Overview

Per WHO 2021 reference values, normal semen requires adequate sperm in count, motility, and morphology. The three most common sperm abnormalities are: Oligospermia (count below 16 million/mL), Asthenospermia (less than 42% progressive motility), and Teratospermia (less than 4% normal morphology). These frequently coexist as OAT syndrome.

Causes & Risk Factors

• Varicocele — most common and correctable cause
• Hormonal imbalances
• Smoking — strongly linked to poor motility and morphology
• Alcohol, anabolic steroids, recreational drugs
• Heat exposure — hot tubs, laptop on lap, tight underwear
• Obesity raises scrotal temperature and disrupts hormones
• Oxidative stress — elevated ROS damages sperm DNA and motility
• Infections, genetic factors, medications, environmental toxins

Diagnosis

• Semen analysis (WHO 2021) after 2–5 days abstinence
• Repeat analysis to confirm and exclude temporary causes
• Hormone panel — FSH, LH, testosterone, oestradiol, prolactin
• Scrotal ultrasound — for varicocele
• Sperm DNA fragmentation (SDF) — recommended in recurrent failure
• Genetic testing for severe oligospermia (<5 million/mL)

Treatment

• Lifestyle modification — improvements seen within 3 months
• Antioxidant supplements — CoQ10, vitamin C/E, zinc, selenium
• Varicocele repair — improves parameters in most men
• IUI — for mild-to-moderate cases
• IVF with ICSI — for moderate-to-severe abnormalities
• Testicular sperm for high SDF cases

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