Hyperspermia: The forgotten condition?

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DOI: 10.1093/oxfordjournals.humrep.a135944 · Source: PubMed
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Abstract
The seminal volumes of 4223 men with known periods of abstinence of ejaculation, complete collections and with no dysfunction known to affect production of accessory gland secretions have been examined to define a minimum value for hyperspermia. The 95th percentile of the skewed data distribution was 6.3 ml and of the 229 men with values equal to or greater than this, 113 (49.3%) had sperm concentrations below the World Health Organization accepted minimum 'normal' value of 20 x 10(6)/ml. Basic seminal parameters should not be forgotten when assessing infertile men.
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Human Reproduction vol.10 no.2 pp.367-368, 1995
Hyperspermia: the forgotten condition?
S.Cooke, J.P.P.Tyler1 and G.L.Driscoll
Integrated Fertility Services, 12 Caroline Street, Westmead,
NSW 2145, Australia
'To whom correspondence should be addressed
The seminal volumes of 4223 men with known periods of
abstinence of ejaculation, complete collections and with no
dysfunction known to affect production of accessary gland
secretions have been examined to define a minimum value
for hyperspermia. The 95th percentile of the skewed data
distribution was 6.3 ml and of the 229 men with values
equal to or greater than this, 113 (49.3%) had sperm
concentrations below the World Health Organization
accepted minimum 'normal' value of 20Xl06/ml. Basic
seminal parameters should not be forgotten when assessing
infertile men.
Key words: hyperspermia/ semen analysis/semen volume
Introduction
The normal range for seminal volumes produced by masturba-
tion after ~3 days of abstinence has been well established,
with the upper value being quoted as 6.0 ml (Eliasson, 1976)
and the normal range between 2.0 and 6.0 ml (Mortimer,
1994).
While every seminologist knows larger volumes can
be produced, there is little in the literature to describe the
incidence of men who consistently produce high volumes
(hyperspermia) or to define where a pathological value may
begin. Indeed, the World Health Organization (WHO, 1993)
does not include reference to an upper limit value in its
guidelines for minimal standards for semen analysis and nor
do Menkveld et al. (1993) in their recent proposal for the re-
classification of WHO semen parameters.
While Bostofte et al. (1982), in a 20 year follow-up study
of infertile couples, concluded that there was no relationship
between semen volume and ultimate attainment of
a
pregnancy,
they did, however, find a statistically significant correlation
between increasing seminal volume and the time taken for
conception to occur. This has relevance for today's infertility
clinics, where the average age of couples presenting for
investigation appears to be increasing, and their expectations
of quick success are high.
The aim of this short report was to define a seminal volume
above which hyperspermia occurred in a large group of men
who had collected semen during the routine course of their
infertility investigation, and to determine the incidence of
reduced sperm concentrations in this group.
Materials and methods
The records of every semen analysis performed at Integrated
Fertility Services for the past 10 years were reviewed (« =
6684).
Each man had been requested to abstain from ejaculation
for a period of 3 days before producing his semen by
masturbation. At sample delivery, patients were asked about
seminal fluid loss at collection and the actual period of
abstinence was recorded. For this study, only data from men
who gave an exact abstinence period (whether honest or not!)
were reviewed and values >10 days, or recorded as greater
than so-many days, were omitted because of the increased
likelihood of inaccuracy. Data were also excluded if the
patients reported loss of semen at collection or if azoospermia
was diagnosed, since congenital absence of the vas deferens
and seminal vesicles would be associated with a reduced
seminal volume. Similarly, sperm concentrations too low to
be counted accurately (<0.1X106/ml) and coincident with
hypospermia (<1.0 ml) were also excluded since partial
retrograde ejaculation might have occurred.
Results
Figure
1
shows the skewed distribution (kurtosis 2.07; skewness
1.02) of the 4223 data sets that met the above criteria. Seminal
volumes have been grouped in 0.5 ml increments. The median
value was 3.2 ml and 75% of the data (interquartile range)
fell between 2.3 and 4.5 ml. Because of the non-normal
distribution, the 95th percentile was taken as the defined
volum«((ral))
100
200 300 400 500 60(
Fig. 1. The distribution of seminal volumes after 3-10 days
abstinence for 4223 men.
© Oxford University Press367
at OUP site access on November 11, 2015http://humrep.oxfordjournals.org/Downloaded from
S.Cooke, J.P.P.Tyier and G.L.Driscoll
50.66%
23.14%
13.10%
Fig. 2. The incidence of reduced sperm concentrations in 229
hyperspermic men. M = million.
presented a statistical value in their study group of 1300 men
of proven fertility, quoting the 84th (!) percentile as 4.5 ml
(cf. 4.8 ml in this study) and 11.0 ml as the maximum.
While seminologists today are increasingly interested in
tests of sperm function and clinicians are embracing intracyto-
plasmic sperm injection, the basic parameters of a seminal
analysis should not be ignored. Thus this paper simply defines
hyperspermia in a large population as those men who produce
seminal volumes ^6.3 ml, but further demonstrates that in
almost 50% of these a sperm concentration exists which is
considered to reduce fertility potential because of dilution.
Procedures such as the split ejaculation technique, where sperm
concentration is artificially improved because of the reduction
in seminal volume delivered to the partner at coitus, may
circumvent this problem and 'high-tech' procedures may not
be required.
minimum value for hyperspermia. This value was 6.3 ml and
229 men had seminal volumes equal to or greater than this.
Of these, 113 (49.3%) had sperm concentrations below the
WHO accepted minimum 'normal' value of 20X106/ml
(Figure 2).
Discussion
The production and delivery of excessive seminal plasma to
the female partner at coitus might reduce fertility potential
by limiting the availability of spermatozoa to the female's
reproductive tract, both by dilution and loss of semen. While
this review excluded, for the reasons outlined above, 36.8%
of men presenting for routine analysis, unlike other surveys
the data in this study were less likely to be artefactual because
of incomplete ejaculation, poor or non-defined abstinence, or
spillage of the sample at collection. Similarly, larger volumes
would also mean ejaculatory preparation and delivery was
complete, thus maximizing sperm content.
Therefore the 95th percentile value quoted may be an
underestimate, as most detrimental factors would decrease,
rather than increase, seminal volumes (e.g. accessory gland
infection). Furthermore, combining data with abstinence
periods of between 3 and 10 days is valid, since studies which
have reviewed the effects of abstinence on seminal parameters
have shown the accessory glands can replenish their secretions
within 2-3 days of an ejaculation and little extra is added to
seminal volume (-0.4 ml/day) with increasing time (Jouannet
etai, 1981).
Few publications have addressed the subject of seminal
volume in recent times. While Eliasson (1976), in a description
of seminal terminology, did not note high seminal volume as
a pathology, he did recognize an upper limit value for 'normal'
as being 6.0 ml (in our study 13.0 ml was the largest volume).
Few details of seminal volume were given by Murphy (1967)
in a study of 3544 men whose analyses were performed
between 1942 and 1965, except to note that 8.9% had volumes
>8.0 ml. Similarly, MacLeod (1950), in a study of 800
fertile men, gave an incidence of 4.8% with seminal volumes
>6.5 ml, further noting that 'highest semen volumes were
associated with infertile individuals'. Only Rehan et al. (1975)
368
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at OUP site access on November 11, 2015http://humrep.oxfordjournals.org/Downloaded from
  • ... A study carried out in Australia, examined the semen of 4223 men, and found 229 men (5.42%) as hyperspermic. 16 Of them, 49.3% were found to have a sperm concentration of less than the WHO recommended minimal level of 20 million/ml. Similarly, a study carried out in South Africa, where 70% patients had possible contribution to male factor for infertility, reported hypospermia in 45% and hyperspermia in 9% of the patients studied. ...
    ... In two European studies, 18,19 no case of hyperspermia was observed in contrast to the Australian 16 and South African 17 studies, as seen in the present study. This can be attributed to the geographical location of the 5 countries, with Australia, South Africa and Pakistan falling in the tropical region and the two European countries belonging to a comparatively colder temperate zone. ...
    ... Since the Australian study was specifically carried out to measure the upper range of semen volume of the population, it was more likely to show hyperspermia. 16 In this study on volume disturbances, revealed incidence of low ejaculatory volume in 23.34% and high volume in 7.88% of the males. The mean seminal concentrations were within normal range for both low (56.50 ± 10.50) and high ejaculatory volume groups (62.20 ± 14.50) but were significantly lower than the control group (102.12 ± 1.34, Table IV). ...
    Article
    To determine the seminal volume among infertile males and the frequency distribution of hypospermic and hyperspermic patients in infertile males. Cross-sectional observational study. Department of Reproductive Physiology/Health, Public Health Laboratories Division, National Institute of Health, Islamabad, from 2002 to 2009. Semen examinations of infertile male were carried out according to the standardized method of the World Health Organization. Seminal volume of 2-6 ml were considered normal, while volumes less than 2 ml and higher than 6 ml were considered hypospermic and hyperspermic respectively. Out of 1521 patients, 355 were hypospermic (23.34%), 1046 were normospermic (68.78%) while 120 were hyperspermic (7.88%). In the hypospermic cases, 57 out of 355 (16.05%) had a volume of less than 1 ml. Of those 57 patients, 34 were found to be azoospermic, 12 were asthenozoospermic, one each were terato- and polyzoospermic, while 6 had normal counts. Among the hyperspermic patients (n=120), 3 were azoospermic, 24 were oligozoospermic and 19 cases (15.84%) had count within the normal range, while 1 patient was polyzoospermic. Significant differences (p < 0.05) were observed among azoospermic, oligoasthenozoospermic and teratozoospermic groups when comparing hypo and hyperspermic patients. Seminal volume is an important parameter for assessment of infertility investigation and its abnormalities constitute a valuable index of problems with the male partner, even if the count and motility are well within the acceptable limits.
  • ... Abnormal concentrations of these substances are routinely detected in seminal fluid and they are often indicative of gland dysfunction. On the other hand, analysis of the physical properties of ejaculate has been of less concern clinically, although abnormal coagulation, liquefaction, volume, viscosity and pH are also commonly detected in routine semen analysis (15)(16)(17). ...
    ... The prevalence of samples of low or high volume in the current study was in agreement with earlier reports (16,(37)(38)(39). However, higher percentages have also been reported (40,41). ...
    ... Nevertheless, data from Table 1 show that abnormal biochemical markers of the prostate and seminal vesicles should also be appraised. Likewise, sexual abstinence, spillage of the sample and psychological distress at collection can influence the cut-off point for volume (16). Therefore, a more refined study of the data is needed. ...
    Article
    The purpose of this study was to ascertain whether analysis of the physical properties of ejaculate also has any diagnostic potential for evaluating the function of these accessory sex glands. Diverse normal and abnormal states of coagulation, liquefaction, volume, viscosity and pH were studied with regard to the levels of biochemical markers of the seminal vesicles (fructose and inorganic phosphorus) and prostate (calcium, zinc and acid phosphatase). Fructose and inorganic phosphorus were significantly decreased in samples with absent or poor coagulation (p<0.001), volume < 2.0 mL (p=0.009 and p<0.001, respectively), hypoviscosity (p=0.013 and p<0.001), hyperviscosity (p=0.006 and p<0.001) and pH < or = 7.1 (p=0.018 and p<0.001). Also, fructose and inorganic phosphorus were significantly decreased in samples with liquefaction > 120 min (p=0.003) and pH > 8.0 (p<0.001), respectively. Calcium, zinc and acid phosphatase activity were significantly increased in samples with absent or poor coagulation (p<0.001), and significantly decreased in samples with volume > 5.0 mL (p=0.007, p=0.034 and p=0.011) and pH > 8.0 (p<0.001). Also, calcium and zinc were significantly increased in hypoviscous samples (p=0.012 and p=0.003), whereas the zinc concentration was significantly lower in hyperviscous samples (p=0.026). Using receiver operating characteristic (ROC) curve analysis, pH showed the highest predictive power to identify prostate dysfunction (83.6%) and simultaneous prostate and seminal vesicle dysfunction (98.8%). Physical analysis of ejaculate was also found to be clinically useful for evaluating the secretory activity of the seminal vesicles and prostate. Abnormal coagulation, liquefaction, volume, viscosity and pH strongly suggest gland dysfunction.
  • ... Our results that the seminal vesicle function could be also affected by RF suggest similar phenomena may occurred in shift workers. Hypospermia is the medical term when a man has an unusually low ejaculate/semen volume(less than 1.5 mL), and would be a factor in infertility when the oligospermia is combined (Cooke et al., 1995). Instead, hyperspermia could be an impeding factor for quality of life, because it lowers male sexual performance and satisfaction. ...
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    Previously, we demonstrated that the shift and/or restriction of feeding time during relatively short-term period (4 weeks) could alter the pituitary gonadotropin expression and the weights of seminal vesicle and prostate in rats. We also found that the reverse feeding (RF) schedule (up to 8 weeks) might induce an adaptable metabolic stress and cause impairment of androgen-dependent reproductive tissues. In the present study, we extended the RF time regimen up to 12 weeks, and measured the reproductive tissue weights. After 4 and 8 weeks of RF, the weights of epididymis were not significantly different. After 12 weeks, however, epididymis weights of RF animals were significantly different (CON 12W : RF 12W = 48.26±0.62 mg : 44.05±1.57 mg, p<0.05). After 4 and 12 weeks of feeding, seminal vesicle weights of RF animals were significantly decreased (CON 4W : RF 4W = 79.36±8.34 mg : 46.28±2.43 mg, p<0.001; CON 12W : RF 12W = 72.04±3.76 mg : 46.71±2.27 mg, p<0.001, respectively). Prostate weights were not changed by RF. Kidney and spleen weights of RF animals were significantly different on weeks 4 and 12 (Kidney, CON 4W : RF 4W = 249.72±4.20 mg : 228.41±3.03 mg, p<0.001; CON 12W : RF 12W = 309.15±7.49 mg : 250.72±6.13 mg, p<0.001, respectively, Spleen, CON 4W : RF 4W = 111.26±3.76 mg : 96.88±4.69 mg, p<0.05; CON 12W : RF 12W = 123.93±10.72 mg : 94.68±5.65 mg, p<0.05, respectively). Histology analysis of seminal vesicle revealed that the thinner epithelial cell layers, reduced complexities of swollen papilla folding in the exocrine glands on weeks 4 and 12 of RF. There was no histological difference between control and RF group on week 8. The present study indicates that up to 12 weeks RF induced differential changes in tissue weights of male mice. In particular, seminal vesicle, kidney and spleen seemed to temporarily adapted to the RF-induced metabolic stress on week 8 of feeding schedule. These results confirmed the our previous study that the RF might induce an adaptable metabolic stress and cause impairment of androgen-dependent reproductive tissues such as epididymis and seminal vesicle as well as non-reproductive tissues such as kidney and spleen. Further studies will be needed to achieve a better understanding of the how does mealtime shift affect the reproductive function and exact nature of adaptation.
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    Objective: To investigate sperm parameters of ejaculates with hyperspermia. Methods: One hundred and thirty-three ejaculates with hyperspermia (semen volume >6 ml) were divided into three groups: group A, n=66, semen volume 6.0-6.9 ml; group B, n=63, semen volume >7.0 ml; group C, n=4, semen volume >6.0 ml, no sperm in the ejaculates. Sperm motility, count, and morphology were determined according to the World Health Organization Laboratory Manual (2010). Results: Of the 133 ejaculates studied, the largest volume was 10.8 ml. Most samples with hyperspermia had normal conventional sperm parameters. No differences were found on sperm motility and abnormal morphology rate between groups A and B (P>0.05). In addition, no differences were also found on incidences of low motility, low sperm count, high abnormal morphology, and white blood cell (WBC) positivity between groups A and B (P>0.05). However, sperm count in group B was significantly lower than that in group A (P<0.05). Ejaculates in group C had no WBC positivity. Conclusion: Hyperspermia could have multiple forms for sperm parameters including good or poor status. Increasing seminal volume could not influence sperm parameters except for sperm count. © 2015 The Editorial Board of Journal of Reproduction and Contraception.
  • Article
    Ejaculatory dysfunction is one of the most common male sexual disorders. The spectrum of ejaculatory dysfunction extends from premature ejaculation (difficult to define) through delayed ejaculation to a complete inability to ejaculate including retrograde ejaculation. Despite the significant progress in understanding the neuroanatomy neurophysiology and neuropharmacology of ejaculatory disorders our knowledge remains incomplete. Many critical mechanisms yet require clarification and further basic and clinical investigations are warranted.
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    This retrospective study compared semen parameters from fertile men of two South American cities (Medellín-Colombia and Petrópolis-Brazil) to investigate their differences in some semen parameters. We evaluated semen volume using a graduated tube, total progressive motility (a + b) using light microscopy (40X) and sperm concentration using a Neubauer Counting Chamber. We observed that fertile men from Medellín presented a significantly lower volume (p<0.0001), whereas individuals from Petrópolis presented a significantly lower percentage of total progressive motility (p<0.0001). On the other hand, no difference was found in sperm concentration (p>0.05). In conclusion, this study showed differences in semen parameters between fertile men of these South American populations. We think that these differences could be attributed to the geographical variations, like those observed in other countries. However, new studies are required to investigate this phenomenon and their causes.
  • Article
    The Greek-based terms used to describe semen-analysis abnormalities (e.g., "oligozoospermia" and "azoospermia") are unscientific, have overlapping definitions, and are often misinterpreted. The best course is to abandon these vague and difficult labels and simply report semen analyses quantitatively.
  • What constitutes a normal semen?
    • J Macleod
    MacLeod.J. (1950) What constitutes a normal semen? Fertil. Sterii, 1,347-361.
  • Commentary: WHO criteria of normality for semen samples
    • R Menkveld
    • . D Franken
    • T Kruger
    Menkveld,R., Franken.D. and Kruger.T. (1993) Commentary: WHO criteria of normality for semen samples. Newslett. Int. Soc. Androl., 10, 10-11.
  • Male Infertility; Workup, Treatment and Research
    • R Eliasson
    Eliasson,R. (1976) Semen analysis and laboratory workup. In Cockett.A.T.K and Urry,R.L. (eds), Male Infertility; Workup, Treatment and Research. Grune and Stratton, New York, pp. 169-188.
  • World Health Organization (1993) WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction
    World Health Organization (1993) WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction, 3rd edn. Cambridge University Press, Cambridge. Received on July II, 1994; accepted on October 18, 1994
  • Article
    The prevasectomy semen analyses of 1300 men who had fathered at least two children were studied. The ages of the men ranged from 23 to 64 years, with a mean age of 39.6 years; 84% of the men were Caucasian, 5% were black, and 5% were of other ethnic groups; 32% of the men were Roman Catholic, 26% Jewish, 22% Protestant, and 11% professed no religion; in 9% religion was not recorded. The number of children ranged from 2 (48%) and 3 (30.6%) to 10 (0.1%). The volume of the ejaculate ranged from 0.1 to 11.0 ml, with a mean of 3.2 ml plus or minus 1.4 SD. Sperm density ranged from 1.5 to 375 million/ml, with an arithmetic mean of 79 million/ml plus or minus 57 SD; however, the logarithmic or geometric mean was chosen as being more representative of the asymmetric distribution under study. The geometric mean was 65 million/ml, with standard deviation limits of 30 to 142 million/ml, figures that correspond to the 16th and 84th percentiles. The percentage of motile sperm ranged from 5 to 95%, with a mean of 65% plus or minus 22 SD. The grade of sperm motility, according to MacLeod and Gold's classification (Fertil Steril 2:187, 1951) of 0 to 4, ranged from 1 to 4, with a mean grade of 3. There were 25 men (2%) with a sperm count below 10 million/ml and 26 (2%) in whom the percentage of motile sperm was less than 20%. Polyzoospermy (count greater than 250 million/ml) was found in 15 men (1.2%); one or more spontaneous abortions had occurred in six of the spouses of these men (40%), whereas the over-all spontaneous abortion rate was 7% and the spontaneous abortion rate for wives of men with sperm counts below 10 million/ml was 4%. A positive relationship was found between sperm density and percentage of motile sperm; the relationship between motility and the logarithm of sperm density was represented by a straight line (a 10-fold increase in sperm count was accompanied by an increase of 20.4% in sperm motility); the slope of the line was highly significant, although the correlation coefficient was weak (0.27). A similarly positive relationship was found between sperm density and grade of motility; however, the correlation coefficient was also weak (0.22). The relationship between the grade of motility and the proportion of motile sperm also positive, was reasonably large (0.70), although its significance is questionable because of the crudeness of the scale utilized to assess the grade of sperm motility. A comparison of the findings with those of similar studies was made.
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    The clinical fertility of 1077 men investigated with sperm analysis including sperm count and semen volume during the years 1950-52 was studied 20 years later using a questionnaire, replied by 785 (72.9%). There was a significant correlation (P less than 0.01) between sperm count and number of living children, but no relation to abortions and pathological pregnancies. Furthermore, sperm count was correlated (P less than 0.01) to time interval from wish of pregnancy to pregnancy obtained. Of 53 men with sperm count less than or equal to 5 mill/ml 22.6% obtained living children compared with 52.2-63.1% living children in 730 men with sperm count greater than 5 mill/ml. Sperm count is concluded to be proper for fertility classification, and sperm count 5 mill/ml is found to be the clinically significant borderline of male infertility. There was no relation between semen volume and pregnancies obtained, however, there was a statistical relation (P less than 0.01) to time interval to pregnancy obtained. Semen volume is concluded not to be suited for fertility classification.
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    The semen characteristics studied were the sperm count, semen volume, morphology and pre-freeze and post-thaw motility. Two categories of fertile men were investigated: semen donor candidates for artificial insemination and pre-vasectomy subjects. Since mean values for each variable in the two series were similar, they could be considered as a single group of 484 fertile men. Only those subjects whose ejaculates were obtained after an abstinence of 5 days or less were retained. The distribution, mean and percentiles were determined for each variable. The 10th and 90th percentiles for sperm count, percentage of motile forms and percentage of normal cells were respectively 25 and 180 million per ml, 60% and 80% and 50% ad 75%. The three variables, sperm count, semen volume and total number of spermatozoa which were dependent on abstinence were analysed in the same manner for 3 days of abstinence. The group studied seemed to be as representative and as well defined as possible.