Asthenozoospermia, also known as asthenospermia, is an alteration that affects sperm motility. It is commonly known as slow moving sperm or lazy sperm.
In the situation where a man has a high percentage of spermatozoa that do not have adequate movement, it may be difficult to achieve pregnancy naturally. Therefore, an assisted reproductive technique may be necessary.
The different sections of this article have been assembled into the following table of contents.
Astenozoospermia is a sperm quality defect caused by a decrease in the percentage of motile spermatazoa. Sometimes this alteration is accompanied by oligospermia (low concentration of spermatozoa in the ejaculated semen) . In this case, it is known as oligoasthenozoospermia.
A man is considered affected with asthenozoospermia when less than 40% of his spermatozoa are motile.
Asthenozoospermia is a cause of male infertility, since the sperm are not able to reach the egg and fertilize it due to their lack of mobility. Therefore, this situation hinders the possibility of getting pregnant.
Asthenozoospermia does not cause clinical manifestations. The man can have sexual intercourse and ejaculate normally, unaware of the motility problem in his sperm. However, when trying to achieve pregnancy, complications occur.
The seminogram or spermiogram is the test used to analyze the male semen. One of the parameters that is assessed in the semen is the mobility and motility of the spermatozoa.
During sperm analysis, a drop of semen is introduced into the sperm-counting chamber (Makler or Neubauer chamber) and observed under the microscope. Next, the movement of approximately 200 spermatozoids is studied.
When performing this study it is not only important to know whether or not the spermatozoa move, but is also important to analyze how they move. Therefore, in the analysis of sperm motility we determine:
According to criteria established by the WHO, a man does not suffer from asthenozoospermia, that is to say, their sperm has normal motility when it presents:
If you want to learn more about sperm motility, you can continue reading here: What values are normal in sperm motility analysis?
Depending on the exact percentage of immotile sperm found in the sperm sample analyzed, the degree of asthenozoospermia will be more or less severe.
Here we discuss the two levels of asthenozoospermia, according to their severity.
There are no exact criteria to differentiate between severe and mild asthenozoospermia. The fundamental difference is based on the speed and form of the movements, as well as on the quantity of immotile spermatozoa.
A semen sample is said to have mild grade asthenozoospermia when the percentage of non-motile or poorly motile sperm is between 60% and 75%.
It is essential to consider the type of movement, since if, at least, a small amount of spermatozoa move with straight, forward movements, an advance of sperm could be seen.
Severe asthenospermia is diagnosed when there is a very high percentage of spermatozoa with low or no motility.
When the percentage of immotile spermatozoa is close to 75-80% or even higher, it is considered to be a case of severe asthenospermia.
The causes that can affect sperm motility and lead to asthenozoospermia are diverse and have not been precisely defined. It could be a result of environmental factors, infections, genetic or immunological alterations, etc.
However, it is known that sperm motility can be influenced by the following factors:
Similarly, the presence of other alterations in spermatozoa such as teratozoospermia can lead to asthenozoospermia. It should be remembered that the term teratozoospermia refers to alterations affecting the shape or morphology of the spermatozoa, which can also affect their movement.
If a man is not seen to have any sperm in his semen, or the semen present with motility issues, it could also be due a genetic basis.
Kartagener syndrome, also known as primary ciliary dyskinesia or dyskinetic cilia syndrome, is a rare autosomal recessive disease characterized by defects in the structure and function of the cilia. This syndrome is associated with male infertility, as it affects sperm motility.
To help improve sperm motility and even resolve certain cases of mild or mild asthenozoospermia, leading a healthy lifestyle and avoiding toxic habits (smoking, alcohol consumption, etc.) is recommended. These affect overall sperm quality, including sperm motility.
In addition, it may be advisable to take a vitamin supplement containing antioxidants (supervised by the specialist). The physician may recommend the intake of foods rich in vitamins or zinc, for example.
Severe or serious asthenozoospermia is difficult to improve with such natural treatments. Therefore, in these cases, it would be necessary to resort to assisted reproduction techniques in order to achieve pregnancy.
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If, however, the cause of the asthenozoospermia is known, a treatment aimed directed at curing that cause can be given. For example, if the cause is an infection, the specialist should prescribe the appropriate antibiotic treatment for the patient and the semen analysis should be repeated after 3 months.
Asthenozoospermia is a fairly common cause of male infertility. Sperm must travel a long and arduous path from the time they are deposited in the vagina until they reach the egg in the Fallopian tubes.
Therefore, if the mobility of the sperm is affected, it is difficult for them to make the entire journey and fertilize the egg, resulting in infertility. The progressive movement and speed of the spermatozoa are very important aspects to achieve pregnancy in a natural way.
When the sperm do not move, or do so inadequately (without forward progression), natural fertilization becomes very complicated. It is in these cases when assisted reproductive techniques should be used.
When a man is diagnosed with astenozooaspermia, and his partner does not fall pregnant, in vitro fertilization (IVF) is recommended, by conventional IVF or by ICSI (introcytoplasmic sperm injection.)
Artificial insemination with conjugal sperm (AIH) is not indicated in these cases. With this technique, the sperm must ascend on their own from the uterus to the fallopian tubes and, therefore, a good number of motile sperm is required.
In short, the potential assisted reproduction treatment options available are as follows:
If these techniques prove to be unsuccessful, an alternative is to turn to donated sperm in order to have children. If this option is pursued, it becomes possible to perform artificial insemination with donor sperm (AID) or in vitro fertilization (IVF).
In an interview with embryologist Laura Mifsud, we heard that it is crucial to repeat the semen analysis before rendering a definitive diagnosis of asthenozoospermia to a patient.
Diagnosing asthenozoospermia or any other sperm diagnosis with a single sperm analysis is a mistake, since it might be due to a external or environmental factor, or a temporary circumstance of the patient.
For this reason, repeating the sperm test is essential to confirm the diagnosis. Moreover, the time period between semen analyses should be such that that any external factors influencing the results have disappeared.
Asthenozoospermia is a decrease in sperm motility. According to the World Health Organization (WHO), a progressive motility of more than 32% (31-34%) is considered normal, while total motility (progressive + non-progressive) is 40% (38-42%).
When in two seminograms performed on a patient with a period of 2-3 months between one and the other a lower motility is found, it is considered asthenozoospermia.
The first line of treatment should be aimed at improving habits and quality of life: not smoking, not drinking alcohol, not taking drugs, exercising, not being overweight, eating a balanced diet, etc.
As for the possible pharmacological treatment, it should always be indicated by a urologist. Androgens, human menopausal hCG/gonadotropin, bromocriptine, alpha-blockers, systemic corticosteroids and magnesium supplements have been shown not to be effective in the treatment of asthenozoospermia. In addition, follicle-stimulating hormone and anti-estrogens in combination with testosterone may be beneficial treatments in selected patients (always under strict medical supervision by a specialist).
The treatment of infertility caused by such asthenozoospermia is the use of assisted reproduction techniques that facilitate the arrival or entry of sperm into the oocyte (egg), such as artificial insemination or in vitro fertilization with or without ICSI.
The male factor has become one of the most relevant aspects of assisted reproduction recently. Different genetic diagnostic techniques have been used to analyze the role that the male plays in achieving a pregnancy.
The period of abstinence is an aspect that has varied over the years, thinking at first that the greater the abstinence, the better the result of both the seminal diagnosis and the embryonic evolution and term pregnancy. Some studies show that a period of frequent ejaculations after a period of abstinence can improve sperm quality.
The period of abstinence differs according to the assisted reproduction unit attended and the standardization of the processes. The recommendations of the World Health Organization is to have sexual abstinence of between 2-7 days. If the abstinence is less than two days, we will find spermatozoa that possibly have less DNA fragmentation, but the count of the number of spermatozoa is lower than in normal conditions. If we have a high abstinence period, it is likely that we will find reduced sperm motility.
In conclusion, it is important to have an optimal period of abstinence according to the recommendations of the assisted reproduction center in order to maximize the chances of success in each case.
There are still chances of achieving a natural pregnancy with asthenozoospermia if it is a mild-to-moderate case. However, if sperm motility is severely affected, the only option to become parents would be using a fertility treatment like IVF with ICSI.
Unfortunately, there are no symptoms associated with asthenozoospermia. The only possible way for a patient to suspect that he has this sperm disorder is by doing a semen analysis.
It means that a percentage greater than 60% of the spermatozoa in the semen sample analyzed are immotile or have motility problems. The qualifier discrete refers to the fact that it is not a very high percentage or well above the reference value.
When there is a case of ideopathic asthenozoospermia, i.e. the cause is unknown, pentoxifylline can improve sperm motility and sperm count.
Pentoxifylline can improve sperm motility and can even cause immotile sperm to become motile.
In any case, this type of treatment must be prescribed by a medical specialist.
In some cases, asthenozoospermia is due to a genetic cause, so it can be passed down from from parents to children. This is true for asthenozoospermia caused by Kartagener's syndrome or by microdeletions in the Y chromosome.
However, there are several factors that affect sperm motility such as infections, immunological alterations, varicocele, poor nutrition, etc.
We have made several references to the semen analysis test in this post. It is the test that allows us to diagnose not only asthenozoospermia, but also other sperm disorders. To learn more about this diagnostic test visit the following link: What Is a Semen Analysis Report? – Purpose, Preparation & Cost.
Finally, if you are interested in, or need to undergo ICSI, the fertility treatment typically used to achieve pregnancy with asthenozoospermia, click here: What Is ICSI Technique? – Process, Success Rates & Cost.
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