Hypospermia
Hypospermia is a condition in which a man has an abnormally low volume of semen ejaculation, less than 1.5 ml 1. The World Health Organization (WHO) indicates that a man has hypospermia when the semen sample he produces when he ejaculates is below 1.5 mL. According to World Health Organisation (WHO) normal ejaculation volume of a man who is properly aroused and not exhausted from prior sex is about 1.5 ml to 6 ml. Out of this, about 1% of the volume is sperm cells.
Hypospermia is not the same as oligospermia, which is a condition in which semen has a very low sperm count (less than 20 million sperm/ml). But when hypospermia is combined with the condition of oligospermia, it can become a serious factor for infertility in men.
Hypospermia itself, however, does not result in severe infertility problems until it is combined with the diagnosis of low sperm count (oligozoospermia). However, semen volume determination can aid in the identification of abnormal semen etiology by providing a measurable parameter.
Furthermore, hypospermia can cause male infertility if it prevents pregnancy in the couple. The good news is that it doesn’t happen in all cases. As a general rule, a man is able to conceive naturally in spite of having a low ejaculate volume as long as the sperm count and quality are normal.
Semen is composed of a variety of fluids collectively produced by various glands in the male reproductive system. The most substantial fluid is seminal fluid contributed by the seminal glands. It comprises over 80 % of the semen. The remaining fluid is provided by the epididymis, prostate, and other glands. Generally said, it is a combination of lipids, proteins, acids, as well as sugars that each plays a role in fertilization.
Low semen production is related to two main organs in the male reproductive organ:
- Prostate – this walnut sized gland stores fructose. The liquid from the seminal vesicles drain into prostate, collect fructose and follow downwards to pick up sperms.
- Seminal vesicles – they are situated just behind the prostate glands. They are responsible for the quantity of semen or production of seminal plasma.
A semen analysis needs to be performed in order to obtain a diagnosis. This test measures different semen parameters such as the volume of the ejaculate, the number of spermatozoa, sperm mobility and so on.
In order to obtain as exact a diagnosis, the semen sample needs to be assessed between 3 and 5 days following abstinence from sexual intercourse. A second sample or even a third sample is also recommended in order to confirm the condition. It is important to point out that frequent ejaculation (several times a day) can cause temporary hypospermia and that this is not an indication of any kind of health issue.
Patients with hypospermia should be assessed by an urologist in order to determine what the actual cause is. If there is also a infertility issue, patients should be given guidance by reproductive medicine and even genetics experts if necessary.
Figure 1. Male reproductive system
Hypospermia causes
Sperm volume is significantly affected by age—it decreases eventually as the man gets older. Unfortunately, this is a natural process that occurs in every male.
On the other hand, the following factors may cause hypospermia as well:
- Semen analysis – ejaculate collection mistake. The most frequent cause of hypospermia is a collection error when providing the ejaculate collection for semen analysis. If the first part of the ejaculate was lost during collection, the semen analysis should reveal a reduced sperm count. Biochemically, the ejaculate will have reduced levels of prostate specific secretions such as prostatic acid phosphatase (enzyme produced by the prostate). If the last portion of the ejaculate was lost, the sperm count may be normal to high, and the secretion of the seminal vesicle, such as fructose, will be reduced.
- Abstinence period. Reduced semen volume may also be related to the period of abstinence. Exceptionally short periods of abstinence (1 day or less) may reduce the volume of semen. Repeating the semen analysis with longer period of abstinence (3 days or more) may correct the problem if collection error was the cause.
- Retrograde ejaculation: Sperm travel backward toward the bladder when the man ejaculates. It can be caused by congenital anomalies of the male urethra or medications to treat prostatic hyperplasia. It has been associated with prostate surgery as well.
- Vas deferens and seminal vesicle agenesis: As a consequence of a congenital absence of seminal vesicles and vas deferens.
- Ejaculatory duct obstruction: Due to an inflammation or infection in the ejaculatory ducts, like prostatitis or varicocele.
- Androgen Insensitivity Syndrome: Androgen Insensitivity Syndrome occurs when a person who is genetically male is resistant to male hormones (i.e. androgens), either partially or totally.
- Neurologic erectile dysfunction: Loss of the nerve impulses that travel through the penis.
- Ejaculating too much: Repeated ejaculation result in lower sperm volume.
- Insufficient sex hormones: When an insufficient amount of the sex hormone testosterone is produced in the male body, it can lead to the condition where a very low amount of semen is ejaculated.
- Bladder neck surgery: In men with problems passing urine a bladder neck surgery to relieve the obstruction can also result in the condition of hypospermia.
Some studies have shown that men who smoke or have overweight problems may have a lower amount of ejaculate as well.
In any case, your urologist should examine your case in detail in order to detect the presence of other severe conditions.
Risk factors for hypospermia
Risk factors for hypospermia:
- Alcohol and drug abuse
- Unhealthy lifestyle
- Infections
- Advanced age (>40 years old), semen volume spontaneously decrease between the ages of 22 and 80 years
- Hormonal imbalance
- Stress and other psychological problems
- Trauma in the testicles or other testicular problems
- Retrograde flow of semen
- Ejaculatory duct obstruction
Hypospermia symptoms
Unless there is another disease or abnormality causing hypospermia, abnormally low volume of semen ejaculation often comes without symptoms. The most obvious sign is, however, the presence of a lower semen volume during ejaculation.
Also, having a abnormally low volume of semen ejaculation may come hand in hand with other signs associated with abnormal semen. If your semen has a yellowish or greenish color, has traces of blood, comes with a foul odor, is abnormally thick or too watery, you should visit your doctor as soon as possible. These signs of abnormal semen can indicate the presence of a Sexually Transmitted Disease (STD), infections, retrograde ejaculation, inability of your ejaculate to clot properly, etc. and can definitely affect your fertility.
Hypospermia diagnosis
In order to evaluate the sperm quality with a semen analysis, a sexual abstinence period of between 3 to 5 days is required prior to collecting the sample. A second sample or even a third sample is also recommended in order to confirm the condition. It is important to point out that frequent ejaculation (several times a day) can cause temporary hypospermia and that this is not an indication of any kind of health issue.
Being diagnosed with hypospermia does not mean that you are infertile by default. It is only logical that, when a man produces a low amount of sperm, the sperm count is lower than in males without hypospermia. However, it is possible for the sperm count, sperm morphology and sperm motility to be normal in spite of hypospermia.
A man with a good ejaculate volume but diagnosed with poor sperm motility and/or morphology may have the same chances of achieving pregnancy than a man that has hypospermia and produces normal, high-quality sperm.
Hypospermia treatment
There are no courses of treatment to improve the quantity of semen in ejaculate. However, some pharmacotherapeutic methods are suggested by taking antibiotics in case of infection or a herbal or pharmaceutical supplements to increase the secretion. Surgical therapy is recommended in case of retrograde ejaculation. There are certain surgeries that can help when the cause is a malformation, whether this malformation be genetic or otherwise. If these treatments do not help enough or there are excluded, the assisted reproduction techniques (ART) may be the solution to conceive.
Hypospermia issues can be present alongside other abnormalities in semen. Some of the most frequent are a low concentration of spermatozoa (oligozoospermia), poor mobility (asthenozoospermia) and a low number of spermatozoa with a normal shape (teratozoospermia). Should this be the case, assisted reproduction treatment (ART) is advised. This can include artificial insemination or in vitro fertilisation (IVF) depending on the extent of the abnormalities.
Assisted reproduction treatment
In case of retrograde ejaculation, it is usually necessary to proceed by timed intrauterine insemination (IUI) with sperm recovered from post-orgasmic urine or by catheter. Semen may also be obtained by rectal electrostimulation. Fluid restriction, sodium bicarbonate, phased fluid intake or instillation of buffer into the bladder are utilized to control urinary pH and osmolarity to minimize the toxic effects of urine to spermatozoa. If the yield of spermatozoa is poor, in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is indicated.
If conservative medical treatments fail to achieve a full term pregnancy, the physician may suggest the patient undergo in vitro fertilization (IVF). IVF and ART generally start with stimulating the ovaries to increase egg production. Most fertility medications are agents that stimulate the development of follicles in the ovary. Examples are gonadotropins and gonadotropin releasing hormone. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman’s reproductive tract, in a procedure called embryo transfer.
Intracytoplasmic sperm injection (ICSI) is beneficial in the case of male factor infertility where sperm counts are very low or failed fertilization occurred with previous IVF attempt(s). The intracytoplasmic sperm injection (ICSI) procedure involves a single sperm carefully injected into the center of an egg using a microneedle. With intracytoplasmic sperm injection (ICSI), only one sperm per egg is needed. Without ICSI, you need between 50,000 and 100,000.
Men having problems with ejaculation or low semen volume, because of blocked tubes in their testes, or because of a genetic condition that prevents their sperm being released, require some form of surgical sperm retrieval to enable ICSI to take place. Epididymal sperm obtained by microsurgical aspiration (MESA) or percutaneous sperm aspiration (PESA) and testicular sperm obtained by surgical excision (TESE) or percutaneous aspiration (TESA) are used in ICSI treatment.
Hypospermia home remedies
Rectal prostate stimulation during sexual intercourse seems to be helpful. Generally, healthy lifestyle is also recommended.
Hypospermia medication
In case of infection, antibiotics are used to treat the patient. Hypospermia or low semen volume may be remedied with the aid of supplements. Supplements like Prosolution pills, Semenax, and Volume Pills have been clinically proven to enhance male performance; Spermac and Vital M-40 capsules are effective herbal remedies for treating low semen production.
In case of retrograde ejaculation, normal ejaculation can also be induced in men with partial neurological lesions (e. g. diabetes mellitus) by ephedrine taken 30 – 60 minutes before coitus or a continuous sympathomimetic.
Hypospermia surgical therapy
Surgical correction of the bladder neck is feasible in case of retrograde ejaculation. Transurethral resection of the ejaculatory ducts (TURED) is a surgical procedure how to treat obstructive male infertility conditions (such as ejaculatory ducts obstruction in this case) and thus to improve semen quality. This relatively invasive operative method with possible sever complications and disadvantages (such as opening of the ejaculatory ducts into the urethra and following backwards flow of urine into the seminal vesicles) has led to natural pregnancies of their partner in approximately 20 % cases of affected men.
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