All about Sperm Cell: Causes of Low Sperm Count, Low Motility and Morphology.





What is Oligoasthenoteratozoospermia?


Oligoasthenoteratozoospermia is one of the major health issues in male infertility. Oligoasthenoteratozoospermia (OAT) syndrome include three semen parameters oligozoospermia (low sperm count), asthenozoospermia (low sperm motility), and teratozoospermia (abnormal sperm morphology).[1]

The role of sperm cell in male fertility


According to WHO, sperm count and motility are important measures of male fertility and play the fundamental role in healthy pregnancy. It is also etiological reported that most causes of male infertility refer to defect in sperm parameters.



 Major Causes of low Sperm Count , Motility and Morphology

 There are several conditions that can negatively affect spermatogenesis and play a role to reduce sperm production and  quality.

Effects of Obesity on  Healthy Sperm Cell

There are several  shreds of evidence that indicate male obesity negatively impacts on male fertility. It is reported that male obesity reduces sperm concentration and DNA integrity. It is important to mention that sperm DNA integrity plays an important part for successful progeny and Poor DNA integrity  has negative effects on fertility.[2]

Association between Alcohols Consumption and Sperm Cell

Alcohol is associated with the decrease in the normal percentage of sperms.[3] It negatively affects on decreased libido, decreased sperm count and sperm morphology. [4]

Chlamydia Infection and Sperm Parameters

The role of chronic asymptomatic chlamydial infection is understandable in male infertility.
Chlamydia can affect sperm development and overall fertility. It is suggested that approximately 28-71%  of infertile men have evidence of a chlamydial infection. [5]

Effects of  Environmental Risk Factors  on Sperm Cell

Current studies indicate that there is the association between   environmental factors and sperm quality. [6]  Environmental factors include such as various chemicals, heat, radiation, cigarette smoking and heavy metals. These above environmental factors can negatively affect spermatogenesis.[7] Heavy metal such as toxic has also negative effects on sperm quality and production (Steven Sinclair, ND, Lac, and Male Infertility: Nutritional and Environmental Considerations)

Dietary and Lifestyle Factors also Negatively Affect Sperm Cell

Heavy dietary contain hydrogenated oils, particularly cottonseed oil and high levels of the chemical gossypol which negatively affect spermatogenesis and sperm quality.[8]

 Tthe impact of Cigarette Smoking on Health Sperm

Cigarette smoking has also linked with decreased sperm count. It can negative affect sperm motility and help to increase in abnormal sperm.[9]


Role of Reactive Oxygen on Sperm Parameters

Approximately 40 to 80% of male infertile patients have high levels of reactive oxygen species.[10]
The recent research indicates that high level of reactive oxygen species (ROS) is one of the major causes which can damage different parts of the spermatozoa[11] including sperm count, sperm motility, sperm morphology DNA and RNA.[12]

In addition, spermatozoa produce the small amount of ROS, which is necessary for normal physiologic cell function such as capacitation, hyperactivation, and sperm-oocyte fusion .

Role of Sex Hormones in The Development of Sperm Cell



Hormones are one of the most important factors that positively or negatively affect the cell development. The sex hormones relate directly and indirectly to sperm parameters.  It is important to know that change in the normal hormonal condition may negatively affect on sperm parameters. It is etiologically established that low testosterone level, elevated in FSH (follicle-stimulating hormone) and LH (and luteinizing hormone) are the generally negative impact on sperm production and QAT.[13]

Androgen

Androgens are the group of sex hormones that play an important role in the development of secondary sex characteristics. It also helps to initiation and maintenance of spermatogenesis.[14] Spermatogenesis relies closely on hormone regulation. Hormones are also important for male sexual and reproductive functions.  The deficiency of Androgens has negative effects on sexual function as well as on the sperm parameters. The major androgen is testosterone which plays a key role in the development of male sexual functions.
Therefore, attention was focused on the androgen receptor (AR) as a possible cause of the impaired spermatogenesis in subjects with idiopathic male infertility.

 Relationship between Testosterone and Sperm Parameters

Testosterone is a hormone that is produced by the human body. It stimulates sperm production, man's sex drive and also helps to build muscle and bone mass. Testosterone plays an important role in supporting spermatogenesis. In the absence/ low level of testosterone and the absence of functional androgen receptors (AR), males are infertile because spermatogenesis rarely progresses beyond meiosis[15].


 Role of FSH and LH in Sperm Quality and Quantity

The present study shows that the serum levels of FSH and LH are associated with sperm motility, morphology, and concentration[16] when these two hormones reach the high, this condition may   lead to testicular failure.[17] If the semen levels of FSH and LH are lower than normal, the pituitary gland is not producing enough hormones which automatically negative effect on sperm parameters. [18]

It is established that FSH level is mostly elevated with low testosterone level.  According to American Society for Reproductive Medicine, “FSH levels greater than twice the upper normal limit is a reliable indicator of spermatogenic failure”. (American Society for Reproductive Medicine and Society for Male Reproduction and Urology, 2008).[19]

 Role of Inhibin B in Sperm  Concentration
Inhibin B is also strongly associated with sperm concentration. According to study, there is a significant relation between FSH and Inhibin  B with sperm parameters.[20] It is also reported that with the decreased level of Inhibin B, reduce the proportions of normal sperm.[21]


Treatment Options for Sperm Count and Motility

Hormone Pharmacotherapy for improving Sperm Count, Motility and Morphology

it is important to understand that there is a strong relationship between low testosterone level and infertility. It is indicated that “Low testosterone level clearly associated with low sexual desire and infertility”. Testosterone replacement therapy is one of the best ways to increase fertility. It also plays a role in the  improvement of sperm quality and quantity. It is also reported that high-level LH and FSH also strongly associate with low testosterone level. A patient with low sperm count and motility must  take a test of testosterone.

Medications and Therapies for Improving sperm count and motility 


L-Carnitine

 L- Carnitine plays an important role in sperm motility and also contributes in the successful maturation of sperm cell. Dietary supplementation of L-carnitine helps in improvement of sperm quality, quantity, and concentration.[22]
L-Carnitine actually protects sperm DNA and cell membranes from free radical-induced damage and apoptosis.[23] The major function of L-carnitine is to provide the energetic substrate for spermatogonia as it is necessary for transport of fatty acids to mitochondria.[24]

L.Arginine


.L-Arginine consider as an antioxidant medication that plays an important role to enhance serum motility.[25]  According to Schachter’s study in which arginine was given to 178 patients with low sperm count, seventy-four percent of the subjects had significant improvement in sperm count and motility after taking 4 g/day for three months.

Zinc

Zinc plays a significant role in normal functioning of the reproductive health system. Zink deficiency may lead to poor sperm count, poor motility and alternately lead to infertility.[26] Moreover, zinc deficiency relates with low testosterone level and sperm count.  It is important to remember that Zinc levels are generally lower in infertile men. Several studies proved that zinc therapy/ supplementation can improve sperm parameters such as low sperm counts, poor motility and may also help to improve the treatment of male infertility.[27]

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Vitamin C`

 It is established that low deficiency of vitamin C can lead to increased abnormal Sperm morphology, low sperm counts and reduces fertility.[28] It is important to understand that antioxidants are the major defense component against oxidative stress. Oxidative stress (it also described recently as reactive oxygen species) and anti-sperm antibodies (ASA) negatively affect on sperm functions including decrease sperm count and motility.[29] Vitamin C is one of the primary factors of the antioxidant system of the spermatozoa and also one of the major protectors against ROS AND LPO attacks.[30]  
Vitamin C plays an important role in increasing sperm count, motility and also help to Increase DNA integrity. Vitamin C (non-enzymatic antioxidant) supplemented drug is  also used in the treatment of  sperm quality in an infertile male. 

Vitamin E

It is well-documented that Vitamin E is one of the most important antioxidants which defends sperm parameters from the attack of ROS. It also protects spermatozoa against endogenous oxidative DNA damage and enhances the sperm performance in the hamster egg penetration assay.

Glutathione/Selenium

Glutathione has demonstrated a positive effect on sperm motility and also play a role for  sperm antioxidant defense and deficiency of  Glutathione may defect sperm motility. 

Vitamin B12

.
Vitamin B 12 is an important vitamin which plays an essential part for proper function of sperm parameter especially for the synthesis of RNA and DNA. The deficiency of B12 associated with decreasing sperm count and motility. It is well established that vitamin B 12 have a great affect on increasing count and sperm concentration.  



It is important to remember that there are various therapist methods  and options which assist in reaching the possible solution for  the successful treatment of sperm parameters. However, unfortunately, many drugs and therapies are presently used without any clinical test. The use of these unscientific therapies doesn’t have any beneficial impact on sperm parameters.
However, there are several effective and scientifically approved therapies, medication, supplements, and drugs which positive effects on sperm parameters without any dangerous side effects.





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[4] Rakesh Sharma, Kelly R Biedenharn, Jennifer M Fedor and Ashok Agarwal, Lifestyle factors and reproductive health: taking control of your fertility, Sharma et al. Reproductive Biology and Endocrinology 2013.
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[6] Lahdetie J. Occupation- and exposure-related studies on human sperm. J Occup Environ Med 1995;37:922-930.
[7] De Celis R, Pedron-Nuevo N, Feria-Velasco A. Toxicology of male reproduction in animals and humans. Arch Androl 1996;37:201-218. See also: Steven Sinclair, ND, Lac, Male Infertility: Nutritional and
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[10] Padron OF, Brackett NL, Sharma RK, Lynne CM, Thomas AJ, Agarwal A. Seminal reactive oxygen species and sperm motility and morphology in men with spinal cord injury. Fertil Steril 1997; 67 : 1115-20.
[11] Griveau JF, Le Lannou D. Reactive oxygen species, and human spermatozoa: Physiology and pathology. Int J Androl 1997; 20 : 61-9.
[12] De Lamirande E, Gagnon C. Reactive oxygen species, and human spermatozoa. II. Depletion of adenosine triphosphate plays an important role in the inhibition of sperm motility. J Androl 1992; 13 : 379-86.
[13] Cavallini G. Male idiopathic oligoasthenoteratozoospermia. Asian J Androl 2006;8:143e57.
[14] Ruey-Sheng Wang, Shuyuan Yeh, Chii-Ruey Tzeng, and Chawnshang Chang, Androgen Receptor Roles in Spermatogenesis and Fertility: Lessons from Testicular Cell-Specific Androgen Receptor Knockout Mice, Published online 2009 Jan 27. PMCID: PMC2662628.
[15] Haywood M, Spaliviero J, Jimemez M, King NJ, Handelsman DJ, Allan CM. Sertoli and germ cell development in hypogonadal (hpg) mice expressing
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[16] .( Relationships Between Serum Hormone Levels and Semen Quality
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[17] Laaksonen DE, Niskanen L, Punnonen K, Nyyssönen K, Tuomainen TP, Valkonen VP. The metabolic syndrome and smoking in relation to hypogonadism in middle-aged men: a prospective cohort study. Journal of Clinical Endocrinology & Metabolism. 2005;90(2):712-19.

[18] Lima N, Cavaliere H, Knobel M, Halpern A, Medeiros-Neto G. Decreased androgen levels in massively obese men may be associated with impaired function of the gonadostat. International journal of obesity. 2000;24(11):1433-7.

[19] S.C. Esteves ,Male infertility due to spermatogenic failure: current management and future perspectives, Anim. Reprod., v.12, n.1, p.62-80, Jan./Mar. 2015)
[20] John D. Meeker,* Linda Godfrey-Bailey, Relationships Between Serum Hormone Levels and Semen QualityAmong Men From an Infertility Clinic, Journal of Andrology, Vol. 28, No. 3, May/June 2007
[21] John D. Meeker,* Linda Godfrey-Bailey, Relationships Between Serum Hormone Levels and Semen QualityAmong Men From an Infertility Clinic, Journal of Andrology, Vol. 28, No. 3, May/June 2007
[22] ( H.J. Al-Daraji# & A.O. Tahir ,  Effect of L-carnitine supplementation on drake semen quality, South African Journal of Animal Science 2014
[23] John D. Meeker,* Linda Godfrey-Bailey, Relationships Between Serum Hormone Levels and Semen QualityAmong Men From an Infertility Clinic, Journal of Andrology, Vol. 28, No. 3, May/June 2007
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[26] Mohammad Shoaib Khan,Rafat Ullah , Assad ullah ,Mohammad Akram, Association of Blood  Zinc with Reproductive Hormones & Seminal Cytology, Ann. Pak. Inst. Med. Sci. 2014; 10(3): 131-135.
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[29] Mangoli E1, Pourentezari M1, Anvari M1, 2, Talebi AR*1, 2, Nahangi H1, The improvement of Sperm Parameters and Chromatin Quality by Vitamin C , Researcher 2012;4(11),
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[30] Mangoli E1, Pourentezari M1, Anvari M1, 2, Talebi AR*1, 2, Nahangi H1, The improvement of Sperm Parameters and Chromatin Quality by Vitamin C , Researcher 2012;4(11),
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