Irregularities in the mobility and shape of the sperm are generally of unknown origin and do not have any specific treatment although on occasion antioxidant treatments may be tried, such as with vitamins C and E. Wherever possible, the presence of a series of factors which may be the triggering factors or may be negatively contributing to the quality of the sperm must be studied. These factors are the following:
Varicocele
This consists of a dilation of the veins which essentially emerge from the left testicle, due to the absence or fault in one of the valves (floodgates) which ensure that once the blood leaves the testicle in an upwards direction via the spermatic vein which empties into the renal vein, it does not return back down to the testicle. When this happens there is a dilation of the entire plexus of testicular veins and it could lead, amongst other things, to an increase in the temperature of the testicle, a lack of oxygenation of the gland and to obstructive processes due to the compression of the first section of the seminal duct. In addition, waste elements from the kidney or the suprarenal gland may reach the testicle and act like toxins. These effects provoke a reduction in the production and/or quality of the sperm.
The varicocele can be detected during a physical examination of the testicle or by means of a Doppler study which shows the reflux of the blood flow to the testicle.
The treatment consists of joining the veins of the testicle at groin level (varicocelectomy) under local anaesthetic and on an outpatient basis.
Infection of the seminal duct
The presence of germs in the semen, generally coming from the prostate, may lead to inflammatory processes which obstruct the seminal duct at any level. They may also adhere to the sperm, affecting their mobility or their fertilising capability. The microorganisms may favour the production of anti-sperm antibodies with a whole series of harmful effects which are detailed in the next section. In the event of suspecting an infection of the seminal duct a culture from urine issued prior to ejaculation and semen should be undertaken. On occasion an expression of the prostatic gland through rectal manipulation may be indicated in order to ensure its secretions pass to the urethra, exiting directly from the meatus or they may be carried away by the urine. The prostatic secretion and post-prostatic massage urine are analysed to identify germs and other cells such as leucocytes (inflammatory cells). There may be disorders of the prostate or other components of the seminal duct which favour the infection and can be detected through an ultrasound scan.
Antisperm antibodies
In the event of different circumstances representing a disorder of the testicle or seminal duct, the organism reacts by producing elements called antibodies which act against the sperm. Examples of this are the obstruction of the seminal duct with the emergence of sperm outside of same and the inflammation (orchitis) or tumour of the testicle. The antibodies may alter the seminal plasma (liquid which accompanies the sperm), as well as the mobility or the fertilising capability of the sperm. There are no treatments for the sperm, although occasionally one might try corticosteroids.
When the sperm disorders are significant the possibility of proceeding with assisted reproduction techniques should be considered. The methodology for the preparation of the sperm in order to apply these techniques permits, in part, the separating out of the anti-sperm antibodies.