Before the WHO 5th edition manual, we called sperm density <20×106/L as oligospermia, but in 2011, the WHO 5th edition Manual of Human Semen Examination and Laboratory Processing called sperm concentration <15×106/L as oligospermia (the number of male sperm became less again than before .....) . There is a high incidence of male infertility caused by a reduced sperm count, which is one of the main causes of male infertility.
What causes can lead to oligospermia?
1, inflammation. Testicular inflammation can destroy the sperm production function of the testes (e.g. mumps testicular inflammation). Inflammation of the epididymis can involve the testes. The vas deferens can be edematous due to inflammation and obstruction causing incomplete obstruction can appear as oligospermia.
2. Varicocele. About 24~39% of oligospermia is caused by varicose veins of the spermatozoa. Due to the elevated temperature of the testes caused by varicose veins, the metabolites and toxic substances affect the spermatogenic function of the testes, thus leading to oligospermia.
3.Cryptorchidism. Cryptorchidism accounts for about 9% of the patients with oligospermia. Unilateral cryptorchidism already has histological changes before the surgery (so it is advisable to do the surgery for cryptorchidism early), which will lead to the decrease of spermatogenic function.
4. Endocrine abnormalities. Abnormalities of various gonadotropins secreted by the pituitary gland, as well as diabetes and thyroid disease can lead to oligospermia.
5, chromosomal abnormalities. Genetic mutations of chromosomes have an important impact on the number, vitality and viability of sperm. Such as AZF gene deficiency, etc.
6, autoimmunity. Autoimmunity can affect the occurrence of sperm to make the germ cells shed, and can also make the output of sperm blocked.
7, obesity. Obese men have decreased testosterone levels and increased estrogen levels. Semen is mostly oligospermia.
8, chronic diseases. About nearly half of the patients with chronic liver disease will have testicular atrophy, resulting in oligospermia. In patients with uremia, patients may have hypospermia or blockage of testicular spermatogenic function.
In addition, there are other factors related to the occurrence of oligospermia.
1, age: the spermatogenic function of the testes, after the age of 30 began to gradually decline, about half of the elderly men before the age of 70 will develop spontaneous testicular output obstruction, which leads to oligospermia.
2, abstinence and frequency of sexual intercourse: too many times of sex will affect the number of sperm. Conversely, although abstinence can increase the number of sperm, but if the abstinence is too long, it will affect the viability and vitality of sperm.
3, X-rays, microwaves, infrared rays, hormones, etc., pesticides, deodorants, food additives, chemicals, etc. affect sperm production.
4, drug factors: chemotherapy drugs, hormonal drugs, can cause oligospermia.
Diagnosis of oligospermia, clinical generally need to do 3 semen examination to reduce physiological oligospermia. In addition, to diagnose idiopathic oligospermia (if the cause cannot be found, we call it idiopathic), some tests are needed to distinguish it from oligospermia due to known causes.
1. the need to rule out oligospermia due to infection by culture of microorganisms.
2. exclusion of oligospermia due to varicocele by specialist physical examination and scrotal ultrasound.
3. to exclude chromosomal causes and genetic problems through chromosomal and genetic testing.
4. the blood sex hormone test (this test is very important and can initially determine the value of conservative treatment and the prognosis) can rule out oligospermia caused by endocrine diseases.
5. immunological factors can be discharged through antibody testing.
6, the above are some non-invasive tests, if necessary, invasive tests, such as epididymal puncture, vasectomy, etc., can be used to determine whether there is incomplete obstruction, etc.
In conclusion, there are more causes of oligospermia, but about half of the patients are still clinically unable to find the cause of the disease. Even if some evidence of etiology is found, it is sometimes difficult to clarify whether it is the real cause of their oligospermia, because the clinical patient’s oligospermia is often the result of a combination of factors. This is why the semen of patients does not improve significantly after we get rid of a single causative factor.
Regarding the treatment of oligospermia, we have to actively treat the causes found, such as infection, immunity, sperm curvature, etc. For patients in whom the cause cannot be found, we have to determine the value of conservative treatment based on their sex hormone levels. Chinese medicine plays a very important role in the conservative treatment of oligospermia, whether it is idiopathic oligospermia, or for infection, immune infertility, or mild to moderate seminal curvature, as well as post-operative recovery of seminal curvature, all have a better therapeutic effect. Conservative treatment usually takes 3-6 months, and some patients can improve their sperm count and sperm motility, and some of them can conceive naturally. If there is no significant effect after 3-6 months, it is necessary to consider second-generation in vitro fertilization.