Diagnosis and treatment of low sperm motility and high teratospermia

**Low sperm motility**

Low sperm motility, also known as asthenospermia, refers to a condition where sperm density is low when a semen analysis is performed within one hour after ejaculation.

≥20×10⁶/mL, while <25% of sperm are rapidly linearly forward-moving, indicating poor or no sperm motility.

Sperm motility. Sperm motility is an important function of normally mature sperm. This function ensures...

It facilitates the meeting of sperm and egg during reproduction and participates in the mechanical penetration of the egg by the sperm.

Sperm motility is one of the main factors determining whether conception occurs. Some patients, despite having a low sperm count, still have [fertility/fertility].

If sperm motility is good, conception is still possible; however, if sperm motility is extremely low, it often leads to infertility.

(education) disease.

**Western Medical Etiology and Pathology**

**(I) Genital Infections**

Genital infections can cause changes in seminal plasma composition, including a decrease in zinc, magnesium, citric acid, fructose, and pH levels.

Elevated levels of certain substances can affect sperm motility. Some studies have found that E. coli infection of the reproductive tract can cause acute epididymitis.

Epididymitis and prostatitis. Epididymal infection can affect sperm maturation and sperm motility; prostatitis, on the other hand, can cause...

A decrease in albumin levels in prostatic fluid. Albumin in prostatic fluid not only promotes sperm motility...

It has the power to protect sperm from damage caused by seminal vesicle fluid. Bacterial infection of the seminal vesicles increases the secretion of seminal vesicle fluid, and...

Seminal vesicle fluid can inhibit sperm motility.

**(II) Varicocele**

Varicocele leads to increased testicular temperature and testicular tissue hypoxia, affecting testicular metabolism and causing...

Chronic testicular poisoning inhibits spermatogenesis and severely reduces sperm motility.

**(III) Drug Factors**

Using certain drugs that inhibit or reduce sperm motility, such as gossypol, cyclophosphamide, colchicine, and phenazine.

Sugar tablets and similar substances can reduce sperm motility.

**(iv) Physical and Environmental Factors**

High-temperature work, hot baths, and other activities can cause excessively high testicular temperature, reducing sperm motility; radiation...

Radiation can have a direct effect on the testes, or frequent exposure to low doses of radiation can significantly reduce sperm motility.

Unhealthy habits, such as smoking, excessive drinking, or even drug use, can all reduce sperm motility.

**(V) Nutritional Deficiency Factors**

A deficiency in vitamins A, C, and E, as well as trace elements such as zinc and magnesium, can reduce sperm motility.

**(vi) Other factors**

Endocrine factors, immune factors, systemic diseases, congenital diseases, etc. can all cause low sperm motility.

Lower disease.

**(vii) Idiopathic hypospermia**

Its etiology and pathogenesis still need further research.

**Traditional Chinese Medicine Etiology and Pathogenesis**

**(I) Damp-Heat Accumulation in the Lower Body**

Excessive consumption of spicy, fatty, or rich foods, or alcohol abuse, can lead to stagnation in the stomach and intestines, damage to the spleen and stomach, and impaired spleen function.

Phlegm and dampness generate internally, which over time transforms into heat, and the evil of damp-heat accumulates in the lower burner; or infection with dampness causes the accumulation of dampness and the generation of heat, disturbing the seminal orifice, affecting...

Vaporization of sound reduces sperm motility.

**(II) Kidney Yang Deficiency**

Kidney yang deficiency can result from congenital insufficiency or excessive sexual activity. Kidney yang is the driving force behind sperm motility.

Yang deficiency leads to low sperm motility.

**(III) Acquired Malnutrition**

Prolonged or severe illness, physical weakness, and insufficient qi and blood, or even kidney yin deficiency or both kidney yin and yang deficiency, can all lead to...

Sperm motility is reduced.

**Key Points of Western Medicine Diagnosis**

**(I) Medical History**

If it is idiopathic hypospermia, there is no specific medical history; if it is caused by a related disease, corresponding symptoms will appear.

Medical history.

**(II) Symptoms and Signs**

(1) Symptoms: Patients with idiopathic hypospermia may not have obvious clinical symptoms.

Some patients experience decreased sexual function, such as impotence and premature ejaculation, while others may exhibit symptoms such as fatigue, weakness, and cold limbs.

Symptoms may also include prostatitis, seminal vesiculitis, or testicular or epididymal lesions.

(2) Physical signs: Generally, there are no obvious physical signs. However, when the decrease in sperm motility is caused by a related disease, there may be...

Corresponding physical signs of certain related diseases.

**(III) Laboratory Tests**

(1) Sperm motility test: Sperm motility is generally divided into four levels.

Level 0: No activity.

Grade I: This indicates poor motility, meaning the sperm only move or rotate in place and do not move forward.

Grade II: Moderate motility, indicating slow or undirected forward movement of sperm.

Level III: Rapid forward linear motion.

If less than 50% of the sperm are grade II or III, the patient can be diagnosed with hypomotility disorder.

(2) Routine prostate fluid endoscopy: to determine if there is prostatitis.

**Western Medical Treatment**

**(I) Drug Treatment**

Antibacterial treatment is suitable for those with decreased sperm motility due to genital tract infections, and is indicated when a definite cause has been identified.

Treatment varies depending on the specific disease. For example, the following medications can be used to treat idiopathic hypospermia:

(1) Kallikrein.

(2) Nucleoside enzymes.

(3) Arginine.

(4) Vitamins.

**(II) Surgical Treatment**

For patients with varicocele, varicocelectomy or high ligation of the spermatic vein may be considered.

**Traditional Chinese Medicine Treatments**

**(I) Kidney Yang Deficiency Syndrome**

[Main Evidence] Infertility after marriage, low sperm motility, lethargy, cold limbs, or low libido.

Impotence, or weak erection, seminal emission, frequent urination with clear urine, pale tongue with teeth marks on the edges, white tongue coating, pulse...

Deliberate and meticulous.

[Treatment] Warm the kidneys and strengthen yang, replenish qi and consolidate essence.

[Prescription] Modified Yougui Yin (from *Jingyue Quanshu*). For those with deficiency of both spleen and kidney, and deficiency of both yang, add Astragalus complanatus and Alpinia oxyphylla.

Seal kidney.

**(II) Kidney Yin Deficiency Syndrome**

[Main Evidence] Infertility after marriage, low sperm motility, dizziness and tinnitus, insomnia and excessive dreaming, lower back pain and weak legs, night sweats.

Sweating, or premature ejaculation, impotence, short and yellow or cloudy urine, red tongue with little coating, and thready and rapid pulse.

[Treatment] Nourish Yin and tonify the kidneys.

[Prescription] Modified Zuogui Yin (from Jingyue Quanshu) combined with Wuzi Yanzong Wan (from Danxi Xinfa).

**(III) Qi and Blood Deficiency Syndrome**

[Main Symptoms] Infertility after marriage, low vitality, physical weakness, dizziness, poor appetite, lethargy, and weakness in the limbs.

The patient presented with a sallow complexion, listlessness, pale tongue, and weak pulse.

[Treatment] Replenish qi and blood, nourish the kidneys and generate essence.

[Prescription] Modified Bazhen Decoction (from Zhengti Leiyao).

**(iv) Damp-Heat Accumulation Syndrome**

[Main Symptoms] Infertility after marriage, low vitality, flushed face and ears, bitter taste in mouth and dry throat, chest and rib pain, lower abdominal pain, and lower back pain.

Symptoms include swollen and painful genitals and testicles, scanty and yellow urine, or dribbling after urination, constipation, yellow and greasy tongue coating, and weak pulse.

Number of chords.

[Treatment] Clear heat and promote diuresis.

[Prescription] Modified Longdan Xiegan Decoction (from "Lan Shi Mi Cang").

**VI. Prevention and Care**

(1) During treatment, avoid smoking, alcohol, spicy and other irritating foods, strengthen nutrition, pay attention to hygiene, and avoid wearing tight clothing.

Pants.

(2) Pay attention to having regular sex life and avoid abstinence or excessive sexual activity.

**High rate of abnormal sperm morphology**

High teratospermia, also known as abnormal sperm morphology hyperspermia, is characterized by a sperm density >20 million/mL and rapid sperm motility.

A high percentage of sperm exhibiting rapid, linear forward motility (>25%), while the percentage of sperm with normal head morphology (<70%), is considered high.

Teratospermia.

**Western Medical Etiology and Pathology**

**(I) Etiology**

A large number of abnormal sperm indicates a testicular abnormality, which can be caused by a variety of factors. Certain medications, such as nitrofurans...

The drug can increase the sperm abnormality rate. In acute clinical cases, this increase in sperm abnormality rate is visible and persistent within 30 days.

70 days. Varicocele is often accompanied by double-headed sperm, band-like sperm heads, and an increase in foresperm cells.

Physical and psychological stress responses, allergic reactions, endocrine, vascular, and nervous system diseases, as well as other factors, also play a role.

It can cause abnormal sperm production. In addition, alcohol, tobacco, and chronic poisoning are also important causes of sperm abnormalities.

reason.

**(II) Pathology**

The determining factor for male fertility is sperm quality, including spermatogenesis, maturation, storage, and retrieval.

Sperm quality abnormalities occur when one or more of these processes change.

**Traditional Chinese Medicine Etiology and Pathogenesis**

This condition is often caused by excessive sexual activity, prolonged illness, inherent weakness of kidney qi, decline of the fire of the gate of life (mingmen), internal generation of yin and cold, and failure of the warming function, leading to...

Sperm abnormalities can result from incomplete sperm production and development; or from depletion of true yin due to smoking, excessive alcohol consumption, or the later stages of febrile diseases, leading to kidney yin deficiency.

Deficiency, yin deficiency and excessive fire, cannot nourish the reproductive essence, which can also lead to incomplete sperm production and development and deformities.

**Key Points of Western Medicine Diagnosis**

Commonly used staining methods for sperm morphology observation include: Giemsa staining (often used to evaluate different types of white blood cells).

Cells); Modified Papanicolaou staining (the most commonly used method in andrology laboratories, which can stain the post-acromial region of the sperm head,

Midsection and tail staining); Blaine-Leydberg staining (used for differentiating immature germ cells from leukocytes).

(Shore staining) (simple to use and sufficient for routine sperm morphology analysis). Human sperm specimens are in

After fixation and staining, observe and classify using a bright-field optical microscope, or observe the wet specimens using a high-quality phase-contrast microscope.

piece.

**Western Medicine Diagnostic Criteria and Differential Diagnosis**

**(I) Diagnostic Criteria**

Sperm density >20 million/mL, and >25% of sperm exhibiting rapid, linear forward motility, while sperm head abnormalities are present.

The number of sperm with different morphologies is >30%.

**(II) Differential Diagnosis**

Sperm abnormalities should be distinguished from sperm agglutination. Sperm agglutination is caused by the reaction of sperm antigens and sperm antibodies.

The original antibody reaction causes sperm to aggregate head-to-head, tail-to-tail, or head-to-tail; while sperm malformation...

This indicates an increased rate of sperm morphological abnormalities. The presence of numerous sperm containing cytoplasmic droplets suggests sperm abnormalities in the epididymis.

Disorders in the internal maturation process often indicate the presence of epididymal disease. Frequent ejaculation can lead to an increase in immature sperm.

This is because there isn't enough time for sperm to mature within the epididymis. Reproductive tract infections can cause a large number of white blood cells.

Cells. When semen is collected using the interrupted intercourse method, a greater number of stratified squamous cells and cells derived from the upper urethral epithelium can be observed.

Epithelial cells.

**Western Medical Treatment**

**(I) Elimination of related causes**

Examples include surgical treatment for varicocele and quitting smoking and alcohol.

**(II) Drug Treatment**

Based on the site of drug action, drugs can be categorized into pretesticular, testicular, and retrotesticular levels.

Pretesticular levels stimulate the release of endogenous gonadotropins or increase the activity of endogenous gonadotropins.

To promote spermatogenesis: Drugs that act at the testicular level may work by correcting specific metabolic processes during spermatogenesis.

It works by addressing defects; drugs acting on the testes can promote sperm maturation and increase sperm motility.

The medications used include clomiphene, vitamin C, vitamin E, and vasodilator.

**(III) In Vitro Sperm Processing**

Assisted reproductive technology involves processing sperm in vitro to remove abnormal sperm, white blood cells, and other abnormalities.

**Traditional Chinese Medicine Treatments**

The kidneys are the foundation of innate essence and govern reproductive essence; therefore, sperm abnormalities should be treated by addressing kidney deficiency. Kidney deficiency is essentially due to excessive yang energy.

It's just deficiency, specifically yin deficiency.

**(I) Kidney Yang Deficiency Syndrome**

[Main Symptoms] Infertility after marriage, high sperm abnormality rate, impotence, premature ejaculation or nocturnal emission, lower back and knee pain, and aversion to cold.

Cold limbs, clear and copious urine, frequent urination at night, lower limb edema, pale and swollen tongue with a thin white coating, and a deep, thready or slightly thready pulse.

[Treatment] Tonify the kidneys and strengthen yang, replenish qi and essence.

[Prescription] Modified Zanyudan (from Jingyue Quanshu).

**(II) Yin Deficiency with Hyperactivity of Fire Syndrome**

[Main Evidence] Infertility after marriage, excessive sperm abnormalities, dizziness and tinnitus, insomnia and night sweats, lower back and knee weakness, five

Symptoms include irritability, dry mouth and throat, scanty and dark urine, increased libido, or seminal emission and premature ejaculation with scanty and viscous semen. The tongue is red with little discharge.

The tongue coating is dry, and the pulse is thready and rapid.

[Treatment] Nourish Yin and reduce fire, benefit the kidneys and replenish essence.

[Prescription] Modified Da Bu Yin Wan (from Danxi Xinfa).