Oligospermia
Encyclopedia
Oligospermia, also oligozoospermia, refers to semen
with a low concentration of sperm
and is a common finding in male infertility
. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility (technically "oligoasthenoteratozoospermia"). There has been interest in replacing the descriptive terms used in semen analysis with more quantitative information.
performed on two occasions. For many decades sperm concentrations of less than 20 million sperm/ml were considered low or oligospermic, recently, however, the WHO
reassessed sperm criteria and established a lower reference point, less than 15 million sperm/ml, consistent with the 5th percentile for fertile men. Sperm concentrations fluctuate and oligospermia may be temporary or permanent.
The diagnosis of oligospermia requires a work-up (listed in Male infertility
).
Mast cell
s releasing inflammatory mediators appear to directly suppress sperm motility
in a potentially reversible manner, and may be a common pathophysiological mechanism for several of the above mentioned factors.
:
), Y chromosome microdeletion
s, mitochondrial changes, environmental pollutant
s, and "subtle" hormonal changes.
In a number of situations direct medical or surgical intervention can improve the sperm concentration, examples are use of FSH in men with pituitary hypogonadism
, antibiotics in case of infections, or operative corrections of a hydrocele
, varicocele
, or vas deferens obstruction.
In most cases of oligospermia including its idiopathic form there is no direct medical or surgical intervention agreed to be effective. Empirically many medical approaches have been tried including clomiphene citrate, tamoxifen
, HMG, FSH
, HCG
, testosterone
, Vitamin E
, Vitamin C
, anti-oxidants, carnitine
, acetyl-L-carnitine, zinc
, high-protein diets. In a number of pilot studies some positive results have been obtained. Clomiphene citrate has been used with modest success. The combination of tamoxifen plus testosterone was reported to improve the sperm situation.
The use of carnitine
showed some promise in a controlled trial in selected cases of male infertility improving sperm quality and further studies are needed.
In many situations, intrauterine inseminations are performed with success. In more severe cases IVF, or IVF - ICSI
is done and is often the best option, specifically if time is a factor or fertility problems coexist on the female side.
.
Semen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...
with a low concentration of sperm
Sperm
The term sperm is derived from the Greek word sperma and refers to the male reproductive cells. In the types of sexual reproduction known as anisogamy and oogamy, there is a marked difference in the size of the gametes with the smaller one being termed the "male" or sperm cell...
and is a common finding in male infertility
Male infertility
Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.-Pre-testicular...
. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility (technically "oligoasthenoteratozoospermia"). There has been interest in replacing the descriptive terms used in semen analysis with more quantitative information.
Diagnosis
The diagnosis of oligospermia is based on one low count in a semen analysisSemen analysis
A semen analysis evaluates certain characteristics of a male's semen and the sperm contained in the semen. It may be done while investigating a couple's infertility or after a vasectomy to verify that the procedure was successful. It is also used for testing donors for sperm donation, in stud...
performed on two occasions. For many decades sperm concentrations of less than 20 million sperm/ml were considered low or oligospermic, recently, however, the WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
reassessed sperm criteria and established a lower reference point, less than 15 million sperm/ml, consistent with the 5th percentile for fertile men. Sperm concentrations fluctuate and oligospermia may be temporary or permanent.
The diagnosis of oligospermia requires a work-up (listed in Male infertility
Male infertility
Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.-Pre-testicular...
).
Pre-testicular causes
Pre-testicular factors refer to conditions that impede adequate support of the testes and include situations of poor hormonal support and poor general health including:- HypogonadismHypogonadismHypogonadism is a medical term for decreased functional activity of the gonads. Low testosterone is caused by a decline or deficiency in gonadal production of testosterone in males...
due to various causes - DrugsDRUGSDestroy Rebuild Until God Shows are an American post-hardcore band formed in 2010. They released their debut self-titled album on February 22, 2011.- Formation :...
, alcoholAlcoholIn chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
, smokingSmokingSmoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them... - Strenuous riding (bicycle riding, horseback riding)
- MedicationMedicationA pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
s, including androgenAndrogenAndrogen, also called androgenic hormone or testoid, is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics in vertebrates by binding to androgen receptors...
s.
Testicular factors
Testicular factors refer to conditions where the testes produces semen of poor quality despite adequate hormonal support and include:- AgePaternal age effectThe paternal age effect can refer to the statistical relationships of: a man's age to sperm and semen abnormalities; a man's age to his fertility; a man's age to adverse pregnancy outcomes in his female partner ; a father's age at the birth of his offspring on the probability of an adverse...
- Genetic defects on the Y chromosomeY chromosomeThe Y chromosome is one of the two sex-determining chromosomes in most mammals, including humans. In mammals, it contains the gene SRY, which triggers testis development if present. The human Y chromosome is composed of about 60 million base pairs...
- Y chromosome microdeletionY chromosome microdeletionY chromosome microdeletion is a family of genetic disorders caused by missing gene in the Y chromosome. Many men with YCM exhibit no symptoms and lead normal lives. However, YCM is also known to be present in a significant number of men with reduced fertility...
s
- Y chromosome microdeletion
- Abnormal set of chromosomes
- Klinefelter syndrome
- Neoplasm, e.g. seminoma
- CryptorchidismCryptorchidismCryptorchidism is the absence of one or both testes from the scrotum. It is the most common birth defect regarding male genitalia. In unique cases, cryptorchidism can develop later in life, often as late as young adulthood. About 3% of full-term and 30% of premature infant boys are born with at...
- VaricoceleVaricoceleVaricocele , also known as varicoscele or varicose seal, is an abnormal enlargement of the vein that is in the scrotum draining the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis...
(14% in one study) - TraumaPhysical traumaTrauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
- HydroceleHydroceleA hydrocoele denotes a pathological accumulation of serous fluid in a body cavity. It can also be noted as a minor malformation of newborns due to high levels of lead in the mother's blood during pregnancy....
- MumpsMumpsMumps is a viral disease of the human species, caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide...
- MalariaMalariaMalaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
- Defects in USP26USP26USP26 is a peptidase enzyme.Recent research has suggested that defects in USP26 may be involved in some cases of male infertility....
in some cases
Mast cell
Mast cell
A mast cell is a resident cell of several types of tissues and contains many granules rich in histamine and heparin...
s releasing inflammatory mediators appear to directly suppress sperm motility
Sperm motility
Sperm motility describes the ability of sperm to move properly towards an egg. This can also be thought of as the 'quality' of the sperm, which is a factor in successful pregnancies, as opposed to the 'quantity'. Sperm which do not properly 'swim', will not reach the egg in order to fertilize it...
in a potentially reversible manner, and may be a common pathophysiological mechanism for several of the above mentioned factors.
Post-testicular causes
Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculationEjaculation
Ejaculation is the ejecting of semen from the male reproductory tract, and is usually accompanied by orgasm. It is usually the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. In rare cases ejaculation occurs because of prostatic disease...
:
- Vas deferensVas deferensThe vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....
obstruction - Lack of Vas deferensVas deferensThe vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....
, often related to genetic markers for Cystic FibrosisCystic fibrosisCystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine... - InfectionInfectionAn infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, e.g. prostatitisProstatitisProstatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:... - Ejaculatory duct obstructionEjaculatory duct obstructionEjaculatory duct obstruction is a congenital or acquired pathological condition which is characterized by the obstruction of one or both ejaculatory ducts. Thus, the efflux of semen is not possible....
Idiopathic oligospermia (oligoasthenoteratozoospermia)
In about 30 % of infertile men no causative factor is found for their decrease in sperm concentration or quality by common clinical, instrumental, or laboratory means, and the condition is termed "idiopathic" (unexplained). A number of factors may be involved in the genesis of this condition, including age, infectious agents ( such as Chlamydia trachomatisChlamydia trachomatis
Chlamydia trachomatis, an obligate intracellular human pathogen, is one of three bacterial species in the genus Chlamydia. C. trachomatis is a Gram-negative bacteria, therefore its cell wall components retain the counter-stain safranin and appear pink under a light microscope.The inclusion bodies...
), Y chromosome microdeletion
Y chromosome microdeletion
Y chromosome microdeletion is a family of genetic disorders caused by missing gene in the Y chromosome. Many men with YCM exhibit no symptoms and lead normal lives. However, YCM is also known to be present in a significant number of men with reduced fertility...
s, mitochondrial changes, environmental pollutant
Pollutant
A pollutant is a waste material that pollutes air, water or soil, and is the cause of pollution.Three factors determine the severity of a pollutant: its chemical nature, its concentration and its persistence. Some pollutants are biodegradable and therefore will not persist in the environment in the...
s, and "subtle" hormonal changes.
Treatment
Treatment takes place within the context of infertility management and needs also to consider the fecundity of the female partner. Thus the choices can be complex.In a number of situations direct medical or surgical intervention can improve the sperm concentration, examples are use of FSH in men with pituitary hypogonadism
Hypogonadism
Hypogonadism is a medical term for decreased functional activity of the gonads. Low testosterone is caused by a decline or deficiency in gonadal production of testosterone in males...
, antibiotics in case of infections, or operative corrections of a hydrocele
Hydrocele
A hydrocoele denotes a pathological accumulation of serous fluid in a body cavity. It can also be noted as a minor malformation of newborns due to high levels of lead in the mother's blood during pregnancy....
, varicocele
Varicocele
Varicocele , also known as varicoscele or varicose seal, is an abnormal enlargement of the vein that is in the scrotum draining the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis...
, or vas deferens obstruction.
In most cases of oligospermia including its idiopathic form there is no direct medical or surgical intervention agreed to be effective. Empirically many medical approaches have been tried including clomiphene citrate, tamoxifen
Tamoxifen
Tamoxifen is an antagonist of the estrogen receptor in breast tissue via its active metabolite, hydroxytamoxifen. In other tissues such as the endometrium, it behaves as an agonist, hence tamoxifen may be characterized as a mixed agonist/antagonist...
, HMG, FSH
FSH
FSH may refer to:* Follicle-stimulating hormone* Fox Sports Houston, a regional Fox Sports Net affiliate station for the Houston, Texas area* Facioscapulohumeral muscular dystrophy* International Civil Aviation Organisation code for Flash Airlines...
, HCG
Human chorionic gonadotropin
Human chorionic gonadotropin or human chorionic gonadotrophin is a glycoprotein hormone produced during pregnancy that is made by the developing embryo after conception and later by the syncytiotrophoblast .. Some tumors make this hormone; measured elevated levels when the patient is not...
, testosterone
Testosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
, Vitamin E
Vitamin E
Vitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols. There are many different forms of vitamin E, of which γ-tocopherol is the most common in the North American diet. γ-Tocopherol can be found in corn oil, soybean oil, margarine and dressings...
, Vitamin C
Vitamin C
Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species. In living organisms ascorbate acts as an antioxidant by protecting the body against oxidative stress...
, anti-oxidants, carnitine
Carnitine
Carnitine is a quaternary ammonium compound biosynthesized from the amino acids lysine and methionine. In living cells, it is required for the transport of fatty acids from the cytosol into the mitochondria during the breakdown of lipids for the generation of metabolic energy. It is widely...
, acetyl-L-carnitine, zinc
Zinc
Zinc , or spelter , is a metallic chemical element; it has the symbol Zn and atomic number 30. It is the first element in group 12 of the periodic table. Zinc is, in some respects, chemically similar to magnesium, because its ion is of similar size and its only common oxidation state is +2...
, high-protein diets. In a number of pilot studies some positive results have been obtained. Clomiphene citrate has been used with modest success. The combination of tamoxifen plus testosterone was reported to improve the sperm situation.
The use of carnitine
Carnitine
Carnitine is a quaternary ammonium compound biosynthesized from the amino acids lysine and methionine. In living cells, it is required for the transport of fatty acids from the cytosol into the mitochondria during the breakdown of lipids for the generation of metabolic energy. It is widely...
showed some promise in a controlled trial in selected cases of male infertility improving sperm quality and further studies are needed.
In many situations, intrauterine inseminations are performed with success. In more severe cases IVF, or IVF - ICSI
ICSI
The abbreviation ICSI may refer to:* Intracytoplasmic sperm injection, a medical technique used in assisted reproduction* International Computer Science Institute, a non-profit research lab in Berkeley, California...
is done and is often the best option, specifically if time is a factor or fertility problems coexist on the female side.
Fertility
Achieving a pregnancy naturally may be a challenge if the male suffers from a low sperm count. However, chances are good if the female partner is fertile; many couples with this problem have been successful. Prognosis is more limited if there is a combination of factors that include sperm dysfunction and reduced ovarian reserveOvarian reserve
Ovarian reserve is a term that is used to determine the capacity of the ovary to provide eggs that are capable of fertilization resulting in a healthy and successful pregnancy...
.