When a couple is struggling to conceive, the conversation often centres on female fertility. Yet, fertility is very much a shared journey. Male factors contribute to around 40-50% of couples experiencing fertility difficulties, either on their own or alongside female factors.
The reassuring news is that many causes of male infertility can be identified, and some are treatable or can be improved with the right medical care or lifestyle changes.
Understanding what affects sperm health is an important step, not just for diagnosis, but for knowing that there are often clear, treatable reasons behind the results.
This article looks at the most common causes of low sperm count, what the evidence says about each, and what men in Saudi Arabia can do if they have concerns about their fertility.
A low sperm count, known medically as oligospermia, refers to semen that contains fewer sperm than the threshold established by the World Health Organization. It can also be defined as fewer than 16 million sperm per millilitre of semen .
However, sperm count is only part of the picture. Semen analysis also addresses:
Together, these measurements provide valuable information about male fertility and help specialists determine whether further investigations are needed.
Varicocele is the most common identifiable and potentially correctable cause of male infertility. It occurs when veins within the scrotum become enlarged, similar to varicose veins in the legs. This can increase the temperature around the testes, where sperm are produced. Because sperm production works best at a temperature slightly below normal body temperature, this rise can affect sperm count, movement and shape.
Surgical or radiological treatment is available and, in many cases, results in a meaningful improvement in semen quality.
Sperm production depends on a finely balanced hormonal system. Disruptions to FSH, LH, testosterone, or prolactin can all impair the process. Conditions affecting the pituitary gland, thyroid disorders, or the use of anabolic steroids can suppress the hormones responsible for stimulating sperm production. Hormone blood tests are often part of the male fertility assessment and can identify these imbalances when they are present.
The testes are located outside the body for a reason: sperm production requires a temperature slightly below core body temperature. Evidence suggests that modest increases in temperature, around 2 to 3°C, may affect sperm DNA integrity, which is why maintaining optimal testicular temperature is considered important in male fertility health.
For men living in Saudi Arabia, where temperatures can be extreme, prolonged occupational or environmental heat exposure warrants consideration. Regular use of hot tubs, prolonged sitting, or working in high-heat environments may also be relevant factors.
Several lifestyle habits are associated with reduced sperm quality, including:
The encouraging aspect of lifestyle-related fertility problems is that many are modifiable. Improvements in diet, weight, exercise and smoking cessation may help improve sperm health over time. Because sperm takes around 70-90 days to develop, positive changes may take several months to be reflected in a semen analysis.
Some infections can affect fertility. Sexually transmitted infections, including chlamydia, may cause inflammation or scarring that affects sperm transport if left untreated. Mumps after puberty can occasionally lead to inflammation and damage of the testes, and can also impair sperm production. A detailed medical history is therefore an important part of every fertility assessment.
In some cases, sperm production is normal but sperm cannot reach the ejaculate due to a blockage within the reproductive tract. This may occur following a vasectomy, previous surgery or, more rarely, because a man was born without part of the vas deferens, the tubes that carry sperm.
Where no sperm are present in the ejaculate despite normal production, this is known as obstructive azoospermia. This is diagnosed through semen analysis combined with further investigations. Depending on the underlying cause, surgical sperm retrieval may be an appropriate treatment option as part of fertility care.
Male fertility does decline with age, though the process is more gradual than it is in women.
Although many men father healthy children well into later life, increasing paternal age is associated with gradual reductions in semen quality and may be linked with a longer time to conception.
Age is therefore one of several factors your fertility specialist will consider when assessing your overall reproductive health, particularly when a couple has been trying to conceive for some time.
A semen analysis is a straightforward, non-invasive test that can provide valuable information about male fertility quickly.
Couples are generally advised to seek fertility assessment after 12 months of regular unprotected sexual intercourse without success, or after six months if the woman is aged 35 or over.
However, it is sensible to seek advice sooner if you have known risk factors, including:
At Child Fertility, we assess both partners from the outset, because fertility is rarely one-sided. Our team understands that approaching this subject can feel sensitive, and we aim to make the process as comfortable and straightforward as possible.
A low sperm count is not a final answer. In many cases, the cause is identifiable, and treatment or lifestyle changes can make a real difference. The first step is simply knowing where things stand.
If you have concerns about male fertility or would like to arrange a semen analysis as part of a broader fertility assessment, we are here to support you.
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