Low Seminal Volume Research Articles

Hematospermia and Its Sexual Ramifications: A Systematic Review

ABSTRACT Introduction Hematospermia (HS) is the presence of blood in ejaculatory fluid. It is a rare, usually benign condition associated with various etiologies and treatments. Though a source of great anxiety for patients, no comprehensive review exists on the sexual ramifications of HS. Objective To determine HS effects on sexual wellbeing, with emphasis on original research. Methods A systematic review of HS was performed via PubMed (Figure 1). The following search terminology was used: “(hemospermia OR hematospermia) AND (sexual OR libido OR anxiety OR infertility OR cryopreservation OR erectile dysfunction).” Articles were assessed for sexual health-related implications, such as emotional disturbances, changes in sexual activity, hindered sexual response cycles, pain associated with intercourse, altered fertility, and sexual infections. Results Thirty-eight articles met our inclusion criteria while 111 were excluded. The effect of HS on sexual health proved multifaceted. Anxiety is known to compromise sexual health. Two articles reported that anxiety following transrectal ultrasound (TRUS)-guided prostate biopsy had a positive correlation with duration of HS. Additionally, in both studies, 50% of patients reported decreased sexual activity due to HS. A similar study showed that patients with substantial prostatic calculi had greater HS after biopsy as well as significantly increased anxiety compared to those with no prostatic calcifications. Patients with underlying comorbidities experienced sexual complications from HS. One study described a man who developed HS due to hypertensive emergency. In response to his HS, sexual partners ostracized him and family members believed he was divinely cursed. Another article described 3 patients with congenital bleeding disorders (e.g., hemophilia A, prothrombin deficiency, von Willebrand disease) who required episodes of sexual abstinence due to HS. HS was associated with blood during parts of the sexual response cycle. Two studies showed urethrorrhagia occurred after sexual excitation in those with HS and urethral hemangiomas. Likewise, four articles revealed HS and post-coital hematuria, sometimes with severe bleeding after ejaculation, in patients with urethral hemangiomas, previous coital trauma, or seminal vesicle cysts (SVC.) Of note, another study demonstrated patients with SVC experienced HS and post-ejaculatory pain. In certain populations, HS indicated increased risk of sexual pathologies. One study illustrated patients with HS and chronic prostatitis had 4-fold increased risk of erectile dysfunction (ED) compared to those without HS. Sixteen articles showed that HS was associated with infertility (IF) in various circumstances, including anatomic genitourinary pathologies (e.g., SVC, prostatic cysts, Mullerian duct cysts, ejaculatory duct stones, vas deferens injuries, varicoceles), herpes simplex virus (HSV) infection with low seminal volume, hydroxyurea treatment of essential thrombocythemia, leukospermia, Zinner syndrome, and isolated follicle-stimulating hormone deficiency. Furthermore, two studies revealed HS was related to temporarily altered semen quality after shockwave lithotripsy. In 7 articles, patients with HS had infections that could be sexually transmitted, including HSV, Chlamydia, enterococcus, Ureaplasma, Schistosoma, and Zika virus. Conclusions Sexual effects of HS included increased anxiety, exacerbated comorbidities, bleeding during sexual response cycle, ED, IF, and increased risk of sexual infections. Further research is needed to better understand causality in addition to associations of HS on sexual wellbeing. Disclosure No

The impact of diabetes mellitus type 1 on male fertility: Systematic review and meta-analysis.

Some evidence suggests that diabetes mellitus type 1 (DM1) could affect male fertility, gonadal axis, semen parameters, and spermatogenesis because of effects of hyperglycemia and insulin deficiency. Anyhow, the exact impact of DM1 on male fertility is unclear. To review the studies evaluating paternity rate, male gonadal axis, and semen parameters in men with DM1. A review of relevant literature from January 1980 to December 2020 was performed. Only studies published in English reporting data on fatherhood (rate of children by natural fertility), hormonal and seminal parameters were included. Out of 14 retrieved articles, the eight studies evaluating semen parameters were meta-analyzed. The rate of children (four studies) was lower than controls among men affected by DM1, especially in men with a longer duration of disease. The data of gonadal hormonal profile in DM1 men (six studies) are very heterogeneous and a neutral effect of DM1 or a condition of subclinical hypogonadism could not be concluded. Meta-analysis showed that men with DM1 (n=380), compared with controls (n=434), have significantly lower normal sperm morphology [-0.36% (-0.66; -0.06), p<0.05, six studies] and sperm progressive motility [33.62% (-39.13; -28.11), p<0.001, two studies] and a trend toward a lower seminal volume [-0.51 (-1.03; 0.02), p=0.06, eight studies], without difference in total sperm count and concentration. Data on scrotal ultrasound and sperm DNA fragmentation are too few. No study evaluated other factors of male infertility, such as transrectal ultrasound, semen infections, sperm auto-antibodies, and retrograde ejaculation. DM1 might impair male fertility and testis functions (endocrine, spermatogenesis), but definition of its actual impact needs further studies. Men with DM1 should be evaluated with a complete hormonal, seminal, and ultrasound workup to better define their fertility potential and need for follow up of testis functions.

A Comprehensive Guide to Sperm Recovery in Infertile Men with Retrograde Ejaculation.

Retrograde ejaculation (RE) is a condition defined as the backward flow of the semen during ejaculation, and when present can result in male infertility. RE may be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate). RE can result from anatomic, neurological or pharmacological conditions. The treatment approaches outlined are determined by the cause. Alkalinizing urinary pH with oral medications or by adding sperm wash media into the bladder prior to ejaculation may preserve the viability of the sperm. This article provides a step-by-step guide to diagnose RE and the optimal techniques to retrieve sperm.

Molecular detection of Chlamydia trachomatis and semen quality of sexual partners of infertile women.

Chlamydia trachomatis is considered as the bacterium that is more sexually transmitted as cause of male urethritis, epididymitis, orchitis and infertility. A total of 116 semen samples of men whose couples are infertile women were analysed. The quality of the semen was measured by standard procedures recommended by WHO while C. trachomatis was detected by the PCR assay. Thirty-seven semen samples were positive for C. trachomatis (31.9%). Regarding semen analysis, no different values were observed between positive and negative samples to C. trachomatis. However, the presence of leucocytes and erythrocytes suggests an inflammatory process; however, these were high in negative samples to C. trachomatis. Furthermore, an association between low seminal volume at 1, 5ml and the positivity to C. trachomatis was observed (OR=2, 1; CI95 % 1,16-3,07). The total semen volume is a contribution by the various accessory glands (this reflects the secretory activity of the glands); a low semen volume could be due to an obstruction of the ejaculatory duct or infection of accessory glands by C. trachomatis. More studies are necessary to identify the causes of a reduced semen volume.

Effects of ground semen collection on weight bearing on hindquarters, libido, and semen parameters in stallions

Collection of semen on the ground from the standing stallion represents an alternative method to dummy mount semen collection and is of increasing popularity for sport stallions, males suffering from health problems, or in studs without a dummy or suitable mare at disposal. Our aim was to collect and compare spermatological and physiological data associated with traditional and ground semen collection. Twelve of 23 Franches-Montagnes stallions were selected to carry out semen collection on a dummy and while standing in a crossed experimental protocol. Semen quantity and quality parameters, weight bearing on hindquarters, and behavioral and libido data were recorded. Ground versus dummy mount semen collection was accompanied by lower seminal volume (15.9 ± 14.6 vs. 22.0 ± 13.3 mL; P < 0.01) and lower total sperm count (4.913 ± 2.721 × 109 vs. 6.544 ± 2.856 × 109 sperm; P < 0.001). No significant differences were found concerning sperm motility and viability. Time to ejaculation was longer, and the number of attempts to ejaculation was higher (P = 0.053) in the standing position compared with the mount on the dummy. A higher (P < 0.01) amount of tail flagging was manifested by the stallions during ejaculation on the dummy compared to when standing. There was no difference in weight bearing on hindquarters when comparing dummy collection (51.2 ± 2.5%) and standing collection (48.9 ± 5.5%). Ground semen collection can be considered as a viable option for stallions that cannot mount a dummy or a mare. However, it requires training and may be not easily accepted by all stallions. Owners should be advised that ground semen collection is associated with significantly lower sperm numbers than with dummy mount semen collection.

Evaluating Spermatogenesis Using Semen: The Biology of Emission Tells Why Reporting Total Sperm per Sample Is Important, and Why Reporting Only Number of Sperm per Milliliter Is Irrational

Evaluating Spermatogenesis Using Semen: The Biology of Emission Tells Why Reporting Total Sperm per Sample Is Important, and Why Reporting Only Number of Sperm per Milliliter Is Irrational

Ejaculate traits in the Namibian cheetah (Acinonyx jubatus): influence of age, season and captivity

The objective was to examine the influence of animal age, season and captivity status on seminal quality in wild-born cheetahs (Acinonyx jubatus) in Namibia, Africa. Animals were divided into three age categories: juvenile (14-24 months; n = 16 males, 23 ejaculates); adult (25-120 months; n = 76 males, 172 ejaculates); and aged (>120 months; n = 5 males, 5 ejaculates). Seasons were categorised into hot-wet (January-April), cold-dry (May-August) and hot-dry (September-December). A comparison between freshly wild-caught (n = 29 males, 41 ejaculates) and captive-held cheetahs (n = 68 males, 159 ejaculates) was also conducted. Raw ejaculates contained 69.0 +/- 1.1% motile spermatozoa (mean +/- s.e.m.) with 73.6 +/- 1.5% of these cells containing an intact acrosome. Overall, 18.4 +/- 0.9% of spermatozoa were morphologically normal, with midpiece anomalies being the most prevalent (approximately 39%) defect. Juvenile cheetahs produced ejaculates with poorer sperm motility, forward progressive status, lower seminal volume and fewer total motile spermatozoa than adult and aged animals. Spermatogenesis continued unabated throughout the year and was minimally influenced by season. Proportions of sperm malformations were also not affected by season. Ejaculates from captive cheetahs had increased volume and intact acrosomes, but lower sperm density than wild-caught counterparts. In summary, Namibian cheetahs produce an extraordinarily high proportion of pleiomorphic spermatozoa regardless of age, season or living (captive versus free-ranging) status. Young males less than 2 years of age produce poorer ejaculate quality than adult and aged males. Because (1) all study animals were wild born and (2) there was little difference between freshly caught males and those maintained in captivity for protracted periods, our results affirm that teratospermia in the cheetah is mostly genetically derived. It also appears that an ex situ environment for the Namibian cheetah can ensure sperm quality comparable with that for free-living males.

Inflammatory-associated obstructions of the male reproductive tract

A history of urogenital inflammation occurs in 5-12% of men attending infertility clinics. Usually, infection has a detrimental effect on sperm quality by reducing concentration and motility, and possibly affecting the number of morphological normal spermatozoa. In addition, infection may be the source of auto-antibodies against spermatozoa, found in about 8% of the infertile male population. In contrast to the situation in women, there is no clear evidence that male accessory gland infections can result in epididymal blockage or vassal obstruction, with the exception of genital tuberculosis. Although Chlamydia trachomatis is a well-documented source of chronic prostatitis, the infection does not seem to cause obstruction of the reproductive tract, as it does in women. If male urogenital infection causes obstruction it is most likely located at the level of the ejaculatory ducts. Chronic prostatitis has been proved to cause scarring of the prostatic and ejaculatory ducts, resulting in low seminal volume with low fructose and alpha-glucosidase. Many of these men present with severe oligozoospermia or azoospermia, normal size testis and normal gonadotrophins. We performed an excisional testicular biopsy in all men presenting with <1 million spermatozoa per millilitre and found that 39 of 78 (50%) had a normal spermatogenesis. A history of male accessory genital infection was found in 12% of the men and 10% had abnormalities found on transrectal ultrasound of the prostate (like oedema, dilatation of the seminal vesicles and ejaculatory ducts) intraprostatic calcifications and dilatation of the periprostatic venous plexus. Ejaculatory duct obstruction is a common cause of male infertility and infections are present in at least 22-50% of these men. Transurethral resection of the ejaculatory ducts may result in a significant improvement of the sperm quality and in spontaneous pregnancies in up to 25% of the couples. In case of failure sperm aspiration from the epididymis and intracytoplasmic sperm injection is the treatment of choice.

Inflammatory-associated obstructions of the male reproductive tract

Summary. A history of urogenital inflammation occurs in 5–12% of men attending infertility clinics. Usually, infection has a detrimental effect on sperm quality by reducing concentration and motility, and possibly affecting the number of morphological normal spermatozoa. In addition, infection may be the source of auto-antibodies against spermatozoa, found in about 8% of the infertile male population. In contrast to the situation in women, there is no clear evidence that male accessory gland infections can result in epididymal blockage or vassal obstruction, with the exception of genital tuberculosis. Although Chlamydia trachomatis is a well-documented source of chronic prostatitis, the infection does not seem to cause obstruction of the reproductive tract, as it does in women. If male urogenital infection causes obstruction it is most likely located at the level of the ejaculatory ducts. Chronic prostatitis has been proved to cause scarring of the prostatic and ejaculatory ducts, resulting in low seminal volume with low fructose and alpha-glucosidase. Many of these men present with severe oligozoospermia or azoospermia, normal size testis and normal gonadotrophins. We performed an excisional testicular biopsy in all men presenting with <1 million spermatozoa per millilitre and found that 39 of 78 (50%) had a normal spermatogenesis. A history of male accessory genital infection was found in 12% of the men and 10% had abnormalities found on transrectal ultrasound of the prostate (like oedema, dilatation of the seminal vesicles and ejaculatory ducts) intraprostatic calcifications and dilatation of the periprostatic venous plexus. Ejaculatory duct obstruction is a common cause of male infertility and infections are present in at least 22–50% of these men. Transurethral resection of the ejaculatory ducts may result in a significant improvement of the sperm quality and in spontaneous pregnancies in up to 25% of the couples. In case of failure sperm aspiration from the epididymis and intracytoplasmic sperm injection is the treatment of choice.

Influence of low corrected seminal fructose levels on sperm chromatin stability in semen from men attending an infertility service

Objective: To determine any correlation between sperm chromatin stability under sodium dodecyl sulfate (SDS), and SDS-ethylendiamine tetraacetic acid (SDS and EDTA) conditions with levels of corrected seminal fructose, obtained multiplying logarithm of sperm count by seminal fructose concentration, in men attending an infertility service. Design: Cross sectional study to compare semen parameters of two groups (control and experimental), one with normal levels of corrected fructose (control) and the second with low levels of corrected fructose (experimental). Subjects were also grouped according to number, motility and morphology of sperm, and according to results of hypo-osmotic test. Setting: Andrology laboratory at the Instituto de Investigaciones de la Altura, Lima, Perú. Patient(s): Two hundred and twenty five male partners in infertile couples attending the Andrology Laboratory Intervention(s): None Main Outcome Measure(s): semen analysis, hypo-osmotic swelling test, sperm chromatin stability after SDS, and SDS and EDTA, and seminal fructose. Result(s): Seminal volume, sperm motility, and seminal fructose were significantly lower in samples from subjects with low levels of corrected fructose. Subjects with low levels of corrected fructose had also high sperm chromatin stability under SDS, and SDS and EDTA treatment. After SDS treatment, sperm chromatin stability was similar in normal samples and in those with oligozoospermia, asthenozoospermia, teratozoospermia, or abnormal hypo-osmotic swelling test. After SDS and EDTA treatment, a high sperm stability was observed in samples with asthenozoospermia. This hyper-stability is observed in asthenozoospermic samples with low corrected fructose levels, but not in asthenozoospermic samples with normal corrected fructose levels. The logistic regression analysis applied to asthenozoospermic data showed that chronological age, seminal volume, acid phosphatase per ejaculate and percent of stable sperm after SDS and EDTA treatment were significantly associated to levels of corrected fructose. Conclusion(s): Low levels of corrected fructose were associated to low seminal volume, low sperm motility, and high sperm chromatin stability under SDS and EDTA treatment.

Transurethral Endoscopic Treatment of Distal Seminal Tract Obstruction

ABSTRACT: The two distal obstructive pathologies of the seminal duct found at our center are ejaculatory duct obstruction and utriculocele. Between 1979 and 1993, we present a total of 22 cases, 13 cases of ejaculatory duct obstruction and nine of utriculocele. The usual manifestations include infertility, ejaculatory discomfort, testicular pain, perineal discomfort, and hematospermia. Also, symptoms of urinary obstruction and repeated urinary infections can be present.The preparatory evaluation studies are many and varied. Excellent images are obtained with transrectal echography. In cases associated with infertility, very low seminal volume is recorded (1 ml or less) with azoospermia or oligospermia. The semen fructose is either very low or absent altogether. The serum FSH is normal. The testicular biopsy is indicative of the conservation of the spermatogenesis. It is also of prime importance to check that there is no epididymal tubular rupture caused by increased pressure or by epididymitis because a combination of endoscopic surgery with epididymovasostomy would then be necessary. Seminal vesiculography indicates the level of obstruction.A high scrotal incision was made over the vas deferens and the vas cannulated with a 24‐gauge intravenous catheter into which methylene blue was injected while the prostatic urethra was monitored under direct vision endoscopically (chromo‐ejaculoscopy). Endoscopic resection was accomplished and appearance of the blue dye could be used as a measure of adequate resection.An improvement in semen volume was observed in 14 patients, and in two patients pregnancies were obtained by means of assisted reproduction techniques. There were no serious complications in any of the cases; only two patients suffered postsurgical epididymitis.

Induction of fertility in a man with hypogonadotropic hypogonadism with very low seminal volume

International Journal of Gynecology & ObstetricsVolume 25, Issue 5 p. 419-420 Citations from the literature fertility and sterility Induction of fertility in a man with hypogonadotropic hypogonadism with very low seminal volume T Tulandi, T TulandiSearch for more papers by this authorRA McInnes, RA McInnesSearch for more papers by this author T Tulandi, T TulandiSearch for more papers by this authorRA McInnes, RA McInnesSearch for more papers by this author First published: October 1987 https://doi.org/10.1016/0020-7292(87)90354-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume25, Issue5October 1987Pages 419-420 RelatedInformation

Induction of fertility in a man with hypogonadotropic hypogonadism with very low seminal volume

Pituitary function studies were performed on a 31-year-old man who had oligospermia and a very low seminal volume (0.1 ml). The low testosterone and gonadotropin levels, the remarkable testosterone response to human chorionic gonadotropin (hCG) stimulation, and the sluggish luteinizing hormone (LH) response to luteinizing hormone stimulating hormone (LH-RH) stimulation suggested the presence of hypogonadotropic hypogonadism. Treatment with a combination of human menopausal gonadotropin (hMG)-hCG resulted in the increase in the volume of seminal fluid and the sperm density. His wife achieved two pregnancies during the treatment. This report indicates that the findings of oligospermia and very low seminal volume should be followed by an investigation of the hypothalamo-pituitary testicular axis. Fertility in men with hypogonadotropic hypogonadism can be effectively induced with a combination of hMG-hCG treatment.

Continuous measurement by radio-telemetry of vaginal pH during human coitus.

Summary. The use of the pH-pill has allowed continuous monitoring of vaginal pH during human coitus. In the case of a couple of normal fertility, there was an immediate buffering by seminal plasma so that the vaginal pH changed in 8 sec from pH 4·3 to pH 7·2. In the case of a couple of low (male) fertility, the immediate effect of the arrival of semen in the vagina was a change from pH 3·5 to pH 5·5. A similarly small change in pH occurred when the seminal volume of a fertile male subject had been depleted, by repeated ejaculation, to 1 ·5 ml. At this pH (5·5), spermatozoa are generally immobilized. It has been possible to alter normal fertility, as judged by postcoital tests for sperm motility, by the introduction of a pH 3·6 buffer solution into the vagina before coitus. In this latter experiment, the vaginal pH immediately after ejaculation was 5·0 and, after 2 hr, had reached pH 5·4. These results in vivo suggest that the vagina is not the hostile environment hitherto imagined, since the normal ejaculate readily overcomes the vaginal acidity by its powerful buffering action. Low seminal volume, with or without a concomitantly low sperm count, and artificial changes in vaginal environment by buffer solutions may affect fertility.