Medical Causes of Low Sperm Count

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If you have low sperm count, make sure to screen for each of these potential causes with your doctor.

  • Varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. It’s a common cause of male infertility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm.
  • Silent infections. Some infections can interfere with sperm production and sperm health or can cause scarring that blocks the passage of sperm. These include some sexually transmitted infections, including chlamydia and gonorrhea; inflammation of the prostate (prostatitis); inflamed testicles due to mumps (mumps orchitis); and other infections of the urinary tract or reproductive organs.  Your doctor should check semen for bacteria, as well as white blood cells that an immune response is under way, signaling an infection and both partners need to take antibiotics.
  • Get a blood test for male hormone levels. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal, may impair sperm production. Also get a blood test for male prolactin levels
  • Ejaculation problems. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out of the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, and surgery of the bladder, prostate or urethra. Certain medications also may result in retrograde ejaculation, such as blood pressure medications known as alpha blockers. Some men with spinal cord injuries or certain diseases can’t ejaculate semen at all, though they still can produce sperm.
  • Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them. This is especially common in men who’ve had a vasectomy.
  • Undescended testicles. During fetal development one or both testicles sometimes fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men with this condition.
  • Sperm duct defects. The tubes that carry sperm can be damaged by illness or injury. Some men are born with a blockage in the part of the testicle that stores sperm (epididymis) or a blockage of one of the tubes that carry sperm out of the testicles (vas deferens). Men with cystic fibrosis and some other inherited conditions may be born without sperm ducts altogether.
  • Chromosome defects. Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome, Young’s syndrome, and Kartagener syndrome.
  • Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
  • Genetic disorders (which account for somewhere between 2 and 5 percent of men diagnosed with infertility), including kidney disease, diabetes, cancer and cancer treatments can also negatively affect sperm count and quality.
  • Cancers and nonmalignant tumors can affect the male reproductive organs directly, or can affect the glands that release hormones related to reproduction (such as the pituitary gland). Surgery, radiation or chemotherapy to treat tumors can also affect male fertility.
  • Pituitary disease, dysfunction, or failure
  • Adrenal disorders and endocrine disturbances
  • Sperm testing issues: Lower than normal sperm counts can result from testing a sperm sample that was taken too soon after your last ejaculation; was taken too soon after an illness or stressful event; or didn’t contain all of the semen you ejaculated because some was spilled during collection. For this reason, results are generally based on several samples taken over a period of time.
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