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Sperm quality isn’t necessarily something you think about often. However, if you and your partner want to start or expand your family, the number and quality of swimmers you have may be foremost on your mind.

While it only takes one sperm to fertilize an egg, the journey getting there can be rough. The more sperm you have, the better your chances.

Let’s take a closer look at why you might have low sperm count, how you can find out for sure, and what treatments are available to help boost your reserves or otherwise increase your chances of achieving pregnancy.

Related: Why aren’t more men aware of their fertility status?

Low sperm count, also called oligospermia, is a major cause of male infertility. Sperm count is considered low if it dips below 15 million sperm per milliliter (mL) of semen, although the average is around 75 million sperm per mL.

Risk factors include having obesity or overweight, having experienced trauma or surgery in or around the testicles, and taking certain medications. Other things that may put you at risk include exposing your testicles to too much heat or having other medical issues.

Beyond that, there are various causes of low sperm quality, which can be divided into three main categories: medical, environmental, and lifestyle.

Medical

A history of testicular symptoms, injury, or surgeries, as well as genetic conditions like Klinefelter syndrome, may increase your chances of having a low sperm count.

Cancer treatments, including chemotherapy, radiation, or surgery, may also affect hormone and sperm production. Radiation of the testicles directly damages the cells that produce sperm, while radiation or surgery of the brain can likewise cause low sperm count, as hormones produced in the brain stimulate sperm production.

Other possible causes include:

  • swelling in the veins that drain the testicles, which is called varicocele and one of the most common causes of male infertility
  • previous infections or sexually transmitted infections (STIs), which can cause blockages, scarring, or other damage to the reproductive system
  • issues with erections or ejaculation (For example, diabetes and spinal injuries may cause erectile dysfunction or retrograde ejaculation.)
  • issues with the immune system
  • conditions like cystic fibrosis or being a genetic carrier of cystic fibrosis may block sperm from entering the semen
  • medical procedures, treatments, or medications for a range of conditions, including some cancer, antifungal, antibiotic, and ulcer drugs
  • previous surgery to the male reproductive system, such as testicular surgery, bladder surgery, surgery for undescended testicles, inguinal hernia repair, and of course, a vasectomy

Environmental

You may be surprised to learn that ideal sperm conditions are slightly less than body temperature, which is why the testicles are positioned outside of the abdominal cavity.

Overheating your testicles can lower sperm production. This means that anything from frequently enjoying hot tubs to sitting with your computer atop your lap may lower your counts.

Other possible environmental causes include occupational exposure to herbicides, pesticides, solvents, and other industrial chemicals or heavy metals. Exposure to radiation from X-rays or other sources may harm sperm production as well.

Lifestyle

Activities like heavy drug and alcohol use, as well as using tobacco or vaping, may likewise lower sperm count. Anabolic steroids, which are usually taken to increase muscle mass, will almost always shrink testicles and decrease sperm production.

Marijuana and opioids also reduce sperm production.

Other possible causes include:

  • testosterone boosters, vitamins, and pre-workout supplements marketed toward a workout crowd all may contain small amounts of anabolic steroids, which can impair sperm production
  • jobs that require long periods of sitting, such as truck driving
  • emotional issues, like stress and depression, particularly if they’re long term and severe
  • body weight, particularly if you have obesity or overweight, can also affect hormones

What about masturbation?

You may have heard that masturbating too frequently can lower sperm count. However, this study indicates that you can ejaculate daily and still maintain normal sperm quality.

You may not experience any signs or symptoms of low sperm quality until you try to start a family. That’s right — the main symptom of oligospermia is infertility.

If your low sperm count is caused by an underlying condition — a hormone imbalance, chromosomal abnormality, testicular issue, or blockage — you may experience symptoms related to the condition, which isn’t the same as having symptoms of low sperm count. These symptoms may include:

Related: Everything you need to know about infertility

If you’ve been having unprotected sex regularly for the last year and haven’t gotten your partner pregnant, you may want to see your doctor. In fact, you may want to head in for an appointment sooner if you have symptoms like trouble ejaculating, pain in the testicles, or previous surgeries.

Diagnosis usually involves a physical exam, medical history, and semen analysis.

We know — ejaculating into a cup may be the last thing you want to do. However, for the medical professional requesting or receiving the analysis, it’s really no different than a urine or blood sample, so there’s no reason to feel awkward.

A semen analysis may be particularly helpful in receiving a diagnosis, as your sperm can be counted under a microscope and checked for motility (movement) and morphology (shape). Your doctor may even want to repeat the analysis to ensure consistent results because of high variability between samples.

You’ll likely be provided with a container at your doctor’s office. You’ll be asked to masturbate and ejaculate into the container either at the clinic or at home. If you opt to collect the sample at home, you’ll be instructed on how to care for the specimen until you can get it back to the lab within an hour.

Other tests your doctor may try include:

  • blood tests to check hormones or chromosomes
  • ultrasound to visualize the testicles or prostate
  • biopsy to evaluate sperm production in the case of blockages

Related: Semen analysis and test results

The treatment you receive for low sperm count will depend on the cause. There are also some ways you can change up your trying to conceive (TTC) routine that may make pregnancy more possible.

Surgery

For cases involving large varicoceles, blockages, or issues with sperm leaving the body, surgery is an option. For example, a varicocele can be corrected with a minor outpatient surgery, and previous vasectomies can be reversed.

In other cases, sperm can be directly obtained for assisted reproduction procedures like in vitro fertilization (IVF) by surgically retrieving it from the testicle or epididymis.

Medications

Infections in the reproductive tract can be treated with medications. It’s important to treat infections promptly. Even if an infection is properly treated, sperm count may not always return to normal if permanent tissue scarring has occurred.

Counseling

Issues with sexual intercourse, including erectile dysfunction or premature ejaculation, may respond to a combination of medication and counseling.

Related: Best home remedies for premature ejaculation

Hormonal treatments

Since testosterone and other hormone levels that are either too high or too low can cause low sperm count, addressing the levels with medications and other treatments may help restore fertility.

Remember that the use of anabolic steroids, testosterone, or even most over-the-counter testosterone boosters can cause infertility, so avoid these.

Lifestyle modifications

Things you can do at home to increase the odds of pregnancy with low sperm count include having sexual intercourse more frequently and timing sex with ovulation.

For example, having sex every day or every other day within a few days before, during, and after ovulation will help ensure that the swimmers who make it all the way to the egg get there at the right time.

While you’re at it, skip all lubricants that may slow sperm travel. If you want to use lubrication, try something like Pre-Seed, but use it sparingly. Despite the common misconception, even Pre-Seed can introduce a physical barrier if used in excess.

And avoid activities that raise the temperature of the testicles, such as frequent hot tub dips, saunas, or steam rooms. Lastly, avoid excessive drug and alcohol use, as well as workout supplements that are known to lower sperm quality.

Buy Pre-Seed online.

Alternative medicine

Although a variety of vitamin supplements have been studied, antioxidants or vitamins may have a minimal effect unless you have a true dietary deficiency.

Speak with your doctor before taking supplements, as some may interact with other medications you’re taking. And importantly, certain workout supplements may harm your fertility.

Give it time

It’s important to note that any treatments or lifestyle changes may not be reflected in your sperm count right away, as the time frame of sperm production and transit is up to 2 to 3 months. As such, you may not see an increase for 3 months, on average.

The good news is that having fewer sperm swimming around doesn’t mean it’s impossible to achieve pregnancy — it may just make take a bit longer. Researchers share that unless your sperm count is zero, you may still be able to get your partner pregnant with time.

Statistics are hard to come by here, as just how long it takes depends on a number of factors that are individual to you and your partner, including how low your sperm count is and how healthy your sperm are.

For example, motility refers to a sperm’s ability to get where it needs to go. If your motility is good, having few sperm may not be as big of a problem. However, if your sperm count is low and motility is affected, it could take longer.

Your partner’s fertility affects the equation as well, as does your ability to time sex with the ovulation window. Fortunately, you have options if pregnancy isn’t happening.

Related: Babymaking 101: Ways to get pregnant faster

In some cases of abnormal semen quality, your doctor may suggest intrauterine insemination (IUI). This procedure may involve your female partner taking a drug called clomiphene to support egg development. At the time of ovulation, you supply sperm in a cup that’s then washed and concentrated. Next, the sperm is placed in the uterus using a long, flexible tube.

If your sperm count is very low, in vitro fertilization (IVF) may be a better option. In this procedure, doctors give the female partner certain drugs to develop healthy eggs and retrieve the mature eggs surgically.

Meanwhile, sperm can be collected ahead of time and frozen, or supplied fresh the day of fertilization. Your doctor fertilizes the eggs in a lab and then transfers healthy embryos into the uterus to implant. This whole process takes around 3 weeks to complete.

While this assisted reproductive technology is the most effective, it’s also the most invasive and expensive. According to Planned Parenthood, one cycle of IVF can cost $15,000 or more.

Related: The 30-day guide to IVF success

Couples can get pregnant with low sperm count. It may just take more time than you originally expected, and it may require seeing a doctor to see how you can improve your sperm quality.

Regardless, if you suspect you have an issue, make an appointment with your doctor. That way, you can get a better picture of just how low your count might be, what treatments are available, and whether you want to explore options like IUI or IVF to grow your family.

If your low sperm count is caused by an underlying health condition, your doctor can also help you get the treatment you need to relieve any other symptoms you’re experiencing.