Male sterility is the inability of the male sperm to fertilize an egg. Therefore, pregnancy will be difficult to achieve. There are several factors that can lead to a man's infertility.
In particular, male infertility due to sperm causes is the most common reason for men having trouble conceiving.
In this case, the origin of the infertility is found in alterations of the semen quality, that is, of the spermatozoa. These alterations can be diagnosed by means of a semen analysis with some of the most frequent being asthenozoospermia, teratozoospermia and azoospermia.
Provided below is an index with the 12 points we are going to expand on in this article.
- 1.
- 2.
- 2.1.
- 2.2.
- 2.3.
- 3.
- 4.
- 5.
- 6.
- 7.
- 7.1.
- 7.2.
- 8.
- 9.
- 9.1.
- 9.2.
- 9.3.
- 9.4.
- 9.5.
- 9.6.
- 10.
- 11.
- 12.
Causes
During spermatogenesis, that is, the sperm production process, the process can be compromised due to errors or defects at some point of the process, which leads to the production of sperm problems that can affect the morphology, count, and/or motility.
Any disorder that affects sperm quality can hinder or prevent egg fertilization. In other words, sperm quality is a determining factor when it comes to achieving a pregnancy successfully. For this reason, sperm disorders or abnormalities are considered a cause of male infertility.
The good news is that, thanks to Assisted Reproductive Technology (ART), men who are infertile due to sperm diseases can have biological children. Improvements achieved in ART, the sperm count and motility are not determining factors to achieve a pregnancy anymore.
The World Health Organization (WHO) has published an update of the Laboratory Manual for Semen Examination and Processing in 2021, constituting the sixth edition. However, Sperm parameters taken into account to evaluate sperm quality are based on the guidelines provided by the WHO back in 2010. The test used to examine them is called semen analysis, also known as sperm test or seminogram.
In case all sperm parameters are normal, we talk about normozoospermia. In case a sperm abnormality is detected, the man will be diagnosed with any of the sperm disorders that we will explain in the following sections.
Abnormal sperm count
One of the causes of male sperm factor infertility is having an insufficient number of sperm in the ejaculate. A low sperm count reduces the chances that one of the sperm will fertilize the egg and cause a pregnancy.
Depending on the severity of the alteration in sperm concentration, different situations can occur: oligozoospermia, cryptozoospermia, and azoospermia.
Oligozoospermia
Oligospermia or oligozoospermia is diagnosed when the sperm count is significantly low (below 15 million/ml).
According to WHO reference values, a semen sample is normal when it contains at least 15 million sperm per mL of ejaculate. However, when the sperm contains less than this value but more than 100,000 sperm per mL of ejaculate it is said to be an oligozoospermic sample.
Check out this for information: What Is Oligospermia? – Low Sperm Count Causes & Treatment.
Cryptozoospermia
Cryptozoospermia refers to an extremely low sperm count. If the man's ejaculate contains less than 100,000 sperm/ml, the sample will be diagnosed as cryptozoospermic. Therefore, cryptozoospermia is a variation of oligozoospermia.
Due to the reduced number of sperm in the ejaculate, finding spermatozoa is a challenging process. In fact, it is likely that sperm are found only by using the semen centrifugation method. In these cases, if the sample is diagnosed with azoospermia (zero sperm count), the specialist will mistakenly recommend a testicular biopsy.
Further reading: Cryptozoospermia – Definition, Causes, Treatment & Pregnancy.
Azoospermia
Azoospermia is a sperm disorder that is diagnosed when the sperm count is zero, which is to say, no sperm is found in the ejaculate. Azoospermia males can ejaculate, but when the semen is analyzed, no sperm are observed.
This disorder, depending on what causes it, can be:
- Obstructive azoospermia
- When the absence of sperm is associated with problems in the transport of sperm to the urethra.
- Non-obstructive azoospermia
- Also known as secretory azoospermia, it is defined as having sperm production issues.
In males who have had a vasectomy done, azoospermia should be diagnosed eventually as well. Otherwise, it would mean that the vasectomy was not effective.
Read this next: What Is Azoospermia or Zero Sperm Count? - Causes & Treatment.
Asthenozoospermia
Asthenozoospermia is the name of a sperm disorder that affects sperm motility. According to the WHO's criteria, two types of motility should be taken into account when examining a sperm sample:
- Total motility
- Total amount of active spermatozoa.
- Progressive motility
- Total amount of active spermatozoa that are able to make forward progression.
For a sperm sample to be considered normal, at least 40% of sperm must be active, and 32% be able to make forward progression. If these requirements are not met, the man will be diagnosed with asthenozoospermia.
Based on the grade of severity, we can classify this disorder into three groups: severe, moderate, or mild asthenozoospermia.
More on this story: What Is Asthenozoospermia? - Definition, Causes & Treatment.
Teratozoospermia
Teratozoospermia or teratospermia is a sperm disease that affects sperm morphology. Normal sperm morphology has the following characteristics:
- Oval-shaped head
- Thick middle-piece or neck
- Long, thin tail
For a man to have a normal sperm morphology, at least 4% of sperm must be free from abnormalities.
Inversely, if less than 4% of sperm in the ejaculate is normal in terms of morphology, the sample will be diagnosed with teratozoospermia—over 96% of the total sperm count are abnormal.
Recommended for you: What Is Teratozoospermia? – Causes, Pregnancy Rate & Treatment.
Hypospermia
Hypospermia is defined as having a sperm volume below 1.5 ml. According to the WHO's reference values, sperm volume of a normal semen sample should be at least 1.5-6 ml.
Abnormal sperm volume can be due to abnormalities in the seminal vesicles or in the ejaculatory ducts, amongst other potential causes.
Although hypospermia can be a cause of male sterility, this is not always the case. The main reason for this is that if the concentration and quality of the sperm is adequate, the male will be able to conceive without any problem.
Whether you need to undergo IUI or IVF to become a mother, we recommend that you get your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.
Similar post: What Is Hypospermia? – Causes, Symptoms, Fertility & Treatment.
Necrospermia
The term necrospermia refers to an elevated amount of dead sperm in the ejaculate. For a man not to be considered childless in spite of this disease, at least 58% of sperm present in the ejaculate must be live.
In short, if the number of dead sperm cells is 58% or more, necrospermia will be diagnosed.
Related content: What Causes Necrospermia? – Symptoms, Diagnosis & Treatment.
Combined disorders
Oftentimes, samples are not only diagnosed with single sperm disorders, but with a combination of two or more. Most common combinations include:
Oligoasthenozoospermia
Oligoasthenozoospermia is caused by issues related to low sperm count and poor sperm motility. Therefore, oligoasthenosperma is the combination of oligospermia and asthenospermia.
In such cases, the sperm concentration is below 15 million sperm per milliliter, along with a percentage of progressive motility that is under 32%.
Men with oligoasthenozoospermia will have difficulty achieving a natural pregnancy because the chance of sperm fertilizing the egg is lower.
More: Oligoasthenozoospermia - Definition, Causes, Symptoms & Treatment.
Oligoasthenoteratozoospermia
Oligoasthenoteratozoospermia (OAT) is diagnosed when:
- Low sperm count (less than 15 million/ml)
- Poor motility (less than 32% are able to make forward progression)
- Abnormal morphology (less than 4% have a normal morphology)
The possibility of achieving pregnancy when this seminal alteration exists will depend on the severity of the alteration. Therefore, it is essential to make a good diagnosis in order to establish the best treatment.
You may like: What Is Oligoasthenoteratospermia (OAT)? – Causes & Treatment.
Treatment
Sperm quality is a determining factor when it comes to referring a patient to a particular fertility treatment. Thus, depending on the quality, and as long as no other fertility issues are present, the treatment of choice may be:
- Intrauterine Insemination (IUI)
- When sperm quality is good because all parameters explained above are normal but pregnancy is not achieved naturally, this is the technique of choice.
- In Vitro Fertilization (IVF)
- In those cases where sperm quality is altered, IVF will be the first choice. In patients with severe sperm disorders, IVF with ICSI will be necessary.
- Testicular biopsy
- When azoospermia is diagnosed, your doctor will recommend a testicular biopsy to determine if sperm production is taking place, or if donor sperm is needed.
In any case, one should note that each case should be treated individually, since there are many factors that may have an influence, including the medical history of the couple or female fertility.
FAQs from users
If I have mild oligozoospermia, can I give artificial insemination a try?
Yes, as long as the number of mobile spermatozoa (REM) is greater than 5x106 spermatozoa/ml, but it will also depend on other factors such as the age of the woman or the time of sterility.
Can you test your sperm count at home?
Yes, although not so accurately as andrology labs. There exists a sperm test called SpermCheck Fertility that works similarly to a pregnancy test. It uses colored lines to indicate if your sperm count is normal or not.
How can you know if your sperm is infertile?
The most basic test to evaluate if a man's sperm is fertile or not is a semen analysis. Other tests to check fertility in men include:
- Physical exam
- Hormone evaluation
- Genetic testing
- Analysis of anti-sperm antibodies
Read more: Male Fertility Testing - How Do You Know if You Are Infertile?
What does healthy sperm look like?
Not exactly. Apparently, a man's ejaculate is healthy if it's white or light grey in color. Yellowish or greenish discoloration may indicate the presence of an infection. Other factors that contribute to healthy sperm include following a balanced diet, doing exercise, wearing lose underwear, not having unhealthy or toxic habits, etc.
In any case, ejaculate may have all these characteristics but still be unhealthy due to the presence of genetic diseases, low sperm count, abnormal morphology, etc. The best way one can get accurate information about sperm quality is via a semen analysis.
Can jelly-like sperm stop pregnancy?
Ejaculating jelly-like semen is actually quite normal, and in fact it can increase your chances of conceiving. A jelly-like appearance indicates that the semen contains fructose, a type of simple sugar that keeps the sperm viable after ejaculation. Semen consistency can be normal yet not have viable sperms, though.
Is thick sperm more fertile?
Normal sperm is thick and gelatinous (jelly-like). It is a natural feature of sperm that enables it to stick to the cervix of the female.
Suggested for you
As we have seen through this post, a semen analysis is a fundamental test when a man wants to have his fertility checked. If you liked this post, you may want to go through this: Sperm Test Results Explained – Interpretation & Normal Values.
If you are interested in learning about the characteristics of sperm cells, you may also enjoy some further information reading this: What’s the Function of a Sperm Cell? – Definition & Structure.
We make a great effort to provide you with the highest quality information.
🙏 Please share this article if you liked it. 💜💜 You help us continue!
References
Adamopoulos DA. Medical treatment of idiopathic oligozoospermia and male factor subfertility. Asian J Androl. 2000;2(1):25-32.
Aitken RJ, Buckingham DW, Brindle, J, Gomez E, Baker HWG, Irvine DS (1995): Analysis of sperm movement in relation to the oxidative stress created by leukocytes in washed sperm preparations and seminal plasma. Hum Reprod 10:2061–2070.
Auger J, Jouannet P, Eustache F. Another look at human sperm morphology. Hum Reprod. 2016;31(1):10-23 (View)
Bollendorf A, Check JH, Lurie D. Evaluation of the effect of the absence of sperm with rapid and linear progressive motility on subsequent pregnancy rates following intrauterine insemination or in vitro fertilization. J Androl 1996; 17550-7 (View)
Dahlberg B (1988): Sperm motility in fertile men and males in infertile units: In vitro test. Arch Androl 20:31-34.
Francavilla F, Romano R, Santucci R, Poccia G. Effect of sperm morphology and motile sperm count on outcome of intrauterine insemination in oligozoospermia and/or asthenozoospermia. Fertil Steril. 1990;53(5):892-7 (View)
Shabtaie SA, Gerkowicz SA, Kohn TP, Ramasamy R. Role of Abnormal Sperm Morphology in Predicting Pregnancy Outcomes. Curr Urol Rep. 2016;17(9):67 (View)
World Health Organization (WHO) (2010). WHO laboratory Manual for the examination of human semen and sperm-cervical mucus interaction. Cambridge Academic Press (View)
FAQs from users: 'If I have mild oligozoospermia, can I give artificial insemination a try?', 'Can you test your sperm count at home?', 'How can you know if your sperm is infertile?', 'What does healthy sperm look like?', 'Can jelly-like sperm stop pregnancy?' and 'Is thick sperm more fertile?'.
Authors and contributors
How can I get my wife pregnant with anormal sperm morphology?
Hello Sonny,
in case of anormal sperm morphology the indicated technique would be ICSI. To understand how the process works, read more about it in the following article: What is ICSI?
If you’re looking for the right fertility clinic for your ICSI treatment, I recommend you to have a look at our fertiliy report.
Hope this helps,
Best wishes
Respected madam,
I have been diagnosed with Severe OAT (15 sperm/ml, volume 1.7 ml, normal pH) and viscosity – 3% normal viable sperms. My karyotype is normal male 46XY. Should I go for a sperm DNA fragmentation test to rule out any alterations or sperm chromosomal abnormalities, which may lead to the development of genetical disorders in the newborn? What is a FISH test and when should it be done? Is it done on sperm, blood, blastocyst or fetus to know any alterations? We have decided to go for ICSI with donor oocytes.
Kindly clear my doubts and give your valuable advice to proceed.
Best regards,
Suresh Reddi.