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Generally speaking, couples are considered infertile after about a year of trying to conceive with unprotected sex. Crossing the invisible line into the infertility world can be overwhelming and intimidating. Aside from feeling like pregnancy announcements are posted everywhere you look, you may worry about your overall health and not know what to do next.

You’re not alone. Some 12 to 13 in 100 couples experience infertility. Up to 50 percent Trusted Source of these cases can be attributed to what’s called male-factor infertility. Azoospermia is a possible cause, which is marked by a total lack of sperm in the semen. While rare, about 1 percent Trusted Source of men have azoospermia, and it’s the root of between 10 to 15 percent Trusted Source of infertility cases.

No sperm count

Here’s a quick lesson in how the body works: Sperm is made in the testicles. It travels through the reproductive tract and mixes with the fluid that’s found in the seminal ducts. Together, the sperm and this fluid make semen the thick, white ejaculate that comes out of the penis.

With azoospermia, the sperm is taken out of the equation. You may have ejaculate, but it doesn’t contain sperm. You may be familiar with the term “low sperm count” — but azoospermia, on the other hand, is referred to as “no sperm count.”

There are three types of azoospermia:

  • Pre-testicular azoospermia (non-obstructive) is caused by impaired production of the hormones responsible for creating sperm.
  • Testicular azoospermia (non-obstructive) is caused by any abnormalities in the function or structure of the testicles.
  • Post-testicular azoospermia (obstructive) is caused by problems with ejaculation due to an obstruction of some sort in the reproductive tract.
What causes the different types of azoospermia?

Each type of azoospermia has its own set of possible causes or associated conditions. Overall, genetic conditions that affect the Y chromosome may cause between 10 and 15 percent of cases of no or low sperm count.

Pre-testicular azoospermia

This non-obstructive type may be brought about by certain genetic disorders. For example, Kallmann syndrome affects the body’s ability to produce gonadotropin-releasing hormone (GnRH) and can, in turn, impact sperm production.

Issues with the brain, specifically damage to the hypothalamus or pituitary gland, may also cause this type of azoospermia. Taking certain medications or having radiation treatments for cancer can contribute as well.

Testicular azoospermia

This non-obstructive type may happen due to:

  • the absence of testicles (anorchia)
  • testicles that haven’t dropped (cryptorchidism)
  • testicles that don’t produce sperm (sertoli cell-only syndrome)
  • testicles that don’t produce mature sperm (spermatogenic arrest)

Klinefelter syndrome is another possibility, and may result when a person is born with chromosomes XXY instead of XY.

Other causes include:

  • having the mumps in late puberty
  • tumors
  • radiation
  • diabetes
  • prior surgery
  • reactions to certain medications
  • varicocele (when the veins coming from testicles are dilated/wide)

Post-testicular azoospermia

This obstructive type is present in about 40 percent of azoospermia cases. Obstruction may happen due to a missing connection somewhere, like in the epididymis or vas deferens tubes that move and store sperm.

Congenital conditions may also cause obstruction. For example, congenital bilateral absence of the vas deferens (CBAVD) is a genetic condition where the vas deferens ducts that carry sperm from the testes may be missing. It’s associated with either having or carrying genes for cystic fibrosis.

Other causes of obstructive azoospermia include things like previous or current infection, cysts, injury, or vasectomy.

What are the symptoms of azoospermia?

You may not have any symptoms or even know you have azoospermia until your efforts conceive are unsuccessful. Any other signs or symptoms you encounter may be more related to the underlying causes, like hormonal imbalances or genetic chromosomal conditions.

Otherwise, possible symptoms might include:

  • low sex drive
  • erectile dysfunction
  • lump, swelling, or discomfort around the testicles
  • decreased hair on the face or body
How is azoospermia diagnosed?

The most basic way you might be diagnosed with azoospermia is through a semen analysis. Your doctor will ask you to ejaculate into a cup and submit the specimen to a lab for testing. If no living sperm is observed in the ejaculate, it’s possible you may have azoospermia.

Along with a physical exam, your doctor will be interested in your medical history. They may ask questions about:

  • your fertility history (whether or not you’ve conceived children)
  • your family history (like cystic fibrosis or fertility issues)
  • illnesses you had as a child
  • different surgeries or procedures you’ve had to the pelvic area or reproductive tract
  • history of infections, like urinary tract infections (UTIs) or sexually transmitted infections (STIs)
  • prior or current exposure to things like radiation or chemotherapy
  • prior or current medication use
  • any possible misuse of drugs or alcohol
  • recent illness that involved fever
  • recent exposure to high heat

Other diagnostic tools might include:

  • blood tests to evaluate hormone levels or genetic conditions
  • ultrasound to visualize the scrotum and other parts of the reproductive tract
  • brain imaging to look for issues with the hypothalamus or pituitary gland
  • biopsies to more closely examine sperm production
What are the medical treatments for azoospermia?

Obstructive azoospermia may be treated by either reconnecting or reconstructing the tubes or ducts that aren’t allowing the sperm to flow. This may mean surgery or other procedures. Hormonal treatments and medications may also help if the underlying cause is low hormone production.

Non-obstructive azoospermia may or may not respond to medical treatment. But there’s some good news: You may still be able to achieve pregnancy with a biological child through in vitro fertilization or intracytoplasmic sperm injection.

How? Your doctor can extract sperm from the testes using a tiny needle. This retrieval may be done during a biopsy as well. This procedure may work even if you only have a few sperm present in your testicles.

If you choose to go this route, it’s important to receive genetic counseling to understand the root cause and how it may impact any biological children.

Are there any natural remedies that can help?

Home methods to help with sperm production may or may not work with azoospermia. While low sperm count may respond well to certain herbs and dietary changes, sperm that’s absent due to an obstruction or genetic condition may not respond in the same way (if at all).

That isn’t to say that taking care of yourself by eating a well-balanced diet, getting plenty of rest, drinking enough fluids, and keeping stress in check can’t help. Aside from caring for your general well-being, consider working closely with your doctor to determine what if any natural remedies may help in your case.

Things to try:

  • Eat a diet full of whole, nutrient-dense foods to foster sperm production
  • Exercise regularly. Doing so may help boost testosterone levels
  • Try yoga or meditation to lower your stress levels. Cortisol (stress hormone) can impact testosterone production
  • Ask your doctor about herbs and supplements that may promote male fertility, like Tribulus terrestris, black seed, Coenzyme Q10, folic acid, horse chestnut, L-carnitine, Panax ginseng, and zinc.
Preventing azoospermia

There are some ways you can protect sperm production in cases of azoospermia that are caused by things like injury or certain medications.

Try to:

  • Stay away from any activities, like rough contact sports, that may harm your testes and reproductive tract.
  • Limit your exposure to radiation.
  • Speak with your doctor about the benefits and risks of medications that may impact sperm production.
  • Avoid activities that may expose your testes to high temperatures, like saunas or steam baths.

Being diagnosed with azoospermia or hearing the words “no sperm count” can be scary. Take a deep breath having this condition doesn’t necessarily mean you can’t have biological children.

It’s important to first understand what’s causing the issue. After discussing and addressing the cause, your doctor may have different treatment options that correct the blockage. Otherwise, procedures like IVF may help you achieve pregnancy with your partner.

10 Ways to Boost Male Fertility and Increase Sperm Count

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If you and your partner are experiencing fertility issues, know that you’re not alone. Infertility is more common than you might think.

It affects about one in every six couples, and researchers estimate about one in every three cases is due to fertility problems in the male partner alone

While infertility is not always treatable, there are some things you can do to boost your chances of conceiving. Fertility can sometimes be improved with a healthy diet, supplements, and other lifestyle strategies.

This article lists some of the main lifestyle factors, foods, nutrients, and supplements that have been associated with improved fertility in men.

What is male infertility?

Fertility refers to people’s ability to reproduce without medical assistance.

Male infertility is when a man has a poor chance of making his female partner pregnant. It usually depends on the quality of his sperm cells.

Sometimes infertility is linked to sexual function, and other times it could be linked to semen quality. Here are some examples of each:

  • Libido. Otherwise known as sex drive, libido describes a person’s desire to have sex. Foods or supplements that claim to increase libido are called aphrodisiacs.
  • Erectile dysfunction. Also known as impotence, erectile dysfunction is when a man is unable to develop or maintain an erection.
  • Sperm count. An important aspect of semen quality is the number or concentration of sperm cells in a given amount of semen.
  • Sperm motility. An essential function of healthy sperm cells is their ability to swim. Sperm motility is measured as the percentage of moving sperm cells in a sample of semen.
  • Testosterone levels. Low levels of testosterone, the male sex hormone, may be responsible for infertility in some men.

Infertility can have multiple causes and may depend on genetics, general health, fitness, diseases, and dietary contaminants.

Additionally, a healthy lifestyle and diet are important. Some foods and nutrients are associated with greater fertility benefits than others.

Here are 10 science-backed ways to boost sperm count and increase fertility in men.

1. Take D-aspartic acid supplements

D-aspartic acid (D-AA) is a form of aspartic acid, a type of amino acid that’s sold as a dietary supplement.

It should not be confused with L-aspartic acid, which makes up the structure of many proteins and is far more common than D-AA.

D-AA is mainly present in certain glands, such as the testicles, as well as in semen and sperm cells.

Researchers believe that D-AA is implicated in male fertility. In fact, D-AA levels are significantly lower in infertile men than fertile men

This is supported by studies showing that D-AA supplements may increase levels of testosterone, the male sex hormone that plays an essential role in male fertility.

For example, a study in infertile men suggested that taking 2.7 grams of D-AA for 3 months increased their testosterone levels by 30–60% and sperm count and motility by 60–100%.

The number of pregnancies also increased among their partners

Another controlled study in healthy men showed that taking 3 grams of D-AA supplements daily for 2 weeks increased testosterone levels by 42%

However, the evidence is not consistent. Studies in athletes or strength-trained men with normal to high testosterone levels found that D-AA didn’t increase its levels further and even reduced them at high doses

The current evidence indicates that D-AA supplements may improve fertility in men with low testosterone levels, while they don’t consistently provide additional benefits in men with normal to high levels.

More research is needed to investigate the potential long-term risks and benefits of D-AA supplements in humans.

Shop for D-aspartic acid supplements online.

2. Exercise regularly

Besides being good for your general health, exercising regularly can boost testosterone levels and improve fertility.

Studies show that men who exercise regularly have higher testosterone levels and better semen quality than inactive men

However, you should avoid too much exercise, as it may have the opposite effect and potentially reduce testosterone levels. Getting the right amount of zinc can minimize this risk

If you rarely exercise but want to improve your fertility, make becoming physically active one of your top priorities.

3. Get enough vitamin C

You’re probably familiar with vitamin C’s ability to boost the immune system.

Some evidence indicates that taking antioxidant supplements, such as vitamin C, may improve fertility.

Oxidative stress is when levels of reactive oxygen species (ROS) reach harmful levels in the body.

It happens when the body’s own antioxidant defenses are overwhelmed because of disease, old age, an unhealthy lifestyle, or environmental pollutants

ROS are constantly being produced in the body, but their levels are kept in check in healthy people. High levels of ROS may promote tissue injury and inflammation, increasing the risk of chronic disease

There’s also some evidence that oxidative stress and excessively high levels of ROS may lead to infertility in men

Taking in enough antioxidants, such as vitamin C, may help counteract some of these harmful effects. There’s also some evidence that vitamin C supplements may improve semen quality.

A study in infertile men showed that taking 1,000-mg vitamin C supplements twice a day for up to 2 months increased sperm motility by 92% and sperm count by more than 100%. It also reduced the proportion of deformed sperm cells by 55%

Another observational study in Indian industrial workers suggested that taking 1,000 mg of vitamin C five times a week for 3 months may protect against DNA damage caused by ROS in sperm cells.

Vitamin C supplements also significantly improved sperm count and motility, while reducing the numbers of deformed sperm cells

Taken together, these findings suggest that vitamin C may help improve fertility in infertile men with oxidative stress.

However, controlled studies are needed before any definite claims can be made.

4. Relax and minimize stressIt’s hard to get in the mood when you’re feeling stressed, but there might be more to it than not feeling up for sex. Stress may reduce your sexual satisfaction and impair your fertility

Researchers believe the hormone cortisol may partly explain these adverse effects of stress.

Prolonged stress raises levels of cortisol, which has strong negative effects on testosterone. When cortisol goes up, testosterone levels tend to go down

While severe, unexplained anxiety is typically treated with medication, milder forms of stress can be reduced with relaxation techniques.

Stress management can be as simple as taking a walk in nature, meditating, exercising, or spending time with friends.

5. Get enough vitamin D

Vitamin D can be important for male and female fertility. It’s another nutrient that may boost testosterone levels.

One observational study showed that vitamin-D-deficient men were more likely to have low testosterone levels (27Trusted Source).

A controlled study in 65 men with low testosterone levels and vitamin D deficiency supported these findings. Taking 3,000 IU of vitamin D3 every day for 1 year increased their testosterone levels by around 25%

High vitamin D levels are linked to greater sperm motility, but the evidence is inconsistent

6. Try tribulus terrestris

Tribulus terrestris, also known as puncture vine, is a medicinal herb frequently used to enhance male fertility.One study in men with low sperm counts showed that taking 6 grams of tribulus root twice daily for 2 months improved erectile function and libido

While Tribulus terrestris does not raise testosterone levels, research indicates that it may enhance the libido-promoting effects of testosterone

However, further studies are needed to confirm its aphrodisiac properties and evaluate the long-term risks and benefits of supplementing with it.

7. Take fenugreek supplements

Fenugreek (Trigonella foenum-graecum) is a popular culinary and medicinal herb.One study in 30 men who strength-trained four times a week analyzed the effects of taking 500 mg of fenugreek extract daily.

The men experienced significantly increased testosterone levels, strength, and fat loss, compared with a placebo

Another study in 60 healthy men showed that taking 600 mg of Testofen, a supplement made from fenugreek seed extract and minerals, daily for 6 weeks improved libido, sexual performance, and strength

These findings were confirmed by another, larger study in 120 healthy men. Taking 600 mg of Testofen every day for 3 months improved self-reported erectile function and the frequency of sexual activity.

Also, the supplement significantly increased testosterone levels

Keep in mind that all of these studies examined fenugreek extracts. It’s unlikely that whole fenugreek, which is used in cooking and herbal tea, is as effective.

8. Get enough zincZinc is an essential mineral found in high amounts in animal foods, such as meat, fish, eggs, and shellfish.

Getting enough zinc is one of the cornerstones of male fertility.

Observational studies show that low zinc status or deficiency is associated with low testosterone levels, poor sperm quality, and an increased risk of male infertility

Also, taking zinc supplements increases testosterone levels and sperm count in those who are low in zinc

Furthermore, zinc supplements may reduce the decreased testosterone levels that are associated with excessive amounts of high-intensity exercise

Controlled trials need to confirm these observational findings.

9. Consider ashwagandhaAshwagandha (Withania somnifera) is a medicinal herb that’s been used in India since ancient times.

Studies suggest that ashwagandha may improve male fertility by boosting testosterone levels.

One study in men with low sperm cell counts showed that taking 675 mg of ashwagandha root extract per day for 3 months significantly improved fertility.

Specifically, it increased sperm counts by 167%, semen volume by 53%, and sperm motility by 57%, compared with levels at the start of the study. In comparison, minimal improvements were detected among those who got a placebo treatment

Increased testosterone levels may be partly responsible for these benefits.

A study in 57 young men following a strength-training program showed that consuming 600 mg of ashwagandha root extract daily significantly increased testosterone levels, muscle mass, and strength, compared with a placebo

These findings are supported by observational evidence indicating that ashwagandha supplements may improve sperm counts, sperm motility, antioxidant status, and testosterone levels

10. Eat Maca rootTaking maca root supplements may improve libido, as well as fertility and sexual performance.

Maca root is a popular plant food that originated in central Peru. Traditionally, it has been used for its ability to enhance libido and fertility.

Several studies in men showed that taking 1.5–3 grams of dried Maca root for periods of up to 3 months improved self-reported sexual desire or libido.

Studies also suggest that maca root may improve sexual performance. In men with mild erectile dysfunction, taking 2.4 grams of dried maca root for 12 weeks slightly improved self-reported erectile function and sexual well-being.

Taking 1.75 grams of Maca root powder every day for 3 months also increased sperm count and motility in healthy men.

These findings have been partly confirmed by reviews, but the researchers noted that the evidence is weak and more research is needed before definite claims can be made.

Additionally, maca root doesn’t seem to affect hormone levels. Taking 1.5–3 grams of Maca root per day for 3 months had no effects on testosterone or other reproductive hormones in healthy, fertile men

Other tipsMany things can help boost fertility, but what works for you depends on the cause of your fertility issues.

Also, keep in mind that fertility and libido usually go hand in hand with your general health.

For this reason, anything that improves your overall health is likely to boost your fertility.

Here are 8 additional tips to boost fertility and sperm count/quality:

-Lead a healthy lifestyle. Unhealthy lifestyle practices impair your overall health, including fertility.

-Lose excess weight. Carrying extra weight is associated with infertility. If your doctor suspects that weight may be linked to your infertility, discuss weight loss as one of your health goals

-Limit your alcohol intake. Avoid heavy alcohol consumption, as it may reduce testosterone levels and impair semen quality.

-Get enough folate. A few studies indicate that a low intake of folate may impair semen quality

-Get adequate sleep. Getting adequate sleep is vital to maintaining your health. Restricted or excessive sleep has also been linked to poor semen quality.

-Snack on walnuts. Eating a lot of antioxidant-rich foods, such as walnuts, seems to benefit fertility

-Consider supplements. Antioxidant supplements also seem to work. Some evidence suggests that coenzyme Q10 improves semen quality.

-Avoid eating too much soy. Soy is rich in isoflavones, which are associated with lower semen quality.

The bottom lineInfertility is fairly common and affects many men worldwide.

If you’re having fertility issues, one thing you can do is focus on improving your general health. Many of the tips mentioned above are key components of a healthy lifestyle.

There’s no guaranteed fix, but if nutrient deficiencies or low testosterone levels are contributing factors, chances are that these lifestyle tips may help.

What Is a Normal Sperm Count?

What’s normal?

Sperm count can be important if you’re trying to conceive a child. An abnormal sperm count may also indicate an underlying health condition.

A normal sperm count ranges from 15 million sperm to more than 200 million sperm per milliliter (mL) of semen. Anything less than 15 million sperm per milliliter, or 39 million sperm per ejaculate, is considered low. A low sperm count is often referred to as oligospermia. A high, or above average, sperm count is over 200 million sperm per millimeter.

You can determine your sperm count through a semen analysis. You can get the analysis done at your doctor’s office, a fertility clinic, or with an at-home test.

Understanding your semen analysis

A semen analysis tests for the following:

  • number of sperm (volume)
  • shape of sperm
  • movement of sperm, or “sperm motility”

The number, shape, and mobility of sperm are important for testing for male factor infertility. Your doctor may recommend testing up to three samples of sperm at different visits to get an accurate analysis.

At-home tests only test for the number of sperm. Talk to your doctor if you are interested in a full analysis.

Semen analysis results table

The following are the healthy or normal semen analysis results, as determined by the World Health Organization (WHO). Since results can vary from person to person, results are given as a range.

WHO reference range
Total sperm count in ejaculate 39–928 million
Ejaculate volume 1.5–7.6 mL
Sperm concentration 15–259 million per mL
Total motility (progressive and non-progressive) 40–81 percent
Progressive motility 32–75 percent
Sperm morphology 4–48 percent

Why does sperm count matter?

If you’re trying to conceive naturally, a healthy sperm count is often necessary. Even though it only takes one sperm and one egg to get pregnant, more healthy sperm will increase your chances of pregnancy each month.

Even if you aren’t trying to conceive, your sperm count may be an important measure of overall health. One study found men with a low sperm count were more likely to have a higher percentage of body fat (bigger waistline and higher BMI) and higher blood pressure than men with higher sperm counts. They also experienced a higher frequency of metabolic syndrome, or higher chance of developing diabetes, heart disease, and stroke.

For these reasons, if you’re diagnosed with a low sperm count, your primary care doctor may want to evaluate your testosterone levels, lifestyle, and overall health.

Sperm count can affect fertility because your chance of getting your partner pregnant decreases with a lower sperm count. Problems with the quality of sperm can also affect your chances of getting a woman pregnant.

Male infertility factor, often due to a low sperm count, is a common reason many couples have trouble conceiving. But couples may also experience other health issues that can affect fertility. In some cases, infertility may be due to female factors, like:

  • low ovarian reserve
  • a blocked fallopian tube
  • endometriosis

Lack of conception may also be the result of not trying to conceive for long enough. In many cases, it can take six months to a year to get pregnant when there are no fertility concerns.

If you are over 35, and you and your partner have been trying to conceive for six months, your doctor may refer you to a fertility specialist. If you have been trying to conceive for over one year, and you and your partner are under 35, see your doctor for a referral.

Are there treatments for low sperm count?

Infertility or a low sperm count may be caused by a number of factors, including:

  • genetics
  • past surgeries
  • general health
  • sexually transmitted diseases

Your doctor can assess your sperm count and recommend treatment.

Possible treatment options include:

  • Surgery. If you have a varicocele or obstructed vas deferens, surgical correction or repair may be recommended.
  • Antibiotics. If a bacterial infection is affecting your sperm count or fertility, your doctor may prescribe antibiotics.
  • Medication or counseling. These may be used for sexual intercourse problems such as premature ejaculation or erectile dysfunction.
  • Hormone treatments and medications. For cases where high or low hormone levels influence infertility, hormone treatments may help.
Improving sperm count

While many causes of a low sperm count require medical intervention, lifestyle choices can also factor in. The following may improve sperm count:

  • Lose weight. Being obese or overweight can cause a low sperm count. Try to maintain a healthy lifestyle through diet and exercise.
  • Take vitamin supplements. Ask your doctor for a blood test to test for vitamin deficiencies. They may recommend adding new foods to your diet, or taking supplements to help restore vitamin and mineral levels.
  • Avoid substance abuse, including heavy drinking and drug or tobacco use.
  • Wear loose, cotton boxers.

There are many factors that can affect your sperm count, including lifestyle choices or underlying medical conditions. If you have a low sperm count, your doctor may recommend options for you to raise your sperm count, or they may refer you to a urologist or fertility specialist, if needed.

If you have a low sperm count and are hoping to conceive a child, there are many fertility options available today, including a range of treatments like:

  • intrauterine insemination (IUI)
  • in vitro fertilization (IVF)
  • IVF with intracytoplasmic sperm injection (ICSI)

How Long Does It Take to Get Pregnant?

For some people, getting pregnant can take longer than expected. For others, pregnancy happens with one mistake in birth control.

It’s important to take care of yourself when trying to conceive. Adopt a healthy lifestyle and avoid alcohol, smoking, and recreational drugs. You might also begin taking a daily prenatal vitamin.

The timing of pregnancy for one couple can be very different from the timing with another couple. Your likelihood of conceiving depends on a few factors, including your:

  • age
  • health
  • family and personal medical history

Of course, how often you have sex also plays a role.

Most couples are able to get pregnant within six months to a year. If you’re unable to conceive after a full year of trying, it’s a good idea to consult a fertility specialist.

Sometimes there’s an obvious cause of infertility, like a physical problem with the ovaries, uterus, or testicles. In other cases, the cause is unknown.

Here’s what you need to know if you’ve been trying to get pregnant and it’s taking longer than you’d planned.

How long does it take to get pregnant?

Women have the best odds of getting pregnant in their 20s. That’s when you have the largest number of healthy eggs.

Fertility naturally declines with age. The older you are, the longer it might take you to conceive.

Women are born with all the eggs they’ll ever have. As you get older, your egg supply diminishes. And the ones that remain aren’t as healthy.

By age 35, you have only a 12 percent chance of getting pregnant within any given three-month period, according to a study in PLoS One. By age 40, that number drops to 7 percent.

A man’s fertility also declines with age. An older man’s sperm is also more likely to have genetic abnormalities.

How common is infertility?

According to RESOLVE, 1 out of every 8 couples, or 12 percent of women, have trouble getting pregnant or carrying a pregnancy to term.

When should you see a doctor about infertility?

  • if you’re 35 or younger and you’ve been trying to get pregnant for a year
  • if you’re over age 35 and you’ve been trying for more than 6 months

If you know you have a health condition that affects your fertility, see your doctor sooner.

Female infertility is a factor for about one-third of couples who are trying to conceive.

The most common cause is a problem with ovulation. If you don’t ovulate, you won’t release an egg to be fertilized.

Ovulation problems can be caused by:

  • polycystic ovarian syndrome (PCOS)
  • premature ovarian insufficiency (POI)

Blocked fallopian tubes prevent the egg from meeting the sperm. Possible causes of a blockage include:

  • pelvic inflammatory disease (PID)
  • endometriosis
  • surgery for an ectopic pregnancy

A problem with the uterus can also make it harder to get pregnant. This may be due to an abnormal structure, or due to growths like fibroids.

Causes of male infertility

Male infertility is a factor for about 8 percent of couples who are trying to conceive.

Causes of male infertility include:

  • enlarged veins on the testicles, called varicocele
  • abnormally shaped sperm
  • injury to the testes that reduces sperm production
  • heavy drinking, smoking, or drug use
  • chemotherapy or radiation to treat cancer
  • problems with the glands that produce the hormones needed to make sperm
  • more rarely, genetic disorders such as Klinefelter syndrome
Unexplained infertility

In about 5 to 10 percent of couples, the cause of infertility is unexplained. It may be caused by problems with egg or sperm quality or a physical issue, but the doctor hasn’t been able to diagnose a clear reason.

Not knowing the cause can be frustrating for couples. Yet in vitro fertilization (IVF) and other fertility methods can still help you get pregnant.

Treatments for infertility

Fertility specialists offer a variety of treatments, and sometimes more than one treatment is combined.

Which method your doctor recommends depends on factors like your age, health, and what caused your fertility problem.


A few drugs are commonly used to stimulate a woman’s ovaries to release an egg:

  • clomiphene citrate (Clomid)
  • follicle-stimulating hormone (Follistim, Gonal-F)
  • letrozole (Femara)
  • human menopausal gonadotropin (Menopur, Pergonal, Repronex)
  • metformin (Glucophage)
  • bromocriptine (Parlodel)

One thing to know about these medications is that they can increase your riskTrusted Source of giving birth to twins or other multiples.

Medications can also help men with infertility by increasing their sperm count.


Surgery is a treatment for both male and female infertility. In men, surgical procedures can clear up a sperm blockage, fix a varicocele, or retrieve semen from a man’s reproductive tract.

In women, surgery can be done to fix physical problems with the ovaries or uterus.

Intrauterine insemination (IUI)

This method is also called artificial insemination. The man produces a sperm sample that is then injected through a catheter into the woman’s uterus right around the time when she is ovulating. She may get medicine beforehand to help her ovulate.

Assisted reproductive technology (ART)

Assisted reproductive technology (ART) combines the sperm and eggs outside the body, and then places the embryos into the uterus. The main type of ART is in vitro fertilization (IVF).

Before IVF, the woman will get a series of injections to help her ovaries produce a lot of eggs. Once those eggs are mature, they’ll be removed using a simple surgical procedure.

The eggs are fertilized with her partner’s sperm. Fertilized eggs, known as embryos, are grown in the lab for a few days. One or two good quality embryos are then transferred into the uterus.

Other ARTs are:

  • Intracytoplasmic sperm injection (ICSI). One healthy sperm is injected into an egg.
  • Assisted hatching. The embryo cover is opened to help it implant more easily in the uterus.
  • Donor eggs or sperm. If there’s a problem with the eggs or sperm, you can get either one from a healthy donor.
  • Gestational carrier. Another woman carries your baby to term for you.
The Takeaway

Pregnancy isn’t always the journey you expected. Sometimes it takes longer than you’d hoped to get pregnant, especially if age or physical issues are factors.

If you’ve been trying for a while with no success, see an infertility specialist for help. Or turn to an organization like ASB for advice.

All About Male Fertility Testing

If you’re planning to father a child, know that fertility is a 50-50 deal: half egg, half sperm. So it probably isn’t coincidental that male fertility is a factor in 50 percent of infertility challenges.

This isn’t a blame game, though. It’s about empowering yourself with the knowledge you need to get the outcome you want. If you and your partner are having a hard time getting pregnant, it’s a good idea for both of you to get checked.

Let’s take a look at male fertility testing and what may (or may not) be contributing to the challenge of having a child.

Factors that can affect male fertility

Research shows that male infertility affects up to 6 percent of men in North America. But what causes it? Several factors could contribute:

  • anatomical or genetic abnormalities
  • systemic or neurological diseases
  • infections
  • trauma
  • gonadotoxic radiation therapy
  • sperm antibodies
Can you just use a home fertility test kit and call it a day?

When you’re feeling the sting of another letdown, you may start weighing the pros and cons of home fertility tests. These lists give you a full picture:

The pluses

  • A home kit relieves you of the stress of providing a sperm sample in the doctor’s office.
  • Your concerns remain private.
  • The kits are inexpensive, as well as quick and easy to use.
  • A good kit, like SpermCheck Fertility can reliably tell you whether your sperm count is typical, low, or very low. This will help you plan your next step.

Shop for SpermCheck Fertility online.

The minuses

  • Home kits won’t give you all the information you need. While they can tell you if your sperm count is normal or not, these numbers are only one factor in male fertility.
  • The range for low and optimal sperm counts varies between the kits.
  • Some kits don’t measure sperm counts below certain levels.

For these reasons, while a home kit might be a helpful first step, you’ll need to be medically evaluated by a doctor for a more complete picture of your fertility.

What to expect at an initial medical evaluation appointment

You’ve booked the initial appointment. Knowing that you’re prepped will ease any tension you may be feeling. Here’s a breakdown of what to expect.

First comes the physical exam. The medical practitioner will examine your penis and testicles.

Next, you’ll be asked questions about your:

  • medical history
  • lifestyle
  • sex life

Questions about your medical history may include:

Questions about your lifestyle may include:

  • How much do you exercise? (Give an honest answer!)
  • Do you smoke or take recreational drugs?

When it comes to your sex life, you can expect a frank discussion that includes any problems you may have, such as:

Semen analysis

After the physical exam and the questions, you’ll be asked to provide a semen sample.

How semen analysis is done

Semen samples are given in two different ways.

You can ejaculate into a special container at the doctor’s office. If this isn’t an option because of your religious or cultural beliefs, you can use a special condom during intercourse.

Be prepared to possibly provide several samples, because sperm counts do fluctuate from one specimen to the next.

What semen analysis shows about fertility

You’ve done your part by providing the sample. Now it’s up to the clinician to analyze it. According to a 2015 study done in India, as much as 2 percentTrusted Source of all men have sperm measurements that aren’t optimal.

So what is your doctor looking for? In a nutshell:

  • Signs of infection. The presence of certain bacteria in semen can indicate infection.
  • Volume of semen. This is a measurement of how much semen in total is in your sample.
  • Sperm concentration. The World Health Organization (WHO) classifies sperm counts at or above 15 million spermTrusted Source per milliliter of semen as average.
  • Vitality. This examines what percentage of sperm are alive.
  • Motility. Are the sperm moving? Above 63 percentTrusted Source motility indicates fertility, while less than 32 percent of sperm with motility indicates subfertility.
  • Morphology. How are the sperm shaped? Believe it or not, the majority of sperm in your sample won’t be perfect. But if more than 12 percentTrusted Source are of normal size and shape, it indicates fertility. A sample with less than 9 percent normal morphology could mean sub- or infertility. (Between 9 and 12 percent is inconclusive.)

So much for the numbers. Now let’s crunch them.

While the numbers help to distinguish between fertility, subfertility, and indeterminate fertility, none of them actually diagnoses infertility. That said, here are two things to keep in mind:

  • A semen sample with a decreased sperm concentration often also shows abnormalities in sperm motility and morphology.
  • The percentage of sperm with normal morphology is perhaps the best indicator of healthy semen.

Sometimes, sperm cells pass all the standard medical tests for fertility, but you still have trouble growing your family.

That could indicate a condition called normozoospermic infertility, meaning that the sperm cells themselves are infertile. Here’s where urinalysis comes in.

How urinalysis is done

At the doctor’s office or the testing facility, you’ll be given a plastic cup and asked to be provide a small, clean urine sample. Use the cleaning wipe you’ve been given to wipe around your urethra to prevent bacteria on your penis from entering the cup.

What urinalysis shows about fertility

2014 study shows that doctors can now test for normozoospermic infertility by tracking the levels of five biomarkers (small molecules) in urine.

While standard fertility tests may capture 75 percent of cases, the researchers were able to correctly identify 86 percent of the infertile men and 87 percent of the fertile men.

What does that mean for you? While there’s still more research needed in this area, researchers suggest that the variant levels of these biomarkers may point to physiological problems as the root of normozoospermic infertility.

Making sperm is an energy-intensive process and any spoke in the production wheel could disrupt proper sperm production. The more we learn about the biomarkers, the easier it will be to fix any physiological problems.

Hormone testing

The pituitary gland, hypothalamus, and testicles work together when it comes to sperm production.

Follicle stimulating hormone (FSH) and luteinizing hormone (LH) — acting together with testosterone, which is produced in the testicles — are involved in the process.

A simple blood test will show the level of these three important hormones in your blood.


This hormone contributes to sperm production.

High levels may indicate that your testicles aren’t functioning properly or have been damaged by disease, X-rays, or chemotherapy. Low levels may show that you aren’t producing sperm.


This is produced in the pituitary gland. In the testes, LT binds to receptors in the Leydig cells to release testosterone, which is needed to produce sperm.

LH levels can also be measured after giving an injection of gonadotropin releasing hormone (GnRH). The advantage to measuring LH this way is that your doctor can then pinpoint whether the problem is with your pituitary gland or another part of your body.


Healthy testosterone levels for men range between 300 to 1,000 nanograms per deciliter (ng/dL). Keep in mind that after the age of 40, testosterone levels decrease by an average of around 1 percent every year.

Imaging to check for anatomical issues and any obstructions

In some cases, your doctor may ask for imaging to check that your anatomical structure is OK and that there are no obstructions.

Scrotal ultrasound

In this exam, a handheld probe is swept across your scrotum. The scan uses high-frequency sound waves to check for:

  • infections
  • cysts
  • a collection of fluids inside the testicles
  • tumors

The test also checks for testicular torsion and varicoceles. While many adult men have a varicocele and are never bothered by it, if you’re dealing with infertility, your doctor may recommend surgery.

Transrectal ultrasound

A small, lubricated wand is inserted into your rectum. The imaging helps your doctor to check your prostate and check that there are no blockages in the vas deferens. Blockages can be corrected with surgery.

Anti-sperm antibodies testing

Usually, sperm doesn’t come into contact with the rest of your body and immune system. However, injury, surgery, or prostate gland infections can interfere with this protective system.

And when sperm comes into contact with your immune system, the body may produce anti-sperm antibodies.

Your doctor may ask for an anti-sperm antibody test if the cause for infertility is still missing.

You’ll be asked to provide a sample of semen. The test checks your semen for antibodies that fight against your sperm by using a substance that binds only to affected sperm.

The higher the level of sperm affected by antibodies, the lower the chance of a sperm fertilizing an egg. (These antibodies can also be found in women, so your doctor may ask for your partner to get tested too.)

Doctors are divided over whether this testing is advisable. Some say it doesn’t help set a treatment plan for infertility; others advise taking medication to lower the body’s immune response.

Testicular biopsy

This test may come at the end of the line if the other tests you’ve done aren’t conclusive.

In this test, a sample is removed from the testicle, either with a needle or through a small cut. If the results of the testicular biopsy show that sperm production is normal, your infertility may be caused by a blockage or some other problem with sperm transport.

Genetic testing

Following the development of in vitro fertilizing techniques, research on genetic causes for infertility has expanded. Genetic abnormalities are found in 10 percent to 20 percentTrusted Source of men who have severe disorders with sperm production.

Genetic testing carried out on DNA can help rule out chromosomal abnormalities, especially in men with either azoospermia (no sperm present in the semen) or oligozoospermia (low sperm count).

The test results can:

  • relieve you of uncertainty
  • help you avoid unnecessary surgical or medical treatments
  • help you make informed decisions on what your next steps should be
If everything checks out A-OK for you and your partner

If you’ve done all the tests and everything has come up as normal, you may hear your doctor saying “idiopathic infertility.” Basically, this means that at the moment, there’s no way of figuring out the cause for your infertility.

While it won’t ease your frustration and pain, know that your uncertainty is shared by many. Idiopathic infertility is an extremely common infertility diagnosis in both men and women.

The bottom line

Depending on your diagnosis, you may find that you need to draw on reserves that you never knew you had.

But there are many options for medically assisted pregnancy. And remember many male infertility diagnoses can be successfully treated.

What Causes Low Sperm Count and How Is It Treated?

Illustration of white sperm on green background

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Sperm quality isn’t necessarily something you think about often. However, if you and your partner want to start or expand your family, the number and quality of swimmers you have may be foremost on your mind.

While it only takes one sperm to fertilize an egg, the journey getting there can be rough. The more sperm you have, the better your chances.

Let’s take a closer look at why you might have low sperm count, how you can find out for sure, and what treatments are available to help boost your reserves or otherwise increase your chances of achieving pregnancy.

Causes of low sperm count

Low sperm count, also called oligospermia, is a major cause of male infertility. Sperm count is considered low if it dips below 15 million sperm per milliliter (mL) of semen, although the average is around 75 million sperm per mL.

Risk factors include having obesity or overweight, having experienced trauma or surgery in or around the testicles, and taking certain medications. Other things that may put you at risk include exposing your testicles to too much heat or having other medical issues.

Beyond that, there are various causes of low sperm quality, which can be divided into three main categories: medical, environmental, and lifestyle.


A history of testicular symptoms, injury, or surgeries, as well as genetic conditions like Klinefelter syndrome, may increase your chances of having a low sperm count.

Cancer treatments, including chemotherapy, radiation, or surgery, may also affect hormone and sperm production. Radiation of the testicles directly damages the cells that produce sperm, while radiation or surgery of the brain can likewise cause low sperm count, as hormones produced in the brain stimulate sperm production.

Other possible causes include:

  • swelling in the veins that drain the testicles, which is called varicocele and one of the most common causes of male infertility
  • previous infections or sexually transmitted infections (STIs), which can cause blockages, scarring, or other damage to the reproductive system
  • issues with erections or ejaculation (For example, diabetes and spinal injuries may cause erectile dysfunction or retrograde ejaculation.)
  • issues with the immune system
  • conditions like cystic fibrosis or being a genetic carrier of cystic fibrosis may block sperm from entering the semen
  • medical procedures, treatments, or medications for a range of conditions, including some cancer, antifungal, antibiotic, and ulcer drugs
  • previous surgery to the male reproductive system, such as testicular surgery, bladder surgery, surgery for undescended testicles, inguinal hernia repair, and of course, a vasectomy


You may be surprised to learn that ideal sperm conditions are slightly less than body temperature, which is why the testicles are positioned outside of the abdominal cavity.

Overheating your testicles can lower sperm production. This means that anything from frequently enjoying hot tubs to sitting with your computer atop your lap may lower your counts.

Other possible environmental causes include occupational exposure to herbicides, pesticides, solvents, and other industrial chemicals or heavy metals. Exposure to radiation from X-rays or other sources may harm sperm production as well.


Activities like heavy drug and alcohol use, as well as using tobacco or vaping, may likewise lower sperm count. Anabolic steroids, which are usually taken to increase muscle mass, will almost always shrink testicles and decrease sperm production.

Marijuana and opioids also reduce sperm production.

Other possible causes include:

  • testosterone boostersvitamins, and pre-workout supplements marketed toward a workout crowd all may contain small amounts of anabolic steroids, which can impair sperm production
  • jobs that require long periods of sitting, such as truck driving
  • emotional issues, like stress and depression, particularly if they’re long term and severe
  • body weight, particularly if you have obesity or overweight, can also affect hormones

What about masturbation?

You may have heard that masturbating too frequently can lower sperm count. However, this studyTrusted Source indicates that you can ejaculate daily and still maintain normal sperm quality.

Signs of low sperm count

You may not experience any signs or symptoms of low sperm quality until you try to start a family. That’s right — the main symptom of oligospermia is infertility.

If your low sperm count is caused by an underlying condition — a hormone imbalance, chromosomal abnormality, testicular issue, or blockage — you may experience symptoms related to the condition, which isn’t the same as having symptoms of low sperm count. These symptoms may include:

Related: Everything you need to know about infertility

Diagnosing low sperm count

If you’ve been having unprotected sex regularly for the last year and haven’t gotten your partner pregnant, you may want to see your doctor. If you don’t already have a primary care provider, you can browse doctors in your area through the Healthline FindCare tool. In fact, you may want to head in for an appointment sooner if you have symptoms like trouble ejaculating, pain in the testicles, or previous surgeries.

Diagnosis usually involves a physical exam, medical history, and semen analysis.

We know — ejaculating into a cup may be the last thing you want to do. However, for the medical professional requesting or receiving the analysis, it’s really no different than a urine or blood sample, so there’s no reason to feel awkward.

A semen analysis may be particularly helpful in receiving a diagnosis, as your sperm can be counted under a microscope and checked for motility (movement) and morphology (shape). Your doctor may even want to repeat the analysis to ensure consistent results because of high variability between samples.

You’ll likely be provided with a container at your doctor’s office. You’ll be asked to masturbate and ejaculate into the container either at the clinic or at home. If you opt to collect the sample at home, you’ll be instructed on how to care for the specimen until you can get it back to the lab within an hour.

Other tests your doctor may try include:

  • blood tests to check hormones or chromosomes
  • ultrasound to visualize the testicles or prostate
  • biopsy to evaluate sperm production in the case of blockages

Related: Semen analysis and test results

Treatment for low sperm count

The treatment you receive for low sperm count will depend on the cause. There are also some ways you can change up your trying to conceive (TTC) routine that may make pregnancy more possible.


For cases involving large varicoceles, blockages, or issues with sperm leaving the body, surgery is an option. For example, a varicocele can be corrected with a minor outpatient surgery, and previous vasectomies can be reversed.

In other cases, sperm can be directly obtained for assisted reproduction procedures like in vitro fertilization (IVF) by surgically retrieving it from the testicle or epididymis.


Infections in the reproductive tract can be treated with medications. It’s important to treat infections promptly. Even if an infection is properly treated, sperm count may not always return to normal if permanent tissue scarring has occurred.


Issues with sexual intercourse, including erectile dysfunction or premature ejaculation, may respond to a combination of medication and counseling.

Related: Best home remedies for premature ejaculation

Hormonal treatments

Since testosterone and other hormone levels that are either too high or too low can cause low sperm count, addressing the levels with medications and other treatments may help restore fertility.

Remember that the use of anabolic steroids, testosterone, or even most over-the-counter testosterone boosters can cause infertility, so avoid these.

Lifestyle modifications

Things you can do at home to increase the odds of pregnancy with low sperm count include having sexual intercourse more frequently and timing sex with ovulation.

For example, having sex every day or every other day within a few days before, during, and after ovulation will help ensure that the swimmers who make it all the way to the egg get there at the right time.

While you’re at it, skip all lubricants that may slow sperm travel. If you want to use lubrication, try something like Pre-Seed, but use it sparingly. Despite the common misconception, even Pre-Seed can introduce a physical barrier if used in excess.

And avoid activities that raise the temperature of the testicles, such as frequent hot tub dips, saunas, or steam rooms. Lastly, avoid excessive drug and alcohol use, as well as workout supplements that are known to lower sperm quality.

Alternative medicine

Although a variety of vitamin supplements have been studied, antioxidants or vitamins may have a minimal effect unless you have a true dietary deficiency.

Speak with your doctor before taking supplements, as some may interact with other medications you’re taking. And importantly, certain workout supplements may harm your fertility.

Give it time

It’s important to note that any treatments or lifestyle changes may not be reflected in your sperm count right away, as the time frame of sperm production and transit is up to 2 to 3 months. As such, you may not see an increase for 3 months, on average.

Low sperm count and infertility

The good news is that having fewer sperm swimming around doesn’t mean it’s impossible to achieve pregnancy — it may just make take a bit longer. Researchers share that unless your sperm count is zeroTrusted Source, you may still be able to get your partner pregnant with time.

Statistics are hard to come by here, as just how long it takes depends on a number of factors that are individual to you and your partner, including how low your sperm count is and how healthy your sperm are.

For example, motility refers to a sperm’s ability to get where it needs to go. If your motility is good, having few sperm may not be as big of a problem. However, if your sperm count is low and motility is affected, it could take longer.

Your partner’s fertility affects the equation as well, as does your ability to time sex with the ovulation window. Fortunately, you have options if pregnancy isn’t happening.

Assisted reproduction

In some cases of abnormal semen quality, your doctor may suggest intrauterine insemination (IUI). This procedure may involve your female partner taking a drug called clomiphene to support egg development. At the time of ovulation, you supply sperm in a cup that’s then washed and concentrated. Next, the sperm is placed in the uterus using a long, flexible tube.

If your sperm count is very low, in vitro fertilization (IVF) may be a better option. In this procedure, doctors give the female partner certain drugs to develop healthy eggs and retrieve the mature eggs surgically.

Meanwhile, sperm can be collected ahead of time and frozen, or supplied fresh the day of fertilization. Your doctor fertilizes the eggs in a lab and then transfers healthy embryos into the uterus to implant. This whole process takes around 3 weeks to complete.

While this assisted reproductive technology is the most effective, it’s also the most invasive and expensive. According to Planned Parenthood, one cycle of IVF can cost $15,000 or more.

The takeaway

Couples can get pregnant with low sperm count. It may just take more time than you originally expected, and it may require seeing a doctor to see how you can improve your sperm quality.

Regardless, if you suspect you have an issue, make an appointment with your doctor. That way, you can get a better picture of just how low your count might be, what treatments are available, and whether you want to explore options like IUI or IVF to grow your family.

If your low sperm count is caused by an underlying health condition, your doctor can also help you get the treatment you need to relieve any other symptoms you’re experiencing.