Oligospermia by A.Griguolo

Generality

Oligospermia is the abnormality of the sperm, characterized by a reduced concentration of spermatozoa in the product of ejaculation.

Potentially capable of affecting male fertility (hence the possibility of having children), oligospermia recognizes numerous causes, including varicocele, genital infections, testicular cancer, testicular trauma, smoking, drug use, alcohol abuse, Klinefelter syndrome, genetic defects of the Y chromosome etc.

To solve the problem of oligospermia, it is essential to treat the triggers, detected during the diagnosis.

Short review of what sperm are

Sperm are the male gametes, ie the cells that, in men, are deputies to the reproductive function, once they meet the female cells with the same task (egg cells).

Produced from the testicles (the male gonads ) on the occasion of the so-called spermatogenesis, the spermatozoa are very small cellular elements (5-7 micrometers, the diameter, and at most 70 micrometers, the length) and have a very particular structure, which includes:

• A head, containing the cell nucleus and acrosome ;
• An intermediate portion, rich in mitochondria;
• A tail, equipped with mobility and called a flagellum .

The particular morphology of the spermatozoa is fundamental for the reproductive process, as it allows them to meet and fuse with an egg cell, inside the female genital apparatus.

What is Oligospermia?

Oligospermia is the alteration of sperm, characterized by a low concentration of spermatozoa in the ejaculate (ie the product of ejaculation).

Also known as oligozoospermia, oligospermia is a condition of considerable interest among men wishing to have children, since a reduced number of spermatozoa in the ejaculate may be the reason for a decrease in male fertility ( male infertility ).

Definition of oligospermia according to the WHO

According to what the World Health Organization (WHO) established in 2010, a man suffers from oligospermia when, in the sperm produced following a classic ejaculation, the sperm concentration is less than 15 million per milliliter of sperm (<15 million / ml).

This means that a man capable of producing an ejaculate, in which the concentration of spermatozoa is equal to or greater than 15 million per milliliter, is a man free from the oligospermia problem.

Curiously, before 2010, the WHO was of another opinion regarding oligospermia and believed, based on the medical knowledge of the time, that a male individual suffered from the aforementioned alteration of the seed when, in the ejaculate, the concentration of spermatozoa was less than 20 million per milliliter.

Table . Reference values ​​that sanction the normality of a human ejaculate, according to the latest indications from the WHO (2010).

Degrees of oligospermia

In addition to specifying in numerical terms when it is possible to speak of oligospermia, the WHO has also defined a scale of gravity, as regards the alteration of the sperm just mentioned.

According to this scale, the possible levels (or degrees) of oligospermia severity are three: mild, medium and severe.

Oligospermia is mild, when the sperm concentration in the ejaculate is between 10 and 15 million per milliliter (of sperm); it is average, when the concentration of spermatozoa in the ejaculate is between 5 and 10 million per milliliter; finally, it is serious, when the sperm concentration in the ejaculate is between 0 and 5 million per milliliter.

Epidemiology

Statistical data on the spread of oligospermia in the male population are indeed scarce. Moreover, the conduct of a study that evaluates, within a reliable sample, how many men suffer from the aforementioned sperm alteration is not at all easy; in fact, it would require a lot of time, money and availability from a large number of men (otherwise the statistics are not very reliable).

Origin of the name

The word "oligospermia" derives from the union of two terms of Greek origin, which are:

• "Oligo" from " oligos " (ὀλίγος), which means "little", and
• "Sperm" from " sperm " ( σπέρμα ), which means "seed".

Therefore, literally, oligospermia means "little seed" (where by semen is meant, obviously, the sperm and, specifically, the sperm population).

Causes

Oligospermia can be idiopathic - that is, it does not recognize a specific causative factor - or it can be the fruit of a very specific circumstance ( secondary oligospermia ).

Idiopathic oligospermia

In medicine, the term "idiopathic" associated with a disease means that a specific cause cannot be recognized for the latter.

According to statistics, oligospermia would be idiopathic in about 30% of men with a low sperm concentration in the ejaculate.

Secondary oligospermia

Secondary oligospermia is the predominant form of oligospermia, in the sense that it is the most widespread form among men who produce a low sperm concentration.

The possible causes of secondary oligospermia are varied and concern different aspects of the health of the male human being; among the causes in question, the most important and noteworthy are:

• The varicocele . It is a pathological alteration of the testicular (or spermatic) veins, due to which the latter appear dilated and one or both testicles are swollen. Of the causes of secondary oligospermia, varicocele appears to be the main one; according to some studies, in fact, up to 40% of cases of low sperm concentration in the ejaculate are attributable to it.

• Some infections, such as sexually transmitted infections, malaria and mumps ;
• Advanced age . Statistical studies have shown that, as we age, man produces less and less sperm;
• Hypogonadism . Hypogonadism is the medical term that indicates a more or less marked reduction in the functional activity of the gonads, which in the specific case of man are the testicles, followed by a decrease in the production of sex hormones;
• Alcohol abuse, cigarette smoking and drug use, such as hashish, marijuana or cocaine;
• Exposure to toxic agents (eg: chemical solvents, metals, etc.);
• Drugs such as beta-blockers, antibiotics, androgens and hypertension drugs :
• The presence of a genital infection, in charge of one of those organs in which sperm and seminal fluid usually flow (prostate, seminal vesicles, epididymis and urethra);
• Testicular diseases, such as testicular cancer, hydrocele or cryptorchidism ;
• The traumas of a certain extent against the testicles;

• The obstruction of the vas deferens or of the ejaculatory ducts . The vas deferens are the small channels that join the epididymis to the seminal vesicles and to the ejaculatory ducts; the latter are the small ducts which, crossing the prostate, connect the seminal vesicles to the urethra;
• The presence of specific genetic defects affecting the sex chromosome Y or genetic diseases, such as Klinefelter syndrome, Noonan syndrome or Kartagener's syndrome ;
• Obesity . The excess of adipose tissue seems to affect not only sperm production, but also the production of sex hormones;
• The habit of behaviors that produce an increase in temperature at the testicular level and (eg: the repeated practice of saunas, the tendency to wear tight-fitting clothes, etc.);
• Benign prostatic hypertrophy, a condition also known as an enlarged prostate or prostate adenoma ;
• Chemotherapy and / or radiotherapy, performed during a tumor treatment;
• Prolactinoma, a benign tumor of the anterior pituitary responsible, in the most serious cases, for hyperprolactinemia .

Symptoms and Complications

Oligospermia does not produce obvious physical symptoms ; nevertheless, it is often associated with a certain symptomatic picture - which varies from patient to patient - because its presence depends, in very many circumstances, on typically symptomatic diseases or health conditions (eg: in men with a varicocele, an eventual oligospermia could accompany dull pain in the testicle, a swollen testicle condition and / or discomfort in the groin area, etc.).

Complications

As anticipated, oligospermia can affect a man's fertility and, consequently, his ability to have children.

The use of "may prejudice" rather than "prejudice" - hence the idea that oligospermia does not necessarily mean infertility - finds justification in the observation of men with low concentrations of spermatozoa who have succeeded in having children, without particular problems or at most after several attempts.

Did you know that ...

According to some statistical researches, 30-50% of couples who wish to have children, but unable to have children, owe this inability to a problem of male infertility.

Sperm abnormalities associated with oligospermia

Not infrequently, oligospermia is accompanied by other sperm changes; among the latter, astenozoospermia (reduced number of spermatozoa in the sperm) and teratozoospermia (sperm with an abnormal percentage of malformed spermatozoa) deserve special mention.

When should I go to the doctor?

A man with oligospermia should contact a doctor, in this case a urologist or an andrologist, when:

• It is his intention to have children, but the alteration of the sperm he suffers is an impediment to this intention;
• It shows an associated symptom picture that drastically affects its quality of life. In such circumstances, the cause of oligospermia is a clinically relevant condition, which deserves the due attention and appropriate treatment.

Diagnosis

The diagnosis of oligospermia requires the performance of an examination known as a spermiogram .

The spermiogram is a laboratory investigation, including a first part borne by the examiner, which allows to observe a series of important characteristics of a sperm sample, with the main purpose of establishing the degree of man's fertility "owner" "of the aforementioned sperm sample.

Among the characteristics of the sperm, observed by spermiogram, are:

• Sperm viscosity,
• The sperm liquefaction,
• Sperm volume,
• The number and morphology of spermatozoa e
• Sperm vitality and motility.

Once the presence of oligospermia has been ascertained, the next step consists in searching for the causes responsible for the low concentration of spermatozoa in the ejaculate; this research may require the performance of various diagnostic tests, including instrumental tests.

The basic rules for obtaining a reliable spermiogram

In order for the outcome of a spermiogram to be reliable, it is essential to comply with some preparatory rules for the aforementioned laboratory test; entering more into details, these preparatory rules are:

• Complete abstinence from sexual activity for 3-5 days prior to the exam;
• Ejaculation obtained exclusively by masturbation;
• Before masturbation, provide adequate hand and penis hygiene;
• Provide for the collection of all the sperm produced (therefore including the one for which it is necessary to press the penis, after the main emissions);
• Collect in a clean place;
• For collection, use a suitable and sterile container (eg: urine containers);
• Close the used container tightly, so as to avoid accidental loss of the collected sperm sample;
• After collecting the sample, send the sperm sample to the analysis laboratory as soon as possible (within 30-60 minutes), avoiding thermal shocks. To simplify everything is the now increasingly common possibility of collecting the spermatic sample directly in a bathroom of the analysis laboratory;
• Inform the medical staff of the laboratory of any therapies or diseases followed or occurred in the last three months;
• Inform the medical staff of the analysis laboratory of any failure to comply with one of the aforementioned preparatory standards, in order to understand whether it is necessary to repeat the semen sample collection procedure.

Examinations for the investigation of the causes of oligospermia

The search for what causes oligospermia always starts from the objective examination and from the anamnesis ; therefore, also based on what emerged from these two tests mentioned above, it can continue with: a blood and urine test, a spermioculture, an ultrasound of the testicles, an ultrasound of the lower abdomen etc.

Therapy

The treatment of oligospermia is focused on the treatment or elimination of the causative factor .

Using some examples, this means that:

• If oligospermia is due to an unhealthy lifestyle (alcohol abuse, smoking, drug use, excess calories, etc.), the therapy will consist in the correction / abolition of bad habits that are associated with a low concentration of spermatozoa in the 'ejaculated;
• If the oligospermia is due to a genital infection, the therapy will include all those remedies able to eliminate from the organism the infective agent responsible for the present condition;
• If the oligospermia is related to a varicocele, the therapy will consist in a surgical intervention aimed at restoring the normal structure of the testicular veins.

For obvious reasons, a therapeutic approach focused on the treatment / elimination of the triggering factor oligospermia is possible only when, at the origin of the low sperm concentration, there is a well recognizable cause.

Natural remedies against oligospermia: healthy and balanced diet

According to several experts, it would be beneficial to men with oligospermia - as it would improve the quality of spermatogenesis - a healthy and balanced diet, which gives ample room for the consumption of fruit and vegetables (both sources of antioxidants) and that of foods rich in omega-3 (ex: fish).

Did you know that ...

For men with oligospermia, the chances of having children increase if: they have a more intense sexual activity, they monitor the ovulation of the partner to know when is the moment of greater fertility and, finally, they avoid the use of lubricants (reduce sperm mobility).

When oligospermia persists, there is a desire for paternity: ICSI

For some time now, men eager to have children but unable to have them because they suffer from oligospermia (or other sperm abnormalities) can count on a particular assisted reproduction technique in vitro, known as ICSI or intracytoplasmic injection .

Without going into too much detail, the ICSI provides for the specific collection, from a sample of ejaculate, of healthy spermatozoa (therefore well formed, mobile, etc.), the selection of one of these and its inoculation, in vitro, in a cell egg.

Currently, ICSI is one of the most effective non-conventional IVF techniques that can be used by men with problems of oligospermia, asthenozoospermia, etc. and eager for paternity.

Prognosis

Oligospermia is reversible, as long as the triggering condition is recognizable and treatable.