Causes and treatment of excessive or insufficient semen volume

**Too much or too little semen**

Abnormal seminal plasma quality directly affects male reproductive function. Normal semen ejaculation volume is less than ten...

Strict standards apply, generally 2–6 mL. Ameler's study included 1294 men with low fertility.

1.8% is due to insufficient semen volume (<1mL). Sometimes, even if the quality is good, the small volume can cause problems with the semen and cervix.

Limited contact area of ​​oral mucus can reduce fertility; approximately 10% of infertility is caused by excessive semen.

Increasing sperm concentration (>7.45 mL) can dilute sperm concentration and inhibit sperm motility or affect sperm transport in the female reproductive tract.

Sending it away can also cause infertility.

**Western Medical Etiology and Pathology**

**(I) Insufficient Semen Volume**

(1) Excessive sexual activity: Frequent sexual activity can reduce the amount of semen, so the abstinence period before the examination should not be less than two days.

(2) Congenital seminal vesicle hypoplasia or ejaculatory duct obstruction: manifested as low semen volume, non-coagulation, and high fructose content.

The sperm count was 0, indicating no sperm. In the former case, because the vas deferens and seminal vesicles develop from the same embryonic origin-the mesonephric duct-the physical examination revealed no sperm.

Incomplete development of the vas deferens is often found; the latter is mostly caused by inflammation, trauma, or other reasons.

(3) Hypopituitarism: Hypogonadism caused by hypopituitarism is due to the decreased activity of pituitary hormones.

Endocrine disorders lead to a decrease in the synthesis and secretion of hormones related to accessory gland function, such as androgens and prolactin.

This manifests as a persistent low volume of semen, but may contain sperm or pre-sperm cells.

(4) Ejaculatory dysfunction: Incomplete retrograde ejaculation, where most of the semen is retrogradely ejaculated into the bladder but only a small portion is ejaculated.

A small amount of semen may be discharged; sperm can be found by centrifugation after urination.

(5) Accessory gland inflammation: Acute and chronic inflammation of the accessory glands, due to tissue edema, obstruction of the glandular duct lumen, or

Repeated inflammation and repair processes, along with the proliferation of fibrous scar tissue leading to decreased secretory function, can all cause semen problems.

The quantity decreased.

**(ii) Excessive semen volume**

(1) Long-term abstinence: Long-term abstinence leads to the accumulation of accessory gland secretions, resulting in a large amount of ejaculate being released, thus causing premature ejaculation.

Excessive fluid. Therefore, the abstinence period before sampling should not be too long, generally not exceeding 7 days.

(2) Accessory gland inflammation: Acute inflammation of the accessory glands, where inflammation can lead to excessive secretion, resulting in...

Excessive semen volume is often accompanied by significant inflammatory symptoms, with a high white blood cell count and bacterial count in the semen.

Significant increase.

**Traditional Chinese Medicine Etiology and Pathogenesis**

(1) Low semen volume: mostly caused by congenital deficiency, weak constitution, or excessive intercourse, which depletes kidney essence; or

Prolonged illness leading to depletion of qi and blood, congenital deficiency, acquired malnutrition, inherent weakness, or excessive thinking and overwork damaging the heart.

It can be caused by the spleen; it can also be caused by internal heat, excessive consumption of warming and drying yang-tonifying products, or exposure to heat pathogens, which can lead to excessive heat damaging yin.

Some people have a fondness for rich and fatty foods, which leads to internal damp-heat that flows down to the seminal vesicle; others are infected by external damp-heat pathogens, which steam the seminal vesicle and cause semen to become...

Turbidity and blood stasis in the veins; or the retention of semen during sexual intercourse, leading to the accumulation of fire in the seminal chamber, resulting in the obstruction of semen.

(2) Excessive semen volume: This condition is often caused by congenital deficiency, weak constitution, or excessive sexual activity and lust.

Serious illness, or the initial recovery from a prolonged illness followed by sexual abstinence, leading to weakened kidney qi and loss of control over sexual function; or repeated masturbation, damaging both yin and yang, potentially leading to death.

When the fire element in the kidneys weakens, internal cold and dampness arise, leading to the growth of dampness and turbidity. This can also be caused by excessive consumption of rich, sweet, spicy, and alcoholic foods, which transform phlegm and dampness into heat, accumulating in the seminal vesicle.

It is formed by the fusion of moisture and heat with semen.

**Key Points of Western Medicine Diagnosis**

The amount of semen varies greatly among individuals, and even among different ejaculatory processes of the same individual.

The differences are closely related to factors such as frequency of sexual intercourse, psychological factors, and physical condition; therefore, they cannot be determined solely by...

A diagnosis should not be made based on a single semen analysis. To rule out non-organic causes, further analysis of the semen analysis is necessary.

The following points must be noted during analysis:

(1) Abstinence period: Specimens should be collected after 48 hours of abstinence, but no more than 7 days.

Too short a time can lead to a decrease in ejaculation volume. Generally, a follow-up examination after 3 to 5 days of abstinence will show a significant increase in semen volume.

Prolonged abstinence can also lead to increased ejaculation volume. Similarly, after controlling the abstinence period and undergoing a follow-up examination, semen volume can be restored.

It has returned to normal.

(2) Collect complete specimens: Instruct the examinee before the examination and repeat the questioning after the examination.

Whether any semen was missed during the semen collection process, or if the sample is incomplete, it should not be used for analysis.

Subjects who use masturbation or have their semen collected at a hospital may experience variations in ejaculation volume due to psychological factors.

Bias should be considered when analyzing results. This applies to cases where the interrupted intercourse method is used when ejaculation is not achieved through masturbation.

The test results may be abnormal if the foreparts of semen are left inside the vagina during the semen collection process.

Special silastic condoms can be used to collect semen. If sperm quality is not a concern, regular condoms can also be used.

Semen was collected using a condom to first determine whether any abnormality in semen volume was due to psychological factors or improper collection methods.

When caused.

(3) Repeat examination: If the examinee has been significantly overly fatigued recently or during the examination, or has other related symptoms.

For systemic organic lesions, or those recovering from a long-term illness, or those who have overindulged in smoking and alcohol, treatment should begin once the disease is under control and fatigue has subsided.

And repeat the test after quitting smoking and drinking for more than a week.

(4) At least two semen analyses should be performed before a definitive diagnosis is made: the interval between the two collections should not be less than 7 days.

Or more than 3 months. If the results of two tests differ significantly, two tests should be performed to clarify the diagnosis.

A healthy man ejaculates approximately 2-6 mL of semen per ejaculation. According to WHO diagnostic criteria, this is considered normal semen volume.

It should be ≥2mL. Because abnormal semen volume is often accompanied by mixed factors such as abnormal sperm quality, it is considered in the WHO classification diagnosis.

The study did not categorize excessive or insufficient semen volume. However, abnormal semen volume often involves a series of...

The relationship between this condition and the diagnosis and treatment of infertility cannot be ignored. Therefore, we consider semen volume...

A volume of less than 2 mL is diagnosed as low semen volume, while a volume of more than 6 mL is diagnosed as high semen volume.

**Western Medical Treatment**

**(I) Drug Treatment**

(1) For hypogonadism caused by pituitary hypofunction, the results of endocrine hormone tests can be used to determine the cause.

If the result is adverse, appropriate hormone supplementation should be given. Commonly used hormones include hCG, hMG, or a combination of both, as well as undecanoic acid.

Short-acting or long-acting testosterone preparations, etc. Hormone therapy often has a significant effect on improving sexual function and secondary sexual characteristics.

However, it had no statistical significance in terms of clinical efficacy regarding semen volume.

(2) In most patients with accessory gland infection, ejaculation volume returned to normal after the inflammation was controlled.

Treatment should be based on microbiological testing of prostatic fluid or semen, and antibiotics with sensitive efficacy should be selected.

Due to the prostate's unique anatomical structure, most medications cannot reach effective bactericidal concentrations within the prostate.

Therefore, the use of antibiotics should also prioritize those that easily diffuse into the prostate gland. These types of drugs have certain characteristics...

These are generally lipid-soluble, basic drugs that readily bind to plasma proteins. The widespread overuse of novel antibiotics in recent years...

The increasing number of drug-resistant strains has made antibiotic selection difficult. In clinical practice, combination therapy is used based on drug sensitivity results.

Using drugs such as nitrofurantoin or rifampin often brings unexpected results.

**(II) Assisted Reproduction Technology**

In clinical practice, the effects of drug and surgical treatments for abnormal semen volume are mostly unsatisfactory, therefore the most direct...

The most effective and commonly used method is through fertilization technology.

(1) There is currently no specific treatment for congenital abnormalities of accessory glands. Furthermore, because they are often accompanied by other...

In cases of reproductive organ malformation, such as testicular agenesis, artificial insemination using donor semen is often necessary.

(2) Simple low semen volume. If the total number of grade A and grade B motile sperm in the semen is less than 1000...

For those with over 10,000 sperm, this portion can be collected through in vitro semen processing for intrauterine artificial insemination; if the sperm count is...

Sperm with low density or lack of high motility can be collected multiple times, cryopreserved, and then thawed before use.

Artificial insemination, or in vitro fertilization-embryo transfer using ICSI technology.

(3) Infertility caused by excessive semen volume. If the sperm density and quality of the foremilk are good, it is possible to improve the condition.

A fractional ejaculation method is used to collect the foremilk for artificial insemination. Alternatively, external treatment methods such as upstream washing can be employed.

After treatment, artificial insemination can be performed either outside the cervix or inside the uterus.

(4) Obstruction of the vas deferens caused by ejaculatory duct obstruction or other reasons. Although it can be corrected surgically...

While this method is generally effective, the results are usually unsatisfactory. In such cases, sperm can be collected by epididymal or testicular puncture, followed by in vitro fertilization and embryo transfer using ICSI technology.

**(III) Other Treatments**

Monotherapy is often ineffective for chronic accessory gland inflammation, and a combination of methods is frequently used in clinical practice.

Combined treatment. Commonly used methods include:

(1) Local hot water sitz bath: The water bath should be 42℃~43℃, 1~2 times a day, 15~20 minutes each time.

(2) Regular prostate massage: 1-2 times a week for 4-8 consecutive times. Urinate immediately after the massage.

(3) Physiotherapy: Iontophoresis, microwave therapy and magnetic therapy, etc.

(4) Local drug instillation in the prostate: In the past, drug instillation was mostly performed by perineal or rectal puncture.

However, because the medication accumulates at the puncture site, it is difficult for it to penetrate to other parts of the prostate and is prone to causing damage.

It can even cause iatrogenic secondary infections; therefore, some scholars do not advocate using this treatment. Currently in China...

Cheng Huaijin's double-balloon four-lumen catheter injection method, using a pressure infusion method through the prostatic urethral opening, allows the drug to be administered more effectively.

It diffuses retrogradely through the glandular ducts into the prostate gland and even the seminal vesicles. Although this method still has many drawbacks, because...

It causes minimal damage and has good results, making it a new technology worth promoting.

**Traditional Chinese Medicine Treatments**

**(I) Insufficient Semen Volume**

Deficiency syndromes are more common than blood stasis syndromes. Deficiency syndromes are caused by a lack of kidney essence, qi, and blood, or by heat damaging body fluids; blood stasis syndromes are caused by obstruction of the seminal ducts.

1. Kidney essence deficiency syndrome

[Indications]Slow sperm count, infertility, forgetfulness, tinnitus, lower back and knee weakness, fatigue, accompanied by decreased libido.

The patient presents with impotence, premature ejaculation, pale red tongue with a thin white coating, and a deep, thready pulse.

[Treatment] Replenish kidney essence.

[Prescription] Modified Sheng Sui Yu Lin Dan (from *Bian Zheng Lu*). Ingredients: Ginseng, Dioscorea opposita, Cistanche deserticola, Cuscuta chinensis, Placenta officinalis.

Carrot, Rehmannia glutinosa, Angelica sinensis, Lycium barbarum, Morus alba, Ophiopogon japonicus, Tortoise plastron (decocted first), Cornus officinalis, Schisandra chinensis, Platycladus orientalis seed.

2. Qi and Blood Deficiency Syndrome

[Main Symptoms] Low semen volume, infertility, fatigue, emaciation, shortness of breath, reluctance to speak, dizziness.

Palpitations and anxiety, pale complexion, pale tongue with white coating, and weak pulse.

[Treatment] Replenish Qi and nourish blood.

[Prescription] Modified Shi Quan Da Bu Tang (from Taiping Huimin Heji Ju Fang).

3. Heat-induced damage to the seminal vesicles

[Main Symptoms] Low semen volume, infertility, hot flashes in the palms, soles, and chest, dry mouth and throat, irritability and insomnia, red tongue with little coating.

The pulse is thin and rapid.

[Treatment] Nourish Yin and generate essence.

[Prescription] Modified Da Bu Yin Wan (from "Medical Orthodox Transmission").

4. Symptoms of obstruction of the seminal vesicle

[Main Symptoms] Low semen volume, infertility, chest and rib discomfort, loss of appetite, lower abdominal pain, or ejaculation.

Pain, fever, dry mouth and throat, dark tongue with ecchymosis and petechiae, and a deep, wiry or hesitant pulse.

[Treatment Method] Unblock the meridians.

[Prescription] Modified Jingmai Shutong Decoction (empirical formula). Ingredients: Impatiens balsamina, Liquidambar formosana, Pangolin scales, Corydalis yanhusuo, and Ligusticum striatum.

Ginseng, peach kernel, safflower, Sichuan achyranthes root, lychee seed, dodder seed, cynomorium, and prepared cyperus rhizome.

**(II) Excessive Semen Volume**

It is called excess, but in reality it is deficiency. It is due to weak kidney qi or deficiency of the fire of the gate of life, and can occasionally be seen in those with excessive damp heat.

1. Kidney Qi Deficiency Syndrome

[Main Symptoms] Excessive semen volume, lower back pain, fatigue, premature ejaculation, frequent and clear urination, and dribbling after urination.

The tongue is pale and the pulse is thin and weak.

[Treatment] Tonify the kidneys and consolidate essence.

[Prescription] Modified Gujing Pill (from Jisheng Fang).

2. Deficiency of Fire in the Gate of Life (Mingmen)

[Main Symptoms] Excessive semen volume with thin and watery consistency, lower back pain and weak knees, aversion to cold and cold limbs, pale complexion, dizziness and tinnitus.

The patient has clear and copious urine, loose stools, a pale and swollen tongue with a white coating, and a deep, thready, and weak pulse at the cun position.

[Treatment] Warm and tonify kidney yang.

[Prescription] Zanyudan (from Jingyue Quanshu) with added ingredients.

3. Damp-heat retention syndrome

[Main Symptoms] Excessive semen volume, obesity, dark yellow and cloudy urine, dribbling white discharge after urination, chest tightness, irritability, and dry mouth.

The tongue is sticky, with a thick, yellow, greasy coating, and the pulse is slippery.

[Treatment] Resolve phlegm and dampness, clear heat.

[Prescription] Modified Bi Xie Shen Shi Tang (from *Collection of Experiences in Ulcer Treatment*). Ingredients: Dioscorea hypoglauca, Coix lacryma-jobi, Phellodendron chinense, Poria cocos, Paeonia suffruticosa, Alisma plantago-aquatica.

The formula includes: purgative, talc, akebia stem, atractylodes macrocephala, magnolia flower, patchouli, and turmeric.

**VII. Prevention and Care**

(1) Participate in appropriate physical exercise to enhance the body's disease resistance.

(2) Regulate emotions and increase confidence in disease treatment.

(3) Control the frequency of sexual intercourse. It is not advisable to have sex too frequently, nor is it advisable to abstain from sex for a long time.

(4) Avoid tobacco, alcohol, spicy and other irritating foods, as well as rich, greasy foods.

(5) Actively treat the primary disease.