One of the most common and intractable problems we face as fertility specialists is teratospermia and oligoasthenoteratospermia. First of all, let’s be clear that men participate in the process of conception with a very poor genetic makeup. This is because we use tens of millions of spermatozoa to fertilise our partner’s single egg, without knowing that only 4% of these are of normal morphology and therefore capable of fertilising. This percentage used to be higher, reaching 14%, but it has had to be lowered in accordance with the latest guidelines of the World Health Organisation. The problem is complicated by the fact that many laboratories underestimate the morphology test and give information that is not accurate. In many cases it is even necessary to repeat the test to reveal the real problem.
Teratospermia is when the total sperm count is normal but the typical and normal forms of spermatozoa are less than 4%.
Oligospermia refers to concentration, i.e. the amount of sperm in a semen sample, according to the World Health Organization (WHO) criteria and a sample should have a concentration of more than 15 million sperm per mL of ejaculate sample, to be considered normal. Proportionally, that is, if a sample has a total volume of 2 mL it should have more than 30 million spermatozoa in total to be considered normal. If a sample has a concentration of less than 15 million sperm per mL it is considered oligospermic.
Similarly, asthenospermia refers to the motility of a sperm specimen, and to be considered normal, it should be above 40% for total motile-moving spermatozoa, and should be above 32% for fast and briskly forward moving spermatozoa. If these motility criteria are not met, the specimen shall be considered as an asthenospermic specimen.
The term oligoasthenoteratospermia is the condition combining all three of the above pathological conditions with reduced concentration, poor movement and abnormal morphology according to normal values set by the World Health Organization (WHO).
Etiology
The actual etiology of teratospermia is unknown. It is thought that an important role is played by oxidative stress in the testis, whether this is caused by chronic inflammation, environmental factors (e.g. smoking, alcohol) or varicocele.
General treatment
– Avoiding toxic factors such as smoking, alcohol and of course drugs
– Avoiding weight gain and pursuing weight loss for the overweight men, as well as adding physical exercise in the daily activity routine
– Pursuing relatively frequent ejaculation, at least 2-3 times per week. The latest studies report that frequent ejaculation causes the testicle to “work” more efficiently, renewing the sperm population and reducing the time they are exposed to the oxidant factors.
– Avoiding electromagnetic radiation, especially from mobile phones and computers located near the genital area.
– Administration of antioxidant agents (e.g. carnitine, zinc and vitamin E).It should be noted though, that for them to be effective, the oxidative stress must first be eliminated, otherwise they are truly ineffecive.
Finally, it should be noted that the application of all these therapeutic measures does not produce results in the immediate future, but at least after a spermatogenesis cycle has elapsed, which takes at least three months
Special treatment
Semen culture is such a simple and inexpensive test to complete the man’s clinical examination and it can lead to the isolation of a germ whose treatment can improve the semen quality. It should be noted that in most cases this inflammation is chronic and elimination of the responsible germ is difficult, even with long-term antimicrobial treatment. However, with the appropriate antimicrobial treatment, we can reduce the microbial load and remove the inflammatory threat. There are many cases that I recall that have even led to spontaneous conceptions just right after the application of appropriate antimicrobial treatment.
