Low sperm count...is it a cause for concern?

Editor's note: Dr. Jamin Brahmbhatt, a urologist and robotic surgeon with Orlando Health, is an assistant professor at the University of Central Florida College of Medicine. - There are two situations in which men pay great attention to their health: erection problems and difficulty conceiving. Those concerned about fertility are often younger and come with their partners, so these visits provide an opportunity to discuss their overall health, not just fertility.

I spend time in the clinic correcting misconceptions about semen and fertility, most notably concerns about global decline in sperm counts. As I heard these concerns repeatedly, I began to wonder: Are sperm counts really declining around the world?

A global analysis published in 2022 raised concern because it estimated that average sperm concentration fell by about half between 1973 and 2018, based on 223 studies including more than 57,000 men from 53 countries. A meta-analysis combines the results of multiple studies to reveal general patterns, the results of which may influence doctors' and patients' understanding of health issues and the guidance provided to the public.

The researchers estimated that sperm concentration decreased by 51.6%, and their total number decreased by 62.3%. Concentration refers to the number of sperm per milliliter of semen, while total count refers to the number of sperm in one ejaculate.

These results raised concerns about sperm production and the factors affecting it, and also raised another question: Do their measurements reveal indicators of men's health in general? Smoking can affect semen quality.

In one study that included heavy smokers suffering from infertility, sperm concentration and total sperm count improved three months after quitting smoking. A study conducted in Argentina linked exposure to heat waves to a decrease in sperm concentration and total sperm count in men who underwent semen analysis as part of routine examinations.

The presence of the testicles outside the body is not a coincidence, as the sperm production process is better at temperatures lower than normal body temperature, so chronic exposure to heat may hinder this process. I advise every man who wants to have children now or in the future to avoid testosterone replacement therapy.

The instructions warn that this treatment may suppress sperm production, and may sometimes stop it completely. If you're concerned about symptoms of low testosterone, ask your doctor about alternative fertility-preserving options.

How can GLP-1 drugs contribute in this context? A systematic review published in 2026 linked the use of GLP-1 drugs to higher total testosterone levels.

Other studies have also shown improvement in some semen indicators in men with obesity or low testosterone levels. These results are encouraging, but I would be wary of classifying GLP-1 drugs as fertility drugs or prescribing them for this purpose.

These medications help men lose weight and control chronic diseases, and this may explain the noticeable improvement in testosterone levels and sperm quality. Whether these changes increase the chances of pregnancy, the matter still needs more research.

Sperm Health Goes Beyond Reproduction I treated a patient whose sperm count and morphology were normal, but had poor sperm motility. He exercised, did not smoke, and rarely drank alcohol, but suffered from work stress and lack of sleep.

After six months of improved sleep and stress reduction, his sperm motility improved, with no other changes to his diet or lifestyle. But this improvement does not prove that better sleep and less stress caused it, as semen analysis results vary over time.

However, the analysis provided an opportunity to discuss other aspects of his health, apart from changing sperm parameters. Most people associate sperm count with fertility and childbearing, but doctors also view it as an indicator within a man's overall health picture.

Men who suffer from infertility or have abnormal semen analysis results have increased rates of some diseases, which requires making them aware of this relationship. Abnormal results do not indicate a diagnosis of heart disease or diabetes, or indicate early death, but they do require a broader health evaluation that includes: What factors may affect sperm health?

Sperm health is affected by factors including: A review of 112 studies showed that obesity, diabetes and metabolic syndrome are associated with poor semen quality and sperm DNA damage. Another study that included 1,176 couples in 2018 showed that the probability of a successful pregnancy for men who slept less than six hours a night was about 40% lower in any given month, compared to those who slept eight hours.

Also, smoking may harm the quality of semen; A study on heavy smokers suffering from infertility showed an improvement in sperm concentration and total number three months after quitting smoking. An Argentine study linked heat waves to a decrease in sperm concentration and total sperm count.

The testicles produce sperm better at temperatures lower than normal body temperature, which makes chronic exposure to heat a factor that may hinder their production. What I advise men and their partners to do is not to panic because of one abnormal semen analysis result.

The analysis is usually repeated and the result is reviewed in light of the medical history, as some causes may be treatable, and examinations may reveal more serious underlying health problems. It is important to inform the doctor about the medications used, and whether the man is using cannabis or using products containing nicotine.

During examinations, I recommend habits that support overall health, including: Diet is an essential part of these habits. The Mediterranean diet has been linked to an improvement in some semen parameters, but the evidence on increasing the chances of pregnancy is still inconclusive.

Therefore, it should be viewed as part of a long-term health plan, not a quick fix for fertility problems. Sperm need time to respond to lifestyle changes or treatment, so they are usually re-evaluated after about three months.

This is different from repeating the first abnormal analysis to confirm the result. The controversy over sperm counts will continue, but dealing with each case individually remains the basis of the clinic: