A male with a normal sperm count should typically have at least 40 million sperm in his ejaculate, and 75 percent or more should be alive, according to the World Health Organization (WHO). Couples that have trouble trying to conceive can test the sperm count at their doctor's office to determine if the sperm count is normal. Many causes of a low sperm count, such as medications, infections and hormonal imbalances, can be reversed to allow a normal sperm count to be attained. When the problem cannot be fixed, there are other options for conception, such as in vitro fertilization (IVF) and the use of donor sperm. A low sperm count, however, does not always result in infertility or problems conceiving.
Testing one's sperm count often requires ejaculating into a sterile container, which is usually supplied by a doctor. Patients are then typically advised to take their sperm sample to the doctor's office for safe storage, at which point it will be analyzed to determine if they have a normal sperm count. If the result is high sperm count, nothing typically needs to be done, because this does not tend to affect conception unless the number is extreme. If the analysis finds that the man has a low sperm count and he also has trouble conceiving with his partner, then options for improving the number can be discussed.
Doctors typically need to discover the reason for an abnormal sperm count before deciding on treatment. For example, medications that include erythromycin and ketoconazole can lower sperm count, so doctors may have to prescribe different medications to resolve the issue. A virus or infection also can keep men from having a normal sperm count, so doctors may look for and treat any illnesses that may be present. They also may test to find out if the problem is retrograde ejaculation, in which the sperm is sent into the bladder rather than outside the body, because this can usually be corrected with medication. If it turns out that the sperm count is low as the result of a varicocele, in which the scrotum's veins are swollen, surgery can often correct the issue.
If it turns out that the low sperm count is not caused by the most common problems and, therefore, normal sperm count cannot be attained, there are other options to help couples conceive. One example is IVF, which involves taking sperm from the male and combining it with the female partner's egg outside the body. When this does not work, or if it is considered too expensive for the couple, then donor sperm from another man may be used to conceive a child.