Low sperm count

Disease Description (Causes and Symptoms)

• Definition (provided criteria): Semen volume of 3 mL or more, motility ≥60%, normal morphology ≥60%, and a sperm count of ≥6 million/mL are considered normal; oligospermia is defined as a sperm count of approximately 2 million/mL to 4 million/mL.
• Main pathophysiology: Reduced sperm production in the testes (decreased sperm production or abnormal maturation). When testicular temperature rises or blood flow or hormonal abnormalities occur due to conditions such as varicocele, sperm formation is impaired.
• Main causes: Varicocele, hydrocele, sequelae of an undescended testis, repeated exposure to high temperatures (saunas or hot work environments), tight underwear/clothing, and other hormonal abnormalities or a history of infection or trauma.
• Main symptoms: Usually asymptomatic. Clinically, it is often discovered as a cause of infertility in a couple.

Treatment Methods

• Treatment of the cause
  • If varicocele is the cause: Vein ligation (varicocele repair, microsurgical varicocelectomy) can improve sperm parameters and increase the possibility of natural pregnancy.
  • If there is an underlying disease such as an infection or hormonal abnormality, treat that disease (antibiotics, hormone therapy, etc.).
• Assisted reproductive technology (infertility treatment)
  • If the condition does not improve with medication and conservative treatment, or in severe cases, assisted reproductive technologies such as intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) may be considered.
• Medications/supplements
  • Antioxidants (vitamin E, vitamin C, zinc, etc.) or certain hormone treatments (such as luteinizing hormone inducers) may be used in some cases, but their effects vary depending on the patient's condition. Consultation with a specialist is recommended before use.
• Lifestyle management (self-care)
  • Avoid exposure to high temperatures (saunas, hot baths, and high-temperature work), wear loose-fitting underwear, avoid smoking, excessive alcohol consumption, and drugs, and maintain a balanced diet and an appropriate weight.
• Precautions and complications
  • If the underlying condition (e.g., varicocele) is not treated, infertility may persist. Postsurgical complications such as infection, pain, and surgical failure may occur. The effects on psychological stress and the couple's relationship should be considered.
• Prognosis
  • After treatment of the cause (e.g., varicocele surgery), improvements in semen parameters and cases of natural pregnancy have been reported in many patients. Prognosis depends on the cause, timing of treatment, and the initial status of the sperm parameters.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items/information to prepare
  • List of medications and supplements currently being taken (both prescription and nonprescription), history of previous surgery or trauma (especially involving the testes or groin), previous semen analysis results (if possible, at least the two most recent), previous hormone test and ultrasound results, information about smoking/alcohol use and occupational exposure (high temperatures and chemicals), and information related to the partner's pregnancy history (menstrual cycle and previous test results).
• Precautions before testing
  • Semen analysis is generally performed after 2–7 days of abstinence (3–4 days recommended). Avoid excessive alcohol consumption, heat exposure, and extreme stress before the test.
• Information to tell the medical staff during the visit
  • Recent high fever (a cold or febrile illness), symptoms of a genital infection, and previous infertility treatment experience.
• Example questions (general)
  • "How long should I abstain before the test?"
  • "Could the medications I am currently taking (e.g., blood pressure medication or antidepressants) affect my sperm?"

General Example Questions to Ask the Doctor

• "What are the side effects and expected benefits of this medication (or supplement)?"
• "Given our situation, what is the likelihood of natural pregnancy? What is the prognosis?"
• "What should we pay particular attention to in our lifestyle?"

Examples of Customized Questions by Disease

• "After varicocele surgery (vein ligation), how long does it usually take for the sperm count and motility to improve? (Expected timing and examination schedule)"
• "Given the current sperm count (or semen analysis results), which assisted reproductive technology (e.g., IUI or IVF/ICSI) is appropriate?"

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Reference (summary of the main information provided): Definition criteria, tendency to be asymptomatic, main causes (varicocele, hydrocele, exposure to high temperatures, etc.), diagnostic methods (semen analysis after 3–4 days of abstinence → if abnormal, hormone testing, ultrasound, vasography, testicular biopsy, etc.), and treatment consisting of treatment of the cause (e.g., vein ligation) and, if necessary, assisted reproductive technology.