HomeLow Sperm Count (Oligospermia) Treatment | ART Fertility Clinics
A sperm concentration below 15 million per millilitre is classed as oligospermia, and it is one of the most common and most treatable causes of male infertility. Assessment starts with two semen analyses, hormone tests and a scrotal scan to find the cause. Mild cases often improve with lifestyle changes and three to six months of medical therapy; severe cases are best treated with ICSI, which needs only a handful of sperm.
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Medically reviewed by
Dr. Shreshtha Sagar Tanwar
, Senior Consultant - ART Fertility Clinics, Delhi & Gr. Noida
— Last reviewed: August 2026
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Understanding Low Sperm Count
Low sperm count — medically called oligospermia — means fewer than 15 million sperm per millilitre of semen. It is one of the most common causes of male infertility, affecting 1 in 3 couples with fertility problems. At ART Fertility Clinics, low sperm count is highly treatable — through lifestyle optimisation, medical management, IUI, or IVF with ICSI depending on severity.
A normal semen analysis, according to WHO 2021 reference values, shows a sperm concentration of 16 million per millilitre or more, with total sperm count of 39 million per ejaculate. When the count falls below 15 million per millilitre, we classify this as oligospermia.
Oligospermia exists on a spectrum:
- Mild oligospermia: 10-15 million/mL — natural conception remains possible, often with support
- Moderate oligospermia: 5-10 million/mL — IUI or IVF/ICSI recommended depending on other parameters
- Severe oligospermia: Below 5 million/mL — IVF with ICSI is typically the most effective path
- Cryptozoospermia: Fewer than 1 million/mL — on the border of azoospermia, surgical retrieval may be considered
Critically, sperm count is only one part of the picture. Motility (how well sperm swim), morphology (shape), and DNA integrity all contribute to fertility potential. A man with 8 million/mL sperm but 60% progressive motility may have better functional fertility than a man with 12 million/mL sperm with 10% motility. This is why a complete semen analysis — not just the count — is essential.
What Causes Low Sperm Count?
Varicocele: The most common reversible cause of male infertility. Enlarged veins in the scrotum raise testicular temperature, impairing sperm production. Present in approximately 40% of infertile men. Surgical repair (varicocelectomy) improves sperm parameters in 60-70% of affected men.
Hormonal imbalances: Low testosterone, elevated FSH, high prolactin, or thyroid dysfunction all affect sperm production. These are often identified and corrected medically.
Infections: Previous mumps orchitis, sexually transmitted infections, or epididymitis can cause lasting damage to sperm-producing tissue.
Lifestyle factors: Smoking reduces sperm count by 13-17%. Excessive alcohol, obesity, heat exposure (laptops, tight clothing, hot tubs), and anabolic steroid use all significantly impair sperm production.
Medications: Testosterone supplements, chemotherapy, immunosuppressants, and certain antibiotics affect sperm count — often temporarily.
Genetic factors: Y chromosome microdeletions and chromosomal abnormalities can cause low or absent sperm production.
Unexplained (idiopathic): In approximately 30-40% of cases, no specific cause is identified despite thorough investigation.
Treatment Approach at ART Fertility Clinics
Step 1 — Complete Diagnosis
We do not prescribe treatment without understanding the cause. Our male fertility assessment includes semen analysis (with strict morphology), hormonal profile, scrotal ultrasound, and genetic testing where indicated.
Step 2 — Lifestyle Optimisation (All Patients)
Regardless of the treatment pathway chosen, lifestyle changes improve sperm parameters in 3-6 months — the time it takes for a complete cycle of sperm production (spermatogenesis):
- Stop smoking — shown to improve count by 13-17%
- Reduce alcohol to under 5 units per week
- Achieve healthy BMI (obesity significantly impairs testosterone and sperm production)
- Supplement with CoQ10 (600mg/day), vitamin C, vitamin E, zinc, selenium, and folic acid
- Avoid heat exposure to the scrotum
- Manage stress (cortisol directly suppresses testosterone)
Step 3 — Medical Treatment
For men with hormonal causes, targeted medical treatment often significantly improves sperm count:
- Clomiphene citrate — stimulates FSH and LH production
- Gonadotrophin injections — for men with hypogonadotropic hypogonadism
- Antioxidant therapy — reduces oxidative stress which damages sperm DNA
Step 4 — Assisted Reproduction
For mild to moderate oligospermia with adequate motility, IUI (Intrauterine Insemination) after sperm washing concentrates the best-performing sperm and places them directly at the cervix — improving the chances of natural fertilization without full IVF.
For moderate to severe oligospermia, or when IUI has not succeeded, IVF with ICSI is the most effective option. A single viable sperm is injected directly into a mature egg — bypassing the need for large numbers of sperm entirely. At ART Fertility Clinics, ICSI success rates exceed 60% per cycle for couples where low sperm count is the primary factor.
Citation
- Kothekar, M. & ART India [ART Fertility Clinics]. (2025, July 12). 10 Ways to boost male fertility and increase sperm count. ART Fertility Clinics, India. Retrieved January 6, 2026, from https://artfertilityclinics.in/blog/10-ways-to-boost-male-fertility-and-increase-sperm-count
- Patel, A. & ART India [ART Fertility Clinics]. (2025a, July 9). Watch your partner’s weight, ladies! it may be a cause for infertility. ART Fertility Clinics, India. Retrieved January 6, 2026, from https://artfertilityclinics.in/blog/obesity-infertility-weight-impact-male-fertility
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Dr. Shreshtha Sagar Tanwar
ART Fertility Clinics, India
Senior Consultant - ART Fertility Clinics, Delhi & Gr. Noida
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ART Fertility Clinics, India
Director - ART Fertility Clinics, Gurgaon 4.9/5
Dr. Manjushri Amol Kothekar
ART Fertility Clinics, India
Senior Consultant - ART Fertility Clinics, Mumbai & Navi Mumbai 5.0/5Limited slots available this week
How Low Sperm Count Treatment Works
Treatment begins by finding the underlying cause, then follows the least invasive route that gives you a realistic chance of pregnancy.
Semen Analysis
Two samples taken a few weeks apart establish your true count, motility and morphology.
Cause Investigation
Hormone profiling, scrotal Doppler and genetic screening look for varicocele, hormonal or genetic causes.
DNA Fragmentation Testing
Where indicated, a DFI test checks sperm DNA integrity, which affects fertilisation and miscarriage risk.
Lifestyle & Medical Therapy
Heat exposure, smoking and weight are addressed alongside three to six months of targeted medical treatment.
Reassessment
A repeat semen analysis after therapy shows whether the count has improved enough for natural conception or IUI.
IUI or ICSI
Mild cases proceed to IUI; severe oligospermia is treated with ICSI, which needs only a few viable sperm.
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People Also Asked
It depends on the cause. Varicocele repair, hormonal treatment, and lifestyle changes can permanently improve sperm count. Where the cause is genetic or irreversible, assisted reproduction (IVF/ICSI) achieves pregnancy despite the low count.
The commonest identifiable cause we see is varicocele, present in around 40% of men with abnormal semen parameters. Others include hormonal problems affecting the pituitary or testis, previous infection such as mumps orchitis, undescended testis in childhood, genetic factors like Y-chromosome microdeletions or Klinefelter syndrome, certain medications, anabolic steroid use, and heat exposure from occupation or laptop habits. In roughly 30 to 40% of cases no cause is identified — this is called idiopathic oligospermia, and it still responds to treatment.
Spermatogenesis — the full cycle of sperm production — takes approximately 74 days. Any lifestyle or medical intervention requires at least 3 months to show measurable improvement in sperm parameters.
With mild oligospermia and good motility and morphology, natural conception is absolutely possible. Many men with counts of 8-12 million/mL conceive naturally. The likelihood depends on all semen parameters together, not count alone.
That depends on your post-wash motile count and your partner's fertility status, not on the raw count alone. If more than about 5 million motile sperm are recovered after washing and your partner's tubes are open and ovarian reserve adequate, IUI is a reasonable first step for 3 cycles. Below 1 to 2 million, IUI success drops sharply and ICSI becomes the more sensible choice — it requires only a single viable sperm per egg. We make this decision together after seeing both partners' results, not on the semen report alone.
