Can a man with low sperm count still get a woman pregnant?
Yes, it is possible.
A low sperm count can reduce the chance of natural conception, but it does not automatically mean a man is infertile.
In fact, some men with low sperm counts achieve pregnancy naturally. Others may need treatment or fertility support such as IUI, IVF or ICSI.
The more important question is:
Why is the sperm count low, and what can be done about it?
For many couples trying to conceive, fertility investigations often begin with the woman. However, male factors can contribute to infertility too.
International fertility guidance recommends that both partners undergo evaluation rather than investigating only the woman. Male factors contribute wholly or partly to infertility in a substantial proportion of couples.
This makes understanding low sperm count in men an important part of fertility care.
Why Male Fertility Is Getting More Attention
Male reproductive health is receiving greater attention globally and in Nigeria.
The World Health Organization released its first global guideline on infertility in November 2025. WHO estimates that around one in six people of reproductive age experience infertility during their lifetime.WHO Publication
Nigeria also recently hosted the 2nd AFFS and 16th AFRH Annual Conference in Abuja from 24–26 September 2026.
The conference brought African and international reproductive-health experts together under the theme “Fertility Frontiers: Global Innovations & Advances in Human Reproduction.”
Importantly, sperm quality and its effect on assisted reproductive treatment outcomes formed part of the scientific conversation.
For Nigerian men, this conversation matters.
Male fertility deserves the same early attention as female fertility.
What Is Low Sperm Count?
Low sperm count means that the semen contains fewer sperm cells than expected.
Doctors call it oligozoospermia.
According to reference data used in the sixth edition of the WHO semen laboratory manual, a sperm concentration below about 16 million sperm per millilitre falls below the fifth percentile seen among men whose partners conceived naturally within 12 months.
The reference value for total sperm number is about 39 million sperm per ejaculate.
However, these figures need careful interpretation.
A Low Number Does Not Automatically Mean Infertility
A semen analysis is not simply a pass-or-fail test.
WHO reference values do not create a strict dividing line between men who can conceive and men who cannot.
A man slightly below a reference value may still father a pregnancy. Meanwhile, someone with a sperm concentration above that value may have problems involving sperm movement, shape or other fertility factors.
That is why doctors assess the whole semen analysis, not sperm count alone.
What Does a Semen Analysis Check?
A proper semen analysis provides much more information than simply counting sperm.
The laboratory usually assesses several important factors.
| Semen Parameter | What It Measures | WHO 2021 Lower Reference Value |
|---|---|---|
| Semen volume | Amount of semen produced | 1.4 mL |
| Sperm concentration | Sperm per millilitre | 16 million/mL |
| Total sperm number | Sperm in the whole ejaculate | 39 million |
| Total motility | Percentage of moving sperm | 42% |
| Progressive motility | Sperm moving forward | 30% |
| Vitality | Percentage of live sperm | 54% |
| Normal morphology | Normally shaped sperm | 4% |
These figures represent lower reference values rather than guarantees of fertility.
Your doctor will interpret them alongside your medical history, examination and your partner’s fertility assessment.
What Causes Low Sperm Count in Men?
There is no single cause of low sperm count in men.
Sometimes doctors identify a clear problem. In other cases, the cause remains unexplained.
Several medical, hormonal, lifestyle and environmental factors can affect sperm production.
1. Varicocele
A varicocele is an enlargement of veins around the testicle.
It can affect sperm production and sperm quality in some men.
A man may have no symptoms. Others may notice discomfort, swelling or enlarged veins in the scrotum.
For selected men who have infertility, abnormal semen results and a clinical varicocele, treatment may improve fertility outcomes. Both WHO and specialist male-fertility guidelines support treatment in appropriately selected cases.
2. Hormonal Problems
Sperm production depends on hormones from the brain and testicles working together.
Problems involving testosterone, FSH, LH, the pituitary gland or other parts of the hormone system can reduce sperm production.
A fertility specialist may request hormone tests if your history or semen results suggest a hormonal problem.
Treatment depends on the exact cause.
3. Infections
Some infections can affect male reproductive health.
For example, certain sexually transmitted infections and infections involving the testicles or epididymis may affect sperm production or block sperm movement.
However, taking antibiotics without proper testing is not the answer.
A doctor should first determine whether an infection is present and whether it contributes to the fertility problem.
4. Blockage of the Sperm Pathway
A man may produce sperm normally but have a blockage that prevents sperm from entering the semen.
Previous infections, injuries, operations or certain conditions present from birth may cause such blockages.
Depending on the cause, doctors may consider surgery, sperm retrieval or assisted reproduction.
5. Undescended Testicles
Some boys are born with one or both testicles outside their normal position in the scrotum.
A history of undescended testicles can increase the risk of fertility problems later in life.
Therefore, men undergoing a fertility assessment should mention this history to their doctor.
6. Genetic Conditions
Very low sperm counts or complete absence of sperm may sometimes have a genetic cause.
For example, chromosomal conditions or certain Y-chromosome abnormalities can affect sperm production.
Men with severe oligozoospermia or azoospermia may need genetic testing after specialist assessment.
7. Certain Medicines and Cancer Treatment
Some medicines can interfere with sperm production.
Chemotherapy and radiation can also affect fertility.
Therefore, always tell your fertility doctor about medications, supplements, injections and previous cancer treatment.
Do not stop prescribed medication without speaking with your doctor.
8. Testosterone Injections and Bodybuilding Steroids
This one surprises many men.
Taking testosterone can actually reduce sperm production.
External testosterone tells the brain that the body already has enough testosterone. As a result, the brain may reduce the hormonal signals needed for the testicles to produce sperm.
In some men, sperm production can become extremely low or stop.
For this reason, AUA/ASRM fertility guidance advises doctors not to prescribe testosterone monotherapy to men who want current or future fertility.
Anabolic steroids used for bodybuilding can cause a similar problem.
If you are trying for a baby, tell your fertility specialist about any testosterone injections, gym steroids or hormone products you use.
9. Smoking, Alcohol and Recreational Drugs
Lifestyle does not explain every case of male infertility.
However, smoking, heavy alcohol use and some recreational drugs can affect sperm production or quality.
WHO also identifies smoking, excessive alcohol intake and obesity among lifestyle factors associated with infertility.
Therefore, improving general health can form part of a male fertility plan.
10. Obesity and Metabolic Health
Excess body weight can affect hormones involved in reproduction.
It may also contribute to other health problems that affect fertility.
Weight loss does not guarantee that sperm count will suddenly become normal.
Still, reaching a healthier weight may support reproductive and general health when excess weight is present.
11. Heat and Environmental Exposure
Frequent high heat around the testicles may affect sperm production.
Environmental exposure to pesticides, industrial chemicals and heavy metals may also affect male fertility.
Men with regular workplace exposure should mention this during a fertility consultation.
What Are the Signs of Low Sperm Count?
Here is what many men do not expect:
Low sperm count often has no obvious physical symptoms.
A man may feel healthy.
He may have normal erections.
His sex drive may be normal.
He may also ejaculate normally.
The first sign may simply be that pregnancy is not happening.
However, an underlying condition can sometimes cause additional symptoms.
These may include reduced sexual desire, erection problems, ejaculation problems, pain or swelling around the testicles, or reduced facial and body hair linked to hormonal problems.
Does Watery Sperm Mean Low Sperm Count?
This is one of the most searched and misunderstood male-fertility questions.
First, the correct term is watery semen, not watery sperm.
Sperm cells are microscopic. You cannot judge their number simply by looking at semen.
Thin or watery-looking semen may sometimes occur alongside a low sperm concentration. However, semen can also look different because of frequent ejaculation and normal day-to-day changes.
Therefore:
Watery semen does not automatically mean low sperm count or infertility.
Likewise, thick-looking semen does not guarantee excellent fertility.
A laboratory semen analysis provides much more useful information than appearance alone.
Can a Man With Low Sperm Count Get a Woman Pregnant?
Yes.
Natural pregnancy may still happen.
However, the chance can fall as sperm numbers decrease, particularly when poor motility or abnormal morphology occurs at the same time.
That is why doctors do not look at concentration alone.
They also consider how many sperm are moving properly, their shape, semen volume and the fertility of the female partner.
In some couples, natural conception remains reasonable.
Others may benefit from fertility treatment.
When Should a Man Have a Semen Analysis?
A man should not wait indefinitely while only his partner undergoes fertility tests.
International guidance recommends evaluating both partners when a couple has difficulty conceiving.
Consider a semen analysis if pregnancy has not occurred after about 12 months of regular unprotected sex.
An earlier fertility assessment may make sense when the female partner is 35 or older or when either partner has a known fertility risk.
Men should also seek earlier advice if they have a history of testicular problems, genital surgery, chemotherapy, undescended testicles, varicocele, erection or ejaculation problems.
How Is a Semen Analysis Done?
Your clinic will give you clear instructions before the test.
Laboratories commonly ask men to avoid ejaculation for a short period before producing the sample.
WHO’s semen laboratory manual discusses collection following around 2–7 days of ejaculatory abstinence, while stressing that collection conditions can affect results.
The laboratory then examines the sample.
Why One Abnormal Semen Analysis May Not Be Enough
Sperm measurements can vary from one sample to another.
Illness, fever, collection problems, the length of abstinence and other temporary factors may affect the result.
Therefore, doctors often repeat an abnormal semen analysis.
Current European male-infertility guidance recommends at least two consecutive analyses when the first test is abnormal. AUA/ASRM guidance also emphasises repeat testing because semen parameters naturally vary.
So, do not panic after seeing one abnormal number.
Get the result interpreted properly.
What Other Tests Might Be Needed?
A semen analysis is usually the starting point, not always the end.
Depending on the results, a fertility specialist may recommend further evaluation.
This may include a physical examination, hormone blood tests, ultrasound, urine testing after ejaculation or genetic testing.
Specialised tests may also be appropriate in selected situations.
For example, sperm DNA fragmentation testing may have a role in men with unexplained infertility, recurrent pregnancy loss or failure of assisted reproductive treatment.
Not every man needs every test.
The results of the first assessment should guide the next step.
Can Low Sperm Count Be Treated?
Sometimes, yes.
However, there is no single medicine that treats every case of low sperm count.
Successful treatment starts by understanding the cause.
Treating an Underlying Medical Problem
If doctors identify a hormonal disorder, they may recommend targeted treatment.
When infection contributes to the problem, appropriate treatment may help.
Selected men with a clinical varicocele may benefit from varicocele treatment.
If a blockage prevents sperm from entering the semen, surgery or sperm retrieval may provide an option.
That is why proper diagnosis matters more than simply buying a product advertised as a “sperm booster.”
Can Lifestyle Changes Increase Sperm Count?
Healthy lifestyle changes may support male reproductive health.
Men trying to conceive should consider stopping smoking, avoiding anabolic steroids and recreational drugs, reducing excessive alcohol intake, maintaining a healthy weight and limiting unnecessary exposure to extreme heat or workplace toxins.
However, lifestyle changes cannot repair every cause.
They will not remove a serious blockage, correct every genetic condition or automatically cure severe male-factor infertility.
Use lifestyle improvement as part of proper medical care rather than a replacement for it.
What Foods Increase Sperm Count?
There is no single fruit, vegetable, drink or Nigerian food that can guarantee a higher sperm count.
A balanced diet supports general health and provides nutrients needed by the body.
However, be cautious of claims that a particular food can “flush the system,” “multiply sperm overnight” or cure infertility.
Male fertility problems often require proper testing.
Food should support treatment, not replace diagnosis.
Do Sperm Supplements Work?
Many products marketed online contain antioxidants, vitamins, zinc and other ingredients.
Some men may have nutritional deficiencies that require correction.
However, supplements are not a guaranteed treatment for infertility.
AUA/ASRM guidance notes that the clinical value of antioxidant and vitamin supplements for male infertility remains uncertain and that evidence does not support recommending one specific supplement for everyone.
Speak with a doctor before combining several fertility supplements.
Can Herbal Mixtures Increase Sperm Count?
Be careful with promises such as:
“Boost sperm count in seven days.”
“Cure zero sperm naturally.”
“One bottle reverses male infertility.”
Male infertility has many possible causes.
A herbal mixture cannot correct every hormonal, genetic, structural or medical problem.
More importantly, delaying proper testing may waste valuable time for both partners.
Get a semen analysis first.
Then treat the cause.
Fertility Options for Men With Low Sperm Count
Not every man with low sperm count needs IVF.
The best fertility option depends on the severity of the sperm problem, the cause, the female partner’s fertility and how long the couple has been trying.
Natural Conception
Some couples can still conceive naturally, particularly when the sperm count is only mildly reduced and other semen parameters remain favourable.
Your fertility doctor may recommend continued regular intercourse while addressing correctable factors.
Intrauterine Insemination — IUI
During IUI, the laboratory prepares a semen sample and places selected sperm inside the uterus around ovulation.
This can help in selected cases.
However, very low numbers of moving sperm may reduce IUI success. AUA/ASRM guidance notes that assisted reproductive treatment such as IVF or ICSI may become more appropriate when repeated semen analyses show a very low total motile sperm count.
IVF for Male-Factor Infertility
During in vitro fertilisation or IVF, doctors collect eggs from the female partner and fertilisation occurs in the laboratory.
IVF may form part of treatment when male fertility problems occur alongside other fertility factors.
The treatment plan should consider both partners.
ICSI for Low Sperm Count
Intracytoplasmic sperm injection, or ICSI, has changed fertility treatment for many couples dealing with significant male-factor infertility.
During ICSI, an embryologist selects a viable sperm and injects it directly into an egg.
This approach can help overcome some problems involving very low sperm numbers, poor movement or sperm morphology when suitable viable sperm are available.
ICSI does not cure the man’s underlying condition.
Instead, it can help achieve fertilisation despite certain sperm problems.
What If No Sperm Is Found in the Semen?
The complete absence of sperm in the ejaculate is called azoospermia.
This requires specialist evaluation.
Azoospermia may result from a blockage or from problems with sperm production.
Depending on the cause, fertility specialists may consider hormonal treatment, surgery or surgical sperm retrieval for IVF/ICSI.
Therefore, a report showing “zero sperm” should lead to further investigation rather than immediate loss of hope.
Common Myths About Low Sperm Count in Men
Myth 1: “If I Can Ejaculate, My Sperm Count Must Be Normal”
False.
Most of the fluid in semen does not consist of sperm cells.
A man can produce what looks like a normal amount of semen and still have a low sperm count.
Only semen analysis can provide useful information about sperm concentration.
Myth 2: “Watery Semen Means I Am Infertile”
Not necessarily.
Semen appearance varies.
Watery semen can occur temporarily and cannot diagnose male infertility on its own.
Get tested instead of judging fertility by colour or thickness.
Myth 3: “A Low Sperm Count Means Pregnancy Is Impossible”
False.
Low sperm count reduces fertility potential but does not always eliminate it.
Natural conception may still happen, while IUI, IVF or ICSI may provide options when needed.
Myth 4: “Taking Testosterone Will Increase My Sperm”
This can have the opposite effect.
External testosterone can suppress the hormones required for sperm production.
Men who want children should discuss low testosterone symptoms with a fertility-aware doctor rather than self-medicating with testosterone injections.
Myth 5: “Infertility Is Mainly a Woman’s Problem”
Male and female factors can both affect conception.
That is why fertility organisations recommend evaluating both partners.
Testing the man early can save time, reduce unnecessary investigations and help the couple receive the right treatment sooner.
Frequently Asked Questions About Low Sperm Count in Men
Possible causes include varicocele, hormonal disorders, infections, reproductive-tract blockage, genetic conditions, undescended testicles, certain medicines, cancer treatment, anabolic steroids, smoking, excessive alcohol, obesity and environmental exposures.
Sometimes doctors cannot identify a single cause.
Yes.
Pregnancy can still occur naturally in some couples.
However, lower sperm numbers may reduce the monthly chance of conception, especially when sperm movement or shape is also abnormal.
Most men have no obvious symptoms.
Difficulty achieving pregnancy may be the first sign.
Some men may also have erection problems, reduced sexual desire, ejaculation problems, testicular swelling or signs of a hormonal condition.
Yes, in some cases.
Treatment depends on the cause.
Options may include lifestyle changes, treatment of hormonal problems or infection, varicocele treatment, surgery, IUI, IVF or ICSI.
The WHO 2021 reference data place the lower fifth percentile for sperm concentration at about 16 million sperm per millilitre and total sperm number at 39 million per ejaculate.
However, these numbers do not create a strict line between fertile and infertile men.
Not always.
Semen can look watery because of normal variation or frequent ejaculation.
Persistent changes, fertility problems or other symptoms deserve proper evaluation.
A semen analysis is more reliable than visual appearance.
Frequent ejaculation can temporarily change the amount or concentration measured in a semen sample.
However, masturbation itself does not automatically cause permanent male infertility.
Follow your laboratory’s abstinence instructions before a semen analysis so the test can be interpreted properly.
Do Not Make Male Fertility an Afterthought
When pregnancy takes longer than expected, both partners deserve proper evaluation.
Do not assume the woman is responsible.
Do not assume that normal erections mean normal sperm.
And do not assume that semen that “looks healthy” confirms fertility.
A simple semen analysis can provide valuable information about low sperm count in men, sperm movement, morphology and other important parameters.
More importantly, an abnormal result is not the end of the story.
It is the beginning of finding out why.
Speak With a Male Fertility Specialist at St. Ives Specialist Hospital
If you and your partner have been trying to conceive without success, consider assessing both partners.
At St. Ives Specialist Hospital, our fertility and reproductive-health teams provide evaluation and treatment for male and female fertility concerns.
Male fertility assessment may include semen analysis, medical review and further investigations where needed.
Where natural conception remains difficult, couples can also discuss fertility options such as IUI, IVF and ICSI based on their individual results.
St. Ives Specialist Hospital provides specialist care across fertility and IVF, women’s health, men’s health, pregnancy and maternity care, children’s health, family health and general wellbeing, with services across Lagos and Abeokuta.
Whether you have received an abnormal semen analysis, have been told your sperm count is low or simply want to understand your fertility before trying for a baby, early assessment can give you clearer answers.
Your fertility is not determined by one number.
Start with the right test.
Understand the cause.
Then choose the right treatment with your fertility specialist.
