Male Infertility and Low Sperm Count: Causes, Diagnosis and Treatment

Understanding Male Infertility

When a couple has difficulty conceiving, the cause lies with male factors in a substantial proportion of cases — either alone or alongside a female factor. Male infertility usually comes down to problems with sperm count, movement (motility), or shape (morphology), though in some men, no sperm is found in the ejaculate at all, a condition called azoospermia.

Common Causes

• Varicocele — enlarged veins in the scrotum that raise testicular temperature and impair sperm production
• Hormonal imbalances affecting testosterone and related hormones
• Lifestyle factors: smoking, excess alcohol, obesity, and prolonged heat exposure
• Genetic conditions affecting sperm production
• Prior infections, surgery, or injury affecting the reproductive tract

Signs That May Point to a Problem

Male infertility often has no obvious symptoms and is discovered only when a couple struggles to conceive. Some men may notice testicular swelling, pain, or a visible varicocele, or have a history of undescended testis or previous surgery in the area — all worth mentioning during evaluation.

How It's Diagnosed

A semen analysis is the starting point, assessing sperm count, motility and morphology. Depending on the findings, further tests may include hormone blood work, a scrotal ultrasound to check for a varicocele, and genetic testing when sperm count is very low or absent.

Treatment Options

Treatment depends on the underlying cause. Lifestyle changes and, where relevant, hormonal medication can improve mild cases. A varicocele affecting fertility can be corrected surgically through microsurgical varicocelectomy. For men with azoospermia, sperm retrieval techniques such as TESA (testicular sperm aspiration) or Micro-TESE (microsurgical testicular sperm extraction) can retrieve sperm directly from the testicle for use in assisted reproduction, even when none is found in the ejaculate.

Lifestyle Factors That Support Fertility

• Maintaining a healthy weight
• Avoiding smoking and limiting alcohol
• Managing heat exposure (prolonged hot baths, laptop use on the lap, tight underwear)
• Managing chronic conditions like diabetes

When to Consult Dr. Raju R

If you and your partner have been trying to conceive without success, a semen analysis is a straightforward first step. Dr. Raju R evaluates and treats male infertility — including varicocelectomy and advanced sperm retrieval techniques like Micro-TESE — at Genesiss Multi-Speciality Hospital, Bangalore.