Hyperspermia

Hyperspermia is a condition in which a male has an abnormally large ejaculate or semen volume. Hyperspermia is the opposite of hypospermia, and is generally defined in humans when the ejaculate is over 5.5 ml ¹. While this paper ² simply defines hyperspermia in a large population (4223 men with known periods of abstinence of ejaculation) as those men who produce seminal volumes greater than 6.3 ml ml, but further demonstrates that in almost 50% of these a sperm concentration below the World Health Organization (WHO) accepted minimum ‘normal’ value of 20×10⁶/ml, which is considered to reduce fertility potential because of dilution.

The normal range for seminal volumes produced by masturbation after ~3 days of abstinence has been well established, with the upper value being quoted as 6.0 ml ³ and the normal range between 2.0 and 6.0 ml ⁴.

While every seminologist knows larger volumes can be produced, there is little in the literature to describe the incidence of men who consistently produce hyperspermia (high volumes) or to define where a pathological value may begin. Indeed, the World Health Organization ⁵ does not include reference to an upper limit value in its guidelines for minimal standards for semen analysis and nor do Menkveld et al. ⁶ in their recent proposal for the reclassification of WHO semen parameters.

Hyperspermia can be either caused by excessive production of sperm in the testicles or by overproduction of seminal fluid by accessory sex glands. Hyperspermia can occur after long periods of sexual abstinence, which causes a build up of fluids. In this case, the ejaculate may contain greater proportion of dead or dysfunctional sperm, that are not capable of fertilizing the egg. If the volume of seminal fluid is significantly increased, it can lead to dilution of the sperm and lower chances of fertilization. However, if the amount of sperm is proportional to the amount of semen, hyperpermia can actually enhance fertility.

Hyperspermia is not a pathological condition of its own, and is often considered harmless by men experiencing it. However, it should be investigated to prevent possible complications in the future and to rule out any associated conditions affecting future fertility. While Bostofte et al. ⁷, in a 20 year follow-up study of infertile couples, concluded that there was no relationship between semen volume and ultimate attainment of a pregnancy, they did, however, find a statistically significant correlation between increasing seminal volume and the time taken for conception to occur. This has relevance for today’s infertility clinics, where the average age of couples presenting for investigation appears to be increasing, and their expectations of quick success are high.

The impact of hyperspermia on fertility depends mainly on the concentration of sperm in the ejaculate. In most cases, hyperspermia does not severely compromise fertility. If the amount of sperm is proportional to the volume of seminal fluid, hyperspermia can actually increase fertility of the male. If the semen is thinner, however, the sperm becomes more diluted and the chances of fertilization of the egg are lower. Also, if hyperspermia follows a period of longer sexual abstinence, the semen may contain a higher proportion of dead and damaged sperm, which cannot fertilize the egg. Some men experiencing hyperspermia can therefore suffer from infertility.

Hyperspermia causes

Conditions associated with hyperspermia include mostly behavioral and dietary factors, rather than specific diseases. These include:

• Devices and drugs boosting sex drive and sexual performance: Various substances and devices can cause increased production or build up of semen, increasing the quantity of ejaculate.
• High potency steroids and highly nutritional diet: The production of semen is influenced by dietary intake of proteins and nutrients, as well as levels of androgens (the male sex hormones). Intake of a heavy diet rich in proteins, fiber and with a higher nutritional value, and consumption of steroid hormones with androgenic activity may lead to increased semen production and also higher sex drive.
• Sexual abstinence: Longer periods without ejaculation can cause the semen to build up, leading to discharge of larger quantities of semen during ejaculation.

Hyperspermia prevention

Apart from avoiding the known causative factors of hyperspermia (long sexual abstinence, sex boosting drugs and devices, high potency steroids and highly nutritional diet), there is no definitive way of prevention for hyperspermia.

Hyperspermia symptoms

Several symptoms accompanying hyperspermia can usually be observed. These include a longer duration of ejaculation, little pain felt during the discharge of semen, a period of weakness, fatigue and shortness of breath after ejaculation, dizziness, and thin semen at the end of the discharge. Men experiencing hyperspermia frequently have higher sex drives than men that do not.

Hyperspermia complications

If the ejaculate is large in volume but excessively diluted, infertility may ensue due to low concentrations of the sperm. Because hyperspermia can cause fatigue and exhaustion after ejaculation, it can lead to poor erection quality and even male impotence after a period of time.

Hyperspermia treatment

Below are a few ways in which you can prevent hyperspermia:

• Stay away from drugs that increase sexual performance: Stay away from sex boosting drugs and devices as it builds up the semen which in turn increases the ejaculate quantity.
• No sexual abstinence: Avoid long gap between sexual intercourse.
• Stay away from steroids and protein and fiber rich diet: One should avoid consumption of high potency steroid hormones and a diet rich in protein and fiber that may lead to an increase in semen production.

Treatment for hyperspermia

If you have fertility problems due to hyperspermia, then proper treatment should be taken. Doctors can provide the right treatment according to the problem faced by the patient.

Before a man’s sperm can fertilize a woman’s egg, the head of the sperm must attach to the outside of the egg. Once attached, the sperm pushes through the outer layer to the inside of the egg (cytoplasm), where fertilization takes place.

Sometimes the sperm cannot penetrate the outer layer, for a variety of reasons. The egg’s outer layer may be thick or hard to penetrate or the sperm may be unable to swim. In these cases, a procedure called intracytoplasmic sperm injection (ICSI) can be done along with in vitro fertilization (IVF) to help fertilize the egg. During intracytoplasmic sperm injection (ICSI), a single sperm is injected directly into the cytoplasm the egg.

There are two ways that an egg may be fertilized by IVF: traditional and ICSI. In traditional IVF, 50,000 or more swimming sperm are placed next to the egg in a laboratory dish. Fertilization occurs when one of the sperm enters into the cytoplasm of the egg. In the ICSI process, a tiny needle, called a micropipette, is used to inject a single sperm into the center of the egg. With either traditional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), once fertilization occurs, the fertilized egg (now called an embryo) grows in a laboratory for 1 to 5 days before it is transferred to the woman’s uterus (womb).

Hyperspermia treatment includes:

• Treatment for excessive seminal discharge: Large volume of seminal discharge may cause issues for the patient as well as his partner. Seminal discharge may be thick or thin in consistency. The partners of such patients may feel uncomfortable or irritated by such an excessive volume of ejaculation which in turn causes mental stress and psychological issues in one’s life. It is always best advised to consult an urologist who can help with the treatment procedures to reduce the seminal discharge volume.
• Increase sperm count: If the patient is unable to impregnate his partner, then he must consult a fertility expert who can help by providing medicines to increase the sperm count. When the sperm count and semen volume becomes proportional, a patient with hyperspermia may have high chances of fertilizing his partner.
• In Vitro Fertilization (IVF), Intrauterine Insemination (IUI) or Intracytoplasmic Sperm Injection (ICSI): In some cases, fertility experts may harvest the healthy sperm from the patient’s reproductive tract and inject it into his partner’s egg using In Vitro Fertilization (IVF), Intrauterine Insemination (IUI) or Intracytoplasmic Sperm Injection (ICSI) technique.
  • Intrauterine Insemination (IUI) also called artificial insemination, is a common treatment for male infertility. Intrauterine Insemination (IUI) is a procedure in which sperm are placed directly into the uterine cavity through a catheter near the time of ovulation. This procedure is most commonly performed when there are male infertility problems with the sperm, such as low count or low motility, or an incompatibility between the sperm and the cervical mucus. It can also be performed to overcome problems associated with a man’s inability to ejaculate inside the woman’s vagina due to impotence, premature ejaculation or other medical conditions. Intrauterine Insemination (IUI) increases the chances of pregnancy because the sperm are placed directly in the uterus, bypassing the cervix and improving the delivery of the sperm to the egg. Intrauterine Inseminations (IUIs) can be performed either with the partner’s sperm or with donor sperm. It is recommended that the patient abstain from sexual intercourse for two to three days before the procedure. In some cases, it may be necessary for the female to take medication to induce ovulation if her cycles are not regular. The male will provide a semen sample one to two hours before the procedure is to be performed. The semen will be washed, a procedure in which the sperm is separated from the seminal fluid and the quality of the sperm is analyzed. Following the wash, it is time for the insemination procedure, which only takes a few minutes and does not cause much, if any, discomfort for the female. The doctor will insert a small catheter into the uterine cavity through the cervix and inject sperm directly into the uterus. The patient is able to resume normal activity immediately following the Intrauterine Insemination (IUI) procedure. If pregnancy does not result from the initial Intrauterine Insemination (IUI), the procedure may be repeated during the following cycles.
  • In Vitro Fertilization (IVF). During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer. IVF is the most effective form of assisted reproductive technology. The In Vitro Fertilization (IVF) procedure can be done using your own eggs and your partner’s sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — a woman who has an embryo implanted in her uterus — might be used. Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. In addition, IVF can be time-consuming, expensive and invasive. If more than one embryo is transferred to your uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy). Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.
  • Intracytoplasmic Sperm Injection (ICSI), a single healthy sperm is injected directly into each mature egg. Intracytoplasmic Sperm Injection (ICSI) is often used when semen quality or number is a problem or if fertilization attempts during prior in vitro fertilization (IVF) cycles failed.

Hyperspermia prognosis

Hyperspermia generally does not interfere with male fertility in most cases. Patients with this condition should nonetheless consult an urologist. If the patient suffers from infertility due to low sperm concentrations in the ejaculate, intrauterine insemination (IUI) or split ejaculate therapy may be advised. As the first portions of the ejaculate contain higher concentrations of sperm, separating this portion from the rest of the ejaculate and subsequently using it to inseminate the partner carries a higher chance of achieving a pregnancy.

References

1. Padubidri; Daftary (2011). Shaw’s Textbook of Gynaecology, 15e. p. 204. ISBN 9788131225486
2. Cooke, Simon & Tyler, J.P.P. & Driscoll, Geoffrey. (1995). Hyperspermia: The forgotten condition?. Human reproduction (Oxford, England). 10. 367-8. 10.1093/oxfordjournals.humrep.a135944
3. Eliasson,R. (1976) Semen analysis and laboratory workup. In Cockett.A.T.K and Urry,R.L. (eds), Male Infertility; Workup, Treatment and Research. Grune and Stratton, New York, pp. 169-188.
4. Mortimer.D. (1994) Practical Laboratory Andrology. Oxford Univeristy Press.
5. Rehan,N.E., Sobrero,A.J. and Fertig,J.W. (1975) The semen of fertile men: statistical analysis of 1300 men. Fertil. Sterii, 26, 492-502. World Health Organization (1993) WHO Laboratory Manual for the Examination of Human Semen and Sperm—Cervical Mucus 3rd edn. Cambridge University Press, Cambridge.
6. Menkveld,R., Franken.D. and Kruger.T. (1993) Commentary: WHO criteria of normality for semen samples. Newslett. Int. Soc. Androl. 10, 10-11.
7. Bostofte,E., Serup.J. and Rebbe,H. (1982) Relation between sperm count and semen volume, and pregnancies obtained during a twenty-year follow-up period. Int. J. Androl., 5, 267-275.