If you and your partner have been trying to conceive for a while without success, one of the first things that often comes up is sperm count. It can feel like a heavy thing to hear, but a low sperm count is more common than most people realise — and it doesn't always mean the end of the road for natural conception.

This article walks you through what low sperm count actually means, what might be causing it, and what you can do about it.

What is a low sperm count?

A low sperm count — medically known as oligozoospermia — is when your semen contains fewer sperm than normal. According to the NHS, a low sperm count is generally considered to be below 15 million sperm per millilitre of semen.¹

To put that in context, a healthy ejaculate typically contains tens of millions of sperm. The reason numbers need to be that high is because the journey to the egg is genuinely difficult. Most sperm don't make it. So having fewer to start with naturally reduces the odds.

That said, a low sperm count can make it harder to get pregnant, but it may still be possible to conceive naturally — and there are fertility treatments that can help.

How to know if you have a low sperm count

Here's the thing — there are rarely any obvious physical signs of low sperm count. You likely won't notice anything different day to day. No pain, no visible changes.

You could have a low sperm count if you and your partner are having difficulty getting pregnant. You usually find out after having tests to check your fertility.

What does low sperm count look like?

This is a question people often search for, and the honest answer is: you can't tell from looking. Semen colour, texture, or volume doesn't reliably indicate sperm count. The only way to know for certain is through a semen analysis test.

When should you get tested?

See a GP if you and your partner have been having regular sex without using contraception for over one year — or six months if your partner is 36 or over — and have not been able to get pregnant.

The main test to check for low sperm count is a semen analysis test. This involves a sample of your semen being tested to check the amount of sperm in it. The test also checks how fast the sperm move and the shape of your sperm.

If your results find a possible problem, you'll have another semen analysis test, usually around three months after the first. If the second test also finds a problem with your sperm, you will be referred to a specialist for more tests — which may include blood tests, an ultrasound scan of your testicles, or a urine test.

What causes low sperm count?

There's rarely a single cause. Low sperm count is often the result of several overlapping factors — some medical, some lifestyle-related.

Medical causes

Varicocele — This is a swelling of the veins that drain the testicle. It's one of the most common reversible causes of male infertility. It's thought to affect sperm production by raising the temperature around the testicles.

Hormonal imbalances — If you have very low levels of gonadotrophin hormones, which stimulate the production of sperm, you should be offered treatment with gonadotrophin medication to improve your fertility.

Infections — Some infections, including sexually transmitted infections like chlamydia, can affect sperm production or cause scarring that blocks sperm.

Genetic factors — In some patients, the underlying cause may be genetic — a fault in the genes inherited from parents. It is possible to pass a genetic abnormality onto any male offspring.

Blockages in the reproductive tract — These can prevent sperm from being ejaculated, even when production is normal.

Lifestyle causes

These are the ones you have more direct control over, which is actually good news:

• Smoking — Tobacco use is consistently linked to reduced sperm count and quality

• Alcohol — The NHS recommends drinking no more than 14 units of alcohol a week, spread across three or more days

• Being overweight — Excess body fat can affect hormone levels involved in sperm production

• Heat exposure — Temperature is very important for sperm production. In order to produce sperm, the testicles have to be more than one degree cooler than the rest of the body — which is why they are situated outside the body. Hot baths, tight underwear, and long periods sitting down can all contribute to overheating

• Recreational drugs — Anabolic steroids and cocaine are known to affect sperm count negatively

• Chemical exposure — Exposure to chemicals at work such as pesticides, solvents, or some heavy metals can have an impact

Can a man recover from low sperm count?

Yes — in many cases, sperm count can improve. Sperm are regenerated roughly every 64 to 72 days, which means changes you make today can start to show results in semen quality within a few months.

If your low sperm count is linked to lifestyle factors, there's a real opportunity to improve things through consistent changes. If it's caused by something structural or hormonal, medical treatment can sometimes address the underlying issue.

It's worth being realistic too. Not every cause is reversible, especially if it's genetic or due to a physical blockage. But working with your GP or a fertility specialist can help you understand what's driving it and what your actual options are.

Ways to improve low sperm count

Lifestyle changes worth making

These are evidence-backed steps that the NHS recommends for anyone with a low sperm count:

• Cut down on alcohol — stick within the 14-unit weekly guideline¹;

• Stop smoking — this is one of the most impactful changes you can make

• Maintain a healthy weight — being overweight affects hormone levels involved in sperm production

• Wear looser underwear — tight underwear can increase the temperature of your testicles, which may affect the quality of your sperm

• Reduce heat exposure — swap hot baths for showers, and take breaks if you sit for long periods

Medical treatments in the UK

If you have a low sperm count and you and your partner have not been able to get pregnant after trying for over one year — or six months if your partner is 36 or over — there are treatments on the NHS that may help.

Treatment may include in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), where eggs are removed from your partner's ovaries and fertilised with your sperm in a lab, then put back into your partner's womb to grow and develop.

ICSI is a type of IVF technique in which a single sperm is injected directly into an egg to fertilise it. This can be particularly useful when sperm count is very low.

NHS access to these treatments depends on meeting specific criteria, and availability can vary by region. Your GP can advise on what you're eligible for based on your area.

Is there a faster way to improve low sperm count?

There isn't a magic fix. Anyone telling you otherwise is selling something. The honest answer is that the fastest improvement typically comes from addressing the most impactful changeable factors — stopping smoking, significantly cutting alcohol, losing excess weight, and reducing heat exposure.

For some men, particularly those with a hormonal imbalance, targeted medical treatment can produce relatively quicker improvements. But this needs to be assessed and managed by a specialist.

Consistency over several months is key, given the sperm regeneration cycle.

twoplus Fertility: For those trying to conceive with low sperm count

If you're dealing with a low sperm count and trying to conceive, timing and delivery of sperm really do matter. Even with a lower count, getting sperm as close to the cervix as possible during your fertile window gives it the best possible chance.

Trying to conceive can quickly start to feel like a chore. Timed sex, misaligned schedules, and even performance pressure often adds up. The twoplus Applicator Extra takes that pressure off, so every fertile window becomes an opportunity again, not an obligation.

The twoplus Applicator Extra is a self-assisted artificial insemination that can be used from the comfort of your home. In just 3 simple steps, the Applicator Extra helps deposit sperm close to the cervix, giving nature a helping hand.

• No medical help or clinic visit needed

• Deposits semen close to the cervix, giving sperm a more direct path

• Designed for comfort with soft tip made of 100% medical grade silicone 

• Make your fertile window count

• Affordable alternative to try now: 3 steps. 15 minutes

Sources:

1. NHS. Low sperm count 

2. NIdirect. Low sperm count