Article 50: Definition, Etiology, and Diagnosis of Oligospermia

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Treatment and recuperation of common diseases

Oligospermia

Oligospermia refers to a condition where the number of sperm in ejaculated semen is significantly lower than normal. A normal man's semen contains over 60 million sperm per milliliter. If, after three or more semen analyses, the sperm density is consistently below 20 million per milliliter, it is considered oligospermia and is one of the most common causes of male infertility.

Causes of disease

1. Reproductive tract inflammation: Reproductive tract infections such as mumps complicated by orchitis, acute orchitis, prostatitis, seminal vesiculitis, etc. can all lead to varying degrees of sperm reduction.

2. Varicocele: Varicocele reduces blood supply to the seminiferous tubules, causing testicular damage, affecting spermatogenesis, and leading to abnormal sperm morphology and motility, resulting in reduced sperm count.

3. Endocrine abnormalities: Pituitary diseases, hypogonadism, diabetes, hypothyroidism, etc., can all lead to a decrease in the secretion of sex hormones and insufficient testosterone secretion, thus affecting sperm count.

4. Effects of physical and chemical factors: X-rays, high-temperature operations, synthetic pesticides, industrial chemicals, etc., can damage spermatogenic cells when they act on the body.

5. Effects of drugs: Chemotherapy drugs such as cyclophosphamide, vincristine, cyclophosphamide, colchicine, and hormone drugs can all affect spermatogenesis.

6. Other factors such as excessively high scrotal temperature, nutritional deficiencies, and smoking and alcohol consumption can also cause oligospermia.

What are the symptoms?

Most of these patients have no obvious symptoms. A few may have a history of testicular trauma or infection, or be accompanied by urogenital diseases, such as testicular hypoplasia, cryptorchidism, varicocele, or prostate or seminal vesicle lesions. They may also have a history of sexual dysfunction.

Some patients may experience a heavy psychological burden, low mood, or mental and psychological symptoms such as anxiety, irritability, and insomnia.

What tests should be done?

1. Routine semen analysis: Sperm count less than 20 million per milliliter.

2. Prostatic fluid examination: White blood cell count exceeding 10 per high-power field.

3. Testicular biopsy: to determine testicular spermatogenesis and spermatogenesis status.

4. Vas deferens angiography: to determine if the vas deferens is obstructed.

While performing semen analysis, plasma follicle-stimulating hormone (FSH) is also measured. If FSH levels are significantly elevated, it indicates primary oligospermia. If FSH and luteinizing hormone (LH) levels in plasma are lower than normal, it indicates secondary oligospermia.

The sperm count in semen fluctuates greatly. Newly diagnosed patients should have 2-3 samples taken every 1-2 weeks for testing to ensure reliable results. Fever or excessive alcohol consumption can also cause temporary oligospermia or azoospermia. Too short a period of abstinence (less than 3 days) will decrease sperm density and semen volume; too long a period (more than 7 days) will decrease sperm motility and increase white blood cells in the semen.

What precautions should be taken when collecting semen samples?

1. Avoid sexual intercourse for 3-5 days before the examination.

2. Semen should be collected by masturbation or external ejaculation. The semen should be collected in a clean, dry glass bottle, and the bottle should not contain water.

3. Specimens should be delivered to the hospital for testing within 1 hour. In winter, the glass bottle containing semen should be placed in a pocket of your underwear.

4. All semen from a single ejaculation must be collected in a glass bottle.

5. It is generally not advisable to use a penile sheath to collect semen, as the chemical reaction of the powder and latex film inside the sheath can affect sperm motility, and the semen adheres to the sheath, affecting the accurate calculation of semen volume.

How does Western medicine treat this?

Treatment varies depending on the underlying cause of oligospermia.

1. Treatment of oligospermia caused by endocrine dysfunction: Some patients can increase sperm count with clomiphene, 25 mg daily, 25 days a month, followed by a 5-day break, for 6-12 months as one course of treatment. There are reports that long-term use can reduce the percentage of morphologically normal sperm; therefore, low-dose therapy, i.e., 25 mg every other day, is currently recommended. Human chorionic gonadotropin (hCG) 1000 units, injected intramuscularly twice weekly, for 8-10 weeks as one course of treatment, can also be used; simultaneously, vitamin E 100-200 mg can be taken orally daily for 3-4 months. Recent reports indicate that ketotifen (methiptifenone) 1 mg twice daily for 3 months significantly improves sperm density and motility. Pentoxothecoside, added to semen or taken orally, can increase the motility of sperm with insufficient motility in idiopathic oligospermia.

2. Varicocele is the most common cause of oligospermia. Varicocele can be treated with varicocelectomy. One year after the surgery, sperm density increases in 50% to 80% of patients, and about 30% to 50% of patients have their wives become pregnant.

3. Acute and chronic orchitis, epididymitis, prostatitis, seminal vesiculitis, and other reproductive tract inflammations are also common causes of oligospermia. Treatment may include carbenicillin 4 grams daily, divided into 4 doses, for one month. Compound sulfamethoxazole can penetrate prostatic fluid and is also effective; take 2 tablets twice daily for 3 months.

4. Supplementing trace elements: Zinc supplementation has a certain therapeutic effect on oligospermia and azoospermia, and sperm count increases significantly after taking the medication. Due to the antagonistic effect between zinc and copper, zinc supplementation also treats high copper levels. The treatment method is to take 50-100 mg of zinc gluconate orally twice a day for 3 months as one course of treatment.

5. Supplement with arginine: Arginine is an essential component for sperm production. The amino acid content in the semen of men with oligospermia is significantly lower than that of normal men. Supplementing with arginine, 4 grams orally daily for 10 weeks, can increase sperm count.