Sperm Counts: How Low Is Too Low if You Want To Be a Dad?

neatly ordered books
Oh how we like to count and order things… (courtesy: Unsplash.com)

We humans like to count and label things. We order the stars above us into constellations. We organize time into hours, minutes and seconds. We name the colors of the rainbow. We track how many steps we take with widgets on our wrists. Maybe it gives us a sense of control over our big, wide world. Or maybe it helps us feel like we belong. Regardless, we do the same when it comes to male fertility.

We Count Sperm, Too

Semen analysis is another example of how we like to order our world. We have normal values, means and averages, and reference ranges for everything sperm-related, including total number, movement and shape. Does this have real value? Absolutely. Our ability to order the world is fundamental to how we think about things. And this weird habit of ours has certainly helped us to better evaluate and treat male infertility.

Let’s break down the Greek-derived terms given to sperm numbers so it makes more sense:

Polyspermia High sperm concentration >100 million sperm/mL
Normospermia Normal sperm concentration 15-100 million sperm/mL
Oligospermia Low sperm concentration <15 million sperm/mL
Cryptozoospermia Very few sperm present Sperm on spun semen only
Azoospermia No sperm present 0 sperm in ejaculate


Every Sperm is Sacred

Now, here’s where the ordering and the science goes a little soft on us. Note the following 5 truths about ejaculated sperm numbers:

  • There is no known association of polyspermia with male infertility. The more the merrier it seems.
  • Having a normal sperm count does not mean you’re fertile. It means that you’re more likely to be fertile. Take a “deeper dive”  into sperm counts and you will discover that at least 25% of men with normal sperm counts are infertile. It’s a quality issue, not just quantity.
  • Having a low sperm count increases the probability of being infertile but does not necessarily mean that you are. Perfectly normal babies are conceived by men with low sperm counts, precisely because women don’t need “normal” numbers to get the job done.
  • Men with low numbers of ejaculated sperm, which are often nearly impossible to find unless you look really hard, need not fear. A very small number of sperm can do a very good job of making babies with assisted reproduction (IVF-ICSI).
  • Having no sperm in the ejaculate is pretty much the only guarantee of male infertility. Many of these cases are due to blockage and can be corrected. Others are due to impaired sperm production, which although generally not correctable, does not necessarily preclude a man from having children. Pregnancy is possible using small numbers of testicular sperm and IVF-ICSI.

So, ordering our thoughts about sperm has led to a better understanding of the root causes of male infertility. But sperm counts are by no means the whole story, only a small part of it. For conception is a performance with many acts, actors and actresses that involves miracles as much as science.


8 thoughts on “Sperm Counts: How Low Is Too Low if You Want To Be a Dad?

  1. I have tried everything, doctors said i have Azoospermia, last time my sperm count was less than 5Mill and less 7mill after extractions from my eggs, i have stopped trying after my wive divorced me because of this. Is there any newer thing i can try in the market?

    1. Dear Botha Soo sorry to hear what happened with your relationship! Not sure whether this is fixable but it sounds super important to you. Give us a shout. Consider a Second Opinion to start!

  2. God morning doc
    You are doing a nice job sir, God bless you sir. Please sir can we use some of your articles to educate our patients in Nigeria via print?


  3. Hi Dr. Turek,

    Thank you for such an informative blog. My husband was recently diagnosed with severe oligospermia (concentration 0.2 mil/mL) with normal motility (55%) and normal forward progression (3). His hormonal work up shows is not clearly hypergonadotropic hypogonadism (FSH very high, LH upper limit of normal and testosterone totally normal E2 normal, PRL normal). Hes very healthy but only history he has of remote mild testicular trauma as a child and phimosis requiring circumcision at 12 yrs od age. A scrotal US shows no other abnormalities but he has heterogeneity of both testicles. What could this mean and does this require further work up or is our next and only hope for conception via ICSI?
    Thanks 🙂

    1. Dear MhD, I cannot really opinionate over the intranet on your case, but it does sound like classic nonobstructive azoospermia. Although generally not “correctable” (does he have a clinical varicocele on exam that can be fixed?) there is typically a 60% chance that testicular sperm is present and can be used with IVF-ICSI. Consider a Second Opinion or Virtual Visit to learn more!

      1. Thanks for your response. He does not have azoospermia, he has severe oligospermia, so he shouldn’t require TESE etc so long as he continues to have sperm in the ejaculate. In any case, we will move forward with ICSI when possible. Thanks.

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