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Low Sperm Motility (Ashtenospermia)
What is Low sperm motility
Causes of low sperm motility
Investigations & Diagnosis
Response of treatment
What is Low sperm
When sperm motility is less than normal i.e. less then 50% of
sperms are actively motile is called Oligo-asthenia i.e. low sperm
motility (when all the sperms are immotile are called
astheno-spermia. This leads to difficulty in conceiving i.e. wife
does not becomes pregnant. This is one of the common causes of male
infertility. This is also one of the most common semen
What is Low sperm
When less than 50% sperms are motile then this condition is called
oligoasthenia. When motility is less then chances of spontaneous
pregnancy decreases (i.e. difficulty in conceiving i.e. wife does
not becomes pregnant). This is one of the common causes of male
factor infertility. This is also one of the most common semen
abnormalities in men.
How sperms develop:
When boy becomes of 14 years of
age then L.H. & F.S.H. hormone secretion from pituitary increases.
The rise in these hormones leads to proliferation of sperm forming
cells (Germ Cells) in the testis. These germ cells start multiplying
under the effect of above-mentioned pituitary genital hormones along
with assistance of other hormones as testosterones, Growth hormones,
Androstenidione, insulin like growth factor-I, Thyroids hormone,
paracrine hormone & growth factors. Under the control of
above-mentioned hormones germs cells divide & transformed into
primary spermatocytes. Then further maturation of primary
spermatocytes to spermatids & then finally into mature spermatozoa
(i.e. normal sperms) occurs under the control of above-mentioned
hormones. After few weeks of progressive maturation inside the
testis these sperms become normally motile & develop the capacity to
fertilize the ovum. This total sperm cycle from first stage to final
stage of normal mature sperms is of three months. Any hindrance in
the development of these spermatozoa will lead to less count of
sperm & decreased motility, immotile or even dead sperms.
Causes of low sperm
The various causes of decreased motility are as
1) Deficiency of central sperm producing hormones:
Hypothalamic – pituitary deficiency: Idiopathic GnRH deficiency,
Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl
syndrome, Hypothalamic deficiency, pituitary hypoplasia, Trauma,
post surgical, postiradiation, Tumour (Adenoma, craniopharyngioma,
other), Vascular (pituitary infraction, carotid aneurysm),
Infiltrative (Sarcoidosis, histiocytosis, hemochromatosis)
Autoimmune hypophysitis, Drugs (drug-induced hyperprolactinemia, genital
Untreated endocrinopathies, Glucocorticoid excess, Hypopituitarism,
Isolated gonadotropin deficiency (non acquired): Pituitary,
Hypothalamic, Associated with multiple pituitary hormone
deficiencies: Idiopathic pan hypo pituitarism (hypothalamic
defects), Pituitary dysgenesis, Space-occupying lesions (craniopharyngioma,
Rathke pouch cysts, hypothalamic tumors, pituitary adenomas), ,
Laurence-Moon-Beidl syndrome Prader-Willi syndrome , Frohlich
syndrome, Hypergonadotropic hypogonadism : Klinefelter syndrome,
Noonan syndrome, Viral orchitis, Cytotxic drugs, Testicular
2) Testicular disorders (primary leydig cell dysfunction i.e.
, Chromosomal (Klinefelter syndrome and variants,
XX male gonadal dysgenesis), Defects in androgen biosynthesis,
Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins
(alcohol, opiates, fungicides, insecticides, heavy metals, cotton
seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine,
3) Partial obstruction in outflow tract from testis to
penile opening in epididymis or of vas deferens (cystic fibrosis,
diethlstibesterol exposure) also called obstructive oligospermia.
4) Varicocele: varicocele is dilatation of scrotal
vein in the scrotum that leads to rise in temperature of testis and
raise testicular temperature, resulting in decreased sperm
motility, less sperm production & death of whatever sperms are
Drugs (e.g. spironolactone, ketoconazole,
cyclophosphamide, estrogen administration, sulfasalazine)
6) Autoimmunity i.e. presence of Antisperm antibody. These
Antisperm antibodies bind with sperms & either make them less
motile, totally immotile or even dead which is called necrospermia.
7) Undescended testicle (cryptorchidism). Undescended
testis is a condition when one or both testicles fail to descend
from the abdomen into the lower part of scrotum during fetal
development. Undescended testicles can lead to decreased sperm
motility. Because the testicles temperature increase due to the
higher internal body temperature compared to the temperature in the
scrotum, sperm production may be affected.
8) Mosaic Klinefelter's syndrome. In this disorder of the genital
chromosomes, of the man is abnormal. This causes abnormal
development of the testicles, resulting in low sperm production or
decreased sperm motility. Testosterone production may be low or
9) Viral orchits as mumps or other viral infections.
10) Infections as tuberculosis, sarcoidosis involving testis
or surrounding structures as epididymis.
11) Chronic systemic diseases as Liver diseases, Renal
failure, Sickle cell disease, Celiac disease
12) Neurological disease as myotonic dystrophy
13) Development and structural defects as mild degree of
Germinal cell hypo-plasia
14) Partial Androgen resistance
15) Mycoplasmal infection
16) Partial Immotile cilia syndrome
17) Partial Spermatogenic arrest due to interruption of the
complex process of germ cell diffrentation from spermatid level to
the formation of mature spermatozoa results in decreased sperm count
i.e. oligospermia. Its diagnosis is made by testicular biopsy. This
is found in upto 30% of all cases of low sperm count patients.18)
Heat Exposure to testis: as febrile illness or exposure to hot
ambience induces a fall in sperm count or motility which is usually
19) Infection – as bacterial epididimo-orchitis, even in prostatis
spermatogenic defect have been noted.
20) Hyper-thermia due to cryptorchidism
21) Chromosomal abnormality: has been found in many cases of low
22) Alcohol use, Cocaine or heavy marijuana use or Tobacco smoking
may lower sperm count
23) Anti-sperm antibodies. In some people there occurs
development of some abnormal blood proteins called anti-sperm
antibodies which binds with sperm and make them either immotile or
dead or decrease their count.
24) Infections. Infection of urogenital tract may affect
sperm production. Repeated bouts of infections are one of the common
causes associated with male infertility.
25) Klinefelter's syndrome. In this disorder of the genital
chromosomes, a man has two X chromosomes and one Y chromosome
instead of one X and one Y. This causes abnormal development of the
testicles, resulting in low or absent sperm production & what ever
are produced are less motile. Testosterone production also may be
26) Trauma to testis
27) Environmental toxins: as Pesticides and other chemicals in food
or as ayurvedic medicines.
28) Genetic Factors: as idiopathic partial hypo-gonadotropic
Diagnosis of Cause of Low Sperm motility
For correct diagnosis of
cause of low sperm count, we need detail history & physical
examinations then certain relevant investigations are required.
History & Physical Examinations: First
step in proper treatment is accurate diagnosis of cause of low sperm
motility. So we first try to find out cause. We take detailed
history, thorough drug counseling, and general physical examination,
examination of testis, epididymis & testicular veins sperm carrying
duct examinations. These examinations give idea about whether testis
is normally developed or not & how is its function. After that
depending on likelihood of particular,
cause relevant tests are done. All
testing facilities are available at our centre. Thus you may consult
us at our centre & at same time you may get all tests done. The time
taken in getting all the reports ready is 36 hours. So if you are
from out of Delhi, you may come here for two days.
For completes diagnosis of causes of decreased
sperm motility & one or more of the following tests may be required
1) Complete male hormone profile: This
profile includes all the male hormone tests which control testicular
development, functions including normal sperm Productions. The tests
include L.H., F.S.H., Testosterones, prolactins, thyroids test, &
other relevant hormone tests depending on history & examinations.
3) USG or Doppler study of scrotum & testis
4) Semen culture sensitivity
5) Semen fructose
6) Immunobead test
7) Sperm Function Tests
8) Human Sperm-Zona Pellucida Binding Ratio
9) Human Sperm-Zona Pellucida Pentration test
10) Genetic Studies
11) FNAC Testis
12) Egg penetration test
13) Molecular genetic studies done in some special cases
14) Chromosome analysis i.e. Karyotype
15) Assessment of androgen receptor
16) Combined Pituitary hormone tests is performed when
17) MRI head if pituitary hormone defect suspected
18) Hemogram test for systemic diseases.
The hamster egg penetration assay (HEPA) and the hemizona assay (HZA)
are sperm function tests which can help assess the ability of sperm
to fertilize the egg. These tests will not definitively tell whether
a pregnancy will occur, but an abnormal test result helps predict
reduced fertilizing capability. These tests are performed only
20) Semen Fructose
At our center
facility for all the above tests are available.
Once the cause of low sperm motility are found then with in three
months of treatment sperm motility & motility becomes normal in more
than 90% cases.
The various treatments are as follows:
First of all we try to find out the primary
cause of infertility by above mentioned investigations. Then we
correct the basic defect i.e. correction of hormone disorder & other
defects as varicocele surgery, stopping of alcohol & smoking,
stopping of offending drug. We also give following treatment for
permanent cure of low sperm motility & motility disorder.
Correction of Hormone
then it is corrected by any of the below medicines. Usually sperm
motility normalizes in three month time with proper hormone
2) Gonadotropin Therapy: Gonadotropins
are most potent natural stimulators of sperm production in the
testis. Once we start gonadotropin therapy, these gonadotropins
stimulates the sperm producing cells in testis. Under the
stimulating influence of gonadotropins sperm forming cells start
dividing & produce multiple normally motile sperms.Thus in more than
90% cases sperm production can be normalized in three to four months
time. Gonadotropin therapy is most successful of all the treatment
available till now for sperm motility & motility enhancement.
Gonadotropin therapy is indicated & effective all cases of
hypogonadotropic Hypogonadism& almost all case of low sperm motility
& motility. In many cases of low sperm motility when all other
treatment has failed even in those cases gonadotropin therapy is
Gonadotropin-releasing hormone (Gn-RH)
in many cases where somatrop deficiency is found.
Mineral & Micronutrient Therapy
9) Free Radial Scavangers: These are
drug to reduce the free damaging oxidative radical in the testis.
For your information every minute lot of oxidant radicals are
generated inside the testis which damages sperm forming cells. These
special antioxidant drugs scavange these damaging oxidative free
radicals thus leading to production of normal sperms by the testis.
In many study these free radical scavengers have been found to be
very-very effective in normalizing sperm motility.
10) Coenzyme ubique: These drugs improve
the nutritional status of the testis. Thus testis as well as sperm
forming cells get enough nutrient which helps in fast generation of
sperms in good number with good motility & fertilizing capacity.
11) Carnititine supplimentation
increases the production of sperm, with normalization of sperm
motility in three months.
12) Fertyl: This drug is taken orally
and it causes the pituitary gland to release more FSH and LH, which
then stimulates the testis to produce more sperms.
13) Bromocriptine. This medication is
for men who have elevated levels of prolactin.
14) Correction of thyroid hormone
15) Correction of congenital adrenal
28) Certain Newer Drugs has been found very
29) Treatment of antisperm antibody is
achieved by steroid therapy, intrauterine insemination intra-cytoplasmic
sperm injection (ICSI)
30) Surgery: Depending on the cause,
surgery may be a treatment option for low sperm motility due to
partial blockade of the tract from testis to the tip of pennis.
Surgery is also the treatment of choice for significant varicocele.
Similarly surgery may be one of the treatment options for many
31) Intra-uterine insemination: In
certain patients motile sperms are selected by various methods &
then transferred directly in uterine cavity leading to improved
32) Test tube baby is also delivered
with our efforts by use of intra-cytoplasmic sperm injection (ICSI),
then transfer of embryo to uterus of mother.
33) Treatment of general genital problems.
Addressing imppotence or premature ejaculation can improve fertility.
Treatment for these problems often is with medication or behavioral
34) Semen Bank: Facility for good
quality sperm is semen bank in also available. At our center we have
facility for all the testing & treatment facility required for low
sperm motility to achieve pregnancy.
Assisted reproductive technology (ART)
ART has revolutionized the treatment of infertility. Each year
thousands of babies are born in India as a result of ART. Medical
advances have enabled many couples to have their own biological
The most common forms of ART include:
In vitro fertilization (IVF). This is the very
effective ART technique. IVF involves retrieving mature eggs from a
woman, fertilizing them with a man's sperm in a dish in a laboratory
and implanting the embryos in the uterus three to five days after
fertilization. IVF often is recommended as a first-line therapy.
It's also widely used for unexplained infertility, male factor
Electroejaculation. Electric stimulus brings
about ejaculation to obtain semen.
Surgical sperm aspiration. This technique
involves removing sperm from part of the male reproductive tract
such as the epididymis, vas deferens or testicle. This allows
retrieval of sperm if blockage is present.
Intracytoplasmic sperm injection (ICSI). This
technique consists of a microscopic technique (micromanipulation) in
which a single sperm is injected directly into an egg to achieve
fertilization in conjunction with the standard IVF procedure. ICSI
has been especially helpful in couples who have previously failed to
achieve conception with standard techniques. For men with low sperm
concentrations, ICSI dramatically improves the likelihood of
A varicocele is an
abnormal tortuosity and dilation of veins of within the scrotum. It
can be surgically treated - which might help fertility in some
When we start treatment, maturation of
spermatocyte to mature spermatozoa start occurring in three to 4
weeks time and achievement of normal sperm motility in three months.
Thus cure rate is achieved in more than 95% of patients in three
This treatment is harmless because we prescribe well proven drugs
which are prescribed in scientific literature. These medicines have
to be purchased from medical store by patient himself.
For consultation & treatment (by appointment / or online)
to Consult Us