Disease Name
Oligospermia (Oligospermia)
1) Disease Description (Causes and Symptoms)
- Definition: A condition in which the sperm concentration in semen is lower than the normal reference level, reducing the likelihood of pregnancy.
- The WHO criteria widely used internationally (2010) consider a sperm concentration of less than 15 million/mL to be low. In clinical practice, it may also be classified as mild, moderate, or severe.
- Depending on the clinical data, stricter or different values may be used (e.g., a range of several million/mL).
- Pathophysiology: The number of sperm decreases due to reduced sperm production (spermatogenesis) or problems with the mechanism of semen discharge (such as obstruction). Increased testicular temperature, abnormalities in blood flow or hormones, genetic abnormalities, infection or inflammation, and exposure to medications or toxic substances may contribute.
- Main causes (representative)
- Varicocele
- Undescended testis (cryptorchidism), history of testicular injury or surgery
- Chronic high fever, sauna use or hot work environments, tight underwear
- Infection (orchitis or epididymitis), inflammation
- Endocrine abnormalities (low hormone levels, hypothalamic-pituitary problems)
- Genetic causes (e.g., Y-chromosome microdeletion, abnormal testicular development)
- Medications (androgens/steroids, some anticancer drugs, some antibiotics, etc.) and toxic substances (lead, pesticides, etc.)
- Smoking, excessive alcohol consumption, obesity
- Symptoms: Most cases are asymptomatic, and the main problems are infertility or delayed conception. In rare cases, testicular pain or swelling (such as with varicocele) or symptoms of hormonal abnormalities may occur.
- Epidemiology (observational findings): It has been reported that varicocele is observed in approximately 30% or more of men with infertility, and that a high proportion (varying by report) is observed in men with secondary infertility.
2) Treatment Methods
- Diagnosis and initial testing
- Repeated semen analysis (at least 2 times, with samples collected after 2–7 days of abstinence; around 3 days is commonly recommended). The analysis checks concentration, motility, morphology, particulate matter, and other factors.
- Hormone tests (testosterone, LH, FSH, prolactin, etc.), testicular ultrasound (evaluation of varicocele), and, if necessary, vasography or testicular biopsy (when obstruction is suspected), as well as genetic testing (in cases of severe oligospermia or azoospermia).
- Treatment of the cause
- If varicocele is suspected to be the cause, surgical correction (varicocelectomy) may be considered — some patients may experience improved sperm parameters and an increased chance of natural pregnancy.
- If infection or inflammation is the cause, appropriate antibiotic or anti-inflammatory treatment is provided.
- Endocrine causes (such as low hormone levels) are treated endocrinologically (hormone replacement or administration of gonadotropins).
- If medication or toxic exposure is the cause, the causative substance should be discontinued and the environment should be modified.
- Medication / adjunctive treatment
- Cause-specific hormone therapy: for hypogonadotropic hypogonadism (low LH/FSH), hCG, hMG, or other gonadotropin therapy may be used (as directed by a specialist).
- Selective estrogen receptor modulators (such as clomiphene) or aromatase inhibitors may be used in some cases, but effectiveness varies depending on the patient and the evidence.
- Antioxidants (vitamin C, vitamin E, zinc, coenzyme Q10, etc.) have been shown in some studies to improve semen parameters, but uniform effectiveness is not guaranteed.
- Assisted reproductive technology (ART)
- For mild to moderate oligospermia, IUI (insemination after ovulation and semen processing) may be considered.
- In cases of severe oligospermia or when other factors are combined, pregnancy may be attempted through IVF or ICSI (direct injection of sperm after in vitro fertilization).
- Lifestyle management (self-care)
- Quit smoking, limit alcohol consumption, control weight, and exercise regularly
- Avoid exposure to high temperatures (avoid saunas, excessive heat at work, and hot sitz baths); loose-fitting underwear is recommended
- Avoid excessive steroid or medication use and minimize occupational exposure to hazardous substances
- Follow-up after treatment
- Because the sperm production cycle takes approximately 70–90 days, treatment effectiveness should be assessed after at least 3 months of follow-up.
Precautions and complications
- If the cause is left untreated, infertility may persist, and psychological stress or relationship problems may occur
- Possible complications after surgery (such as varicocele ligation): infection, hematoma, pain, and recurrence
- Some medications and treatments have side effects, so consultation with a specialist is necessary
3) Checkpoints Before an Outpatient Visit (Including Preparations and Example Questions)
- Preparations
- A complete list of all medications and supplements currently being taken (including steroids, androgens, and antibiotics)
- Medical history: testicular surgery, trauma, infection (orchitis), and whether treatment for childhood undescended testis was received
- Previous semen analysis results, if available (printed copies or digital data)
- Lifestyle information: smoking, alcohol consumption, occupation (exposure to heat or chemicals), exercise, and weight changes
- Collection instructions (before semen analysis)
- Abstinence period: generally 2–7 days (3 days is usually recommended)
- Collection method: collect the sample according to the hospital’s instructions (collection at the hospital is recommended); do not use saliva or lubricants
- Materials helpful to provide to the doctor during the outpatient visit
- A recent medication list and previous test results (hormone tests, ultrasound, and semen analysis)
- The spouse’s gynecological examination results (for joint evaluation if necessary)
4) Examples of General Questions to Ask the Doctor
- "What level is my semen analysis result, and what is the likelihood of pregnancy?"
- "What tests do you recommend, and why?"
- "What are the advantages, disadvantages, and expected side effects of the recommended treatments (surgery, medication, or assisted reproductive technology)?"
- "When and using which indicators will we assess the effectiveness of treatment?"
- "Are there any lifestyle changes that I absolutely need to make?"
5) Examples of Disease-Specific Questions
- "A varicocele has been identified. How likely is surgery (vein ligation) to improve my sperm parameters or natural pregnancy rate?"
- "My sperm concentration is very low (e.g., no more than several million/mL). Should I undergo genetic testing (e.g., Y-chromosome microdeletion testing or chromosomal analysis)?"
References/Additional Information
- Because evaluation of treatment effectiveness must take into account the sperm production cycle (approximately 3 months), medium- to long-term observation is needed rather than making an immediate judgment.
- In cases of severe oligospermia or azoospermia, consultation with reproductive medicine specialists (urology or obstetrics and gynecology reproductive medicine specialists) and genetic counseling are recommended.