettes

The silver lining with all of this self-care is that you’ll probably want to work on building all of those habits anyway when you’ve got a newborn baby in your life, and if you start them now, it’ll be easier to continue with them than if you juggle starting self-improvement in one hand and your new baby in the other. 

Substance-specific do's and don’ts

Don’t: take medications associated with (temporary) reduction of sperm count, including some antibiotics, anabolic steroids, testosterone, and narcotics like oxycodone and methadone. As always, talk to your doctor about options if you have questions about avoiding any of those.

Don’t: drink excessively or smoke. Alcohol abuse affects sperm morphology and sperm production. Smoking hampers sperm motility and seminal fluid quality.

Do: consider taking vitamins and supplements that have been shown to increase sperm count, including: 

  • Coenzyme Q10
  • L-Carnitine
  • Glutathione
  • Selenium
  • Zinc + Folate 

These are some of the most evidence-based supplements that are generally accepted by professionals in the field of male fertility. There are hundreds of other suggestions out there, but the data are currently insufficient to recommend them. 

A word on temperature

In case you don’t remember this fun fact from biology class, the male anatomy is arranged so that your balls stay at a slightly lower temperature than your body. Generally, they want to be just a few degrees cooler than the rest of your body. That’s also why swimming in super cold water has that memorable effect—your balls move up towards your body to try to keep your sperm from getting too cold. 

You may hear that “scrotal cooling” (cooling your balls) with cold showers, ice-pack underwear, or frozen peas can improve male fertility. Though there might be something to this idea, unfortunately there just isn’t enough evidence that scrotal cooling definitely improves fertility to recommend it at this point.

But you will want to avoid high temperatures. You’ve probably heard that you’re not supposed to leave a hot laptop on your lap. This is trueit’s not a good idea to expose your testicles to high temperatures. This means you’ll also want to avoid saunas and hot tubs for the time being (sorry!).

Conclusion

As we’ve outlined, sperm count is just a piece of male fertility. If you’ve been diagnosed with low sperm count (oligospermia), it’s not the end of the road. Sperm regenerates about every two to three months, so follow the lifestyle recommendations above to give your sperm the best shot possible. And as always, we recommend seeing a doctor if you have any questions or concerns. 

 

Cover art by Anthony Zinonos