Asthenozoospermia is a semen disorder that refers to sperm motility problems . When sperm have mobility problems, they are colloquially known as lazy, slow, or immobile sperm .
In the event that the man has a high percentage of vague sperm, it is difficult to achieve pregnancy naturally. Therefore, some assisted reproductive technique is necessary .
This article explains the causes of poor sperm motility , as well as how to detect it and the treatment that is usually applied for this seminal alteration.
Below you have an index with the 11 points that we are going to deal with in this article.
Asthenozoospermia or asthenospermia consists of an alteration in seminal quality caused by a decrease in the percentage of motile sperm. Sometimes this alteration is accompanied by oligospermia , that is, a low concentration of sperm in the ejaculated semen.
A man is considered affected with asthenozoospermia when at least 60% of the sperm are immobile.
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, the possibility of achieving pregnancy is difficult.
If you want more information about oligospermia, you can visit the following link: What is oligospermia? – Causes, types and treatments.
Asthenozoospermia does not cause clinical manifestations, so the man can have sexual intercourse. However, when trying to achieve pregnancy it is complicated.
The seminogram or spermiogram is the diagnostic test used to analyze the man’s semen. In this way, one of the parameters that is assessed is the mobility and motility of the sperm.
Sperm analysis is carried out by depositing a drop of semen in the counting chamber (Makler chamber or Neubauer chamber) and observing it under the microscope. Subsequently, the movement of approximately 100 spermatozoa is noted.
When carrying out this study, it is important to know whether or not the spermatozoa move, but the way in which they move must also be analysed. Therefore, in the analysis of sperm motility, it is determined:
- the spermatozoa are capable of advancing over a distance, which would allow them to cross the female reproductive system and fertilize the ovum.
- motion form
- sperm can move in a zigzag, in a circle, or in a straight line.
- sperm can move quickly or slowly.
Asthenozoospermia is diagnosed if a high number of immotile spermatozoa, with slow or non-progressive movement, is observed in the semen sample.
The World Health Organization (WHO) establishes reference values to mark the quality of a sperm sample. Specifically, it is indicated that it is a case of asthenozoospermia when the sperm analysis shows:
- Values less than 40% of spermatozoa with total motility (progressive and non-progressive)
- Values less than 32% of spermatozoa with progressive mobility , that is, capable of moving and advancing in distance with that movement
If you want more information about sperm motility, you can continue reading here: What values are normal in the analysis of sperm motility?
Classification according to severity
Depending on the exact percentage of immotile sperm found in the analyzed sperm sample, the degree of asthenozoospermia will be more or less severe.
Next, two levels of asthenozoospermia are distinguished according to the established severity: mild or severe.
There are no exact criteria to differentiate cases of severe from mild asthenozoospermia. The fundamental difference is based on the speed and shape of the movements, as well as the number of sperm that are immobile.
Mild or moderate
A semen sample is said to have mild asthenozoospermia when the percentage of sperm with no motility or poor motility is between 60% and 75%.
It is essential to consider the type of movement, since if they move at least a small amount by making rectilinear movements, an advance could be seen.
Severe or severe asthenospermia is diagnosed when there is a very high percentage of spermatozoa with low or no motility .
Although there is no set value, it can be said that it is a case of severe asthenozoospermia when the percentage of immotile sperm is close to 75-80% or even higher.
It is also important to take into account not only the total motility, but also the type of motility: if there are very few spermatozoa with progressive and rapid motility, we will also speak of severe asthenozoospermia.
Causes of quick release of sperm
The causes that can affect sperm motility and cause asthenozoospermia are diverse and have not been exactly defined. It can be due to environmental factors, infections, genetic or immunological alterations, etc.
However, it is known that sperm motility can be influenced by the following factors:
- Presence of antisperm antibodies .
- Excessive consumption of alcohol, tobacco, marijuana and other drugs.
- Advanced age. A significant decrease in mobility has been studied after 45 years of age.
- Exposure to toxic agents such as fertilizers, chemical solvents, etc.
- Infections that affect the semen.
- Poor nutrition with an inadequate or unhealthy diet. A healthy and balanced diet is essential for good sperm mobility.
- Prolonged exposure to heat.
- Testicular problems.
- Cancer treatments such as chemotherapy and radiotherapy.
- Vasectomy .
- Varicocele . It is the presence of dilated veins in the spermatic cord and in the scrotum.
Similarly, the presence of other alterations in the sperm such as teratozoospermia or oligospermia can lead to asthenozoospermia. In short, all these alterations refer to the poor quality of the sperm.
It should be remembered that the term teratozoospermia refers to alterations that affect the shape or morphology of sperm . Instead, oligospermia refers to a low concentration of sperm in semen.
If the man does not show any sperm in his semen sample or they have mobility problems, the cause may also be genetic. In these cases, a difference is made between:
- Kartagener’s syndrome
- also known as Primary Ciliary Dyskinesia or Immotile Cilia Syndrome . It is a rare autosomal recessive disease characterized by the presence of alterations in the structure and function of the cilia. It is associated with male infertility as it affects the mobility of sperm.
- Microdeletions on the Y chromosome
- they are small deletions in the AZF region of the Y chromosome, where there are several genes related to spermatogenesis or sperm formation.
As for treatment options, there are two ways that can help improve sperm motility and even provide a solution to mild asthenozoospermia:
- natural treatment
- It is recommended to lead a healthy lifestyle and avoid toxic habits (use of tobacco, alcohol, etc.) that can affect the general quality of sperm, including sperm motility. This can be of great help in cases of mild or slight asthenozoospermia. In addition, the consumption of a vitamin supplement that has antioxidants is recommended to stimulate the mobility of sperm. The doctor may recommend the patient to eat foods rich in vitamins or zinc, for example.
- There are some medications designed to improve seminal quality that can help reduce sperm mobility problems. However, this will only be effective in mild cases of male sperm factor infertility .
Severe or severe asthenozoospermia is difficult to improve with any of these treatments. In these cases, it will be necessary to resort to assisted reproduction techniques to recover the fertilizing capacity and to be able to achieve pregnancy.
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On the other hand, if the cause of asthenozoospermia is known, a treatment aimed at the causing alteration can be established. If the cause was an infection, the patient would have to be prescribed an antibiotic and repeat the seminogram after 3 months, for example.
Asthenozoospermia is a very common cause of infertility in men. Sperm must travel a long and costly path from the time they are deposited in the vagina until they reach the egg in the fallopian tubes. If the mobility of the spermatozoa is affected, they are not able to complete the entire journey and fertilize the egg, which causes infertility.
Since this alteration affects the mobility of the sperm, artificial insemination with conjugal semen is not indicated in these cases.
Throughout the female reproductive tract, sperm encounter different obstacles. Only the most skilled and fastest sperm will be able to overcome these obstacles and reach the goal first, that is, to meet the egg. Therefore, the progressive movement and speed of the sperm are very important aspects to achieve a pregnancy naturally.
When the spermatozoa do not move or do so inadequately (without progress), natural fertilization becomes very complicated. It is in these cases when assisted reproduction techniques should be used.
Solutions to achieve pregnancy
If a man is diagnosed with asthenozoospermia and cannot get his partner to become pregnant, it is advisable to undergo in vitro fertilization (IVF) treatment , either conventionally or through ICSI (intracytoplasmic sperm injection).
However, artificial insemination is not indicated when it comes to low mobility in the sperm, since they will not be able to cross the entire female reproductive system to reach the egg.
In summary, the possible assisted reproduction treatments when the man is diagnosed with asthenozoospermia are detailed below.
- conventional IVF
- it is the recommended option when asthenozoospermia is mild. It is the simplest and most physiological version of in vitro fertilization. A large number of sperm come into contact with the egg for fertilization to occur.
- In the most extreme cases, this technique is used. In it, it is the embryologist himself who introduces the selected sperm inside the egg, so it is not necessary for it to move.
- sperm donation
- If pregnancy is not achieved with any of these techniques, it would be necessary to resort to sperm donation in order to have children. It could be carried out through artificial insemination or in vitro fertilization.
What are the possible treatments for asthenozoospermia?
Asthenozoospermia is decreased motility in sperm. According to the World Health Organization (WHO), progressive motility greater 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 them, less 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, hCG / human menopausal gonadotropin , bromocriptine, alpha-blockers, systemic corticosteroids, and magnesium supplementation have been shown to be ineffective in the treatment of asthenozoospermia. In addition, follicle-stimulating hormone and anti-estrogens in combination with testosterone may be beneficial treatments in a selection of patients (always under strict medical supervision of 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 (ovum), such as artificial insemination or in vitro fertilization with or without ICSI.
Can the abstinence period influence sperm motility?
The male factor is one of the most relevant aspects recently in assisted reproduction. Different diagnostic techniques of a genetic nature have been used to analyze the role that the male is playing in achieving a pregnancy.
The abstinence period is an aspect that has varied over the years, initially thinking that the greater the abstinence, the better the result of both the seminal diagnosis and the embryonic evolution and full-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 depending on the assisted reproduction unit that is attended and the standardization of the processes. The recommendations of the World Health Organization is to have a sexual abstinence of between 2-7 days. In case the abstinence is less than two days, we will find spermatozoa that possibly present less DNA fragmentation, but the count of the number of spermatozoa is lower than in normal conditions. If we have a period of high abstinence, it is likely that we will find reduced sperm motility.
In conclusion, it is important to have an optimal abstinence period according to the recommendations of the assisted reproduction center in order to maximize the chances of success in each case.
Can I be a father naturally if I have asthenozoospermia or do I need treatment to get my wife pregnant?
There is a possibility of natural pregnancy even with asthenozoospermia, as long as it is mild. However, in the event of serious sperm motility problems, it will be necessary to apply some type of reproductive treatment in order to achieve pregnancy.
What are the symptoms that can make me suspect that I have asthenozoospermia?
Asthenozoospermia does not give rise to any specific symptoms, so the only way to detect whether or not you suffer from it is by performing a spermiogram.
The results of my seminogram indicate discrete asthenozoospermia, what does it mean?
It means that a percentage greater than 60% of the sperm in the analyzed seminal sample are immobile or have mobility problems. The discrete qualifier refers to the fact that it is not a very high percentage or much above the reference value.
What can be done when it comes to idiopathic asthenozoospermia?
When there is a case of idiopathic asthenozoospermia, that is, the cause that causes it is unknown, pentoxifylline can improve the mobility and quantity of sperm.
Pentoxifylline improves sperm motility and is even capable of causing immobile sperm to become mobile.
In any case, this type of treatment must be indicated by a specialist doctor.
Is asthenozoospermia hereditary?
In some cases, asthenozoospermia is due to a genetic cause, so it can be inherited from parents to children. This is the case of asthenozoospermias caused by Kartagener syndrome or by microdeletions on the Y chromosome.
However, there are several factors that affect the mobility of sperm such as infections, immune disorders, varicocele, poor diet, etc.