What does a semen analysis showing oligospermia (low sperm count), asthenospermia (reduced motility) of 50%, and motility grade 1+ indicate, and what is the next step?

Understanding and Managing Oligospermia with Reduced Motility

This semen analysis shows significant male factor infertility with severe oligospermia and reduced motility that requires further evaluation and likely specialized treatment.

Interpretation of Semen Analysis Results

• The sperm count of 3 million/mL is significantly below the normal reference range of >15-20 million/mL, indicating severe oligozoospermia 1
• Motility of 50% is borderline normal (reference range >50%), but the grade 1+ indicates poor forward progression (normal is >2 on a scale of 0-4) 1
• This combination of findings (oligozoospermia with asthenozoospermia) significantly reduces natural fertility potential and indicates male factor infertility 1

Next Steps in Evaluation

Immediate Follow-up Testing

• A second confirmatory semen analysis should be performed at least one month after the first to verify findings, as recommended by guidelines 1
• Endocrine evaluation is strongly indicated due to the severe oligospermia (<10 million/mL), including:
  • Serum testosterone level 1
  • Follicle-stimulating hormone (FSH) level 1

Additional Evaluation

• Complete reproductive history should be obtained, including:

  • Duration of infertility and previous fertility 1
  • Childhood illnesses and developmental history 1
  • Systemic illnesses and previous surgeries 1
  • Sexual history and function 1
  • Medication use and gonadal toxin exposure 1

• Physical examination with focus on:

  • Testicular size and consistency 1
  • Presence of varicocele 1
  • Presence and consistency of vas deferens and epididymis 1
  • Secondary sex characteristics 1

Genetic Testing

• Karyotype testing is recommended for males with sperm concentration <5 million/mL 1
• Y-chromosome microdeletion testing should be considered due to the severe oligospermia 1

Management Considerations

• The combination of severe oligospermia and poor motility significantly reduces chances of natural conception 1
• Depending on additional findings, management options may include:
  • Treatment of any identified underlying causes (hormonal, varicocele, etc.) 1
  • Referral to reproductive endocrinology and infertility specialist 1
  • Discussion of assisted reproductive technologies (ART) including intrauterine insemination (IUI) or in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) 1

Important Caveats

• Semen analysis alone has limitations in predicting fertility; multiple parameters together provide better predictive value than any single parameter 1, 2
• Lifestyle modifications should be discussed, including avoiding excessive heat exposure, smoking cessation, and weight management if applicable 1
• Empiric treatments such as androgens have not shown significant benefit for idiopathic oligoasthenospermia in controlled trials 3
• The female partner's fertility status must also be evaluated concurrently for comprehensive infertility management 1