Sperm disorders include defects in quality or quantity of sperm produced and defects in sperm emission and are a prominent cause of male factor infertility. Male infertility can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors may contribute to male infertility. A comprehensive sperm analysis is always the first step when evaluating a male for potential infertility.
Types of Abnormal Sperm
Normozoospermia
Normozoospermia is a term used as a diagnosis of a semenogram that means that the seminal features meet the criteria of normality. The criteria of normality is given as below:
Volume: ≥ 1.5 ml.
Concentration: ≥15 million sperm / ml.
Total number of sperm: ≥ 39 million.
Total motility: ≥ 40% of the sperm of the ejaculate
Progressive motility: ≥ 32% of the sperm of the ejaculate
Vitality: ≥ 58% of the sperm of the ejaculate.
Morphology: ≥ 4% of the sperm of the ejaculate.
The semen analysis does not assess the genetic load: in spite of having a normal spermiogram, failures or miscarriages may have occurred in previous treatments.
Aspermia
Aspermia is a male fertility condition wherein there is no ejaculate and no sperm, this is at times referred to as a dry orgasm. This may be caused due to either an inability to transport semen or to ejaculate the same. The condition can be attributed to a number of factors such as retrograde ejaculation, ejaculatory duct obstruction, and anejaculation. In some cases, aspermia occurs as a result of surgical procedures done in the past, by nerve damage caused by disease or congenital cysts which can all be treated.
Hypospermia
Hypospermia is a condition characterized by low semen volume and it is one of the common conditions that is associated with male infertility. The low sperm count can be a short-term or a chronic problem. There are many causes of hypospermia. One of the main pathological reasons for hypospermia is retrograde ejaculation. Retrograde ejaculation is the condition where instead of flowing through the urethra during ejaculation, sperm enters the bladder. Congenital causes for hypospermia include the absence of seminal vesicles, important organs in semen production.
Azoospermia
Azoospermia is the medical condition of a man whose semen contains no sperm. This is different from Aspermia – wherein there is neither sperm nor any semen. Causes of Azoospermia include a blockage along the reproductive tract, hormonal problems, ejaculation problems or issues with testicular structure or function. Many causes are treatable, and fertility can be restored. For other causes it may be possible to retrieve live sperm to be used in assisted reproductive techniques.
Oligozoospermia
Oligospermia is characterised by a low sperm count in semen. if the sperm count is less than 15 million sperm per millilitre of semen fluid then the condition is called oligospermia and the individual might find it difficult to impregnate a woman. The condition can be categorized into three categories – mild, moderate, and severe. The causes associated with Oligospermia include – hormonal imbalances, ejaculation problems, undescended testicles, anti-sperm antibodies, chromosomal abnormalities, injuries, and trauma, amongst others.
Asthenozoospermia
Asthenozoospermia is low sperm motility, which is the ability of the sperm to successfully reach the egg and fertilise it. The motility factors that are important for fertilization include – volume, motility, morphology, and others. There are many causes of Asthenozoospermia including – inflammation, varicoceles, abnormal liquefaction of the semen, abnormalities of the chromosomes, immunological factors, and others.
Teratozoospermia
Teratozoospermia abnormal sperm morphology or shape, that is caused by either defect in the sperm head, its midsection and/or tail. It is a disorder in which males produce abnormal looking sperms and thereby causing difficulty in fertilization. A normal shaped sperm is characterized by – an oval shaped head, with a clean, distinct cap covering it and no drops of fluid, alongside a regular looking neck and mid-section and a single tail. In case of abnormal looking sperm, they have a round head, or two tails or two heads.
Necrozoospermia
Necrozoospermia refers to a condition wherein the sperm present in the semen are dead. This is different from another condition, where the sperm are alive but immobile. With Necrozoospermia, the usual fertility treatments such as IVF and ICSI are no longer viable and couples will have to opt for donor sperm to realize their parenthood dreams.
Leukocytospermia
Leukocytospermia refers to an abnormally high number of white blood cells in the semen. This is also known as pyospermia. It is important to note, here it is not the sperm that is abnormal but the seminal fluid that has a higher concentration of the white blood cells. High levels of white blood cells may lead to sperm damage, which can decrease fertility.
Semen Analysis Results and Potential Fertility
The normal and abnormal ranges for semen analysis are based on percentiles, if the results are subpar, that could indicate the difficulty of conceiving, but it is not an impossibility. Likewise, normal results on a basic semen analysis do not necessarily guarantee fertility. Analysis of the semen is not a fertility test; rather it indicates the probability of the individual to fertilize.
For example, a low sperm count is not a diagnosis itself, but a symptom that can be only discovered through semen analysis. The results of the semen analysis will provide the doctors with indicators of the fertility problems and treatment can be modified based on the same.
Further Male Fertility Testing
Once the results of the semen analysis are returned further investigations and testing may be necessary to fully ascertain the complications. Some of the additional investigations that are required include
- Urology consultation
- Blood tests
- Hormonal analysis
- Advanced semen analysis
- Genetic testing
- Post-coital testing
- Ultrasonography
- Testicular biopsy
- Vasography
What If Poor Results Repeat?
Repeated poor results will require intervention – both clinical and lifestyle modifications to ensure that semen quality improves over a period of time and the individual is able to fertilize and have a child. Sometimes multiple treatment methods may have to be pursued and it will often take time to perfect the solution that is to be implemented.
Sperm Morphology & Infertility
Semen analysis is the most common test of a man’s fertility as it measures several features of the sperm and seminal fluid. Some of the most important parameters of semen analysis are – sperm count, sperm motility, sperm morphology and the volume of fluid.
Sperm morphology is assessed with the help of a microscope wherein they are checked for their shape. One must note that all men will have some percentage of abnormal shaped sperm, and that is quite common. However, a much higher percentage of abnormally shaped sperm will result in difficulty of fertilization and conception.
A normal shaped sperm is characterized by – an oval shaped head, with a clean, distinct cap covering it and no drops of fluid, alongside a regular looking neck and mid-section and a single tail. In case of abnormal looking sperm, they have a round head, or two tails or two heads.
Currently there is no conclusive manner of saying that abnormally shaped sperm will result in any genetically abnormal offspring. The abnormality only causes difficulty in penetrating the eggshell and fertilising it. But what happens post fertilization is currently understood as the same for normal and abnormal cells.
The shape matters because an improperly shaped sperm will find it more difficult to penetrate through the eggshell and fertilize it. It is not that it cannot happen, but the odds of it happening are reduced drastically, hence the shape of the sperm is important.
Statistics reveal that the shape of the sperm is directly correlated to certain lifestyle choices of the individuals. Abnormal sperm shape has been evidenced in individuals consuming higher amounts of tobacco, alcohol, or caffeine. These substances can directly hurt the sperm DNA can cause abnormalities of shape and motility.
Yes. There is evidence that suggests that the intake of dietary supplements and multivitamins helps sperm morphology.
Abnormal Semen Analysis
Abnormal semen analysis at a glance
Semen analysis is the most common test of a man’s fertility as it measures several features of the sperm and seminal fluid. Some of the most important parameters of semen analysis are – sperm count, sperm motility, sperm morphology and the volume of fluid. Abnormalities in the analysis indicate the possible male factor contribution to the couple’s infertility.
What is an abnormal semen analysis?
An abnormal semen analysis is the evidence of below par parameters with respect to sperm count, sperm motility, sperm morphology and the volume of seminal fluid. While this is no indication yet of a man’s fertility or infertility it provides a window into the possibilities that may exist or not. A man with an abnormal semen analysis must seek expert opinion and treatment. The abnormal semen analyses are most often caused by lifestyle factors, other medical conditions, blockage to the passage of sperm, or genetic conditions affecting sperm production.
Conducting a laboratory semen analysis
For the conduct of semen analysis, a man is required to provide a sperm sample in a container or use a special condom to collect the same during intercourse. The sample is then sent to a laboratory to look for abnormalities. A normal result will not require further testing, but an abnormal result will need additional tests to ascertain the cause of the abnormalities. Also, it is common for there to be some variability in a man’s semen analysis between different samples.
Characteristics of semen, sperm count, sperm motility & sperm morphology
The seminal fluid is a whitish-grey in appearance, with any abnormalities evidenced in greenish, yellowish, brownish, or reddish shades. Excessive viscosity or the lack of it, the possible odour is some of the other characteristics of abnormalities. The parameters based on which the assessment of abnormalities are made include:
Sperm Concentration: A low volume can indicate a possible blockage, retrograde ejaculation and dysfunction in the seminal vesicles or prostate.
Sperm Count: A sperm count that is ≥ 15 million per each millilitre of semen ejaculated is taken to be low sperm count and must be ascertained further.
Sperm Morphology: Sperm morphology refers to the shape and size of the sperm. A normally shaped sperm is characterized by – an oval-shaped head, with a clean, distinct cap covering it and no drops of fluid, alongside a regular looking neck and mid-section and a single tail.
Sperm Motility: This is the ability of the sperm to move through the birth canal and enter the fallopian tubes to fertilize the egg.
Causes for abnormal semen analysis
Some of the common causes of abnormal semen analysis can be enumerated as:
- Past or present infections
- Injury or trauma of the testicles
- Exposure to toxins
- Previous vasectomy or pelvic surgery
- Cancer treatment
Treatment options after an abnormal semen analysis
The treatment options available for abnormal semen analysis would be two-fold. Lifestyle modifications by the patient, and surgical interventions by the doctors. Surgical interventions are usually taken after lifestyle modifications which include – quitting smoking, reducing alcohol consumption, managing stress better, taking sufficient rest, eating healthy and having an overall healthy lifestyle.
Surgical interventions can be based on the cause of the abnormality. There are three main surgical interventions that can be undertaken – treatment of varicoceles, reversal of vasectomy, and in some extreme cases sperm retrieval surgeries might also be required.
