When it comes to Male Fertility, quality and quantity matter. Not only is it important that you produce good quality sperm, but you also need to produce enough volume of semen to “carry” the sperm to their final destination.
Semen is the transport fluid that contains the sperm which eventually fertilizes the egg. While you need the sperm to create an embryo which eventually becomes a baby, you need other components found in the semen to enable fertilisation to occur. The situation can be thought of as the testes being the “factory” to produce the sperm while the semen being the “trucks” that carry the sperm.
Low semen volume is due to several underlying causes and understanding the reason behind low semen volume is important for your doctor to estimate the likelihood of a natural conception or if assisted reproductive should be considered.
Making that decision early can save you valuable time and lessen the stress of trying to conceive.
Sperm is produced and stored in the testicles. It is important to note that sperm makes up only 5% of semen volume, therefore, the volume of semen does not say much about how well your testes function.
Semen is a mixture of several fluids that are produced in different parts of your reproductive system namely the seminal vesicles and the prostate. These fluids provide a stable environment for your sperm to survive after they have left your body and entered the female reproductive tract to travel towards the egg.
Low volume ejaculate
Ejaculation volume should range between 1.5ml to 5ml. That is half to one TEASPOON. The volume does vary based on how frequently you have been ejaculating, hence a common threshold when analysing volume is to have a patient abstain from ejaculating for at least 3 days.
Having a low ejaculate volume seen on your semen analysis test can be due to reasons such as:
- Poor sample collection (spillage of not having all the sample end up in the sample cup)
- Medication
- Blockage in the prostate and seminal vesicles
- Retrograde ejaculation
- Nerve/ Spinal Cord damage
Poor sample collection
Poor collection is a common reason for low ejaculate volume seen on the semen analysis. Many men take an overly casual approach when providing a sample and panic later when the results get flagged as abnormal. When providing the sample, do make sure that the entire amount of ejaculate is placed into the bottle. Be sure to inform the testing center if there was any spillage when providing the sample. DO NOT scoop any spillage back into the bottle, it is better to re-schedule the test than to provide an inadequate sample.
You also have to retract your foreskin completely when providing the semen sample. Otherwise a portion of the semen may get trapped behind the foreskin. If you are unable to retract your foreskin or retraction causes pain, you may be suffering from phimosis and would need treatment.
Medication Side Effects
Certain medications can cause poor volume depending on how long you have been on these medications and at what doses. These medications include:
- 5-Alpha Reductase Inhibitors – This medicine is commonly used to treat enlarged prostate and also used to treat Male Pattern Balding
- Thiazides – High blood pressure medication
- Neuroleptics – Seizure medication
Blockage in the Prostate or Seminal Vesicles
An enlarged prostate can physically obstruct the ejaculatory ducts and cause a low semen volume. Similarly for the seminal vesicles, certain infections such as STDs can lead to the tubes getting damaged thus limiting the amount of fluids produced. An ultrasound scan will be able to identify if there are any obstructions while a STD screen will detect any ongoing infections that can be treated to prevent further damage.
Retrograde ejaculation
This is a situation where the semen goes backwards into the bladder rather than out towards the penis. This can be due to extra tissue lining the tract meant to lead the semen out but can also be due to damage caused by a previous or ongoing STD. A simple way to assess if there is retrograde ejaculation is to do a post ejaculation urine test. The urine after ejaculation should have a minimal amount of sperm. Depending on the severity of the situation, surgery may be required to remove the obstruction. Retrograde ejaculation is also commonly caused by medications such as alpha-blockers which are frequently prescribed to treat symptoms arising from an enlarged prostate. So solving the problem could be as easy as stopping or replacing the offending medication.
Nerve damage
Ejaculation is a reflex much like how you blink when something approaches your face. Hence the condition of your nerves and to a larger extent your spinal cord is important to ensure that your body is able to eject the semen out into your partner’s vaginal canal.
In younger men, the most common cause for poor sperm volume is trauma to the nerves/ spinal cord such as motor vehicle accidents, sports accidents, chronic slip-disc/ back pains. In older men, damage due to diabetes that is poorly controlled becomes more likely. Informing your doctor if any of the above situations are applicable to you will make it easier to plan any necessary investigations and treatments that can help alleviate the problem.
What next?
The most common question I get from patients with low sperm volume is “Do I really need to do all these tests and even surgery?”
The answer to this question really centers on whether natural conception can be achieved if we fix these issues or Assisted Reproductive Therapy (ART), like IVF is needed?
Although sperm volume is important for both natural conception and ART, it is much more important in natural conception. If you and your partner are very sure that ART is not an option, then optimising the sperm volume becomes more of a priority. However, if ART is on the cards and there is a need to have a surgery to fix the sperm volume, then specialised techniques such as microscopic sperm extraction can be done during the same surgery thus saving you the hassle of going for multiple surgeries.
Click here if you wish to make an appointment at our Men’s Health Medical Center.
Have a question? Feel free to put it in the comments section below.
Or visit us at our Men’s Health Clinic.
Have a question but need more privacy? Contact us on our Telegram channel. You can also follow us to get the latest news on STDs/HIV and Men’s Health.
Men’s Health – https://t.me/joinchat/uj8HDPzLtpk3NTA1
STD/ HIV Channel – https://t.me/joinchat/83vmPfDJa205ZTc1