What does a semen analysis showing reduced sperm motility in a male of reproductive age mean, and what can be done to address potential fertility issues?

Semen Analysis Results: Reduced Sperm Motility (Asthenozoospermia)

What These Results Mean

Your semen analysis shows asthenozoospermia—significantly reduced sperm motility that falls below the fertility threshold and will likely impair your ability to conceive naturally. 1, 2

Specific Abnormalities Identified

• Progressive motility is critically low at 20%, well below the normal reference limit of ≥30% required for optimal fertility 3, 2
• Total motility (progressive + non-progressive) is 44%, just barely above the 42% lower reference limit, but the distribution is problematic 2
• 56% of sperm are completely immotile, meaning more than half cannot move at all 1
• Your sperm count (38 million/mL) and total sperm number (171 million) are actually normal and exceed reference limits of 16 million/mL and 39 million respectively 2
• This pattern indicates isolated asthenozoospermia—the sperm are being produced in adequate numbers but have severely impaired movement 1

Clinical Significance

• Reduced sperm motility coexists with higher rates of sperm DNA damage and oxidative stress in semen, which further compromises fertilizing capability under both natural conception and assisted reproduction conditions 4
• Progressive motility is essential for sperm to travel through the female reproductive tract and penetrate the oocyte 5
• Your results suggest underlying sperm dysfunction beyond just movement problems 4

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What Can Be Done: Diagnostic Workup

Immediate Next Steps

Repeat the semen analysis in 1 month to confirm these findings, as semen parameters show significant intra-individual variability and a single abnormal test is not diagnostic 1, 2

• Maintain 2-3 days of sexual abstinence before the repeat test 2
• Ensure proper collection technique with examination within one hour 2
• Note that seasonal variations exist—sperm motility tends to be lower in winter and higher in summer 6

Essential Hormonal Evaluation

Obtain a complete hormonal panel including FSH, LH, total testosterone, and SHBG to distinguish primary testicular dysfunction from secondary causes 7

• FSH >7.6 IU/L suggests some degree of testicular dysfunction, though your normal sperm count makes severe testicular failure unlikely 1, 7
• Calculate free testosterone to assess for hypogonadism, which can affect sperm motility 7

Genetic Testing Considerations

Genetic testing is NOT indicated based on your current results because your sperm concentration is 38 million/mL, well above the 5 million/mL threshold that triggers karyotype testing 3, 1

• Karyotype and Y-chromosome microdeletion testing are reserved for men with severe oligozoospermia (<5 million/mL) or non-obstructive azoospermia 3, 1

Advanced Sperm Function Testing

Consider testing for sperm DNA fragmentation and oxidative stress, as these abnormalities are significantly more prevalent in asthenozoospermic men 4

• Men with poor sperm motility have over 10-fold higher risk for sperm DNA damage compared to normal controls 4
• Risk for oxidative stress is almost 6-fold higher in asthenozoospermia 4
• These tests help guide antioxidant therapy decisions 4

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What Can Be Done: Treatment Approach

Identify and Eliminate Risk Factors

Systematically address modifiable lifestyle and environmental factors that reduce sperm motility: 3, 1

• Anabolic steroid use: Strongly associated with reduced fertility—must be discontinued immediately if applicable 3, 1
• Smoking cessation: Smokers have slightly reduced fertility and poorer sperm parameters 3, 7
• Stress reduction: Stress is directly associated with reduced sperm progressive motility 3, 1
• Dietary optimization: Poor diet results in reduced fertility; increase fruits and vegetables while reducing fats and meats 3, 7
• Environmental toxin exposure: Avoid DEHP (found in plastics), pesticides, lead, and cadmium, all associated with lower sperm motility 3, 1
• Heat exposure: Minimize heat to the testes (avoid hot tubs, laptops on lap, tight underwear) 7
• Maintain healthy body weight: Obesity with or without metabolic syndrome causes mildly reduced fertility 3

Antioxidant Therapy Considerations

The evidence for antioxidant therapy is insufficient to make a strong recommendation, but given the association between asthenozoospermia and oxidative stress, a trial may be reasonable after confirming elevated oxidative stress markers. 3, 4

• There are no high-quality data supporting any single antioxidant or specific combination 3
• No effective treatment regimen can be definitively recommended based on current evidence 3
• However, recent research shows oxidative stress is much more frequent in asthenozoospermia, and appropriate antioxidant therapy may be justified when oxidative stress is documented 4
• Herbal therapies have insufficient data and cannot be recommended 3

Monitoring Strategy

Repeat semen analysis in 6 months to establish whether parameters are stable or declining 7

• A declining trend warrants immediate referral to a male reproductive specialist 7
• Monitor for development of sexual dysfunction or symptoms of hypogonadism 7

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Fertility Prognosis and Assisted Reproduction

Natural Conception Potential

Your ability to achieve natural pregnancy is significantly reduced but not impossible, as sperm motility is more predictive of fertility than sperm count alone 8

• The combination of adequate sperm numbers but poor motility creates a mixed prognosis 8
• Time to pregnancy will likely be prolonged compared to men with normal motility 8

Assisted Reproductive Technology Options

If natural conception does not occur within 6-12 months of attempting, proceed directly to assisted reproduction consultation 8

• Intrauterine insemination (IUI) may be attempted if post-wash total motile sperm count is adequate 8
• In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) bypasses the motility requirement entirely and is highly effective for isolated asthenozoospermia 3, 8
• Your normal sperm count means sperm retrieval procedures (micro-TESE) are not necessary 3

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Critical Pitfalls to Avoid

• Do not accept a single abnormal semen analysis as definitive—always confirm with repeat testing 1, 2
• Do not use exogenous testosterone or anabolic steroids, as these completely suppress sperm production through negative feedback and can cause azoospermia lasting months to years 7
• Do not delay evaluation if parameters worsen on repeat testing—progressive decline requires immediate specialist referral 7
• Do not assume normal sperm count equals normal fertility—motility is equally critical for conception 4, 8
• Do not pursue expensive genetic testing unnecessarily—it is not indicated with your sperm concentration 3, 1