When boy becomes of 14 years of age then L.H. & F.S.H. hormone secretion from pituitary increases. The rise in these hormones leads to proliferation of sperm forming cells (Germ Cells) in the testis. These germ cells start multiplying under the effect of above-mentioned pituitary sex hormones along with assistance of other hormones as testosterones, Growth hormones, Androstenidione, insulin like growth factor-I, Thyroids hormone, paracrine hormone & growth factors. Under the control of above-mentioned hormones germs cells divide & transformed into primary spermatocytes. Then further maturation of primary spermatocytes to spermatids & then finally into mature spermatozoa (i.e. normal sperms) occurs under the control of above-mentioned hormones. After few weeks of progressive maturation inside the testis these sperms become normally motile & develop the capacity to fertilize the ovum. This total sperm cycle from first stage to final stage of normal mature sperms is of three months. Any hindrance in the development of these spermatozoa will lead to less count of sperm & decreased motility, immotile or even dead sperms.

Causes of low sperm count: The various causes of low sperm count are as follows:

a) Deficiency of central sperm producing hormones as LH, FSH & other hormones may occur due to any of the below mentioned cause as Hypothalamic – pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome, Hypothalamic deficiency, pituitary hypoplasia, Trauma, post surgical, postiradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, hemochromatosis) Autoimmune hypophysitis, Hypopituitarism, Pituitary, Hypothalamic, Associated with multiple pituitary hormone deficiencies: Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Space-occupying lesions (craniopharyngioma, Rathke pouch cysts, hypothalamic tumors, pituitary adenomas), , Laurence-Moon-Beidl syndrome Prader-Willi syndrome , Frohlich syndrome

b) Drugs (drug-induced hyperprolactinemia, sex steroids use), Glucocorticoid excess

c) Isolated gonadotropin deficiency (non acquired)

bstruction in outflow tract from testis to penile pening in epididymis or of vas deferens (cystic fibrosis, diethlstibesterol exposure) also called obstructive oligospermia.

4) Varicocele: varicocele is dilatation of scrotal vein in the scrotum that leads to rise in temperature of testis and raise testicular temperature, resulting in less sperm production & death of whatever sperms are produced.

5) Partial Spermatogenic arrest due to interruption of the complex process of germ cell diffrentation from spermatid level to the formation of mature spermatozoa results in decreased sperm count i.e. oligospermia. Its diagnosis is made by testicular biopsy. This is found in upto 30% of all cases of low sperm count patients.18) Heat Exposure to testis: as febrile illness or exposure to hot ambience induces a fall in sperm count which is usually reversible.

6) Autoimmunity i.e. presence of Antisperm antibody. In some people there occurs development of some abnormal blood proteins called anti-sperm antibodies which binds with sperm and make them either immotile or dead or decrease their count. These Antisperm antibodies bind with spems & either make them less motile, totally imotile or even dead which is called necrospermia.

7) Undescended testicle (cryptorchidism). Undescended testis is a condition when one or both testicles fail to descend from the abdomen into the lower part of scrotum during fetal development. Undescended testicles can lead to less sperm production. Because the testicles temperature increase due to the higher internal body temperature compared to the temperature in the scrotum, sperm production may be affected.

8) Infections. Infection of urogenital tract may affect sperm production. Repeated bouts of infections are one of the common causes associated with male infertility.

9) Viral orchits as mumps or other viral infections.

10) Infections as tuberculosis, sarcoidosis involving testis or surrounding structures as epididymis.

11) Chronic systemic diseases as Liver diseases, Renal failure, Sickle cell disease, Celiac disease

12) Neurological disease as myotonic dystrophy

13) Development and structural defects as mild degree of Germinal cell hypo-plasia

14) Partial Androgen resistance

15) Mycoplasmal infection

16) Partial Immotile cilia syndrome

17) Drugs (e.g. spironolactone, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)

19) Infection – as bacterial epididimo-orchitis, even in prostatis spermatogenic defect have been noted.

20) Hyper-thermia due to cryptorchidism, Environmental exposure as laptop use or hot working conditions

21) Chromosomal abnormality: has been found in many cases of low sperm count

22) Alcohol use, Cocaine or heavy marijuana use or Tobacco smoking may lower sperm count

23) Anti-sperm antibodies.

24) Klinefelter’s syndrome. In this disorder of the sex chromosomes, a man has two X chromosomes and one Y chromosome instead of one X and one Y. This causes abnormal development of the testicles, resulting in low or absent sperm production. Testosterone production also may be lower.

25) .Mosaic Klinefelter’s syndrome. In this disorder of the sex chromosomes, of the man is abnormal. This causes abnormal development of the testicles, resulting in low sperm production. Testosterone production may be low or normal.

26) Trauma to testis

27) Environmental toxins: as Pesticides and other chemicals in food or as ayurvedic medicines.

28) Genetic Factors : as idiopathic partial hypo-gonadotropic hypogonadism