low sperm quality

Insufficient sperm cells and other seminal disorders might be caused by hormonal problems, anatomical problems, immunological problems or even environmental factors. The quality of the sperm cannot be ascertained with the naked eye. Only an analysis of a sperm sample in a laboratory (sperm analysis) will provide information about the quantity, the motility, the form and the vitality of the sperm cells in a man’s semen. In addition, the clotting, the inflammatory cells and the level of acidity can also be checked. As a result of this analysis, a man might be given one of the following diagnoses:

Azoospermia - There are no sperm cells in the semen. In some cases, sperm is still being produced in the testicles but there could be a blockage or defect that prevents the sperm entering the semen. This blockage may be congenital disorder in the development of the male reproductive system or caused by an infection.
Oligozoospermia - The semen contains only a small amount of sperm cells.
Asthenozoospermia - This diagnosis is used if sperm cells with insufficient or low motility are hindering other healthy sperm cells in their attempt to reach the ovum.
Teratozoospermia - The sperm cells are so malformed that the chance of fertilising an egg is very low.

Sometimes multiple abnormalities are identified in which case the classification becomes even more complicated.

There are many causes for reduced sperm quality. Below you can find a summary of the most common causes of sperm problems.

obstructions
hereditary / congenital disorders
retrograde ejaculation
ectopic testis (cryptorchism)
varicocele
hormonal disorders
sterilisation (vasectomy)
other factors

obstructions

Any blockage in the sperm ducts (vas deferens) or urinary tract hinders the sperm from actually being ejaculated. Such blockages are a common cause of infertility. They can be caused by infections (including sexually transmitted diseases - STDs) and can sometimes be reversed with the use of antibiotics thereby restoring fertility. If the obstruction is structural (physical), surgery or another procedure might be necessary. If the structural blockage cannot be cleared, then a biopsy or testicular puncture can be carried out to extract the sperm from the testicles.

hereditary / congenital disorders

Sometimes the sperm ducts may not have developed. In this instance, sperm production does occur, but due to the absence of sperm ducts, it is impossible for the sperm cells to be present in the seminal ejaculation. Without intervention, it would be impossible for such men to father a child. In addition, these men often have an increased chance of a genetic disorder, which may increase the chance of the child having cystic fibrosis.

Klinefelter’s syndrome is a hereditary disorder (congenital disorder of the sex chromosomes in the hereditary material) in men characterised by an absence of or insufficient sperm cells in the semen. It is caused by an extra X-chromosome (XXY instead of XY). In many cases, sperm is still produced in the testicles, which can be collected through a testicular biopsy or puncture. However because it is a hereditary disorder, affected men will be advised to consult a genetic specialist before trying to start a family. The reason for this is that some of the sperm will also pass on an extra X-chromosome, which means that the child could inherit the same disorder as the father. A chromosome test of the embryos - preimplantation diagnosis - is one of the options that can make it possible to have healthy children.

Another hereditary disorder is the so-called Y-deletion. If a man has very poor sperm quality, the cause might be a hereditary problem with the male Y chromosome. This can be identified by undergoing a blood test, and again, because this disorder is passed on to male offspring, genetic advice is essential.

retrograde ejaculation

If a male suffers from retrograde ejaculation, the sperm cells travel in the wrong direction when an ejaculation occurs ending up in the bladder instead of in the urinary tract. From an anatomical perspective, the sperm ducts join the urinary tract normally but the valves that regulate the flow of urine and semen through the urinary tract are defective. (If the system functions as it should, the valve between the bladder and the urinary tract contracts during an ejaculation, while the valve between the sperm duct and the urinary tract closes during urination.) This rare disorder is sometimes associated with diabetes or removal of the prostrate gland. Infertility treatment is usually based on assisted reproductive technology with the use of sperm cells recovered from the bladder after ejaculation. A catheter is placed in the bladder first to introduce a buffered salt solution and secondly to retrieve the buffer semen mixture after ejaculation. The solution is needed, as urine can be poisonous to the sperm. Alternatively, the man is asked to drink neutralizing fluid two hours before ejaculation. After ejaculation, the bladder is emptied normally and the urine semen mixture collected and processed in the laboratory.

ectopic testis (cryptorchism)

The scrotum hangs on the exterior of the body because the sperm must be a few degrees cooler than normal body temperature. If the testicles do not drop into the scrotum within or around the first month after birth, fertility problems can arise. Ectopic testis can be surgically corrected, but permanent damage can arise if the testicles don’t drop during childhood. The corrective surgical intervention may in itself be damaging to future fertility.

varicocele

Varicose veins can occur in the scrotum. It is not clear precisely how this affects fertility, but one general theory is that the veins increase the temperature in the testicles. This warmth weakens the sperm and hampers sperm production. Varicose veins can be surgically fused, but there is no general agreement regarding the value of this surgical intervention in relation to its impact on fertility.

hormonal disorders

The exact hormonal balance in the male body is critical for the normal functioning of the male reproductive system. Male infertility can develop if the body produces insufficient testosterone or gonadotropins, namely follicle stimulating hormone (FSH) and luteinizing hormone (LH). However, hormonal disorders affecting reduced sperm quality are not that common.

Hormonal problems can either be traced back to the primary glands that produce the hormones or to the glands where the hormones exert their affects: hypothalamus, pituitary, thyroid, prostate and testicles. If one of these glands does not function properly, this can be problematic to either sperm production or to the milk-like nutritional fluids that make up the semen.

sterilisation (vasectomy)

A common factor that leads to the absence of sperm in the ejaculate is previous male sterilisation (vasectomy). Men who desire offspring (subsequently) can opt for restorative surgery, to reverse the effects of the vasectomy. The success of this procedure depends on how long ago the vasectomy was carried out. If the vasectomy was performed more than five years, there is a smaller chance that it can be reversed successfully. Moreover, the greater the intervening gap, the greater the chance that antibodies against the sperm cells will be produced, causing sperm clotting. Vasectomy reversal is an outpatient procedure consisting of rejoining the patient’s sperm ducts or directly attaching the sperm ducts to the epididymis.

If the vasectomy has been carried out more than five years ago, or if the restorative surgery is unsuccessful, then there are methods for retrieving the sperm from the epididymis or testicles for use in in vitro fertilisation (IVF) or ICSI.

other factors

Sperm can also be influenced by the immune system. As a result of trauma or an infection, the immune system may produce antibodies that envelop the sperm and cause clotting of the individual sperm cells.

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