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Sperm count may be impacted by many of the following factors: Medical conditions: Infections and inflammations such as gonorrhea, human immunodeficiency virus (HIV), orchitis, and epididymitis Varicocele (enlargement of the veins within the scrotum) Retrograde ejaculation (a condition in which the semen enters the bladder during an orgasm instead of coming out of the tip of the penis) Nerve diseases due to diabetes or spinal injuries Injury or surgery in the pelvic area Certain autoimmune diseases Tumors Radiation and chemotherapy Hormonal imbalances, including hypogonadism Celiac disease Medications: Alpha-blockers Anabolic steroids Certain antibiotics Anti-ulcer medications Developmental disorders: Undescended testes Abnormal tubules that transport sperm Genetic conditions: Klinefelter syndrome Kartagener syndrome Environmental causes: Heavy metals Industrial solvents and other chemicals Radiation exposure High temperature Lifestyle: Alcohol or drug abuse Smoking Stress Being overweight What factors determine sperm health