Hypospermia

The most common sign of hypospermia is a low volume of semen during ejaculation. The diagnosis is confirmed when one has a semen volume of less than 2.0 mL on at least two successive spermograms. If hypospermia is caused by retrograde ejaculation, sign include cloudy urine after orgasm. There may not be any symptoms of hypospermia unless it is caused by an abnormality. == Causes ==

Even though there are numerous causes for hypospermia, all of the known contributing factors can be placed into two major distinct categories: Drugs Drugs can have various types of impact on the male body, side effects of medications may affect male fertility, spermatogenesis, and sexual function. Drugs can affect sperm parameters by inhibiting normal exocrine functions of the testes which can lead to a decrease in production of sperm, or by creating hormone imbalances. For an example, anti-androgenic drugs like spironolactone, cimetidine, and ketoconazole can disrupt androgens in the glands and seminal tract to cause a decrease in production of semen volume. == Lifestyle factors ==

Alcohol use Lifestyle factors, such as substance use or adiposity, can play a detrimental role in the quality of the semen. One study examining the consequences of alcohol consumption and its effect on semen quality concluded that alcohol intake can lead to a negative effect on semen volume in daily alcohol consumers. However, occasional or moderate use of alcohol was observed to not have an adverse effect on the semen. Body mass index (BMI) A body mass index (BMI) level not within normal range can also affect semen quality negatively. Being underweight, presented by a low BMI value, was observed in an analysis to decrease the total sperm count and semen volume. No significant changes were observed in sperm concentration and motility due to a low BMI. However, due to the lack of raw data, further research is needed to clarify the role of BMI in semen quality. On the other hand, an overweight (BMI of 25.9–29.9) or obese status (BMI over 30) is similarly associated with low semen quality through a decrease of semen volume, concentration, motility, count, and morphology. Alteration of sex hormone levels were also concluded to result from a high BMI status, with affected hormones such as inhibin B or testosterone observed to decrease in concentration, whereas estradiol was increased. The reduction in hormone levels can subsequently result in being diagnosed with hypogonadism. Trace minerals An inadequate level of essential trace minerals in the body can further compromise semen quality. A significantly lower zinc plasma concentration value within the semen was observed in infertile males. Supplementation with zinc could benefit sperm quality by increasing the semen volume and improving sperm motility and morphology. In addition to zinc, nutritional deficiencies or excess intake of selenium is also associated with impaired semen quality. However, in moderate levels, the antioxidant properties of selenium, likely due to an increase in glutathione peroxidase-1 activity (enzyme protecting from oxidative damage) and reduction of reactive oxygen species (ROS) production, may be recommended for supplementation. According to a review, higher consumers of cola showed a statistically significant decrease in semen volume. The high starch levels in potatoes promotes oxidative stress along with risk of inflammation from a resulting high glycemic index. Meanwhile, processed meats can possibly contain xenoestrogens and may compromise semen quality. However, additional research is warranted prior to recommending a set dietary regimen in regard to improving sperm parameters. Currently, the only general recommendation that can be made is to adhere to a healthy dietary pattern such as the DASH diet or Mediterranean diet. As low density of the sperm population is usually associated with infertility, hypospermia becomes an infertility issue when one is also identified to have oligospermia. Further semen analysis may be needed prior to being identified as oligospermic. When a semen analysis does indicate abnormal results, lifestyle factors recommendations prior to a new semen sample include a nutritional diet, as well as limitations on smoking and alcohol use. A cold bath and removal of tight-fitted underwear apparel may also be recommended within the month prior to re-examination. == Etiological testing ==

Ultrasound imaging Imaging the urogenital system via an ultrasound is the first-line imaging test for hypospermia. This assessment looks out for testicular degeneration, testicular anomalies, and carry out a detailed study of the deep genital tract and glands using a high endorectal probe frequency. This examination makes it possible to visualize the vas deferens over their pelvic path and therefore to diagnose possible agenesis (absence of cells within organs) on portions not accessible to clinical examination. Two days before the urine sample is collected, one is required to drink an alkalinized water to allow the sperm cells to survive. After this preliminary preparation step, urine collection is done in a fractional way: the first milliliters of urine are collected and analyzed in isolation through centrifugation and examination under a microscope. The presence of substantial sperm in the post-ejaculatory urine specimen confirms the diagnosis of partial retrograde ejaculation, a dysfunction of the ejaculatory reflex and a known cause of hypospermia. Unfortunately, even after thorough etiological assessments, an assessor many come to the conclusion of no known etiological cause to explain one's diagnosis of hypospermia. The significance of these idiopathic hypospermia cases are currently unknown and requires more research in the future. == Treatment ==

Although there are no existing medications on the market for the treatment of hypospermia, some medications and herbal medications have off label uses which can aid in the treatment of this condition and should be considered as soon as possible. According to a review, the use of maca has shown to improve semen volume through an unclear mechanism. In addition, some classes of medications that have been studied include both antidepressants and vessel dilators. Use of pharmacological therapy is uncommon thus individual must rely on psychosexual therapy. Psychosexual therapy addresses issues focused on sexual skills/techniques, self esteem, performance anxiety and interpersonal conflict. Furthermore, according to a review, longer abstinences from sexual intercourse has been associated with increases in sperm count and semen volume. According to a review, the management for hypospermia will depend upon the etiology of the disease. Studies have shown that functional retrograde ejaculation can be treated with oral pharmacotherapy such as imipramine and pseudoephedrine which can prevent the backflow of semen and stimulate ejaculation. In the case of structural retrograde ejaculation, pharmacotherapy might not work but surgical procedures can fix the bladder neck problem. The blockage of the ejaculatory duct can be treated via transurethral resection of the ejaculatory duct (TURED) and is indicated for people with low sperm volume. TURED has been shown to improve the volume of semen in men with ejaculatory duct obstruction leading to significant improvement in the fertility rate. Hormonal abnormalities caused by either primary or secondary hypogonadism can be treated with off-label use of oral clomiphene citrate which has been shown to increases the level of testosterone in the body. Administration of exogenous testosterone for the treatment of hypogonadism has shown to a have negative impact on the process of spermatogenesis. Abnormalities in the seminal vesicle and vas deferens usually don't respond well to surgeries or medications. In such situations, sperm can be extracted along with assisted reproductive technologies (ARTs) such as intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) for successful conception. These procedures can be very costly. == Prevention ==

A study was done to compare the sperm outcomes of individuals with or without infection of the human papilloma virus (HPV), which currently affects 79 million Americans. The study concluded that individuals who had not been infected with HPV had higher rates of sperm motility, functionality, and concentration of sperm. This study suggests that individuals who do not contract HPV or who are vaccinated against HPV have better fertility outcomes than those who are not vaccinated or who have contracted HPV. Vaccination against HPV with Gardasil9 can be administered by hospitals, clinics or most pharmacies in 3 doses ideally at age 11–12 in both girl and boys, but can be taken up to age 45 per Center of Disease Control (CDC) guidelines. == See also ==