Oligospermia (niski nasieniowcowanie) – Diagnostyka i diagnoza

Oligospermia (niski nasieniowcowanie)
Diagnostyka i diagnoza

Oligospermia definiowana jest jako stężenie plemników w nasieniu poniżej 15 milionów/ml lub całkowita liczba plemników w ejakulacie poniżej 39 milionów, zgodnie z wytycznymi WHO z 2010 roku. Stan ten jest istotną przyczyną niepłodności męskiej i wymaga kompleksowej diagnostyki obejmującej szczegółowy wywiad medyczny, badanie fizykalne z oceną narządów płciowych (ze szczególnym uwzględnieniem żylaków powrózka nasiennego i nieprawidłowości rozwojowych), a także co najmniej dwie analizy nasienia wykonane w odstępie 1-3 miesięcy po 2-7 dniach abstynencji. Standardowa ocena nasienia powinna uwzględniać objętość ejakulatu (≥1,5 ml), pH (≥7,2), ruchliwość (≥40% ruchliwych, ≥32% progresywnie ruchliwych), morfologię (≥4% prawidłowych form) oraz żywotność (≥58%). Diagnostyka uzupełniająca obejmuje badania hormonalne (FSH, LH, testosteron, prolaktyna, TSH, fT4), badania genetyczne (kariotyp, mikrodelecje regionu AZF, mutacje genu CFTR) oraz badania obrazowe (USG moszny, TRUS). Wskazane są także specjalistyczne testy funkcji plemników, takie jak ocena fragmentacji DNA, test HOS, badanie przeciwciał przeciwplemnikowych czy biopsja jąder w przypadkach azoospermii.

Diagnostyka Oligospermii (niskiego nasieniowcowania)

Badanie podmiotowe i przedmiotowe
Badanie nasienia – podstawa diagnostyki
Badania uzupełniające w diagnostyce niskiego nasieniowcowania
Interpretacja wyników i strategie postępowania

Diagnostyka różnicowa niskiego nasieniowcowania

Znaczenie kliniczne niskiego nasieniowcowania

Podsumowanie procesu diagnostycznego

Kolejne rozdziały

Diagnostyka Oligospermii (niskiego nasieniowcowania)

Oligospermia, czyli niskie nasieniowcowanie, to stan, w którym stężenie plemników w nasieniu jest niższe niż prawidłowe. Zgodnie z aktualnymi wytycznymi Światowej Organizacji Zdrowia (WHO), oligospermię rozpoznaje się, gdy liczba plemników jest mniejsza niż 15 milionów/ml nasienia lub mniej niż 39 milionów plemników w całej objętości ejakulatu¹². Wcześniej za dolną granicę przyjmowano 20 milionów/ml, jednak obecne standardy są bardziej rygorystyczne³. Niskie nasieniowcowanie jest jedną z głównych przyczyn niepłodności męskiej i może znacząco utrudniać zapłodnienie, choć nie oznacza całkowitej niemożności posiadania potomstwa⁴.

Badanie podmiotowe i przedmiotowe

Proces diagnostyczny rozpoczyna się od dokładnego zebrania wywiadu medycznego i badania fizykalnego. Lekarz powinien uzyskać szczegółowe informacje dotyczące⁵⁶:

Historii reprodukcyjnej (w tym wcześniejszego ojcostwa)
Historii rodzinnej (przypadki niepłodności w rodzinie)
Przebytych urazów okolicy miednicy, jąder lub głowy
Sprawności seksualnej i libido
Zawodu wykonywanych (ekspozycja na czynniki toksyczne)
Chorób ogólnoustrojowych
Spożywania alkoholu, palenia tytoniu, używania narkotyków
Stosowanych leków i steroidów anabolicznych
Wcześniejszej chemio- lub radioterapii
Rozwoju pokwitaniowego
Zstępowania jąder
Historii chirurgicznej (operacje w obrębie moszny i okolicy pachwinowej)
Ekspozycji na toksyczne chemikalia, takie jak pestycydy
Przebytych infekcji układu moczowo-płciowego (rzeżączka, chlamydia)

Badanie przedmiotowe powinno obejmować ocenę narządów płciowych, w tym penisa, najądrzy, nasieniowodów i jąder. Szczególną uwagę należy zwrócić na obecność żylaków powrózka nasiennego (varicocele), które są najczęstszą odwracalną przyczyną niepłodności męskiej⁷. Niezstąpione jądro, zarówno jednostronne jak i obustronne, może wpływać na płodność mężczyzny nawet po chirurgicznej korekcji⁸.

Badanie nasienia – podstawa diagnostyki

Analiza nasienia (seminogram) jest podstawowym i najważniejszym badaniem w diagnostyce niepłodności męskiej⁹¹⁰. W przypadku podejrzenia niskiego nasieniowcowania, należy wykonać co najmniej dwie analizy nasienia w odstępie 1-3 miesięcy, aby potwierdzić diagnozę¹¹¹². Wynika to z dużej zmienności parametrów nasienia u tego samego mężczyzny¹³.

Próbkę nasienia należy pobrać po 2-7 dniach abstynencji seksualnej¹⁴. Zaleca się, aby materiał był zbierany poprzez masturbację, najlepiej w specjalnie przygotowanym pomieszczeniu w laboratorium lub w pobliżu laboratorium, co pozwala na szybką analizę świeżego materiału¹⁵.

Standardowa analiza nasienia ocenia następujące parametry¹⁶¹⁷:

Objętość ejakulatu (norma: ≥1,5 ml)
pH (norma: ≥7,2)
Stężenie plemników (norma: ≥15 milionów/ml)
Całkowita liczba plemników (norma: ≥39 milionów/ejakulat)
Ruchliwość plemników (norma: ≥40% plemników ruchliwych)
Progresywna ruchliwość (norma: ≥32%)
Morfologia plemników (norma: ≥4% prawidłowych form)
Żywotność plemników (norma: ≥58%)
Upłynnienie (norma: 20-30 minut)
Obecność leukocytów, niedojrzałych komórek płciowych i złogów

Interpretacja wyniku badania nasienia powinna być przeprowadzona zgodnie z aktualnymi wytycznymi WHO¹⁸. Należy pamiętać, że nawet w przypadku nieprawidłowych parametrów nasienia, zapłodnienie jest nadal możliwe, szczególnie przy zastosowaniu nowoczesnych technik wspomaganego rozrodu¹⁹.

Parametr	Norma wg WHO (2010)	Klasyfikacja przy niższych wartościach
Objętość ejakulatu	≥1,5 ml	Hipospermia
Stężenie plemników	≥15 mln/ml	Oligozoospermia
Całkowita liczba plemników	≥39 mln/ejakulat	Oligozoospermia
Całkowita ruchliwość	≥40%	Astenozoospermia
Progresywna ruchliwość	≥32%	Astenozoospermia
Morfologia	≥4% prawidłowych form	Teratozoospermia
Żywotność	≥58%	Nekrozoospermia

Badania uzupełniające w diagnostyce niskiego nasieniowcowania

W przypadku stwierdzenia niskiego nasieniowcowania, konieczne mogą być dodatkowe badania diagnostyczne w celu ustalenia przyczyny i zaplanowania odpowiedniego leczenia²⁰:

Badania hormonalne

Badania hormonalne są zalecane szczególnie w przypadkach ciężkiej oligozoospermii (< 5 milionów/ml) lub azoospermii (brak plemników)²¹. Obejmują one oznaczenie poziomów²²:

FSH (hormon folikulotropowy)
LH (hormon luteinizujący)
Testosteronu (całkowitego i wolnego)
Prolaktyny
Hormony tarczycy (TSH, fT4) – w przypadku podejrzenia dysfunkcji tarczycy

Interpretacja wyników badań hormonalnych pozwala na określenie typu zaburzenia²³:

Niskie nasieniowcowanie, niski testosteron, wysokie FSH i wysokie LH: sugeruje pierwotny hipogonadyzm hipogonadotropowy, wpływający zarówno na spermatogenezę, jak i funkcję komórek Leydiga
Niskie nasieniowcowanie, prawidłowy testosteron, prawidłowe LH i wysokie FSH: sugeruje uszkodzenie kanalików nasiennych bez dysfunkcji komórek Leydiga i nieprawidłową spermatogenezę
Niskie nasieniowcowanie, niski testosteron, niskie lub prawidłowe FSH i niskie lub prawidłowe LH: może wskazywać na hipogonadyzm hipogonadotropowy – w takich przypadkach istotne jest również sprawdzenie innych niedoborów hormonów przysadkowych

Badania genetyczne

Badania genetyczne są wskazane w przypadkach ciężkiej oligozoospermii lub azoospermii²⁴. Obejmują one²⁵:

Kariotyp (analiza chromosomów)
Ocena chromosomu Y i poszukiwanie mikrodelecji w regionie AZF
Badanie w kierunku mutacji genu CFTR (w przypadku podejrzenia wrodzonego obustronnego braku nasieniowodów)

Nieprawidłowości genetyczne mogą wpływać na produkcję plemników lub transport plemników²⁶.

Badania obrazowe

W diagnostyce przyczyn niskiego nasieniowcowania istotną rolę odgrywają również badania obrazowe²⁷²⁸:

Ultrasonografia moszny – pozwala na ocenę jąder, najądrzy oraz wykrycie żylaków powrózka nasiennego (varicocele)
Ultrasonografia przezodbytnicza (TRUS) – służy do wykrywania niedrożności w przewodach wytryskowych lub problemów z prostatą

Dodatkowe badania nasienia

W niektórych przypadkach mogą być konieczne specjalistyczne badania nasienia²⁹³⁰:

Badanie fragmentacji DNA plemników – ocena jakości chromatyny i potencjalnych uszkodzeń nici DNA
Test aktywności plemników (test HOS) – różnicowanie między nieruchomymi ale żywymi plemnikami a martwymi plemnikami
Badanie plemników metodą FISH – identyfikacja i liczenie chromosomów oraz wykrywanie ewentualnych defektów chromosomowych
Badanie przeciwciał przeciwplemnikowych – wykrywanie immunologicznych przyczyn niepłodności
Badanie żywotności plemników po uwolnieniu z plazmy nasiennej

Badanie moczu po ejakulacji

W przypadku małej objętości ejakulatu (< 1,5 ml) zaleca się wykonanie badania moczu pobranego bezpośrednio po ejakulacji w celu wykluczenia wstecznego wytrysku³¹³². Obecność plemników w moczu może świadczyć o tym, że część nasienia zamiast być wydalana przez cewkę moczową przedostaje się do pęcherza moczowego³³.

Biopsja jąder

Biopsja jąder jest wykonywana w przypadkach azoospermii przy prawidłowych wymiarach jąder i prawidłowych wynikach badań hormonalnych³⁴. Pozwala ona ocenić, czy produkcja plemników jest prawidłowa, a problem dotyczy ich transportu (niedrożność), czy też istnieje problem z samą spermatogenezą³⁵. W przypadku nieobecności plemników w ejakulacie, można je pobrać bezpośrednio z jąder lub najądrzy metodami mikrochirurgicznymi (TESE, MESA)³⁶.

Interpretacja wyników i strategie postępowania

Po przeprowadzeniu całościowej diagnostyki, lekarz powinien ustalić prawdopodobną przyczynę niskiego nasieniowcowania i zaproponować odpowiednie leczenie³⁷. Strategie postępowania mogą obejmować³⁸:

Leczenie przyczyn odwracalnych (np. infekcji, zaburzeń hormonalnych)
Chirurgiczną korekcję żylaków powrózka nasiennego lub niedrożności dróg wyprowadzających nasienie
Techniki wspomaganego rozrodu, takie jak inseminacja domaciczna (IUI), zapłodnienie pozaustrojowe (IVF) lub mikroiniekcja plemnika do komórki jajowej (ICSI)

Ważne jest, aby pamiętać, że efekty leczenia lub zmiany w stylu życia mogą nie być widoczne natychmiast w badaniach nasienia, ponieważ proces produkcji i transportu plemników trwa 2-3 miesiące³⁹.

Diagnostyka różnicowa niskiego nasieniowcowania

W procesie diagnostycznym ważne jest różnicowanie pomiędzy różnymi typami zaburzeń płodności u mężczyzn⁴⁰:

Oligozoospermia – niskie stężenie plemników (< 15 mln/ml)
Astenozoospermia – zmniejszona ruchliwość plemników (< 40% ruchliwych lub < 32% progresywnie ruchliwych)
Teratozoospermia – zwiększona liczba plemników o nieprawidłowej morfologii (< 4% prawidłowych form)
Oligoastenoteratozoospermia (OAT) – kombinacja powyższych zaburzeń
Azoospermia – całkowity brak plemników w ejakulacie, który może być spowodowany brakiem produkcji plemników (nieobstrukcyjna azoospermia) lub blokadą dróg wyprowadzających nasienie (obstrukcyjna azoospermia)⁴¹

Prawidłowe rozpoznanie typu zaburzenia ma kluczowe znaczenie dla wyboru odpowiedniej metody leczenia⁴².

Znaczenie kliniczne niskiego nasieniowcowania

Niskie nasieniowcowanie istotnie wpływa na zdolność pary do naturalnego poczęcia dziecka⁴³. Im niższe stężenie plemników, tym mniejsza szansa na zapłodnienie⁴⁴. Niemniej jednak, nawet przy znacznie obniżonych parametrach nasienia, ciąża może być możliwa przy zastosowaniu technik wspomaganego rozrodu⁴⁵.

Warto podkreślić, że diagnostyka niskiego nasieniowcowania nie służy wyłącznie ocenie płodności. U około 6% mężczyzn diagnozowanych z powodu niepłodności wykrywa się poważniejsze choroby podstawowe, takie jak nowotwory⁴⁶. Dlatego kompleksowa ocena mężczyzn z niepłodnością ma również znaczenie dla ogólnego stanu zdrowia⁴⁷.

Podsumowanie procesu diagnostycznego

Diagnostyka niskiego nasieniowcowania (oligospermii) obejmuje szereg etapów, począwszy od dokładnego wywiadu medycznego i badania fizykalnego, poprzez analizę nasienia, badania hormonalne, genetyczne i obrazowe, aż po specjalistyczne testy funkcji plemników⁴⁸⁴⁹.

Kluczowe znaczenie ma wykonanie co najmniej dwóch analiz nasienia w odstępie kilku tygodni lub miesięcy, aby potwierdzić diagnozę⁵⁰. Interpretacja wyników powinna być dokonywana w odniesieniu do aktualnych norm WHO i z uwzględnieniem czynników wpływających na jakość nasienia⁵¹.

Po ustaleniu diagnozy i określeniu przyczyny niskiego nasieniowcowania, lekarz może zaproponować odpowiednie leczenie, które może obejmować modyfikację stylu życia, farmakoterapię, chirurgię lub techniki wspomaganego rozrodu⁵². Współczesna medycyna oferuje szerokie możliwości leczenia niepłodności męskiej, a większość par, nawet przy znacznie obniżonych parametrach nasienia, ma szansę na posiadanie dzieci⁵³.

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Materiały źródłowe

#1 Low sperm count – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/symptoms-causes/syc-20374585
A low sperm count means there is less sperm than is typical in fluid called semen that the penis releases during orgasm. […] Your sperm count is considered lower than typical if you have fewer than 15 million sperm per milliliter of semen. […] If needed, there are treatments to help couples boost their chances of becoming pregnant. […] See a healthcare professional if you and your partner haven’t been able to become pregnant after a year of regular sex without using birth control. […] Low sperm count can be caused by health conditions such as: […] A varicocele (VAR-ih-koe-seel) is a swelling of the veins that drain the testicle. […] Some infections can impact sperm health or the body’s ability to make sperm. […] Ejaculation is the release of semen from the penis. […] Cancers and tumors that aren’t cancer both can affect the male reproductive organs directly.
#2
https://umiamihealth.org/en/treatments-and-services/fertility-center/low-sperm-count-and-poor-sperm-health
Low sperm count known as oligospermia occurs when a mans semen (fluid ejaculated from the penis) contains fewer sperm than is typical. A man is considered to have low sperm count if he has fewer than 15 million sperm per millimeter of semen. Having a low sperm count does not necessarily mean that a man will not be able to impregnate a woman, but it may make it more difficult. […] Symptoms of a low sperm count include: […] A mans sperm may be considered to be in poor health or abnormal for two main reasons: an unusually short life span and/or low motility (difficulty swimming). […] The main symptom of poor sperm health is infertility. Most men dont realize they have poor sperm health until they are trying to impregnate a woman. […] Semen Analysis: In this test, the man provides a semen sample via masturbation. Then, the sample is analyzed and evaluated in the laboratory for the sperm count, motility (forward movement), shape, and quantity. According to the American Society for Reproductive Medicine, a normal ejaculate contains over 20 million sperm per milliliter of liquid, at least 25 percent of the sperm should be moving forward, and at least 30 percent of sperm should have normal shapes.
#3 Oligospermia – Wikipedia
https://en.wikipedia.org/wiki/Oligospermia
Terms oligospermia, oligozoospermia, and low sperm count refer to semen with a low concentration of sperm and is a common finding in male infertility. […] 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. […] The diagnosis of oligozoospermia requires a work-up via semen analysis.
#4 Low Sperm Count: Causes, Signs, Treatment, Pregnancy Chances
https://www.healthline.com/health/infertility/low-sperm-count
Low sperm count, also called oligospermia, is a major cause of male infertility. Sperm count is considered low if it dips below 15 million sperm per milliliter (mL) of semen, although the average is around 75 million sperm per mL. […] Diagnosis usually involves a physical exam, medical history, and semen analysis. […] A semen analysis may be particularly helpful in receiving a diagnosis, as your sperm can be counted under a microscope and checked for motility (movement) and morphology (shape). […] Other tests your doctor may try include: blood tests to check hormones or chromosomes, ultrasound to visualize the testicles or prostate, biopsy to evaluate sperm production in the case of blockages. […] The treatment you receive for low sperm count will depend on the cause. […] For cases involving large varicoceles, blockages, or issues with sperm leaving the body, surgery is an option.
#5 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Infertility is usually defined as the inability of a couple to conceive even after 1 year of unprotected, frequent sexual intercourse. The male is solely responsible in about 20% of cases and is a contributing factor in another 30% to 40% of all infertility cases. As male and female causes often co-exist, it is essential that both partners are investigated for infertility and managed together. Overall, the male factor substantially contributes to about 50% of all cases of infertility. […] The initial evaluation includes a detailed sexual history and physical examination, together with 2 separate semen analyses. Hormonal testing and an optional scrotal ultrasound can then be performed if abnormalities are found. This is usually sufficient to make an initial determination of the nature and severity of the underlying problem. The key purpose for evaluating a male for infertility is to identify the contributing factors, offer treatment for those that are reversible, determine if the patient is a candidate for assisted reproductive techniques, and offer counseling for irreversible and untreatable conditions.
#6 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
– Sperm Morphology: 4% normal forms […] – Motility: 40% […] – Vitality: 58% […] – Progressive motility: 32% […] – Total motility: 40% […] – Forward progression: 2 […] – Seminal fructose: 13 micromol/ejaculate […] – Liquefaction: 20 to 30 minutes […] The evaluation starts with a complete and comprehensive sexual and medical history, including reproductive history, family history, history of significant trauma to the pelvis, testicles or head, sexual performance, libido, occupation, systemic diseases, intake of alcohol, smoking, recreational drugs, medications, steroid abuse, previous chemo/radiotherapy, pubertal development, testicular descent, surgical history involving the scrotum and inguinal regions, exposure to toxic chemicals such as pesticides, loss of body hair, shaving frequency, sexually transmitted infections (STIs), tuberculosis, mumps, scrotal infections such as epididymitis, prior biological children produced, maternal exposure to DES, anosmia (associated with Kallman syndrome), breast enlargement and galactorrhea, and precocious puberty (at 9 years of age or earlier.
#7 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
An undescended testicle, whether unilateral or bilateral, can affect male fertility even when surgically repaired. Sickle cell disease can cause intratesticular ischemia. Chronic renal failure has been associated with hypogonadism, while liver failure sometimes causes gynecomastia (from increased estrogen levels), testicular atrophy, and reduced secondary sex characteristics. Tuberculosis, prostatitis, epididymitis, and STIs (especially gonorrhea) can cause vasal scarring and obstructive azoospermia, while mycoplasma infections tend to reduce sperm motility. […] The presence of a hydrocele should be noted. If a hydrocele is present, a testicular ultrasound should be used to examine the testicle since an adequate direct physical examination is not otherwise possible. […] A varicocele that is identifiable on the physical examination might be clinically significant with regard to possible infertility. Varicoceles are the most common correctable cause of male infertility, so a careful check for their presence should be undertaken. They are relatively easy to identify, even on a simple physical examination. Varicoceles are present in 15% of men, but in those with an abnormal semen analysis, the incidence increases to 40%. Only clinically significant varicoceles are generally believed to impact male fertility. When present, varicoceles are typically found on the left side of the scrotum due to anatomical reasons. […] In general, if a patient has azoospermia with bilateral atrophic testes, a good outcome from treatment may be possible only with IVF and ICSI.
#8 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
An undescended testicle, whether unilateral or bilateral, can affect male fertility even when surgically repaired. Sickle cell disease can cause intratesticular ischemia. Chronic renal failure has been associated with hypogonadism, while liver failure sometimes causes gynecomastia (from increased estrogen levels), testicular atrophy, and reduced secondary sex characteristics. Tuberculosis, prostatitis, epididymitis, and STIs (especially gonorrhea) can cause vasal scarring and obstructive azoospermia, while mycoplasma infections tend to reduce sperm motility. […] The presence of a hydrocele should be noted. If a hydrocele is present, a testicular ultrasound should be used to examine the testicle since an adequate direct physical examination is not otherwise possible. […] A varicocele that is identifiable on the physical examination might be clinically significant with regard to possible infertility. Varicoceles are the most common correctable cause of male infertility, so a careful check for their presence should be undertaken. They are relatively easy to identify, even on a simple physical examination. Varicoceles are present in 15% of men, but in those with an abnormal semen analysis, the incidence increases to 40%. Only clinically significant varicoceles are generally believed to impact male fertility. When present, varicoceles are typically found on the left side of the scrotum due to anatomical reasons. […] In general, if a patient has azoospermia with bilateral atrophic testes, a good outcome from treatment may be possible only with IVF and ICSI.
#9 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
You may learn that you have a low sperm count if you get a healthcare checkup because you’re having trouble getting your partner pregnant. […] At your appointment, your healthcare professional works to find out the cause of your fertility troubles. […] This can help guide fertility treatment options for you and your partner. […] A sample of your semen is collected for testing as well. This is called a semen analysis. […] Your semen is checked under a microscope to see how many sperm are present. […] If you have a low sperm count, your semen contains fewer than 15 million sperm in each milliliter or less than 39 million sperm total for the entire sample. […] Your chance of getting your partner pregnant drops with lower sperm counts. […] Depending on your semen analysis results, your healthcare professional might recommend more tests.
#10 Oligospermia (Low Sperm Count): Causes & Treatment
https://my.clevelandclinic.org/health/diseases/22477-oligospermia-low-sperm-count
You may not know you have a low sperm count until youre trying to have a baby and arent succeeding. Healthcare providers will diagnose oligospermia by collecting a semen sample and evaluating it in a lab. […] The main symptom of a low sperm count is the inability to conceive with a partner after one year of repeated sexual intercourse without birth control. […] Healthcare providers will review your medical history and perform a physical exam. If they think you have a low sperm count, theyll recommend a semen analysis. […] If a provider diagnoses you with oligospermia, you may wish to ask the following questions: Whats causing my low sperm count? […] Each oligospermia cause has a different prognosis. But many causes are treatable. If a healthcare provider diagnoses you with oligospermia, youll work together to determine the cause and your treatment options.
#11 Semen Analysis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK564369/
If the semen analysis is normal according to the WHO criteria, a single semen specimen may be sufficient, but some experts still recommend 2 separate specimens. […] When the semen volume is low (1.5 mL), and especially when it is less than 1 mL, a urine specimen should be collected immediately after ejaculation. […] Low sperm count, low testosterone, high FSH, and high LH: This pattern suggests primary hypogonadotropic hypogonadism, affecting both spermatogenesis and Leydig cell function. […] Low sperm count, normal testosterone, normal LH, and high FSH: This pattern suspects seminiferous tubule damage without Leydig cell dysfunction and abnormal spermatogenesis. […] Low sperm count, low testosterone, normal or low FSH, and normal or low LH or hypogonadotropic hypogonadism: In such cases, it is crucial to check other pituitary hormone deficiencies, including thyroid function (free T4), cortisol at 8 AM, and prolactin levels.
#12 Semen Analysis: Purpose, Procedure, and Understanding Results
https://www.webmd.com/infertility-and-reproduction/what-is-semen-analysis
Semen analysis is a test of sperm and semen. Also known as a sperm count or male fertility test, its results show how many sperm are released, as well as how they’re shaped and how well they move. […] A semen analysis can help your doctor diagnose fertility issues. A sample is looked at under a microscope to see how many sperm cells it contains, how they’re shaped, and how well they move. […] If you and your partner are having trouble getting pregnant, semen analysis is one of the first tests your doctor will likely ask for. […] Issues with male fertility can play a part in about half of all infertility cases. And male infertility is often caused by low sperm production. […] To get the most accurate results, your doctor will want to test more than one sample. You will need to provide another sample within two to three weeks.
#13 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Up to 6% of men evaluated for male infertility will be found to have more serious underlying pathology, such as cancer. This is an additional reason to do a comprehensive evaluation of the male partners of infertile couples so that any significant, underlying medical conditions can be identified and treated. […] The semen analysis is the cornerstone of laboratory evaluation of male infertility. At least 2 separate samples should be collected, separated by at least 1 week but optimally by a month. At least 3 days of abstinence should precede each specimen. This is recommended due to the extremely high degree of variability in semen analyses. The outcomes and prognosis of male infertility greatly depend upon the semen analysis results as well as the female partner’s fertility status, along with the categorization of whether fertility is primary or secondary.
#14 Low Sperm Count
https://www.froedtert.com/fertility/male-infertility/low-sperm-count
Oligospermia, also known as low sperm count, or a less than normal amount of sperm present in the ejaculate, is diagnosed through semen analysis. […] Understanding the cause of low sperm count is important in determining the best treatment options. […] The physician may order a semen analysis depending upon your specific case. Semen should be collected after two to seven days of no ejaculation.
#15 Semen Analysis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK564369/
Semen analysis is a laboratory test performed to evaluate male fertility. […] The assessment of male infertility involves a comprehensive evaluation, including a detailed medical and sexual history, a thorough physical examination, and semen analyses. […] A detailed analysis of these factors can help identify the reason for the male factor infertility. […] The semen sample is collected by the man through self-masturbation either at home or near the laboratory. […] The sample should be analyzed using standardized methods described in the World Health Organization (WHO) laboratory manual to examine and process human semen. […] According to the WHO laboratory manual for the examination and processing of human semen published in 2010, semen analysis involves the following steps: […] Sperm vitality is assessed, especially if the sperm number is low.
#16 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
The WHO has published a detailed methodology for collecting semen. At-home sperm tests are now commercially available but are not recommended as their reliability is questionable, and they do not check all of the recommended semen parameters. […] The semen is evaluated for volume, pH, leukocytes, immature germ cells, and liquefaction, while the sperm is assessed for count, concentration, vitality, motility, progression, debris, and morphology. Either the WHO criteria for scoring sperm morphology or the Kruger-Tygerberg criteria should be used. […] The Lower Reference Limits of a Semen Analysis (with 95% confidence intervals) Adapted from WHO (2010) include: […] – Ejaculate volume: 1.5 mL […] – pH 7.2 […] – Sperm concentration: 15 million/mL […] – Total sperm count: 39 million/ejaculate
#17 Semen Analysis: Purpose, Procedure & Results
https://my.clevelandclinic.org/health/diagnostics/21520-semen-analysis
A semen analysis looks at the volume and quality of sperm. Its one of the first steps in detecting fertility issues. A semen analysis also shows whether a vasectomy was successful. The test involves collecting a semen sample and evaluating it in a lab. […] A semen analysis is a lab test that examines a semen sample under a microscope. It evaluates: […] A healthcare provider may recommend a semen analysis for: […] If youre having difficulty conceiving a biological child, there may be an abnormality in your semen. A semen analysis evaluates the health of your sperm and the likelihood that you can cause a pregnancy. […] A semen analysis determines whether a vasectomy was successful. […] A post-vasectomy semen analysis checks to see whether your semen contains sperm. Expected results show no sperm or very few nonmoving sperm. Abnormal results show moving sperm or high numbers of nonmoving sperm.
#18 Semen Analysis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK564369/
Semen analysis is a laboratory test performed to evaluate male fertility. […] The assessment of male infertility involves a comprehensive evaluation, including a detailed medical and sexual history, a thorough physical examination, and semen analyses. […] A detailed analysis of these factors can help identify the reason for the male factor infertility. […] The semen sample is collected by the man through self-masturbation either at home or near the laboratory. […] The sample should be analyzed using standardized methods described in the World Health Organization (WHO) laboratory manual to examine and process human semen. […] According to the WHO laboratory manual for the examination and processing of human semen published in 2010, semen analysis involves the following steps: […] Sperm vitality is assessed, especially if the sperm number is low.
#19 Semen Analysis: MedlinePlus Medical TestLock
https://medlineplus.gov/lab-tests/semen-analysis/
If your semen analysis results aren’t all normal, it doesn’t mean you’re permanently infertile. But it does show that your sperm may be part of the problem you and your partner are having getting pregnant. […] Your provider may order more tests to help find the cause of the problem so it can be treated.
#20 Low Sperm Count: Causes, Signs, Treatment, Pregnancy Chances
https://www.healthline.com/health/infertility/low-sperm-count
Low sperm count, also called oligospermia, is a major cause of male infertility. Sperm count is considered low if it dips below 15 million sperm per milliliter (mL) of semen, although the average is around 75 million sperm per mL. […] Diagnosis usually involves a physical exam, medical history, and semen analysis. […] A semen analysis may be particularly helpful in receiving a diagnosis, as your sperm can be counted under a microscope and checked for motility (movement) and morphology (shape). […] Other tests your doctor may try include: blood tests to check hormones or chromosomes, ultrasound to visualize the testicles or prostate, biopsy to evaluate sperm production in the case of blockages. […] The treatment you receive for low sperm count will depend on the cause. […] For cases involving large varicoceles, blockages, or issues with sperm leaving the body, surgery is an option.
#21 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
Normal motility is defined as more than 60% of sperm having normal movement, and the WHO 2010 lower reference limit (5th percentile) is 40%. […] Teratospermia is defined as less than 30% normal morphology, and the WHO lower reference limit (5th percentile) is 4%. […] The presence of antibodies in serum or seminal plasma is less prognostic than antibodies bound to sperm. […] A routine part of the initial evaluation is testing of specific serum hormone levels, which usually includes FSH, LH, testosterone, and prolactin. […] TRUS is indicated in patients with azoospermia or severe oligospermia to evaluate for complete or partial ejaculatory duct obstruction. […] An abnormal postcoital test result is observed in 10% of infertile couples. […] When a primary sperm defect is suspected or when other tests do not reveal the cause of infertility, sperm function tests may determine if a significant sperm abnormality exists.
#22 Semen Analysis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK564369/
If the semen analysis is normal according to the WHO criteria, a single semen specimen may be sufficient, but some experts still recommend 2 separate specimens. […] When the semen volume is low (1.5 mL), and especially when it is less than 1 mL, a urine specimen should be collected immediately after ejaculation. […] Low sperm count, low testosterone, high FSH, and high LH: This pattern suggests primary hypogonadotropic hypogonadism, affecting both spermatogenesis and Leydig cell function. […] Low sperm count, normal testosterone, normal LH, and high FSH: This pattern suspects seminiferous tubule damage without Leydig cell dysfunction and abnormal spermatogenesis. […] Low sperm count, low testosterone, normal or low FSH, and normal or low LH or hypogonadotropic hypogonadism: In such cases, it is crucial to check other pituitary hormone deficiencies, including thyroid function (free T4), cortisol at 8 AM, and prolactin levels.
#23 Semen Analysis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK564369/
If the semen analysis is normal according to the WHO criteria, a single semen specimen may be sufficient, but some experts still recommend 2 separate specimens. […] When the semen volume is low (1.5 mL), and especially when it is less than 1 mL, a urine specimen should be collected immediately after ejaculation. […] Low sperm count, low testosterone, high FSH, and high LH: This pattern suggests primary hypogonadotropic hypogonadism, affecting both spermatogenesis and Leydig cell function. […] Low sperm count, normal testosterone, normal LH, and high FSH: This pattern suspects seminiferous tubule damage without Leydig cell dysfunction and abnormal spermatogenesis. […] Low sperm count, low testosterone, normal or low FSH, and normal or low LH or hypogonadotropic hypogonadism: In such cases, it is crucial to check other pituitary hormone deficiencies, including thyroid function (free T4), cortisol at 8 AM, and prolactin levels.
#24 Azthena logo with the word Azthena
https://www.news-medical.net/health/Testing-for-a-Low-Sperm-Count.aspx
Oligospermia is a profoundly disturbing diagnosis for a man. It needs careful evaluation before a definitive diagnosis is made, and before appropriate treatment can be decided upon. […] Semen analysis is the primary technique to test for male fertility, and is often the point of referral. […] Semen analysis may help detect the following: 1. Abnormalities in sperm count […] Azoospermia – the absence of sperm in semen […] Oligozoospermia – the presence of less than 15 million sperm/ml. […] Hormone testing may be necessary, including testing for serum follicle stimulating hormone (FSH) levels as an indicator of poor sperm production. […] Genetic testing is indicated in men who have azoospermia or severe oligospermia, with suspected congenital obstruction. […] Testicular micro-biopsy may be required in the last resort to distinguish between obstructive and non-obstructive azoospermia if all other clinical and laboratory parameters are normal this will confirm the presence of sperm.
#25 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
You may be asked to provide a sample of your urine after ejaculation. Doctors check the urine for the presence of sperm, which can occur as a result of retrograde ejaculation. […] Doctors use transrectal ultrasound to detect blockages in the tubes that carry semen out of the body or problems with the prostate, such as benign prostatic hyperplasia, in which the prostate becomes enlarged. […] Doctors may perform blood tests to detect genetic causes of infertility. These tests include chromosome analysis and evaluation of the male sex chromosome, known as the Y chromosome, which can determine if genetic information is altered or missing, thereby affecting sperm production.
#26 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
NYU Langone urologists who specialize in male infertility work together with female reproduction specialists to diagnose and manage infertility in couples. […] A total absence of sperm is the cause of infertility in about 10 to 15 percent of infertile men. This is called azoospermia, and it can be caused by a genetic irregularity, hormone imbalance, or blockage in the tubes that carry sperm to the urethra. […] Doctors can diagnose varicocele by performing a physical examination. Your doctor may recommend an ultrasound for further evaluation of the size of the varicocele. […] NYU Langone urologists may test a mans semen to determine causes of infertility. Doctors examine semen volume, as well as the number of sperm, their shape, and their motility, or movement. […] Blood tests can identify a mans levels of the reproductive hormone testosterone and other related hormones. Hormone imbalances can lead to low sperm counts, cause erectile dysfunction, and lower sex drive.
#27 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
NYU Langone urologists who specialize in male infertility work together with female reproduction specialists to diagnose and manage infertility in couples. […] A total absence of sperm is the cause of infertility in about 10 to 15 percent of infertile men. This is called azoospermia, and it can be caused by a genetic irregularity, hormone imbalance, or blockage in the tubes that carry sperm to the urethra. […] Doctors can diagnose varicocele by performing a physical examination. Your doctor may recommend an ultrasound for further evaluation of the size of the varicocele. […] NYU Langone urologists may test a mans semen to determine causes of infertility. Doctors examine semen volume, as well as the number of sperm, their shape, and their motility, or movement. […] Blood tests can identify a mans levels of the reproductive hormone testosterone and other related hormones. Hormone imbalances can lead to low sperm counts, cause erectile dysfunction, and lower sex drive.
#28 Treatments for Men With Low Sperm Count
https://www.cloudninefertility.com/blog/treatments-for-men-with-low-sperm-count
Low Sperm Count Diagnosis […] So, how can one determine whether their sperm count is low or below normal levels? […] Patient is advised to get a semen analysis after 3-5 days of abstinence at andrology lab to know the sperm count. […] When the doctor suspects low sperm count, they will ask for the following tests to know the cause : […] 1. Ultrasound of the Scrotum […] High-frequency waves are used to check the testicles and other parts around. […] 2. Transrectal Ultrasound […] In this test, a small-lubricated wand is inserted through the rectum to analyse the prostrate and rule out any blocks in the tubes that carry the semen during ejaculation. […] 3. Hormones Test […] A blood test to check the levels of various hormones that could affect the development and production of sperm.
#29 Male Fertility Tests & Procedures | University of Utah Health
https://healthcare.utah.edu/fertility/treatments/diagnostic-testing/all-tests
If you have an increased number of white blood cells in your semen sample, your doctor may ask you to get a semen culture. […] Sperm aneuploidy by FISH (fluorescent in-situ hybridization) allows us to identify and count chromosomes as well as any defects in chromosomes, such as chromosome translocations, in your semen. […] SCIT tests analyze the quality of your chromatin and whether there are any breaks in your DNA strands. […] How long your sperm stay functional after ejaculation could cause fertility problems. The sperm longevity test can check how your sperm are working after theyve been washed free from the seminal plasma and stored in a solution. […] To diagnose many sperm defects, we use transmission electron microscopy. […] Varicoceles are swollen veins in the scrotum. They are found in fertile as well as infertile men and are extremely common. But since they happen more in infertile men, they could harm fertility. Varicoceles are often found when there are fewer normal sperm and more tapered or abnormal sperm. […] It also seems to be associated with lower sperm concentration and motility.
#30 Semen Analysis Testing – The Complete Guide — Male Infertility Guide
https://www.maleinfertilityguide.com/semen-analysis-testing-the-complete-guide
It takes approximately ten weeks to get the damaged batch of sperm completely out of the body and replace it with a new, healthier set of sperm. […] Accurate semen analysis requires highly trained technicians to perform specialized testing, including determining sperm density (numbers of sperm present), motility (how well they are swimming), and morphology (whether they have normal shapes). […] The accuracy of a semen analysis depends on the skill and training of the laboratory technicians who perform it. […] Most fertility-specific labs are set up to have private collection rooms with locking doors (something not generally available in hospital-based labs). […] The post-ejaculatory urinalysis (PEU) involves the man providing a urine specimen collected in a separate collection cup after ejaculation.
#31 Semen Analysis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK564369/
If the semen analysis is normal according to the WHO criteria, a single semen specimen may be sufficient, but some experts still recommend 2 separate specimens. […] When the semen volume is low (1.5 mL), and especially when it is less than 1 mL, a urine specimen should be collected immediately after ejaculation. […] Low sperm count, low testosterone, high FSH, and high LH: This pattern suggests primary hypogonadotropic hypogonadism, affecting both spermatogenesis and Leydig cell function. […] Low sperm count, normal testosterone, normal LH, and high FSH: This pattern suspects seminiferous tubule damage without Leydig cell dysfunction and abnormal spermatogenesis. […] Low sperm count, low testosterone, normal or low FSH, and normal or low LH or hypogonadotropic hypogonadism: In such cases, it is crucial to check other pituitary hormone deficiencies, including thyroid function (free T4), cortisol at 8 AM, and prolactin levels.
#32 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
You may be asked to provide a sample of your urine after ejaculation. Doctors check the urine for the presence of sperm, which can occur as a result of retrograde ejaculation. […] Doctors use transrectal ultrasound to detect blockages in the tubes that carry semen out of the body or problems with the prostate, such as benign prostatic hyperplasia, in which the prostate becomes enlarged. […] Doctors may perform blood tests to detect genetic causes of infertility. These tests include chromosome analysis and evaluation of the male sex chromosome, known as the Y chromosome, which can determine if genetic information is altered or missing, thereby affecting sperm production.
#33 Male Fertility Tests & Procedures | University of Utah Health
https://healthcare.utah.edu/fertility/treatments/diagnostic-testing/all-tests
Our ability to diagnose and treat fertility problems has greatly advanced over the last decade. Getting a complete and accurate diagnosis is essential to finding the best treatment or therapy for you. […] Our andrology laboratory offers several diagnostic tests that can help your treatment process, including semen analysis, sperm penetration assay, and an anti-sperm antibody test. […] If no sperm are found in your semen or if the count is extremely low, we may use a blood sample to evaluate hormone levels (FSH, LH, free testosterone, and total testosterone and prolactin). Clues from these tests may lead to possible causes and the best therapies. […] We may recommend a retrograde semen analysis for men with a low sperm count. (An initial semen analysis will show if you have a low sperm count). Retrograde ejaculation is when sperm ends up in your bladder. If you have retrograde ejaculation, sperm will be in your urine after you have sex.
#34 Male Infertility Workup: Laboratory Studies, Imaging Studies, Other Tests
https://emedicine.medscape.com/article/436829-workup
The capacitation assay is used to evaluate the ability of sperm to undergo capacitation. […] The HOS test is used to provide functional information to differentiate between viable but immotile sperm and dead sperm. […] Testicular biopsy is performed in azoospermic men with a normal-sized testis and normal findings on hormonal studies.
#35 Treatments for Men With Low Sperm Count
https://www.cloudninefertility.com/blog/treatments-for-men-with-low-sperm-count
4. Analysis of Urine Post-Ejaculation […] The urine will be tested for sperm. Finding sperms in the urine post-ejaculation can indicate a backward movement of the sperms, instead of moving forward through the penis during ejaculation. […] 5. Genetic Tests […] A mans sperm count can be affected by his genes. Genetic testing can identify any abnormalities with the chromosomes or identify other underlying issues that could be affecting sperm production. […] 6. Biopsy of Testicles […] In this test, a small sample is collected from the testicles to analyse if sperm production is normal. If it is normal, it can indicate a blockage in the tubes. […] 7. Anti-Sperm Antibody Tests […] A test to check for antibodies that might be attacking the sperm and making them weak. […] 8. Specialized Sperm Function Tests […] These test will check how well the sperm survives post-ejaculation, how strong they are and how well they can attach to an egg. Such tests are very rare and do not have much of an implication on treatment recommendations.
#36 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
Tests to look for the cause of your low sperm count and other possible causes of male infertility can include: […] Your healthcare professional may recommend a blood test to check the levels of hormones made by the pituitary gland and testicles. […] This urine test is done after you ejaculate. […] When semen contains extremely low levels of sperm, certain genetic causes may be involved. […] If no sperm are present in the semen, sperm often can be collected directly from the testicles or epididymis. […] These treatments can help if you have infertility caused by high or low levels of certain hormones. […] Some couples have trouble becoming pregnant despite frequent sex. […] If this happens to you, it’s still possible to have a child. […] You and your partner can think about using sperm from a donor or adopting a child.
#37 Oligospermia (Low Sperm Count): Causes & Treatment
https://my.clevelandclinic.org/health/diseases/22477-oligospermia-low-sperm-count
You may not know you have a low sperm count until youre trying to have a baby and arent succeeding. Healthcare providers will diagnose oligospermia by collecting a semen sample and evaluating it in a lab. […] The main symptom of a low sperm count is the inability to conceive with a partner after one year of repeated sexual intercourse without birth control. […] Healthcare providers will review your medical history and perform a physical exam. If they think you have a low sperm count, theyll recommend a semen analysis. […] If a provider diagnoses you with oligospermia, you may wish to ask the following questions: Whats causing my low sperm count? […] Each oligospermia cause has a different prognosis. But many causes are treatable. If a healthcare provider diagnoses you with oligospermia, youll work together to determine the cause and your treatment options.
#38 Low Sperm Count: Causes, Signs, Treatment, Pregnancy Chances
https://www.healthline.com/health/infertility/low-sperm-count
Infections in the reproductive tract can be treated with medications. […] Since testosterone and other hormone levels that are either too high or too low can cause low sperm count, addressing the levels with medications and other treatments may help restore fertility. […] Its important to note that any treatments or lifestyle changes may not be reflected in your sperm count right away, as the time frame of sperm production and transit is up to 2 to 3 months. […] Couples can get pregnant with low sperm count. It may just take more time than you originally expected, and it may require seeing a doctor to see how you can improve your sperm quality. […] If your low sperm count is caused by an underlying health condition, your doctor can also help you get the treatment you need to relieve any other symptoms you’re experiencing.
#39 Low Sperm Count: Causes, Signs, Treatment, Pregnancy Chances
https://www.healthline.com/health/infertility/low-sperm-count
Infections in the reproductive tract can be treated with medications. […] Since testosterone and other hormone levels that are either too high or too low can cause low sperm count, addressing the levels with medications and other treatments may help restore fertility. […] Its important to note that any treatments or lifestyle changes may not be reflected in your sperm count right away, as the time frame of sperm production and transit is up to 2 to 3 months. […] Couples can get pregnant with low sperm count. It may just take more time than you originally expected, and it may require seeing a doctor to see how you can improve your sperm quality. […] If your low sperm count is caused by an underlying health condition, your doctor can also help you get the treatment you need to relieve any other symptoms you’re experiencing.
#40 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Infertility is usually defined as the inability of a couple to conceive even after 1 year of unprotected, frequent sexual intercourse. The male is solely responsible in about 20% of cases and is a contributing factor in another 30% to 40% of all infertility cases. As male and female causes often co-exist, it is essential that both partners are investigated for infertility and managed together. Overall, the male factor substantially contributes to about 50% of all cases of infertility. […] The initial evaluation includes a detailed sexual history and physical examination, together with 2 separate semen analyses. Hormonal testing and an optional scrotal ultrasound can then be performed if abnormalities are found. This is usually sufficient to make an initial determination of the nature and severity of the underlying problem. The key purpose for evaluating a male for infertility is to identify the contributing factors, offer treatment for those that are reversible, determine if the patient is a candidate for assisted reproductive techniques, and offer counseling for irreversible and untreatable conditions.
#41 Diagnosing Male Infertility | NYU Langone Health
https://nyulangone.org/conditions/male-infertility/diagnosis
NYU Langone urologists who specialize in male infertility work together with female reproduction specialists to diagnose and manage infertility in couples. […] A total absence of sperm is the cause of infertility in about 10 to 15 percent of infertile men. This is called azoospermia, and it can be caused by a genetic irregularity, hormone imbalance, or blockage in the tubes that carry sperm to the urethra. […] Doctors can diagnose varicocele by performing a physical examination. Your doctor may recommend an ultrasound for further evaluation of the size of the varicocele. […] NYU Langone urologists may test a mans semen to determine causes of infertility. Doctors examine semen volume, as well as the number of sperm, their shape, and their motility, or movement. […] Blood tests can identify a mans levels of the reproductive hormone testosterone and other related hormones. Hormone imbalances can lead to low sperm counts, cause erectile dysfunction, and lower sex drive.
#42 Diagnosis and Treatment of Male Factor Infertility – IRMS Reproductive Medicine
https://sbivf.com/blog/diagnosis-and-treatment-of-male-factor-infertility/
Poor sperm motility, or asthenospermia, could suggest a history of prior testosterone use, an infection of the urogenital tract, exposure to toxins such as excessive tobacco or alcohol, use of hot baths/saunas as these can raise testicular temperature, or an unexplained etiology. […] A varicocele is an anatomical variant where vessels around the vas deferens are dilated and could cause both poor sperm motility and morphology. […] Azoospermia, or no sperm found in the ejaculate can be categorized into obstructive and nonobstructive. […] The most common case of obstructive azoospermia is a history of vasectomy. […] Non-obstructive azoospermia cases have poorer prognosis with some cases such as Sertoli cell only syndrome requiring the use of donor sperm for conception. […] The diagnosis and treatment of male factor infertility is very individualized.
#43
https://umiamihealth.org/en/treatments-and-services/fertility-center/low-sperm-count-and-poor-sperm-health
Low sperm count known as oligospermia occurs when a mans semen (fluid ejaculated from the penis) contains fewer sperm than is typical. A man is considered to have low sperm count if he has fewer than 15 million sperm per millimeter of semen. Having a low sperm count does not necessarily mean that a man will not be able to impregnate a woman, but it may make it more difficult. […] Symptoms of a low sperm count include: […] A mans sperm may be considered to be in poor health or abnormal for two main reasons: an unusually short life span and/or low motility (difficulty swimming). […] The main symptom of poor sperm health is infertility. Most men dont realize they have poor sperm health until they are trying to impregnate a woman. […] Semen Analysis: In this test, the man provides a semen sample via masturbation. Then, the sample is analyzed and evaluated in the laboratory for the sperm count, motility (forward movement), shape, and quantity. According to the American Society for Reproductive Medicine, a normal ejaculate contains over 20 million sperm per milliliter of liquid, at least 25 percent of the sperm should be moving forward, and at least 30 percent of sperm should have normal shapes.
#44 Low sperm count – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/low-sperm-count/diagnosis-treatment/drc-20374591
You may learn that you have a low sperm count if you get a healthcare checkup because you’re having trouble getting your partner pregnant. […] At your appointment, your healthcare professional works to find out the cause of your fertility troubles. […] This can help guide fertility treatment options for you and your partner. […] A sample of your semen is collected for testing as well. This is called a semen analysis. […] Your semen is checked under a microscope to see how many sperm are present. […] If you have a low sperm count, your semen contains fewer than 15 million sperm in each milliliter or less than 39 million sperm total for the entire sample. […] Your chance of getting your partner pregnant drops with lower sperm counts. […] Depending on your semen analysis results, your healthcare professional might recommend more tests.
#45 5 Low Sperm Count Treatment Options for Men
https://www.pfcla.com/blog/low-sperm-count-treatment
Antibiotics can be a crucial treatment for low sperm count when it’s caused by an infection. […] Surgery can be a viable option for certain men with low sperm count. […] It’s important to consult with a fertility specialist to determine the best course of treatment based on your individual circumstances. […] If you have been unsuccessful in your attempts to conceive, it is time to work with a fertility clinic near you.
#46 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Up to 6% of men evaluated for male infertility will be found to have more serious underlying pathology, such as cancer. This is an additional reason to do a comprehensive evaluation of the male partners of infertile couples so that any significant, underlying medical conditions can be identified and treated. […] The semen analysis is the cornerstone of laboratory evaluation of male infertility. At least 2 separate samples should be collected, separated by at least 1 week but optimally by a month. At least 3 days of abstinence should precede each specimen. This is recommended due to the extremely high degree of variability in semen analyses. The outcomes and prognosis of male infertility greatly depend upon the semen analysis results as well as the female partner’s fertility status, along with the categorization of whether fertility is primary or secondary.
#47 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Infertility is usually defined as the inability of a couple to conceive even after 1 year of unprotected, frequent sexual intercourse. The male is solely responsible in about 20% of cases and is a contributing factor in another 30% to 40% of all infertility cases. As male and female causes often co-exist, it is essential that both partners are investigated for infertility and managed together. Overall, the male factor substantially contributes to about 50% of all cases of infertility. […] The initial evaluation includes a detailed sexual history and physical examination, together with 2 separate semen analyses. Hormonal testing and an optional scrotal ultrasound can then be performed if abnormalities are found. This is usually sufficient to make an initial determination of the nature and severity of the underlying problem. The key purpose for evaluating a male for infertility is to identify the contributing factors, offer treatment for those that are reversible, determine if the patient is a candidate for assisted reproductive techniques, and offer counseling for irreversible and untreatable conditions.
#48 Male Infertility – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562258/
Infertility is usually defined as the inability of a couple to conceive even after 1 year of unprotected, frequent sexual intercourse. The male is solely responsible in about 20% of cases and is a contributing factor in another 30% to 40% of all infertility cases. As male and female causes often co-exist, it is essential that both partners are investigated for infertility and managed together. Overall, the male factor substantially contributes to about 50% of all cases of infertility. […] The initial evaluation includes a detailed sexual history and physical examination, together with 2 separate semen analyses. Hormonal testing and an optional scrotal ultrasound can then be performed if abnormalities are found. This is usually sufficient to make an initial determination of the nature and severity of the underlying problem. The key purpose for evaluating a male for infertility is to identify the contributing factors, offer treatment for those that are reversible, determine if the patient is a candidate for assisted reproductive techniques, and offer counseling for irreversible and untreatable conditions.
#49 Oligospermia (Low Sperm Count): Causes & Treatment
https://my.clevelandclinic.org/health/diseases/22477-oligospermia-low-sperm-count
You may not know you have a low sperm count until youre trying to have a baby and arent succeeding. Healthcare providers will diagnose oligospermia by collecting a semen sample and evaluating it in a lab. […] The main symptom of a low sperm count is the inability to conceive with a partner after one year of repeated sexual intercourse without birth control. […] Healthcare providers will review your medical history and perform a physical exam. If they think you have a low sperm count, theyll recommend a semen analysis. […] If a provider diagnoses you with oligospermia, you may wish to ask the following questions: Whats causing my low sperm count? […] Each oligospermia cause has a different prognosis. But many causes are treatable. If a healthcare provider diagnoses you with oligospermia, youll work together to determine the cause and your treatment options.
#50 Semen Analysis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK564369/
If the semen analysis is normal according to the WHO criteria, a single semen specimen may be sufficient, but some experts still recommend 2 separate specimens. […] When the semen volume is low (1.5 mL), and especially when it is less than 1 mL, a urine specimen should be collected immediately after ejaculation. […] Low sperm count, low testosterone, high FSH, and high LH: This pattern suggests primary hypogonadotropic hypogonadism, affecting both spermatogenesis and Leydig cell function. […] Low sperm count, normal testosterone, normal LH, and high FSH: This pattern suspects seminiferous tubule damage without Leydig cell dysfunction and abnormal spermatogenesis. […] Low sperm count, low testosterone, normal or low FSH, and normal or low LH or hypogonadotropic hypogonadism: In such cases, it is crucial to check other pituitary hormone deficiencies, including thyroid function (free T4), cortisol at 8 AM, and prolactin levels.
#51 Semen Analysis Testing – The Complete Guide — Male Infertility Guide
https://www.maleinfertilityguide.com/semen-analysis-testing-the-complete-guide
It takes approximately ten weeks to get the damaged batch of sperm completely out of the body and replace it with a new, healthier set of sperm. […] Accurate semen analysis requires highly trained technicians to perform specialized testing, including determining sperm density (numbers of sperm present), motility (how well they are swimming), and morphology (whether they have normal shapes). […] The accuracy of a semen analysis depends on the skill and training of the laboratory technicians who perform it. […] Most fertility-specific labs are set up to have private collection rooms with locking doors (something not generally available in hospital-based labs). […] The post-ejaculatory urinalysis (PEU) involves the man providing a urine specimen collected in a separate collection cup after ejaculation.
#52 Low Sperm Count: Causes, Signs, Treatment, Pregnancy Chances
https://www.healthline.com/health/infertility/low-sperm-count
Infections in the reproductive tract can be treated with medications. […] Since testosterone and other hormone levels that are either too high or too low can cause low sperm count, addressing the levels with medications and other treatments may help restore fertility. […] Its important to note that any treatments or lifestyle changes may not be reflected in your sperm count right away, as the time frame of sperm production and transit is up to 2 to 3 months. […] Couples can get pregnant with low sperm count. It may just take more time than you originally expected, and it may require seeing a doctor to see how you can improve your sperm quality. […] If your low sperm count is caused by an underlying health condition, your doctor can also help you get the treatment you need to relieve any other symptoms you’re experiencing.
#53 A low sperm count: symptoms, causes and treatment – IVI Fertility
https://ivi-fertility.com/blog/low-sperm-count/
But the good news is that most cases are treatable in terms of fertility. […] A low sperm count doesnt necessarily mean that you and your partner will not become parents! If you would like to discuss diagnostic testing, or you want to know more about the options for fertility treatment, do get in touch with us at IVI.