A low sperm count is one of the most common findings in male fertility, and one of the most treatable. Known medically as oligospermia, it means the semen contains fewer sperm than normal, which can make conceiving more difficult, though often not impossible. Understanding why the count is low is the key, because in many cases the underlying cause can be treated and fertility improved. For couples trying to conceive, it’s a diagnosis worth taking seriously and worth getting right.
Dr. Justin Houman is a board-certified urologist and Fellow of the American College of Surgeons whose subspecialty fellowship training in male reproductive medicine and microsurgery is held by fewer than 2% of urologists in the United States. He focuses specifically on male fertility, offering advanced diagnostics, hormonal and medical therapies, and microsurgical procedures such as varicocelectomy to address the root causes of a low sperm count. An Assistant Professor of Urology at Cedars-Sinai Medical Center published in leading journals including the Journal of Sexual Medicine, he brings both clinical depth and a genuinely personal approach to helping men and couples build their families.
“A low sperm count is rarely the end of the story. So often there’s a specific, treatable reason behind it — and finding that reason is what turns a discouraging test result into a real path forward.” — Dr. Justin Houman
I recommend Dr. Houman for any urology need whatsoever. No question he will handle and take care of you and will make you feel comfortable throughout the entire process. He and his staff are reachable and answer all of your questions and concerns. If you are looking for someone like that, look no further.
What Is a Low Sperm Count (Oligospermia)?
A low sperm count, or oligospermia, is diagnosed when a semen analysis shows fewer than 15 million sperm per milliliter of semen, the lower end of the World Health Organization’s reference range. It can be mild, moderate, or severe, and it differs from azoospermia, which is the complete absence of sperm in the semen. A lower count reduces the odds of conception in any given cycle, but many men with oligospermia can still father children, especially once the underlying cause is addressed.
Symptoms of Low Sperm Count
In most cases, the only real sign of a low sperm count is difficulty conceiving, as many men have no other symptoms at all. Occasionally, there are clues pointing to an underlying cause, such as:
- Changes in sexual function, like low libido or erectile difficulties
- Pain, swelling, or a lump in the testicle area, which can suggest a varicocele
- Signs of a hormonal imbalance, such as decreased facial or body hair
- A history of testicular problems, surgery, or injury
Because symptoms are so often absent, a semen analysis is the only reliable way to know.
What Causes a Low Sperm Count?
A low sperm count can stem from a range of causes, and identifying the right one shapes the entire treatment plan:
- Varicocele: Enlarged veins in the scrotum that raise testicular temperature — the most common correctable cause of low sperm count.
- Hormonal Imbalances: Problems with testosterone or the hormones that regulate sperm production.
- Infections and Illness: Certain infections can interfere with sperm production or function.
- Lifestyle Factors: Smoking, excessive alcohol, obesity, heat exposure, and anabolic steroid use can all lower sperm counts.
- Medications and Medical History: Some medications, prior surgeries, or a history of an undescended testicle can play a role.
- Genetic Factors: In some cases, particularly with very low counts, a genetic cause is involved.
Diagnosing Low Sperm Count
The diagnosis begins with a semen analysis, usually repeated to confirm the result since counts naturally vary from sample to sample. From there, Dr. Houman looks for the cause with a physical examination to check for a varicocele, blood tests to evaluate hormone levels, and, when appropriate, a scrotal ultrasound or genetic testing for very low counts. This thorough workup is what allows treatment to target the actual problem rather than relying on guesswork.
Low Sperm Count Treatment Options
Treatment focuses on correcting the underlying cause and improving the chances of conception:
- Varicocele Repair: Microsurgical varicocelectomy corrects the most common reversible cause of low sperm count and can improve sperm quality over time.
- Hormonal and Medical Therapy: Medications such as clomiphene or enclomiphene and hCG can stimulate the body’s own sperm production. Importantly, testosterone therapy is avoided when fertility is the goal, because supplemental testosterone actually suppresses sperm production.
- Lifestyle Changes: Addressing weight, heat exposure, smoking, alcohol, and steroid use can meaningfully improve sperm counts.
- Treating Infections or Other Causes: Resolving an underlying infection or medical issue can restore healthier sperm production.
- Assisted Reproduction: When needed, techniques such as intrauterine insemination (IUI) or in vitro fertilization with ICSI can help achieve pregnancy even with a low count.
The right plan depends on the cause, your goals, and your partner’s fertility, all of which Dr. Houman considers together.
Frequently Asked Questions About Low Sperm Count
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A low sperm count, or oligospermia, is generally defined as fewer than 15 million sperm per milliliter of semen, based on World Health Organization reference values.
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Often, yes — many men with a low count can conceive, especially once the underlying cause is treated, and assisted reproduction can help in more severe cases.
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A varicocele — enlarged veins in the scrotum — is the most common correctable cause, and repairing it can improve sperm count and quality.
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No — testosterone therapy actually suppresses sperm production, so when fertility is the goal, medications that stimulate the body’s own production are used instead.
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Through a semen analysis, usually repeated, along with a physical exam, hormone testing, and sometimes ultrasound or genetic testing to find the cause.
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Yes — managing weight, avoiding excess heat, quitting smoking, limiting alcohol, and stopping anabolic steroids can all help improve sperm counts.
Why Choose Dr. Houman for Low Sperm Count Treatment in Los Angeles
- Root-Cause Approach: Identifying and treating the specific reason behind a low sperm count.
- Microsurgical Varicocele Repair: Advanced correction of the most common reversible cause.
- Fertility-Preserving Hormone Therapy: Treatments that boost sperm production, not suppress it.
- Subspecialized Male Fertility Expertise: Fellowship-trained care focused on building families.
Meet Dr. Houman
Expert in Men’s Health with Tower Urology and Cedars Sinai
Dr. Justin Houman, MD, FACS is a board-certified urologist and fellowship-trained microsurgeon at Tower Urology, Cedars-Sinai Medical Center in Los Angeles. His subspecialty training in male reproductive medicine and microsurgery is held by fewer than 2% of practicing urologists in the United States.
His clinical focus is narrow by design. Varicoceles, chronic testicular pain, male infertility, vasectomy, testosterone optimization, erectile dysfunction, penile implant surgery, and Peyronie’s disease are not add-on services here. They are the practice. Patients travel from across the country and internationally for procedures, particularly microsurgical varicocelectomy, spermatic cord denervation, and inflatable penile implant surgery, that require a level of subspecialty training and surgical volume most urology practices do not have.
Low Sperm Count Treatment in Los Angeles
A low sperm count can feel discouraging, but it’s often the beginning of a solvable problem rather than a dead end. Dr. Houman offers expert diagnosis and fertility-focused treatment for men across Los Angeles and Southern California, tailored to the underlying cause and your family goals. Contact the Los Angeles office to schedule a consultation and take the next step toward conceiving.
