Treatment Options for Decreased Sperm Motility
For men with decreased sperm motility, lifestyle modifications, antioxidant therapy, and hormonal treatments are recommended, with lifestyle changes being the first-line approach due to their potential to improve sperm parameters and overall health. 1
First-Line Interventions
Lifestyle Modifications
The European Association of Urology (EAU) strongly recommends lifestyle changes as the initial approach for treating decreased sperm motility 1, 2:
- Weight loss - Particularly important for overweight or obese men
- Regular physical exercise - Improves overall reproductive health
- Smoking cessation - Tobacco use negatively impacts sperm parameters
- Moderate alcohol consumption - Excessive alcohol impairs sperm function
- Avoiding excessive testicular heat exposure - Includes avoiding hot baths, saunas, and tight underwear
These modifications are especially important given evidence that infertile men have higher risk of cardiometabolic disorders and increased cardiovascular and overall mortality compared to fertile men 1.
Second-Line Interventions
Antioxidant Therapy
Oxidative stress is a significant contributing factor to decreased sperm motility, with research showing high reactive oxygen species (ROS) levels are associated with impaired sperm parameters 1, 3:
- Antioxidant supplements - May improve sperm count, motility, and morphology 4
However, the EAU notes that evidence for antioxidant therapy remains conflicting, with a Cochrane review showing that when studies with high risk of bias were removed, the improvement in live birth rates was no longer apparent 1.
Prebiotic and Probiotic Supplements
Recent research suggests potential benefits of prebiotic/probiotic supplementation:
- A randomized controlled trial showed significant increases in sperm concentration, motility, normal morphology, and DNA integrity in men treated with prebiotic/probiotic compounds 1
- However, the EAU notes that further high-powered RCTs are needed to establish definitive recommendations 1
Hormonal Treatments
For men with hormonal abnormalities contributing to decreased sperm motility, several options exist:
For secondary hypogonadism:
For idiopathic infertility:
- Selective estrogen receptor modulators (SERMs) - Block estrogen receptors at the hypothalamus level, stimulating GnRH secretion and increasing gonadotropin release 1, 2
- Aromatase inhibitors - May increase endogenous testosterone production and improve spermatogenesis by decreasing estrogen production 1
The EAU notes that while meta-analyses show SERMs significantly increased pregnancy rates and improved sperm parameters, the quality of evidence remains low, and conclusive recommendations cannot be drawn 1.
Advanced Interventions for Severe Cases
For cases with persistently poor sperm motility despite the above treatments:
- In vitro fertilization with intracytoplasmic sperm injection (ICSI) - Recommended for severe male infertility as it negates the negative impact of poor semen quality 2
Monitoring Treatment Response
Regular monitoring is essential to assess treatment effectiveness:
- Semen analyses every 3-6 months to track improvements in motility 2
- Monitoring of testosterone levels when hormonal treatments are used 2
Important Considerations
Oxidative stress assessment - Men with asthenozoospermia (poor sperm motility) have significantly higher risk of sperm DNA damage and oxidative stress (over 10-fold and 6-fold higher, respectively, compared to controls) 3
Timing of semen analysis - Sperm motility naturally decreases over time after ejaculation, with most specimens showing a 5-10% decrease per hour 5. This is particularly important when considering treatment options and interpreting semen analysis results.
Midpiece anomalies - Patients with midpiece anomalies show a higher incidence of motility decrease over time 6, which may require special consideration in treatment planning.