Low sperm count - Wokingham, Berkshire

On this page

1. Overview
2. Semen analysis parameters
3. Causes
4. Low sperm count in Chinese medicine
5. Acupuncture for low sperm count
6. Chinese herbal medicine for low sperm count
7. Self-care
8. Treatment at my clinic
9. Frequently asked questions
10. References

1. Overview

Male factor infertility is responsible for approximately 40–50% of all cases of infertility in couples, and poor semen quality — most commonly manifesting as a low sperm count (oligospermia), reduced motility (asthenozoospermia) or abnormal morphology (teratozoospermia) — is the predominant cause. There is compelling epidemiological evidence that male sperm quality has declined significantly in recent decades: a landmark systematic review and meta-regression analysis demonstrated a decline of approximately 51–60% in sperm counts among men in Western countries between 1973 and 2011, a trend that has continued to be confirmed by subsequent research. A low sperm count, formally defined as oligozoospermia, is one of the most common semen abnormalities and a frequent reason couples seek specialist fertility support. Alongside general male infertility treatment, acupuncture and Chinese herbal medicine offer evidence-supported approaches to improving sperm count and overall semen quality.

2. Semen analysis parameters

The World Health Organization (WHO) sets reference values for semen analysis that define normal semen quality. The current WHO 6th edition (2021) reference values, based on the 5th percentile of fertile men, include: total sperm count above 39 million per ejaculate; sperm concentration above 16 million per millilitre; total motility (progressive + non-progressive) above 42%; progressive motility above 30%; normal morphology (Kruger strict criteria) above 4%; and semen volume above 1.4 mL. Some clinics still use the older 5th edition (2010) values — sperm concentration above 15 million/mL and total count above 39 million — so it is worth checking which reference range your clinic applies when interpreting your results. A low sperm count means the total sperm count per ejaculate falls below 39 million, or concentration falls below 16 million/mL. Severe oligospermia is defined as a count below 5 million/mL, and the complete absence of sperm is azoospermia.

3. Causes

Sperm production (spermatogenesis) is a complex, hormonally driven process that is sensitive to a wide range of internal and external factors. Identified causes of low sperm count include:

1. Varicocele — an abnormal dilation of the veins in the scrotum that raises testicular temperature and impairs spermatogenesis; the most common surgically correctable cause of male infertility
2. Hormonal imbalances — testosterone, FSH, LH and prolactin all play essential roles in sperm production. Disruption to the HPG (hypothalamic-pituitary-gonadal) axis — including stress-related hormonal suppression — reduces sperm output. Chronic alcohol and nicotine consumption have both been confirmed in clinical studies to reduce testosterone levels and sperm count.
3. Environmental and chemical exposure — endocrine-disrupting chemicals (EDCs) including perfluorocarbons (PFCs), phthalates, bisphenol A (BPA) and pesticide residues act as xeno-oestrogens, mimicking oestrogen and suppressing testosterone production and sperm output. Electromagnetic radiation from mobile phones and laptops carried near the groin has also been associated with reduced sperm count and motility.
4. Heat exposure — optimal sperm production requires the testes to be 2–4°C below core body temperature. Elevated scrotal temperature from hot baths, saunas, heated car seats, tight underwear and laptops on the lap can significantly impair spermatogenesis. Research confirms that acupuncture treatment is associated with a reduction in scrotal skin temperature, suggesting one mechanism by which it supports sperm production (Siterman et al., 2009).
5. Infections and inflammation — certain sexually transmitted infections (chlamydia, gonorrhoea), orchitis (testicular inflammation) and prostatitis can damage sperm-producing tissue and obstruct the reproductive tract.
6. Genetic factors — Y chromosome microdeletions, Klinefelter syndrome and cystic fibrosis gene mutations can impair spermatogenesis.
7. Medications and medical treatments — chemotherapy, anabolic steroids, testosterone replacement therapy (which paradoxically suppresses sperm production), some antidepressants and antihypertensives can all reduce sperm count.
8. Obesity — excess adipose tissue converts testosterone to oestrogen via aromatase, disrupting the hormonal balance required for spermatogenesis and reducing sperm count, motility and morphology.
9. Psychological stress — chronic stress elevates cortisol, which suppresses GnRH and therefore reduces FSH and LH, impairing testosterone production and sperm output.

4. Low sperm count in Chinese medicine

In traditional Chinese medicine (TCM), sperm production is governed principally by Kidney Jing (essence) — the same constitutional substance that governs female reproductive capacity — alongside Kidney Yang (which drives the warming, producing function of the testes), Kidney Yin (which provides the nourishing substrate for sperm development) and the free flow of Liver Qi and Blood to the genitals. Sperm quality, including count, motility and morphology, reflects the state of a man’s Kidney Jing and overall constitutional vitality.

The main TCM patterns underlying low sperm count are:

1. Kidney Yang deficiency — the most common pattern in men with low sperm count and poor motility. Yang provides the “fire” that drives spermatogenesis and the vigour of individual sperm cells. Signs include fatigue, cold extremities, frequent urination, lower back aching, reduced libido and a preference for warmth. Corresponds well to men with poor sperm motility alongside reduced count.
2. Kidney Yin deficiency — inadequate Yin means insufficient nourishing substance to support the formation of normal sperm cells, often manifesting as abnormal morphology alongside reduced count. Signs include night sweats, dizziness, tinnitus, dry mouth, poor sleep and a sensation of heat in the afternoon or evening.
3. Kidney Jing (essence) depletion — the deepest constitutional deficiency, associated with very low counts, azoospermia or profoundly poor morphology, often in men with a long history of overwork, excessive sexual activity, chronic illness or constitutional weakness.
4. Damp-Heat obstructing the lower burner — heat and dampness accumulating in the lower abdomen, often from diet (alcohol, fatty, spicy foods), infection or chronic inflammation, impair spermatogenesis and are associated with elevated DNA fragmentation, abnormal morphology and poor motility. Signs include burning sensation on urination, scrotal discomfort, a sticky tongue coating and a feeling of heaviness.
5. Liver Qi stagnation and Blood stasis — emotional stress and tension constrain the flow of Qi and Blood to the reproductive system, impairing testicular circulation and sperm production. Associated with psychological stress, varicocele and elevated sperm DNA fragmentation.

5. Acupuncture for low sperm count

Acupuncture can support sperm production by modulating the HPG axis, improving testicular blood flow, reducing oxidative stress in the testes, normalising testosterone and gonadotrophin levels, and reducing scrotal temperature. Research by Siterman et al. (2009) found that successful acupuncture treatment in men with very low sperm output was specifically associated with a measurable reduction in scrotal skin temperature, directly linking improved thermal regulation to enhanced spermatogenesis. Electroacupuncture and transcutaneous electrical acupoint stimulation (TEAS) have been shown to regulate the neuroendocrine axis governing testicular function and improve multiple semen parameters (Yu et al., 2019).

Research evidence

A systematic review and meta-analysis by Jia, Wang & Yin (2021), published in Medicine (Baltimore), analysed 7 RCTs with 527 subjects on acupuncture for oligospermia and asthenozoospermia. The authors found that while acupuncture alone did not significantly outperform placebo or conventional medication as a monotherapy, adjuvant acupuncture combined with conventional medication significantly enhanced sperm motility (SMD 4.10) and sperm concentration (SMD 1.07) compared with medication alone, suggesting the greatest benefit lies in combined treatment. A 2022 literature review published in Frontiers in Endocrinology (Shuai et al., 2022), examining all clinical trials, animal experiments, meta-analyses and systematic reviews from 1985 to 2022, found that acupuncture or acupuncture combined with another intervention was effective in improving semen quality based on 12 RCTs with 1,088 participants. A pilot study by Sherman et al. (2000) found that acupuncture was associated with improved sperm density in men with very low counts, and laser acupuncture has also been shown in an RCT by Allameh et al. (2021) to significantly improve sperm count, motility and morphology in men with oligospermia. Moxibustion has also demonstrated effectiveness for low sperm count: a study by Mu et al. (2019) found grain-moxibustion combined with medical therapy significantly improved sperm quality in men with asthenospermia and oligospermia, while Ren et al. (2016) demonstrated that acupuncture and moxibustion improved reproductive endocrine function in male rats with partial androgen deficiency, providing a mechanistic basis for the clinical observations.

6. Chinese herbal medicine for low sperm count

Chinese herbal medicine has a 2,000-year clinical history in the treatment of male infertility and is one of the strongest evidence-based therapeutic tools available for improving sperm count and quality. The most well-studied formula is Wu Zi Yan Zong Wan (Five Seeds to Benefit Offspring), a classical Kidney-tonifying formula composed of Gou Qi Zi (Wolfberry/Lycium), Tu Si Zi (Cuscuta), Fu Pen Zi (Raspberry), Wu Wei Zi (Schisandra) and Che Qian Zi (Plantago seed). A meta-analysis published in 2025 covering multiple RCTs found that Wu Zi Yan Zong formula, when used as adjuvant therapy, achieved a 68% increase in the pregnancy rate of female partners compared to control treatment, while also significantly improving sperm concentration, motility, morphology and testosterone levels (PMC12089090). This formula is particularly appropriate for Kidney Jing and Yang deficiency patterns with low count and poor motility.

Other key formulas for male infertility include: You Gui Wan for Kidney Yang deficiency with cold presentation; Zuo Gui Wan for Kidney Yin and Jing deficiency; Long Dan Xie Gan Tang for Damp-Heat in the lower burner affecting sperm quality; and Xue Fu Zhu Yu Tang for Blood stasis patterns with elevated sperm DNA fragmentation. Individual herbs with documented pro-spermatogenic effects include He Shou Wu (Polygonum multiflorum), Lu Jiao Jiao (Deer antler gelatin), and Dong Chong Xia Cao (Cordyceps sinensis).

I prescribe pharmaceutical-grade Chinese herbal granules from Sun Ten (Taiwan), independently tested for purity, safety and heavy metal content. For patients who cannot attend the clinic in person, I offer online Chinese herbal medicine consultations with herbs dispensed by post.

7. Self-care

Lifestyle and dietary factors have a powerful direct impact on sperm production, as spermatogenesis takes approximately 72 days, meaning that improvements made today will begin to show in a semen analysis roughly two and a half months later. The following self-care measures are recommended:

Diet

Diet has a significant influence on sperm count and quality. Foods that support sperm production include oily fish and white fish (rich in omega-3 fatty acids, which improve sperm membrane fluidity and motility), shellfish (excellent sources of zinc, an essential mineral for spermatogenesis and testosterone production), walnuts (shown in research to improve sperm vitality and morphology), and organic produce (which reduces exposure to pesticide-derived endocrine disruptors). See Chinese food therapy for further dietary guidance tailored to the individual TCM pattern. Foods that research associates with reduced sperm quality include high consumption of red and processed meat, full-fat cow’s milk (associated with reduced sperm motility), excessive coffee intake and very spicy foods, which generate heat in the lower abdomen in TCM terms.

Supplements

Several nutritional supplements have been shown in RCTs to improve sperm parameters. Those with the strongest evidence for supporting sperm count and quality include zinc (essential for testosterone production and sperm maturation, with clinical evidence for improving count and motility), lycopene (a powerful antioxidant found in cooked tomatoes, shown to reduce sperm DNA damage), vitamin B12 (improves sperm count and motility, particularly in men with deficiency), maca root (Lepidium meyenii, shown in systematic reviews to improve sperm concentration and motility), and chromium (supports insulin sensitivity and testosterone production). Antioxidant combinations including CoQ10, vitamin C, vitamin E and selenium are also well-supported by systematic reviews for improving sperm parameters in men with oxidative stress-related infertility.

Sleep

Testosterone production is strongly linked to sleep quality and timing, with the majority of daily testosterone secreted during deep sleep in the first hours of the night. Sleeping before 10pm and aiming for seven to eight hours of uninterrupted sleep each night supports optimal testosterone levels and therefore sperm production. In TCM terms, sleep before midnight protects and restores Kidney Jing, which governs sperm quality.

Exercise

Regular moderate-intensity cardiovascular exercise — at least 30 minutes, three or more times per week — improves testosterone levels, reduces oxidative stress and supports overall reproductive health. However, excessive high-intensity training, particularly cycling, long-distance running and heavy weightlifting with anabolic supplement use, can significantly reduce sperm count by raising scrotal temperature, increasing oxidative stress and suppressing the HPG axis. If you exercise heavily and have a low sperm count, moderating the intensity and volume of training is an important step.

Alcohol

Clinical studies have confirmed that chronic alcohol consumption reduces testosterone levels and sperm count. Alcohol is directly gonadotoxic at higher doses and acts as an oestrogen mimic, raising oestrogen relative to testosterone and impairing spermatogenesis. Limiting alcohol to a maximum of two units per week is recommended while trying to conceive. Complete abstinence during the 72-day spermatogenic cycle before a planned conception attempt or IVF cycle is ideal.

Heat avoidance

Sperm production depends on the testes remaining 2–4°C cooler than core body temperature. Sustained scrotal heat exposure — from hot baths, saunas, sunbeds, heated car seats, laptops resting on the lap, and tight synthetic underwear — can significantly suppress spermatogenesis. Wear loose-fitting cotton underwear, avoid prolonged sitting when possible, and avoid direct heat sources to the groin, particularly in the months before fertility treatment.

Stress management

Chronic stress raises cortisol, which suppresses GnRH and reduces testosterone and sperm output. Regular relaxation, mindfulness, adequate rest and activities that genuinely reduce psychological load all directly support the HPG axis and sperm production. Acupuncture itself has well-documented stress-reducing effects and is an effective complement to other stress management strategies.

8. Treatment at my clinic

I treat low sperm count and poor semen quality at my clinics in Wokingham, Berkshire. Online Chinese herbal medicine consultations are also available for patients who cannot attend in person.

Treatment combines acupuncture and Chinese herbal medicine with TCM pattern-specific prescribing alongside dietary and lifestyle guidance. Because the spermatogenic cycle takes approximately 72 days, a minimum treatment commitment of three months is recommended to allow time for improvements in sperm parameters to manifest in semen analysis results. Most patients see meaningful improvements in count, motility and morphology within one to two spermatogenic cycles (three to six months) of consistent treatment. Treatment works comfortably alongside conventional fertility investigation and IVF preparation. Read more about male infertility and fertility in My Fertility Guide or visit the prices page.

9. Frequently asked questions

Can acupuncture increase sperm count?

Acupuncture can support sperm production by modulating the HPG axis, improving testicular blood flow, reducing oxidative stress and normalising testosterone and gonadotrophin levels. Research shows that adjuvant acupuncture combined with conventional medication significantly improves sperm motility and concentration compared to medication alone. Multiple studies confirm that acupuncture improves sperm parameters in men with oligospermia, and its effects on reducing scrotal temperature are a directly measurable mechanism supporting spermatogenesis.

How long does treatment take to improve sperm count?

The full spermatogenic cycle takes approximately 72 days, so any treatment — whether acupuncture, Chinese herbal medicine or lifestyle change — needs at least three months to produce measurable improvements in a semen analysis. Most patients show meaningful gains within one to two full cycles (three to six months). It is important to have a baseline semen analysis and a follow-up test after three months of treatment to track progress.

Can Chinese herbal medicine improve sperm count?

Yes. Chinese herbal medicine has extensive clinical and research support for improving sperm parameters. The classical formula Wu Zi Yan Zong Wan has been shown in meta-analysis to achieve a 68% increase in partner pregnancy rates alongside significant improvements in sperm concentration, motility, morphology and testosterone levels when used as adjuvant therapy.

Does diet really affect sperm count?

Yes — significantly. Diet provides the raw materials for spermatogenesis, influences hormone levels and determines the level of oxidative stress in the testes. Zinc, omega-3 fatty acids, antioxidants and B vitamins are all directly involved in sperm production and quality. Conversely, high consumption of alcohol, processed meats and full-fat dairy, and exposure to pesticide residues, consistently associates with reduced sperm parameters in research. Dietary changes are one of the most impactful and immediately actionable interventions available.

What is the difference between low sperm count, poor motility and abnormal morphology?

These are three distinct semen parameters that are each assessed in a standard semen analysis. Low sperm count (oligozoospermia) refers to fewer total sperm than the WHO reference value. Poor motility (asthenozoospermia) means sperm are not swimming effectively enough to reach and fertilise an egg. Abnormal morphology (teratozoospermia) means the majority of sperm have structural abnormalities that impair fertilisation. Many men present with a combination — called oligoasthenoteratozoospermia (OAT). TCM treatment addresses all three, as the underlying patterns of Kidney deficiency and Damp-Heat affect count, motility and morphology simultaneously.

Is acupuncture safe for men?

Yes. Acupuncture is very safe for men when performed by a qualified, registered practitioner. Multiple systematic reviews confirm that no adverse events were reported in RCTs of acupuncture for male infertility. I am a member of the British Acupuncture Council and the Register of Chinese Herbal Medicine, and all treatment is conducted to the highest professional standards.

10. References

Ren H, Liang D, Xiang P, Hu G, Chen H, Lian W. Effects and mechanisms of acupuncture and moxibustion on reproductive endocrine function in male rats with partial androgen deficiency. Acupunct Med. 2016 Apr;34(2):136–143. https://doi.org/10.1136/acupmed-2014-010734. PMID: 26508663.

Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia. 2000 Jan;32(1):31–39. PMID: 10702864.

Siterman S, Eltes F, Schechter L, Maimon Y, Lederman H, Bartoov B. Success of acupuncture treatment in patients with initially low sperm output is associated with a decrease in scrotal skin temperature. Asian J Androl. 2009 Mar;11(2):200–208. https://doi.org/10.1038/aja.2008.4. PMID: 19169272.

Mu Y, Xu Q, Wu XK. Effect on sperm quality of asthenospermia and oligospermia treated with grain-moxibustion combined with medicine therapy. Zhongguo Zhen Jiu. 2019 Aug 12;39(8):843–848. https://doi.org/10.13703/j.0255-2930.2019.08.012. PMID: 31397129.

Allameh F, Razzaghi M, Hosseini S, Barati M, Razzaghi Z, Salehi S, Ghahestani SM, Shahabi V. The Effect of Laser Acupuncture on Semen Parameters in Infertile Men With Oligospermia: A Randomized Clinical Trial. J Lasers Med Sci. 2021 Dec 27;12:e84. https://doi.org/10.34172/jlms.2021.84. PMID: 35155169.

Yu Y, Sha SB, Zhang B, Guan Q, Liang M, Zhao LG, Zhang QY, Wen J, Sun W. Effects and mechanism of action of transcutaneous electrical acupuncture point stimulation in patients with abnormal semen parameters. Acupunct Med. 2019 Feb;37(1):25–32. https://doi.org/10.1136/acupmed-2017-011365. PMID: 30942613.

Jia W, Wang C, Yin Y. Acupuncture for oligospermia and asthenozoospermia: A systematic review and meta-analysis. 7 RCTs, 527 subjects. Medicine (Baltimore). 2021 Dec 3;100(48):e27816. https://doi.org/10.1097/MD.0000000000027816. PMID: 35049183.

Shuai G, Wang F, Li M, et al. The efficacy and mechanism of acupuncture in the treatment of male infertility: a literature review. 12 RCTs, 1,088 participants. Front Endocrinol (Lausanne). 2022 Sep 21;13:1009537. https://doi.org/10.3389/fendo.2022.1009537. PMC9624472.

Huang N, Li H, et al. Adjuvant treatment with Wu-Zi-Yan-Zong formula for abnormal sperm parameters associated with male infertility: a meta-analysis of randomized controlled trials. 68% increase in pregnancy rate. Am J Mens Health. 2025. https://doi.org/10.1177/15579883241293941. PMC12089090.

Levine H, Jørgensen N, Martino-Andrade A, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update. 2023 Mar 1;29(2):157–176. https://doi.org/10.1093/humupd/dmac035. PMID: 36377604.