decreased ejaculate volume
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Hypospermia is a condition in which a man has an unusually low
ejaculate Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the male reproductory tract as a result of an orgasm. It is the final stage and natural objective of male sexual stimulation, and an essential component ...
(or
semen Semen, also known as seminal fluid, is an organic bodily fluid created to contain spermatozoa. It is secreted by the gonads (sexual glands) and other sexual organs of male or hermaphroditic animals and can fertilize the female ovum. Semen i ...
) volume, less than 1.5 mL. It is the opposite of
hyperspermia In medicine hyperspermia is a condition where a male has an abnormally large amount of semen or ejaculate volume and is generally defined when the ejaculate is above 5.5 ml.Padubidri; Daftary (2011). Shaw's Textbook of Gynaecology, 15e. p. 204. I ...
, which is a semen volume of more than 5.5 mL. It should not be confused with
oligospermia Terms oligospermia, oligozoospermia, and low sperm count refer to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm ...
, which means low
sperm count A semen analysis (plural: semen analyses), also called seminogram or spermiogram, evaluates certain characteristics of a male's semen and the sperm contained therein. It is done to help evaluate male fertility, whether for those seeking pregnancy ...
. Normal ejaculate when a man is not drained from prior sex and is suitably
aroused Sexual arousal (also known as sexual excitement) describes the physiological and psychological responses in preparation for sexual intercourse or when exposed to sexual stimuli. A number of physiological responses occur in the body and mind ...
is around 1.5–6 mL, although this varies greatly with mood, physical condition, and sexual activity. Of this, around 1% by volume is sperm cells. The U.S.-based National Institutes of Health defines hypospermia as a semen volume lower than 2 mL on at least two semen analyses. The presence of high levels of
fructose Fructose, or fruit sugar, is a Ketose, ketonic monosaccharide, simple sugar found in many plants, where it is often bonded to glucose to form the disaccharide sucrose. It is one of the three dietary monosaccharides, along with glucose and galacto ...
(a
sugar Sugar is the generic name for sweet-tasting, soluble carbohydrates, many of which are used in food. Simple sugars, also called monosaccharides, include glucose, fructose, and galactose. Compound sugars, also called disaccharides or double ...
) is normal in the semen and originates almost entirely from the seminal vesicles. The seminal vesicles, which are major contributors to ejaculate volume, render semen viscous with a pH of 7.2–7.8. An acidic seminal pH (pH < 7.2) suggests damage to the seminal vesicles and an alkaline seminal pH (pH > 8) suggests prostatic involvement. In addition, low fructose may indicate problems in the
prostate The prostate is both an Male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, ...
, while low semen pH may indicate problems related to the eminal vesicles Obstruction of the seminal vesicles results in low semen volumes since they normally produce 70% of the seminal plasma.


Signs and symptoms

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 Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation, sealing the bladder which besides inhibiting the releas ...
, 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:


Dysfunction of ejaculatory reflex

* Ejaculatory dysfunction is when a male is unable to ejaculate properly at the time of sexual climax. Ejaculatory reflex dysfunction is one of the leading causes in male infertility. * Some conditions in which ejaculatory reflex dysfunction is observed is
multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...
,
diabetic neuropathy Diabetic neuropathy is various types of nerve damage associated with diabetes mellitus. Symptoms depend on the site of nerve damage and can include motor changes such as weakness; sensory symptoms such as numbness, tingling, or pain; or autonomic c ...
, spinal cord injuries, or side effects of certain medications. Examples of dysfunction of ejaculatory reflex include:


Retrograde ejaculation

*This means that the sperm is produced in the testes but on its way out, it gets misdirected into the bladder rather than coming out through the urethra. This can lead to a low volume of semen (hypospermia) or no semen production (
aspermia Aspermia is the complete lack of semen with ejaculation (not to be confused with azoospermia, the lack of sperm cells in the semen). It is associated with infertility. One of the causes of aspermia is retrograde ejaculation, because of that th ...
). Structural or functional damage to th
bladder neck muscle
causes the backflow of semen during the ejaculation. Nerve damage caused by medical conditions such as diabetes or multiple sclerosis can affect the function of bladder neck muscle. Also, surgery or trauma along with the medications used for hypertension and
benign prostatic hyperplasia Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...
can contribute to bladder neck problems. Retrograde ejaculation can be diagnosed by the presence of sperm in the urine.


Anatomical defects

* Anatomical or functional defects of the seminal tract may cause flow obstruction of seminal pathways. This can be observed in people with genetic mutations (specifically the CFTR gene) or ejaculatory duct obstruction(s) such as
prostate The prostate is both an Male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, ...
or seminal vesicle cysts. *Mutations of the CFTR gene on chromosome 7 can cause an overproduction of thick, sticky mucus in organs with mucus glands, contribute to infertility through clogging the spermatic duct with mucus, and cause congenital bilateral absence of the vas deferens. Examples of anatomical defects include:


Congenital absence of vas deferens and seminal vesicle

*In the male reproductive system, there are structures such as
vas deferens The vas deferens or ductus deferens is part of the male reproductive system of many vertebrates. The ducts transport sperm from the epididymis to the ejaculatory ducts in anticipation of ejaculation. The vas deferens is a partially coiled tube ...
and
seminal vesicles The seminal vesicles (also called vesicular glands, or seminal glands) are a pair of two convoluted tubular glands that lie behind the urinary bladder of some male mammals. They secrete fluid that partly composes the semen. The vesicles are 5†...
which play an important role in transportation and production of semen or ejaculate. Abnormalities or absence of these structures can lead to low volume of semen and infertility in males. This condition can also be caused by the mutation in the cystic fibrosis transmembrane conductance regulator (
CFTR Cystic fibrosis transmembrane conductance regulator (CFTR) is a membrane protein and anion channel in vertebrates that is encoded by the ''CFTR'' gene. Geneticist Lap-Chee Tsui and his team identified the CFTR gene in 1989 as the gene linked wi ...
) gene which encodes for chloride channel protein.


Blockage of the ejaculatory duct

*This is a condition that is caused by obstruction of either one or both ejaculatory ducts leading to hypospermia. The etiology of ejaculatory duct obstruction can be congenital or acquired. The presence of a prostatic cysts, ejaculatory duct stones, or post surgical inflammation of the duct can block the normal flow of semen through the reproductive tract.


Hypogonadism

*Insufficient or low levels of testosterone in the body can affect the proper functioning of the male reproductive structures and thus lead to decreased secretions or hypospermia. Long-term exposure to drugs with anti-androgen properties (e.g. spironolactone) can also lead to infertility or low volume of semen. Testosterone is produced by the testes and can be used to diagnose
hypogonadism Hypogonadism means diminished functional activity of the gonads—the testes or the ovaries—that may result in diminished production of sex hormones. Low androgen (e.g., testosterone) levels are referred to as hypoandrogenism and low estrogen ...
.


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. Furthermore, common drugs used to treat
hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
and
benign prostatic hyperplasia Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...
(increased size of prostate) like tamsulosin are attracted to
dopamine Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic compound, organic chemical of the catecholamine and phenethylamine families. Dopamine const ...
and
serotonin Serotonin () or 5-hydroxytryptamine (5-HT) is a monoamine neurotransmitter. Its biological function is complex and multifaceted, modulating mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and vas ...
receptors in the brain to cause a decrease in sperm volume through a mechanism that remains unknown. Certain medications in the following classes of drugs may affect
spermatogenesis Spermatogenesis is the process by which haploid spermatozoa develop from germ cells in the seminiferous tubules of the testis. This process starts with the mitotic division of the stem cells located close to the basement membrane of the tubule ...
or sperm parameters*: * Immunosuppressants * Non-steroidal anti-inflammatory drugs (NSAIDs) and salicylates * Inhibitors of thyrosine kinases * Opiates * Treatment for benign prostatic hyperplasia * Hormonal treatments and antiadrenergic drugs * Antibiotics, antifungals, antiparasites, antivirals, and antimalarials * Antidepressants * Anti-gastroesophageal reflux drugs * Anti-epileptic drugs * Antihypertensive drugs Certain medications in the following classes of drugs may affect male sexual libido or sexual function**: * Immunomodulators * Inhibitors of protein kinases * Opioids * Analgesics * Treatment of benign prostatic hyperplasia * Antiadrenergic drugs * Hormonal treatments * Diuretics * Antiretroviral therapy * Antihistamines * Antidepressants *''"For most of the drugs that are likely to affect spermatogenesis and/or sperm parameters, the levels of scientific evidence are still insufficient (with the exception of Sirolimus, Sulfasalazine, exogenous testosterone, Finasteride and Cyproterone acetate, for which the levels of evidence are higher). In some cases, data in men do not even exist, and the toxicity of a drug for the male reproductive organs is determined solely on the basis of animal models."'' **''"For a certain number of pharmaceutical molecules that are likely to affect the sexual function of men being treated, the actual imputability of the drug is often difficult to pinpoint owing to the effect of the illness itself on sexuality (cardiovascular disease and erectile dysfunction; depressive illness and loss of desire, etc.)"'' Furthermore, hyperthyroidism, an excess of thyroid hormones, has been associated with reduced semen volume, reduced sperm density, motility, and morphology. Studies in humans show that an excess of circulating thyroid hormones during thyrotoxicosis results in
asthenozoospermia Asthenozoospermia (or asthenospermia) is the medical term for reduced sperm motility. Complete asthenozoospermia, that is, 100% immotile spermatozoa in the ejaculate, is reported at a frequency of 1 of 5000 men. Causes of complete asthenozoospermia ...
,
oligozoospermia Terms oligospermia, oligozoospermia, and low sperm count refer to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm ...
, and
teratozoospermia Teratospermia or teratozoospermia is a condition characterized by the presence of sperm with abnormal morphology that affects fertility in males. Causes The causes of teratozoospermia are unknown in most cases. However, Hodgkin's disease, coeliac ...
. These abnormalities frequently associate with semen alterations like reduced 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 Testosterone is the primary sex hormone and anabolic steroid in males. In humans, testosterone plays a key role in the development of Male reproductive system, male reproductive tissues such as testes and prostate, as well as promoting secondar ...
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 context of nutrition, a mineral is a chemical element required as an essential nutrient by organisms to perform functions necessary for life. However, the four major structural elements in the human body by weight (oxygen, hydrogen, carbon, ...
in the body can further compromise semen quality. A significantly lower
zinc Zinc is a chemical element with the symbol Zn and atomic number 30. Zinc is a slightly brittle metal at room temperature and has a shiny-greyish appearance when oxidation is removed. It is the first element in group 12 (IIB) of the periodi ...
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. Notably, no significant effects on sperm concentration, count, or sperm viability have been conclusively observed. The likely benefits of zinc in the semen stem from its multifaceted contributions to the stability of the membranes and sperm
chromatin Chromatin is a complex of DNA and protein found in eukaryotic cells. The primary function is to package long DNA molecules into more compact, denser structures. This prevents the strands from becoming tangled and also plays important roles in r ...
. In addition to zinc, nutritional deficiencies or excess intake of
selenium Selenium is a chemical element with the symbol Se and atomic number 34. It is a nonmetal (more rarely considered a metalloid) with properties that are intermediate between the elements above and below in the periodic table, sulfur and tellurium, ...
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.


Dietary pattern

In general, a healthy dietary pattern is encouraged, and food modifications may be useful in promoting sperm quality. Some studies have concluded that intake of antioxidants is associated with better sperm parameters as high concentrations of reactive oxygen species can negatively affect the sperm. Consumption of an adequate portion of vegetables and fruits, dietary fibers,
omega-3 Omega−3 fatty acids, also called Omega-3 oils, ω−3 fatty acids or ''n''−3 fatty acids, are polyunsaturated fatty acids (PUFAs) characterized by the presence of a double bond, three atoms away from the terminal methyl group in their chem ...
, poultry, and low-fat dairy products may help to lessen risk of male infertility. On the other hand, diets that have been negatively associated with male infertility include high intake of potatoes, soy foods, coffee, alcohol, and sweetened beverages. According to a review, higher consumers of
cola Cola is a carbonated soft drink flavored with vanilla, cinnamon, citrus oils and other flavorings. Cola became popular worldwide after the American pharmacist John Stith Pemberton invented Coca-Cola, a trademarked brand, in 1886, which was imita ...
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
xenoestrogen Xenoestrogens are a type of xenohormone that imitates estrogen. They can be either synthetic or natural chemical compounds. Synthetic xenoestrogens include some widely used industrial compounds, such as PCBs, BPA, and phthalates, which have estro ...
s 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 The DASH diet (Dietary Approaches to Stop Hypertension) is a dietary pattern promoted by the U.S.-based National Heart, Lung, and Blood Institute (part of the National Institutes of Health (NIH), an agency of the United States Department of Healt ...
or
Mediterranean diet The Mediterranean diet is a diet inspired by the eating habits of people who live near the Mediterranean Sea. When initially formulated in the 1960s, it drew on the cuisines of Greece, Italy, France and Spain. In decades since, it has also incor ...
. 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 Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...
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.


Seminal chemistry

Seminal chemistry is a second-line examination needed in the event of suspicion of abnormalities of the excretory genital tract. This examination consists of measuring biochemical markers of the prostate, seminal vesicles and epididymis and seminal plasma, which can indicate the level of damage in these areas and help locate the level of lesions in the cases of hypospermia. The biochemical markers that are measured are
alpha-glucosidase α-Glucosidase (EC 3.2.1.20, maltase, glucoinvertase, glucosidosucrase, maltase-glucoamylase, α-glucopyranosidase, glucosidoinvertase, α-D-glucosidase, α-glucoside hydrolase, α-1,4-glucosidase, α-D-glucoside glucohydrolase; systematic na ...
(in the epididymis),
fructose Fructose, or fruit sugar, is a Ketose, ketonic monosaccharide, simple sugar found in many plants, where it is often bonded to glucose to form the disaccharide sucrose. It is one of the three dietary monosaccharides, along with glucose and galacto ...
(in the seminal vesicles) and
zinc Zinc is a chemical element with the symbol Zn and atomic number 30. Zinc is a slightly brittle metal at room temperature and has a shiny-greyish appearance when oxidation is removed. It is the first element in group 12 (IIB) of the periodi ...
,
citric acid Citric acid is an organic compound with the chemical formula HOC(CO2H)(CH2CO2H)2. It is a colorless weak organic acid. It occurs naturally in citrus fruits. In biochemistry, it is an intermediate in the citric acid cycle, which occurs in t ...
and/or
acid phosphatase Acid phosphatase (EC 3.1.3.2, acid phosphomonoesterase', phosphomonoesterase, glycerophosphatase, acid monophosphatase, acid phosphohydrolase, acid phosphomonoester hydrolase, uteroferrin, acid nucleoside diphosphate phosphatase, orthophosphoric-m ...
(for the prostate). The levels of these biological markers are lowered in a variable manner depending on the level of damage to the genital tract.


CTFR screening

Depending on the severity of the hypospermia (volume ≤ 1 mL) a molecular study of the
CFTR Cystic fibrosis transmembrane conductance regulator (CFTR) is a membrane protein and anion channel in vertebrates that is encoded by the ''CFTR'' gene. Geneticist Lap-Chee Tsui and his team identified the CFTR gene in 1989 as the gene linked wi ...
gene may be performed. This is done by a molecular "screening" method (high performance liquid chromatography under denaturing conditions (D-HPLC) followed by sequencing of the exons of interest, allowing to detect nearly 95% of mutations in this gene, and even discover new mutations. After this molecular screening step, if variants of the ''CFTR'' gene are detected, the geneticist will use computer databases to distinguish whether this nucleotide variant corresponds to a polymorphism of the ''CFTR'' gene (without consequence on the function of the ''CFTR'' protein) or to a real mutation.


Semen analysis

A common route to diagnosis for hypospermia that may be requested for is a
semen analysis A semen analysis (plural: semen analyses), also called seminogram or spermiogram, evaluates certain characteristics of a male's semen and the sperm contained therein. It is done to help evaluate male fertility, whether for those seeking pregnancy ...
. To obtain the most fresh specimen collection, a semen sample is obtained through the process of
masturbation Masturbation is the sexual stimulation of one's own genitals for sexual arousal or other sexual pleasure, usually to the point of orgasm. The stimulation may involve hands, fingers, everyday objects, sex toys such as vibrators, or combinatio ...
in the setting of a laboratory. An abstinence period of 3–5 days is recommended prior to collection of samples. If a semen analysis cannot be completed, an alternative route to collecting a semen is through
coitus interruptus ''Coitus interruptus'', also known as withdrawal, pulling out or the pull-out method, is a method of birth control in which a man, during sexual intercourse, withdraws his penis from a woman's vagina prior to ejaculation and then directs his ej ...
into a bottle. Normally, a typical specimen displays coagulation after ejaculation due to the presence of enzymes within the seminal vesicle, followed by liquification in approximately 30 minutes.


Urine collection

Furthermore, when the semen volume is low, less than 1 ml, a urine specimen should be collected immediately after masturbation to search for sperm in the urine. 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 MACA or maca can mean: * Maca (plant) Places Geography * Maca District, Peru * Cerro Macá, stratovolcano in the Aisén Region of Chile * Maca River, Romania Outer space * 5228 Máca, a minor planet People * Alain Maca (born 1950), Belgian ...
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 Artificial insemination is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatment ...
(IUI),
in vitro fertilization In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...
(IVF), and
intracytoplasmic sperm injection Intracytoplasmic sperm injection (ICSI ) is an in vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for the obtention of emb ...
(ICSI) for successful conception. These procedures can be very costly and involve a high risk of birth defects.


Prevention

A study was done to compare the sperm outcomes of individuals with or without infection of the
human papilloma virus Human papillomavirus infection (HPV infection) is caused by a DNA virus from the ''Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and res ...
(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

*
Aspermia Aspermia is the complete lack of semen with ejaculation (not to be confused with azoospermia, the lack of sperm cells in the semen). It is associated with infertility. One of the causes of aspermia is retrograde ejaculation, because of that th ...


References

{{Male diseases of the pelvis and genitals , state=expanded Testicular infertility factors