Asthenozoospermia (Poor Sperm Motility)

What is asthenozoospermia?

Asthenozoospermia means reduced sperm motility, or poor movement. Sperm must swim through the cervix, uterus and fallopian tube to reach the egg, so movement matters for natural conception. Under the WHO 2021 reference values, motility is considered low when fewer than 30 percent of sperm show progressive (forward) movement, or fewer than 42 percent show any movement (total motility). It can occur alone or together with low count or abnormal shape.

Symptoms and signs

There are usually no physical symptoms. Most men learn about it from a semen analysis done because of difficulty conceiving. Sometimes there are clues to an underlying cause, such as:

• Pain or swelling in the scrotum, which may suggest a varicocele or infection
• Burning on passing urine or discharge, which may suggest a genital tract infection
• Frequent chest infections or sinus problems, in rare genetic conditions affecting the sperm tail

Causes and risk factors

• Varicocele
• Infection or inflammation of the prostate, seminal vesicles or epididymis
• Oxidative stress from smoking, obesity, pollution or poorly controlled diabetes
• Heat exposure and tight clothing
• Antisperm antibodies, sometimes after injury or surgery
• Long periods of abstinence before the test
• Genetic defects of the sperm tail, such as primary ciliary dyskinesia, in rare cases
• Heavy alcohol use and some medicines

How it is diagnosed

• Semen analysis, repeated if abnormal, with the sample examined soon after collection
• Sperm vitality testing (eosin stain or hypo-osmotic swelling test) when very few sperm move, to see whether non-moving sperm are alive
• Semen culture and white blood cell count if infection is suspected
• Antisperm antibody testing in selected cases
• Scrotal examination and ultrasound
• Sperm DNA fragmentation testing where helpful

Treatment options

Treating the cause

Infections are treated with antibiotics. A varicocele that can be felt on examination may be repaired. Stopping smoking, limiting alcohol, achieving a healthy weight and avoiding heat can help. Antioxidants are often prescribed, though evidence that they increase pregnancy rates is mixed. Changes take about 2 to 3 months to show.

IUI

For mild asthenozoospermia, sperm washing selects the best-moving sperm, which are placed into the uterus around ovulation.

IVF with ICSI

When motility is moderately or severely reduced, or IUI has not worked, ICSI is recommended. The embryologist selects individual sperm and injects one into each egg, so sperm do not need to swim. When no sperm are moving, vitality tests help the embryologist choose live sperm for injection.

Chances of pregnancy

Many couples with poor sperm motility conceive with treatment. ICSI largely overcomes the movement problem, so the chance of pregnancy then depends mostly on the female partner's age, egg reserve and embryo quality. Outcomes vary between couples, and no result can be guaranteed.

When to see a fertility specialist

See a specialist if your semen report shows low motility, if you have tried for 12 months, or sooner if your partner is 35 or older or has her own fertility concerns. Iswarya Fertility offers semen testing and ICSI at its 91+ centres, with EMI options from ₹9,999 per month for eligible treatments.