Low Sperm Count Causes

Spermatogenesis (or production of sperms) is a complex process that demands synchronous functioning of genital organs such as testicles as well as hormonal stimulation and control by higher brain centers such as hypothalamus and pituitary gland. Once sperms are produced in the testicles, delicate tubes transport these motile cells along with other glandular secretions to penis which then help in the deposition of sperms into female genital tract during sexual intercourse. Any dysfunction or anomaly in this normal process can lead to low sperm count.

Low sperm count is also referred to as oligospermia in sophisticated medical terms. It is imperative to mention that oligospermia should not be confused with azoospermia – a condition that is marked by absence of viable sperms in the semen.

What Are Some Common Causes Of Low Sperm Count?

Oligospermia can be a result of medical, environmental and poor lifestyle choices.

Medical Causes:

• Prior Surgeries: A positive history of inguinal or genital surgery can aggravate the risk of developing oligospermia by causing strictures or damage to sperm making machinery. Some surgeries that are known to affect sperm production are scrotal or testicular surgeries (testicular resection, surgery to address an injury etc.), prostate surgeries (for cancer resection, BPH management etc.), urinary bladder surgery, vasectomy, urethral surgery, repair of inguinal hernia, and abdominal surgeries.
• Medications: Consumption of toxins or medications that may affect the hormonal metabolism can also affect the viability of sperms; thereby leading to oligospermia. Frequently implicated pharmacological agents include, anabolic steroids, testosterone replacement therapy, certain antibiotics, antifungals, chemotherapeutic medications, drugs to manage ulcer and other gastrointestinal symptoms, blood pressure medications especially alpha blockers, etc.
• Medical conditions: Certain chronic medical or health issues can also cause low sperm count and resulting infertility. Clinical data indicates that poorly managed diabetes, Celiac disease, spinal injuries, autoimmune disorders and retrograde ejaculation are some common medical causes of oligospermia (2).

• Chromosomal anomalies: Abnormalities or aberrations of chromosomes can affect the normal functioning of testicles; thereby leading to low sperm count. Common chromosomal anomalies that may present with low sperm count are; Kallmann's syndrome, Klinefelter's syndrome, cystic fibrosis, and Kartagener's syndrome.
• Tubular defects: Any obstruction in the passage of sperms through genital ducts may impede the transportation of sperms; such as, injuries, prior infections, surgery or abnormal development of testicles, ducts and associated glands. Likewise, undescended testicles (also known as cryptorchidism) can also lead to low sperm count due to permanent damage to testicular tissue. Likewise, varicocele (a disorder of testicular veins) can also affect sperm production due to temperature dysregulation (3).
• Endocrinological anomalies: Endocrine disorders (such as hypo or hyper-functioning of endocrine glands like hypothalamus, pituitary, thyroid, adrenal etc.) can also affect spermatogenesis.
• Benign and malignant lesions: Tumor or malignant cancers of testicles, prostate or any other part of genital tract can also cause low sperm count directly (as a result of damage to sperm making machinery) or indirectly (due to hazardous complications of cancer management options such as chemotherapy, radiotherapy or resective surgery).
• Infection: Acute as well as chronic infections involving genital tract such as poorly managed sexually transmitted diseases, epididymitis, orchitis or even HIV can also cause oligospermia due to scarring.

2. Environmental Causes:

Spermatogenesis is highly sensitive to changes in the physical environment; some common causes of low sperm count due to environmental reasons are:

• Industrial toxins: Exposure to industrial chemicals as part of occupational or recreational activities such as pesticides, toluene, heavy metals, benzenes, herbicides, xylene, paints and organic solvents can also cause oligospermia.
• Radiation exposure: Extended or chronic exposure to radiations or x-rays can damage sperm producing tissue and may permanently affect your capacity to produce functional sperms.

3. Lifestyle Choices and Miscellaneous Causes:

• Obesity: Higher body mass index may affect metabolic functioning of the body as well as endocrinological balance; thereby causing temporary oligospermia and infertility.
• Chronic stress: Chronic physical, emotional or psychosocial stress can also impair hormonal synchrony and impair sperm production.
• Tobacco and use of illicit drugs: Excessive use of tobacco or other illicit drugs such as marijuana, cocaine etc. can negatively affect spermatogenesis by increasing the production of toxins and free radicals.
• Alcohol abuse: Like tobacco and other environmental toxins, alcohol breakdown products also tend to compromise metabolic and biochemical balance which may compromise sperm production processes.

Likewise, dietary and metabolic choices can also affect spermatogenesis; for example, according to a study reported in the Human Reproduction journal (4), investigators suggested that high intake of fatty acids is inversely related to sperm count in males.

Other less commonly reported causes of low sperm count are; occupational activities (such as long-distance driving, welding) and exposure od testicles to extremely hot temperatures such as hot showers, steam baths, saunas, hot tubs. Likewise, wearing tight clothing or using laptops for extended hours may also impair sperm production temporarily.

The management of low sperm count is dependent on the primary etiology. Therefore, it is very important to conduct thorough workup in an attempt to reach an accurate diagnosis.

References

1. Wright, C., Milne, S., & Leeson, H. (2014). Sperm DNA damage caused by oxidative stress: modifiable clinical, lifestyle and nutritional factors in male infertility. Reproductive biomedicine online, 28(6), 684-703.

2. Vignera, S., Condorelli, R., Vicari, E., D'Agata, R., & Calogero, A. E. (2012). Diabetes mellitus and sperm parameters. Journal of andrology, 33(2), 145-153.

3. Dutta, S., Joshi, K. R., Sengupta, P., & Bhattacharya, K. (2013). Unilateral and bilateral cryptorchidism and its effect on the testicular morphology, histology, accessory sex organs, and sperm count in laboratory mice. Journal of human reproductive sciences, 6(2), 106.

4. Chavarro, J. E., Mínguez-Alarcón, L., Mendiola, J., Cutillas-Tolín, A., López-Espín, J. J., & Torres-Cantero, A. M. (2014). Trans fatty acid intake is inversely related to total sperm count in young healthy men. Human Reproduction, 29(3), 429-440.