Oligospermia

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Oligospermia
Other namesoligozoospermia, low sperm count
Specialty Urology   OOjs UI icon edit-ltr-progressive.svg

Terms oligospermia, oligozoospermia, and low sperm count refer to semen with a low concentration of sperm [1] 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. [2]

Contents

Diagnosis

Histopathology of various spermatogenesis disorders. Spermatogenesis pathologies.png
Histopathology of various spermatogenesis disorders.

The diagnosis of oligozoospermia is based on one low count in a semen analysis 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. [3] Sperm concentrations fluctuate and oligospermia may be temporary or permanent.

Sources usually classify oligospermia in 3 classes: [4]

The diagnosis of oligozoospermia requires a work-up via semen analysis (listed in Male infertility).

Causes

There are many causes for oligospermia including: [5]

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:

Testicular factors

Testicular factors refer to conditions where the testes produces semen of poor quality despite adequate hormonal support and include:

Mast cells 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. [11]

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 ejaculation:

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). [12] A number of factors may be involved in the genesis of this condition, including age, infectious agents ( such as Chlamydia trachomatis ), Y chromosome microdeletions, mitochondrial changes, environmental pollutants, and "subtle" hormonal changes. [12]

A review in 2013 came to the result that oligospermia and azoospermia are significantly associated with being overweight (odds ratio 1.1), obese (odds ratio 1.3) and morbidly obese (odds ratio 2.0), but the cause of this is unknown. [13] It found no significant relation between oligospermia and being underweight. [13]

DNA damage

The human breast cancer susceptibility gene 2 (BRCA2) is employed in homologous recombinational repair of DNA damages during meiosis. A common single-nucleotide polymorphism of BRCA2 is associated with severe oligospermia. [14]

Men with mild oligospermia (semen concentration of 15 million to 20 million sperm/ml) were studied for an association of sperm DNA damage with life style factors. [15] A significant association was found between sperm DNA damage and factors such as age, obesity and occupational stress.

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, 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. [16] The combination of tamoxifen plus testosterone was reported to improve the sperm situation. [17]

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. [18]

In many situations, intrauterine inseminations are performed with success. [19] In more severe cases IVF, or IVF - ICSI is done [16] and is often the best option, specifically if time is a factor or fertility problems coexist on the female side. The Low dose Estrogen Testosterone Combination Therapy may improve sperm count and motility in some men [20] including severe oligospermia. [21]

Fertility

Achieving a pregnancy naturally may be a challenge if the male has 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 reserve.

See also

Related Research Articles

Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species. It is the normal state of a human child or other young offspring, because they have not undergone puberty, which is the body's start of reproductive capacity.

Artificial insemination Pregnancy through in vivo fertilization

Artificial insemination (AI) is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse or in vitro fertilisation. It is a fertility treatment for humans, and is common practice in animal breeding, including dairy cattle and pigs.

Spermatogenesis Production of sperm

Spermatogenesis is the process by which haploid spermatozoa develop from germ cells in the seminiferous tubules of the testis. This process starts with the mitotic division of the stem cells located close to the basement membrane of the tubules. These cells are called spermatogonial stem cells. The mitotic division of these produces two types of cells. Type A cells replenish the stem cells, and type B cells differentiate into primary spermatocytes. The primary spermatocyte divides meiotically into two secondary spermatocytes; each secondary spermatocyte divides into two equal haploid spermatids by Meiosis II. The spermatids are transformed into spermatozoa (sperm) by the process of spermiogenesis. These develop into mature spermatozoa, also known as sperm cells. Thus, the primary spermatocyte gives rise to two cells, the secondary spermatocytes, and the two secondary spermatocytes by their subdivision produce four spermatozoa and four haploid cells.

Hypogonadism means diminished functional activity of the gonads—the testes or the ovaries—that may result in diminished production of sex hormones.

Fertility medications, also known as fertility drugs, are medications which enhance reproductive fertility. For women, fertility medication is used to stimulate follicle development of the ovary. There are very few fertility medication options available for men.

Varicocele Medical condition

A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Varicoceles occur in around 15% to 20% of all men. The incidence of varicocele increase with age.

Azoospermia Medical condition

Azoospermia is the medical condition of a man whose semen contains no sperm. It is associated with male infertility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen in up to 20% of male infertility situations in Canada.

Y chromosome microdeletion(YCM) is a family of genetic disorders caused by missing genes in the Y chromosome. Many men with YCM exhibit no symptoms and lead normal lives. It is present in a significant number of men with reduced fertility. Reduced sperm production varies from oligozoospermia, significant lack of sperm, or azoospermia, complete lack of sperm.

Hypospermia is a condition in which humans have an unusually low ejaculate volume, less than 1.5 mL. It is the opposite of hyperspermia, which is a semen volume of more than 5.5 mL. It should not be confused with oligospermia, which means low sperm count. Normal ejaculate when a man is not drained from prior sex and is suitably aroused is around 1.5–6 mL, although this varies greatly with mood, physical condition, and sexual activity. Of this, around 1% by volume is sperm cells. The U.S.-based National Institutes of Health defines hypospermia as a semen volume lower than 2 mL on at least two semen analyses.

Male infertility refers to a sexually mature male's inability to impregnate a fertile female. In humans it accounts for 40–50% of infertility. It affects approximately 7% of all men. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity. More recently, advance sperm analyses that examine intracellular sperm components are being developed.

Spermatogenesis arrest is known as the interruption of germinal cells of specific cellular type, which elicits an altered spermatozoa formation. Spermatogenic arrest is usually due to genetic factors resulting in irreversible azoospermia. However some cases may be consecutive to hormonal, thermic, or toxic factors and may be reversible either spontaneously or after a specific treatment. Spermatogenic arrest results in either oligospermia or azoospermia in men. It is quite a difficult condition to proactively diagnose as it tends to affect those who have normal testicular volumes; a diagnosis can be made however through a testicular biopsy.

Azoospermia factor (AZF) is one of several proteins or their genes, which are coded from the AZF region on the human male Y chromosome. Deletions in this region are associated with inability to produce sperm. Subregions within the AZF region are AZFa, AZFb and AZFc. AZF microdeletions are one of the major causes of male infertility for azoospermia and severe oligozoospermia males. AZF is the term used by the HUGO Gene Nomenclature Committee.

Semen analysis

A semen analysis, also called seminogram or spermiogram, evaluates certain characteristics of a male's semen and the sperm contained therein. It is done to help evaluate male fertility, whether for those seeking pregnancy or verifying the success of vasectomy. Depending on the measurement method, just a few characteristics may be evaluated or many characteristics may be evaluated. Collection techniques and precise measurement method may influence results.

Semen quality is a measure of male fertility, a measure of the ability of sperm in semen to accomplish fertilization. Semen quality involves both sperm quantity and quality

Fertility preservation is the effort to help cancer patients retain their fertility, or ability to procreate. Research into how cancer, ageing and other health conditions effect reproductive health and preservation options are growing. Specifically sparked in part by the increase in the survival rate of cancer patients.

Ejaculatory duct obstruction (EDO) is a pathological condition which is characterized by the obstruction of one or both ejaculatory ducts. Thus, the efflux of semen is not possible. It can be congenital or acquired. It is a cause of male infertility and/or pelvic pain. Ejaculatory duct obstruction must not be confused with an obstruction of the vas deferens.

Vasography

Vasography is an X-ray study of the vas deferens to see if there is blockage, oftentimes in the context of male infertility. An incision is made in the scrotum, contrast is injected in the vas deferens, and X-rays are taken from different angles. Thus, it is an invasive procedure and carries risk of iatrogenic scarring and obstruction of the vas. Vasography has traditionally been considered the gold standard imaging modality for evaluating the seminal tract patency.

Testicular dysgenesis syndrome is a male reproduction-related condition characterized by the presence of symptoms and disorders such as hypospadias, cryptorchidism, poor semen quality, and testicular cancer. The concept was first introduced by N.E. Skakkaebaek in a research paper along with the department of Growth and Reproduction in Copenhagen University. The paper suggests the origin and underlying cause of TDS can be detected as early as in fetal life, where environmental and genomic factors could affect the development of the male reproductive system.

Obesity is defined as an abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight. This is often described as a body mass index (BMI) over 30. However, BMI does not account for whether the excess weight is fat or muscle, and is not a measure of body composition. For most people, however, BMI is an indication used worldwide to estimate nutritional status. Obesity is usually the result of consuming more calories than the body needs and not expending that energy by doing exercise. There are genetic causes and hormonal disorders that causes people to gain significant amounts of weight but this is rare. People in the obese category are much more likely to suffer from fertility problems than people of normal healthy weight.

Male infertility crisis Observed decline in male fertility and sperm quality

The male infertility crisis is an observed increase in male infertility since the mid-1970s. The issue attracted media attention following an influential 2017 meta-analysis that found that sperm counts had declined by 52.4% between 1973 and 2011. The crisis is particularly prevalent in Western countries such as New Zealand, Australia, Europe and North America. It has also been observed in non-western countries such as China.

References

  1. ↑ thefreedictionary.com > oligospermia Citing: Dorland's Medical Dictionary for Health Consumers, 2007 by Saunders; The American Heritage Medical Dictionary 2007, 2004 by Houghton Mifflin Company; Mosby's Medical Dictionary, 8th edition 2009; McGraw-Hill Concise Dictionary of Modern Medicine, 2002 by The McGraw-Hill Companies
  2. ↑ Grimes DA & Lopez LM 2007 Fertility and Sterility 88(6) 1491-94.
  3. ↑ Cooper TG, Noonan E, von Eckardstein S, et al. (2010). "World Health Organization reference values for human semen characteristics". Hum. Reprod. Update. 16 (3): 231–45. doi: 10.1093/humupd/dmp048 . PMID   19934213.
  4. ↑ Padubidri; Daftary (2011). Shaw's Textbook of Gynaecology, 15e. p. 204. ISBN   9788131225486
  5. ↑ Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AMA. WHO Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male. Cambridge University Press, 2000. ISBN   0-521-77474-8.
  6. ↑ Leibovitch I, Mor Y (2005). "The vicious cycling: bicycling related urogenital disorders". Eur. Urol. 47 (3): 277–86, discussion 286–7. doi:10.1016/j.eururo.2004.10.024. PMID   15716187.
  7. ↑ "Infertility in men" . Retrieved 2007-11-21.
  8. ↑ Costabile RA, Spevak M (2001). "Characterization of patients presenting with male factor infertility in an equal access, no cost medical system". Urology. 58 (6): 1021–4. doi:10.1016/S0090-4295(01)01400-5. PMID   11744480.
  9. ↑ Masarani M, Wazait H, Dinneen M (2006). "Mumps orchitis". Journal of the Royal Society of Medicine. 99 (11): 573–5. doi:10.1177/014107680609901116. PMC   1633545 . PMID   17082302.
  10. ↑ Zhang J, Qiu SD, Li SB, et al. (2007). "Novel mutations in ubiquitin-specific protease 26 gene might cause spermatogenesis impairment and male infertility". Asian Journal of Andrology. 9 (6): 809–14. doi: 10.1111/j.1745-7262.2007.00305.x . PMID   17968467.
  11. ↑ Menzies, F. M.; Shepherd, M. C.; Nibbs, R. J.; Nelson, S. M. (2010). "The role of mast cells and their mediators in reproduction, pregnancy and labour". Human Reproduction Update. 17 (3): 383–396. doi: 10.1093/humupd/dmq053 . PMID   20959350.
  12. 1 2 Cavallini G (2006). "Male idiopathic oligoasthenoteratozoospermia". Asian J Androl. 8 (2): 143–57. doi: 10.1111/j.1745-7262.2006.00123.x . PMID   16491265.
  13. 1 2 Sermondade, N.; Faure, C.; Fezeu, L.; et al. (2012). "BMI in relation to sperm count: An updated systematic review and collaborative meta-analysis". Human Reproduction Update. 19 (3): 221–231. doi:10.1093/humupd/dms050. PMC   3621293 . PMID   23242914.
  14. ↑ Zhoucun A, Zhang S, Yang Y, Ma Y, Zhang W, Lin L (2006). "The common variant N372H in BRCA2 gene may be associated with idiopathic male infertility with azoospermia or severe oligozoospermia". Eur. J. Obstet. Gynecol. Reprod. Biol. 124 (1): 61–4. doi:10.1016/j.ejogrb.2005.09.001. PMID   16257105.
  15. ↑ Radwan M, Jurewicz J, Merecz-Kot D, Sobala W, Radwan P, Bochenek M, Hanke W (2016). "Sperm DNA damage-the effect of stress and everyday life factors". Int. J. Impot. Res. 28 (4): 148–54. doi: 10.1038/ijir.2016.15 . PMID   27076112.
  16. 1 2 Check JH (2007). "Treatment of male infertility". Clin Exp Obstet Gynecol. 34 (4): 201–6. PMID   18225678.
  17. ↑ Adamopoulos DA, Nicopoulou S, Kapolla N, Karamertzanis M, Andreou E (1997). "The combination of testosterone undecanoate with tamoxifen citrate enhances the effects of each agent given independently on seminal parameters in men with idiopathic oligozoospermia". Fertil. Steril. 67 (4): 756–62. doi:10.1016/s0015-0282(97)81379-9. PMID   9093207.
  18. ↑ Lenzi A, Lombardo F, Sgro P, Salacone P, Caponecchia L, Dondero F, Gandini L (1991). "Use of carnitine therapy in selected cases of male factor infertility: a double-blind crossover trial". Fertility and Sterility. 25 (5): 1253–326. PMID   12569937.
  19. ↑ Francavilla F, Sciarretta F, Sorgentone S, Necozione S, Santucci R, Barbonetti A, Francavilla S (2009). "Intrauterine insemination with or without mild ovarian stimulation in couples with male subfertility due to oligo/astheno- and/or teratozoospermia or antisperm antibodies: a prospective cross-over trial". Fertil. Steril. 92 (3): 1009–11. doi:10.1016/j.fertnstert.2009.01.112. PMID   19261275.
  20. ↑ Sah, P (October 1998). "Role of low-dose estrogen-testosterone combination therapy in men with oligospermia". Fertility and Sterility. 70 (4): 780–1. doi:10.1016/S0015-0282(98)00273-8. PMID   9797116.
  21. ↑ Sah, P (December 2002). "Oligospermia due to partial maturation arrest responds to low dose estrogen-testosterone combination therapy resulting in live-birth: a case report". Asian Journal of Andrology. 4 (4): 307–8. PMID   12508135.
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