By Neus Ferrando Gilabert BSc, MSc (embryologist).
Last Update: 12/31/2014

It’s estimated that 15% of couples try to conceive a child during at least one year and can’t achieve it. These couples turn to centres specialised in reproductive medicine to know the causes of their infertility. In 30% of the cases, the cause is due to a female factor, 40% of the cases, is due to a combined cause (male and female factors at the same time), and in 30% of the cases, is due to male infertility.

There are numerous causes that can provoke male infertility; one of the most common problems is the spermatic agglutination. The agglutination consists on the formation of heaps, or groups of spermatozoa that are linked to each other. These strong aggregations prevent the spermatozoa from moving progressively on their own until they can reach the egg and fertilise it.

Diagnosing spermatic agglutination is simple: a sperm analysis is carried out, and, through the examination of the sample under the microscope, the presence or absence of heaps is observed. The spermatozoa can be linked through the heads, tails, or head-tail, forming groups of up to 200 cells.

Depending on how the heaps are, there are two different terms that are commonly used as synonyms.

  • Agglutination: the spermatozoa adhere to one another and are motile, but there’s no presence of other cells or detritus.
  • Aggregation: the spermatozoa glued are immotile and there are other cells in the heaps, such as epithelial cells, detritus…

To value the heap there are grades that range from 0 (no agglutination) up to 3 (which means that there are more than 30%-40% of adhered spermatozoa).

Causes of agglutination

The agglutination suggests the presence of antibodies in ejaculation. These molecules recognize the membranes of the spermatozoa and link to them forming the heaps. This is the most common cause, but there are also others, such as:

  • Extremely high concentration in ejaculation
  • Changes in the sperm pH due to problems in the accessory glands (after an infection or an inflammation).
  • Increase in body temperature due to fever.
  • Presence of a high number of epithelial or squamous cells.
  • Certain types of bacteria may provoke spermatic agglutination.

Methods to solve the agglutination

If the agglutinations are due to fever or an infection, after treating it and waiting a little time, the spermatic agglutination should disappear.

In the cases that the agglutination is mild or moderate, there are several medications to try to reduce it or make it disappear. Vitamin supplements are recommended, especially with vitamin C, since it activates the anti-agglutinin protein.

In severe cases, it’s possible that the agglutinations won’t disappear, but several assisted reproduction treatments can be performed to achieve pregnancy, such as ICSI. In the andrology laboratory, the sperm capacitation would be carried out and the motile spermatozoa that are able to move progressively would be separated from the rest (aggregations and immotile spermatozoa). The seminal sample is observed by the expert, who selects the best spermatozoon to insert it inside the egg.

Thanks to this assisted reproduction technique, many problems due to male infertility have been solved, since not a high number of spermatozoa are required for the fertilisation of the egg.

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Authors and contributors

 Neus Ferrando Gilabert
BSc, MSc
Embryologist
Bachelor's Degree in Biology from the University of Valencia (UV). Postgraduate Course in Biotechnology of Human Assisted Reproduction from the Miguel Hernández University of Elche (UMH). Experience managing Embryology and Andrology Labs at Centro Médico Manzanera (Logroño, Spain). More information
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