From the Guidelines
Treatment of hypomotile sperm should prioritize assisted reproductive technologies (ART) such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) due to their ability to bypass sperm motility issues and achieve pregnancy. According to the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) guideline [ 1 ], ART is a recommended approach for managing male infertility, including cases with low total motile sperm count. The guideline suggests that IUI success rates may be reduced in such cases, and treatment with ART (IVF/ICSI) may be considered [ 1 ].
When considering medical interventions, the use of aromatase inhibitors (AIs), human chorionic gonadotropin (hCG), selective estrogen receptor modulators (SERMs), or a combination thereof may be beneficial for infertile men with low serum testosterone [ 1 ]. However, testosterone monotherapy should not be prescribed for men interested in current or future fertility [ 1 ]. For men with idiopathic infertility, treatment using a Follicle-Stimulating Hormone (FSH) analogue may be considered to improve sperm concentration, pregnancy rate, and live birth rate [ 1 ].
It's essential to note that the benefits of supplements, such as antioxidants and vitamins, are of questionable clinical utility in treating male infertility [ 1 ]. While some studies suggest that supplements like L-carnitine and coenzyme Q10 may improve sperm motility, the evidence is limited, and more research is needed to support their use.
In cases where underlying conditions like hyperprolactinemia or hypogonadotropic hypogonadism are present, treating the underlying etiology is crucial [ 1 ]. Referral to an endocrinologist or male reproductive specialist may be necessary to initiate appropriate treatment, such as exogenous gonadotropins or pulsatile GnRH, to induce spermatogenesis.
Ultimately, the choice of treatment for hypomotile sperm should be individualized, taking into account the patient's specific condition, medical history, and fertility goals. ART remains a viable option for achieving pregnancy, even in cases with severe sperm motility issues [ 1 ].
From the Research
Treatment Options for Hypomotile Sperm
- L-carnitine has been shown to improve sperm motility in patients with idiopathic asthenozoospermia, with studies indicating a significant increase in spermatozoal motility, both in a quantitative and qualitative manner 2, 3.
- The use of L-carnitine has also been associated with an increase in spermatozoal output and a higher rate of pregnancy in treated individuals 2, 3.
- Other treatment strategies, such as the use of N-acetyl-cysteine, have also been shown to improve sperm motility and normal morphology in men with idiopathic asthenozoospermia 4.
- A meta-analysis of seven articles found that L-carnitine/L-acetyl-carnitine and N-acetyl-cysteine had a considerable improvement in sperm motility and normal morphology compared to the placebo group 4.
Mechanisms and Factors Affecting Sperm Motility
- Sperm motility is an important parameter during both natural and assisted conception, and its reduction is associated with increased risk of infertility 5, 6.
- The physiology of sperm, molecular pathways regulating sperm motility, and risk factors affecting sperm motility are important areas of investigation in the development of approaches for maintaining or enhancing human sperm motility 6.
- Various pharmacological agents and biomolecules have been shown to enhance sperm motility in vitro and in vivo conditions, which can improve assisted reproductive technology (ART) outcomes 6.
Clinical Applications and Outcomes
- The clinical effect of L-carnitine for infertile males with asthenozoospermia has been explored, with results indicating a significant increase in the percentage of forward motile sperm and a higher rate of pregnancy in treated individuals 3.
- A meta-analysis found that L-carnitine/L-acetyl-carnitine and N-acetyl-cysteine had a positive effect on sperm concentration and ejaculate volume, although the effect on serum hormones was not significant 4.