Innocent Bestman seminar on oligospermia

             Bayelsa state college of health technology

                        Otuogidi, Ogbia town

                  The school of Allied medical sciences

                 Department of Medical laboratory Science

                      Seminar presentation on Oligozoospermia

                      presented by Innocent Bestman

                             Cert/MLT/15/305

                        Supervised by: MLS Christian Atiegha

                                                                                 2017

                                                     CONTENT PAGE

         Introduction/Definition.

         Epidemology.

         Structure of the sperm.

         Spermatogenesis.

         Hormones required for sperm production.

         Classification of oligozoospermia.

         Causes of oligozoospermia.

         Clinical manifestations

         Preventions.

         Laboratory diagnoses.

         Treatment.

         Summary.

         Conclusion.

                                                       INTRODUCTION

oligozoospermia is also known as a low sperm count or oligospermia . In oligozoospermia there are fewer sperm cells in the ejaculate than normal. Oligospermia is generally defined as less than 15 million spermatozoa per one ml of ejaculate.( Cooper TG, et al 2010)

Oligospermia is one of the main causes of male infertility or sub-fertility. Sub-fertility is a reduced ability to achieve a pregnancy while infertility is defined as the complete inability to produce a pregnancy after about one year of unprotected sexual activity. (WHO, 2010).

Also marrian Webster dictionary, (2017) deined sperm as ''a cell that is produced by the male sexual organ and that combines with the female's egg in reproduction.

EPIDEMOLOGY

Oligozoospermia is one of the most common causes of male infertility, which is estimated to affect 1 in 20 men. Moreover, a male factor is responsible for infertility in approximately 50% of couples. Studies across the world suggest that the contribution of genetic factors significantly varies between countries, but between 2-20% of males have some abnormality that influences the process of spermatogenesis. Gender and ethnic predilection have not been established, but isolated studies show higher prevalence among Caucasians.

(Costabile & Spevak 2012)

  STRUCTURE OF THE SPERM

The spermatozoon is a remarkably complex metabolic, locomotive and genetic machine. It is approximately 60 microns in length and is divided  into 3 sections: head, neck and tail. The sperm head consists of a nucleus containing the highly compacted DNA, and an acrosome that contains the enzymes required for penetration of the egg shell for fertilization. The neck maintains the connection between the sperm head and tail and consists of the connecting piece and proximal centriole. The tail harbors the midpiece, principle piece and endpiece. The tail midpiece contains the axoneme or engine of the sperm and the mitochondrial sheath, the source of energy for movement. Physiologically, the sperm axoneme is the true motor assembly and requires 200-300 proteins to function. Among these, the microtubules are the best-understood components. Sperm microtubules are arranged in the classic “9+2” pattern of 9 outer doublets encircling an inner central doublet. Defects in the sperm axoneme are well-recognized causes of ciliary dyskinesias that are routinely associated with infertility.                                 (The Turek clinic, 2017).

SPERMATOGENESIS

Marian Webster, (2017) defined Spermatogenesis as the origin and development of spermatozoa. Spermatogenesis takes place in seminiferous tubules present inside the testes. During spermatogenesis, a diploid spermatogonium (male germ cell) increases its size to form a diploid primary spermatocyte. This diploid primary spermatocyte undergoes first meiotic division (meiosis I), which is a reductional division to form two equal haploid secondary spermatocytes. Each secondary spermatocyte then undergoes second meiotic division (meiosis II) to form two equal haploid spermatids. Hence, a diploid spermatogonium produces four haploid spermatids. These spermatids are transformed into spermatozoa (sperm) by the process called spermiogenesis.

(Health Hype, 2017)

HORMONES REQUIRED FOR SPERM PRODUCTION

Hormones are stimulating substances and act as body catalysts. They catalyze and control diverse metabolic processes, despite their varying actions and different specificities depending on their target organ.

Hormones that stimulate the production of sperm are;

1. Gonadotropin (GnRH)
2. Follicle Stimulating Hormone (FSH)
3. Luteinizing Hormone (LH)
4. Testosterone

         (padubidri D, 2011)

CLASSIFICATIONS OF OLIGOZOOSPERMIA

1. Mild: concentrations 10 million – 15 million sperm/ml

2. Moderate: concentrations 5 million – 10 million sperm/ml

3. Severe: concentrations less than 5 million sperm/ml

            (Padubiri D, 2011)

                                                 CAUSES  OLIGOZOOSPERMIA

The following are factors that can cause low sperm count:

1. A hormone imbalance, such as hypogonadism (reduced hormone production)
2. A genetic problem such as Klinefelter syndrome having had undescended testicles as a baby
3. A structural problem – for example, the tubes that carry sperm being damaged and blocked by illness or injury, or being absent from birth
4. A genital infection such as chlamydia, gonorrhoea or prostatitis (infection of the prostate gland)
5. Varicoceles (enlarged veins in the testicles)
6. previous surgery to the testicles or hernia repairs
7. the testicles becoming overheated.
8. Excessive alcohol consumption, smoking and using drugs such as marijuana or cocaine.
9. certain medications, including testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some antibiotics and  some antidepressants
10.                     lack of proper diet and exercise.
11.                     Presence of anti-sperm antibodies

             (Bestmale Enhancement. 2017)

CLINICAL MANIFESTATION

1: Infertility and sub-infertility

2: sexually transmitted diseases(STD)

3: Sexual function issues, such as low sex drive or erectile dysfunction

4: Lump in the testicle area, which may or may not be  Accompanied by pain and swelling

5: Decreased body or facial hair, among other signs of  hormone imbalance

     (Information Nigeria, 2013)

PREVENTION OF  OLIGOZOOSPERMIA

The following are the possible preventive measures of   oligozoosermia

1: Abstainance:  abstaining from sexual activities of or having intercourse only within a mutually monogamous relationship in which neither partner is infected with STDs

2: Contraceptives: Latex condoms also provide some protection from some.  sexually transmitted infections that leads to oligozoospermia.

3: Regular medical examination: going for medical check up especially if one fall under the risk factors kind of occupation or suspect any kind of STD.

4: Avoiding hard drugs: Drugs that can stimulate or cause oligozoospermia should

not be consumed.

5: Reduction of alcohol consumption; excess alcohol intake should be avoided.

(Mayor Foundation for Medical Education and Research, 2017)

LABORATORY DIAGNOSIS

1: Scrotal ultrasound. This test uses high-frequency sound waves to look at the testicles and supporting structures.

2: Hormone testing. The doctor might recommend a blood test to determine the level of hormones produced by the pituitary gland and testicles, which play a key role in sexual development and sperm production.

3: Post-ejaculation urinalysis. Sperm in the urine can indicate the sperm are traveling backward into the bladder instead of out the penis during ejaculation (retrograde ejaculation).

4: Genetic tests. When sperm concentration is extremely low, genetic causes could be involved. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might also be ordered to diagnose various congenital or inherited syndromes.

5: Testicular biopsy. This test involves removing samples from the testicle with a needle. The results of the testicular biopsy can tell if sperm production is normal.

6: Anti-sperm antibody tests. These tests,  are used to check for immune cells (antibodies) that attack sperm and affect their ability to function.

7: Transrectal ultrasound. A small lubricated wand is inserted into the rectum to check the prostate, and for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles). Deviation from the normal range of these parameters during semen analysis show abnormality in the semen.

(mayor clinic, 2017)

8: Semen analysis: A low sperm count is diagnosed as part of a semen analysis test. Parameters considered during a semen analysis include;

Volume. This is a measure of how much semen is present in one ejaculation.

Liquefaction time. Semen is a thick gel at the time of ejaculation. It normally becomes liquid within 20 minutes after ejaculation. Liquefaction time is the time it takes for the semen to turn to liquid.

Sperm count . This counts the number of sperm present per milliliter (mL) of semen in one ejaculation. Sperm morphology. This is a measure of the percentage of sperm that have a normal shape.

Sperm motility. This is a measure of the percentage of sperm that can move forward normally. The number of sperm that show normal forward movement in a certain amount of semen can also be measured. This is called motile density.

pH. This is a measure of the acidity (low pH) or alkalinity (high pH) of the semen. White blood cell count. White blood cells are not normally present in semen.

Fructose level. This is a measure of the amount of a sugar called fructose in the semen. The fructose provides energy for the sperm.

(webmd, 2016)

TREATMENT  OF  OLIGOZOOSPERMIA

The following are the possible treatment to oligozoospermia

1: Gonadotrophin medication: If a man have very low levels of gonadotrophin hormones

(which stimulate the production of sperm),He should be offered treatment with gonadotrophin medication to improve his fertility.

2: Intracytoplasmic sperm injection (ICSI): Intracytoplasmic sperm injection (ICSI) is a type of IVF technique, in which a single sperm is injected directly into an egg to fertilise it. The fertilised egg is then transferred to the woman's womb.

3: Surgical Treatment: If the causes of azoospermia can be eliminated, for example, in case of obstruction or varicocele, azoospermia is treated surgically. Usually after the surgical treatment of azoospermia the disease symptoms disappear quickly and the patient can become a father.

4:Hormonal preparates: Endocrine disorders that lead to the secretion of azoospermia can be corrected with the help of modern hormone preparates.

5: Reduced alcohol and drugs consumption: If oligozoospermia is diagnosed The patient is required to stop the intake of hard drug and reduce alcohol consumption, this can improve the treatment of oligozoospermia.

(Mary Harding, 2016)

SUMMARY

oligozoospermatism: An insufficient number of sperm in the semen. The condition is also called Oligospermia . Oligozoospermia can affect male fertility but depending on the cause, this may only be temporary. For example fever, certain drugs, smoking and excess alcohol use may temporarily reduce sperm count. The preventive measures are; abstainance from unprotected sex, avoiding hard drugs,  excess alcohol intake and regular medical check up, etc. The lab can also carry out test to determine if an infection or sexually transmitted disease is present and the type of infectious organism or if the condition is caused by hormonal disorder, high temperature, etc oligozoospermia can be treated by Intracytoplasmic sperm injection (ICSI). Gonadotrophin medication, proper diet and less consumption of alcohol etc.

CONCLUSION

oligozoospermia is a leading cause of infertility or subfertility issues among men. It is indicated in simple Laboratory tests that reveal the concentration of sperm in a given

sample quantity. Sperm count can be impacted by diet, frequency of intercourse, habits like smoking and drinking, and general health and wellness issues, so one should take caution of these factors that can cause oligozoospermia. And patients should adhere strictly to physician's counsels and medications in other to improve sperm count.

REFERENCES

Cooper TG, Noonan E, von Eckardstein S, (2010)." World Health Organization reference values.      For human semen characteristics". Hum. Reprod. Update. 16 (3) 231–45. PMID.            19934213.doi:10.1093/humupd/dmp048 .

Costabile RA and Spevak M. Characterization of patients

          presenting with male factor infertility in an equal access, no

          cost medical system. Urology. 2012;58(6):1021-1024.         

          www.early-pregnancy-tests.com/spermcount

Padubidri Daftary (2011). Shaw's Textbook of

         Gynaecology, 15e. p. 204. ISBN 9788131225486

Mary Harding; infertility, 2016. gotten from.       https://patient.info/health/infertility-a-summary-of-treatments

Mayo Foundation for Medical Education and Research, 2017. Goten from www.MFMER.com

World Health Organization. World Health Organization

          laboratory manual for the evaluation and processing of

          human semen . 5th ed. Cambridge, UK: Cambridge

          University Press; 2010.

www.bestmaleenhancement.me/sexual-issues/oligospermia/oligospermia-a-k-a-low-sperm-cou.         nt-symptoms-causes-know-the-roots-to-win-the-war-against-infertility.html

www.healthhype.com/sperm-production-spermatogenesis-parts-quantity-and-motility.html

www.theturekclinic.com/services/male-fertility-infertility-doctor-treatments-issues-zero-sperm.      count-male-doctors/oligospermia-low-sperm-count-semen-analysis-0-rare-definition-what/

www.webmd.com/infertility-and-reproduction/semen-analysis,2016.

www.informationng.com/2013/07/count-causes-symptoms-and-treatments.html

www.klinikum-friedrichshafen.com/en/ivf/oligozoospermia-trearment.php

www.merriam-webster.com/dictionary/sperm

www.merriam-webster.com/dictionary/spermatogenesis

www.mayoclinic.org/diseases-conditions/low-sperm-count/basics/tests-diagnosis/con-20033441.

DMU Timestamp: August 23, 2017 20:27

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