Can a prostate infection cause oligoasthenoteratozoospermia (OAT) syndrome on sperm analysis and how is it diagnosed and treated?

Prostate Infection and Oligoasthenoteratozoospermia (OAT) Syndrome

Yes, prostate infection can cause or contribute to severe oligoasthenoteratozoospermia (OAT) syndrome, and treatment of the infection may improve sperm parameters.

Relationship Between Prostate Infection and OAT Syndrome

• Chronic prostatitis has been shown to have a detrimental effect on sperm parameters, including reductions in sperm concentration, vitality, total and progressive motility, and normal morphology 1
• Both chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) can negatively impact semen quality, though they may affect different parameters 1
• Prostate infections can lead to increased levels of pro-inflammatory cytokines in seminal plasma, which can impair sperm function 2, 3
• Chronic prostatitis can trigger autoimmune responses against prostate antigens, further compromising semen quality 2
• The inflammatory process associated with prostatitis may induce the release of apoptotic proteins like Omi/HtrA2 from spermatozoa, contributing to reduced sperm quality 3

Diagnostic Approach for Prostate Infection in Men with OAT

Initial Evaluation

• Perform at least two properly conducted semen analyses to confirm OAT syndrome, with specimens kept at body temperature and examined within one hour of collection 4, 5
• Complete a thorough reproductive history and physical examination with particular attention to the prostate 5
• Evaluate for symptoms of prostatitis, including pain or discomfort in the perineum, testicles, penis, and lower back 4

Specific Testing for Prostate Infection

• Perform the Meares and Stamey 2- or 4-glass test, which is strongly recommended for diagnosing chronic bacterial prostatitis 4
• Conduct microbiological evaluation for atypical pathogens such as Chlamydia trachomatis and Mycoplasma species, as these have been associated with male infertility 4
• Consider transrectal ultrasound in selected cases to rule out prostatic abscess 4
• Do not rely solely on ejaculate analysis for diagnosing chronic bacterial prostatitis 4

Additional Testing for Men with OAT

• Perform genetic evaluation for men with severe OAT (sperm concentration <5 million/mL), including karyotype testing and Y-chromosome microdeletion analysis 4, 6
• Conduct endocrine evaluation including serum testosterone and follicle-stimulating hormone (FSH) levels 6
• Consider post-ejaculatory urinalysis if ejaculate volume is less than 1 mL to rule out retrograde ejaculation 6

Treatment Approach

Treating the Prostate Infection

• Antibiotic therapy is recommended for chronic bacterial prostatitis (type II according to NIH classification) 4
• While antibiotics may improve sperm quality, there is limited evidence that treatment of chronic prostatitis/chronic pelvic pain syndrome increases the probability of natural conception 4
• Refer sexual partners of patients with accessory sex gland infections caused by sexually transmitted diseases for evaluation and treatment 4

Additional Treatments for OAT

• Consider varicocelectomy if a clinically palpable varicocele is present and minimal/no female factor infertility is identified 6
• Intracytoplasmic sperm injection (ICSI) is the primary treatment option for severe OAT syndrome when natural conception fails despite treating underlying causes 6
• Consider lifestyle modifications including weight loss and smoking cessation, as these factors may negatively impact sperm parameters 6

Important Considerations

• The relationship between chronic prostatitis and fertility has been controversial, but recent evidence supports a significant association between chronic prostatitis and male infertility 2, 1, 7
• There is a correlation between the duration of chronic prostatitis and worsening of sperm parameters 7
• Chronic prostatitis can increase the risk of developing anti-sperm antibodies in seminal plasma, further compromising fertility 1
• Treatment outcomes may vary, and improvement in sperm parameters doesn't always translate to improved natural conception rates 4

Treatment Algorithm

1. Confirm OAT syndrome with two properly conducted semen analyses 4
2. Test for prostate infection using the Meares and Stamey test 4
3. If bacterial prostatitis is confirmed, treat with appropriate antibiotics 4
4. Evaluate for other potential causes of OAT (genetic, hormonal, anatomical) 6
5. Address modifiable lifestyle factors 6
6. Consider assisted reproductive technologies if natural conception doesn't occur after treating underlying causes 6