The diagnosis and management of men with low sperm motility
Open accessAbstract
Investigations into infertility typically start with semen analysis. In this article the authors describe the diagnostic criteria, potential causes and approaches to the management of low sperm motility.
AI snapshot
Written from the paper’s full text.
TL;DR
This narrative review summarizes the diagnosis, causes, and management of asthenozoospermia (low sperm motility), a common contributor to male infertility. It emphasizes treating reversible causes (varicocele, urogenital infection, smoking) and reserves ICSI for severe cases.
Key findings
- Asthenozoospermia is defined by WHO criteria as less than 40% total sperm motility or less than 32% rapid progressive motility, and diagnosis requires at least two semen samples collected after 3–5 days of abstinence.
- Infertility affects approximately 15% of couples in the first year of trying, with male-specific factors accounting for up to 50% of reproductive difficulties; flagellar defects are responsible for deficient motility in around 70% of infertile men.
- Varicoceles are found in approximately 25% of men with abnormal semen analysis; a multicentre study of 7035 young men found even grade 1 varicoceles associated with reduced sperm motility, count, and morphology. A 2012 subgroup analysis reported varicocelectomy improved pregnancy rates (odds ratio 2.39; 95% CI 1.56–3.66), but with low-quality evidence.
- Antisperm antibodies are found in 10% of infertile men versus <2% of fertile men. A Cochrane review of 4179 subfertile men across 48 RCTs found antioxidants significantly improved live birth and clinical pregnancy rates, but evidence was graded 'very low' to 'low'.
Methods
- Narrative review article (no primary data collection) describing diagnostic criteria, causes, and management approaches for low sperm motility.
- Synthesizes existing literature including WHO semen analysis standards, Cochrane reviews, meta-analyses, and guideline recommendations (NICE, EAU, ASRM).
- Includes two tables (sperm motility grading scale; causes of asthenozoospermia) and one figure of defective sperm cells.
Limitations
- The paper itself states no formal limitations section; it notes that antioxidant studies are limited by small sample size, short duration, and variable end points, and that evidence favoring antioxidant therapy is 'very low' to 'low'.
- The paper acknowledges that the impact of varicocele repair on motility alone, and whether improvements translate into higher pregnancy rates, is unclear, and that Cochrane reviews have been criticized for including men with subclinical varicoceles and normal semen parameters.
- Evident from the text: this is a narrative review without systematic search methodology, and several cited associations (e.g., urogenital infection as a cause) rest on low-level evidence per the authors' own description.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 41 cited sources checked · 0 supported · 0 flagged
- Premisecitation§ Varicocele
In a large multicentre cross-sectional study of 7035 young men, even grade 1 varicoceles were associated with a reduction in sperm motility, count and morphology.
“In a large multicentre cross-sectional study of 7035 young men, even grade 1 varicoceles were associated with a reduction in sperm motility, count and morphology.11”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Urogenital infection
Current guidelines recognise urogenital tract infections as a possible cause of male infertility, albeit with a low level of evidence.
“Current guidelines recognise urogenital tract infections as a possible cause of male infertility, albeit with a low level of evidence.19”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Causes
Excess ROS cause oxidative stress that leads to lipid peroxidation of sperm membranes.
“Excess ROS cause oxidative stress that leads to lipid peroxidation of sperm membranes.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [4]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Urogenital infection
In a recent meta-analysis, chronic bacterial prostatitis was associated with a reduction in sperm total and progressive motility, as well as sperm concentration and vitality.
“In a recent meta-analysis, chronic bacterial prostatitis was associated with a reduction in sperm total and progressive motility, as well as sperm concentration and vitality.27”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Ultrastructural defects of spermatozoa
NFSA are the most frequent flagellar pathology in severe asthenozoospermia.
“NFSA are the most frequent flagellar pathology in severe asthenozoospermia.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Smoking
Spermatozoa from smokers exhibit lower motility compared with the spermatozoa of non-smokers.
“Several studies have found that spermatozoa from smokers exhibit lower motility compared with the spermatozoa of non-smokers.8,9”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [9]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Varicocele
Several Cochrane reviews have shown no benefit of varicocele repair on pregnancy rates.
“Several Cochrane reviews have shown no benefit of varicocele repair on pregnancy rates, [14][15][16]”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [14]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [15]
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- cites [16]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Varicocele
Several studies have shown an improvement in semen parameters following varicocele repair.
“Several studies have shown an improvement in semen parameters following varicocele repair.12,13”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [12]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [13]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisenone given§ Causes
Causes of oxidative stress include cigarette smoking, urogenital infection and varicocele.
“Causes of oxidative stress include cigarette smoking, urogenital infection and varicocele (see Table 2).”
Quote in the paperNot a substantial claim - Premisecitation§ Causes
Lipid peroxidation of sperm membranes leads to a loss of membrane integrity and change in protein composition, which compromises sperm motility.
“Lipid peroxidation of sperm membranes leads to a loss of membrane integrity and change in protein composition, which compromises sperm motility.4”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [4]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Varicocele
A subgroup analysis excluding men with subclinical varicoceles and normal semen parameters reported a beneficial effect of varicocelectomy on pregnancy rates (odds ratio 2.39; 95% CI 1.56-3.66).
“A subgroup analysis excluding these patients was subsequently performed in 2012 and reported a beneficial effect of varicocelectomy on pregnancy rates (odds ratio 2.39; 95%; CI 1.56-3.66).17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Ultrastructural defects of spermatozoa
Sperm abnormalities of proven or suspected genetic origin are rare conditions responsible for severe asthenozoospermia or absolute asthenozoospermia.
“Sperm abnormalities of proven or suspected genetic origin are rare conditions responsible for severe asthenozoospermia or absolute asthenozoospermia.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Smoking
The harmful effects of cigarette smoke affect virtually all semen parameters, including sperm motility.
“The harmful effects of cigarette smoke affect virtually all semen parameters, including sperm motility.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [8]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [9]
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- cites [10]
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- Interpretationreasoning§ Urogenital infection
The mechanism by which urogenital infections cause male infertility is multifactorial and largely related to oxidative stress and the release of inflammatory cytokines.
“The mechanism is multifactorial and largely related to oxidative stress and the release of inflammatory cytokines.”
Quote in the paperNot a substantial claim - Premisecitation§ Ultrastructural defects of spermatozoa
In contrast to NFSA, genetic alterations are observed in all spermatozoa.
“In contrast to NFSA, alterations are observed in all spermatozoa.7”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation§ Ultrastructural defects of spermatozoa
Defects of the flagellum are responsible for deficient sperm motility in around 70% of infertile men.
“Defects of the flagellum are responsible for deficient sperm motility in around 70% of infertile men.6”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ Varicocele
There is no evidence to support the correction of subclinical varicoceles.
“There is no evidence to support the correction of subclinical varicoceles.”
Quote in the paperSubstantial claim - Premisecitation§ Antioxidants
There is evidence to show that certain antioxidants improve sperm motility.
“Although there is evidence to show that certain antioxidants improve sperm motility, [29][30][31]”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [29]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [30]
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- cites [31]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning§ Urogenital infection
Eradication of infection does not always coincide with an improvement in semen quality, probably due to the persistence of a chronic inflammatory state.
“Eradication of infection does not always coincide with an improvement in semen quality, probably due to the persistence of a chronic inflammatory state.”
Quote in the paperNot a substantial claim - Premisecitation§ Antioxidants
The evidence in favour of antioxidant therapy was designated as 'very low' to 'low' due to limitations including small patient numbers, study design inconsistencies and poor reporting of adverse events.
“Additional limitations were small patient numbers, study design inconsistencies and poor reporting of adverse events, resulting in a designation of the evidence in favour of antioxidant therapy as 'very low' to 'low'.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [32]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisereasoning§ Antioxidants
Antioxidants such as zinc, folic acid, N-acetylcysteine, Co-enzyme Q10, vitamin E, vitamin C and carnitine are thought to improve sperm quality by reducing oxidative stress.
“Antioxidants such as zinc, folic acid, N-acetylcysteine, Co-enzyme Q10, vitamin E, vitamin C and carnitine are all thought to improve sperm quality by reducing oxidative stress.”
Quote in the paperSubstantial claim - Interpretationreasoning§ Management
Lifestyle modifications, such as smoking cessation, have a beneficial effect on semen quality.
“Lifestyle modifications, such as smoking cessation, also have a beneficial effect on semen quality.”
Quote in the paperNot a substantial claim - Interpretationnone given§ Conclusion
Asthenozoospermia is an important cause of male infertility.
“Asthenozoospermia is an important cause of male infertility.”
Quote in the paperSubstantial claim- Rests on an assumption: Antisperm antibodies are directed against spermatic surface antigens, causing sperm agglutination, reduced motility and prolonged semen liquefaction.
- Rests on an assumption: Antisperm antibodies form following a breach of the blood-testis barrier, for example vasectomy, trauma or prior urogenital infection.
- May combine two claims. 12
- Classified as probably not a substantial claim. 4
May combine two claims.
Premisecitation§ Urogenital infectionSexually transmitted infections including hepatitis C virus, hepatitis B virus, herpes simplex virus, human papillomavirus, chlamydia trachomatis and ureaplasma urealyticum have all been linked to reduced sperm motility.
“Sexually transmitted infections including: hepatitis C virus, 21 hepatitis B virus, 22 herpes simplex virus, 23 human papillomavirus, 24 chlamydia trachomatis 25 and ureaplasma urealyticum, 26 have all been linked to reduced sperm motility.”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [21]
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- cites [22]
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- cites [23]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ SmokingSpermatozoa of smokers display reduced progressive motility, higher deviations in straight line motility and faster deterioration after ejaculation.
“More specifically, the spermatozoa of smokers displayed reduced progressive motility, higher deviations in straight line motility and faster deterioration after ejaculation.10”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim. May combine two claims.
Premisecitation§ VaricoceleEAU and ASRM guidelines recommend varicocelectomy, but only for men with clinical varicoceles and abnormal semen parameters.
“while the European Association of Urology and American Society for Reproductive Medicine guidelines do recommend varicocelectomy, but only for men with clinical varicoceles and abnormal semen parameters.19,20”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [19]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [20]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ VaricoceleNICE guidelines do not recommend varicocele repair.
“As a result, NICE guidelines do not recommend varicocele repair, 18”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ Ultrastructural defects of spermatozoaNFSA are acquired secondary to either varicoceles or urogenital infection and affect a variable number of spermatozoa.
“Alterations are acquired secondary to either varicoceles or urogenital infection and affect a variable number of spermatozoa.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ CausesAsthenozoospermia may be idiopathic, due to genetic defects such as primary ciliary dyskinesia, or due to the consequences of high levels of reactive oxygen species (ROS) in the male reproductive tract.
“Asthenozoospermia may be idiopathic, due to genetic defects such as primary ciliary dyskinesia or due to the consequences of high levels of reactive oxygen species (ROS) in the male reproductive tract.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [4]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [5]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ CausesSpermatozoa have limited antioxidant defence mechanisms and are particularly susceptible to oxidative stress and oxidative DNA damage.
“Spermatozoa have limited antioxidant defence mechanisms and are, therefore, particularly susceptible to oxidative stress and oxidative DNA damage.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [4]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [5]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim. May combine two claims.
Premisecitation§ VaricoceleThe authors of the subgroup analysis concluded that the results were suggestive rather than conclusive, with a low quality of evidence.
“However, with a low quality of evidence, the authors concluded that the results were suggestive rather than conclusive.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ CausesROS-induced damage of mitochondrial DNA leads to decreased intracellular ATP, which causes axonemal damage, reduced viability and increased morphological defects, all contributing to decreased sperm motility.
“Furthermore, ROS-induced damage of mitochondrial DNA leads to decreased intracellular ATP which, in turn, causes axonemal damage, reduced viability and increased morphological defects -all of which contribute to decreased sperm motility.5”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ Antisperm antibodiesAntisperm antibodies are found in 10% of infertile men, compared with <2% of fertile men.
“They are found in 10% of infertile men, compared with <2% of fertile men 28”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [28]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Interpretationnone given§ ConclusionAsthenozoospermia may occur as a result of antisperm antibodies, structural defects of spermatozoa or oxidative stress in the male reproductive tract.
“It may occur as a result of antisperm antibodies, structural defects of spermatozoa or oxidative stress in the male reproductive tract.”
Quote in the paperSubstantial claim- Rests on an assumption: Antisperm antibodies are directed against spermatic surface antigens, causing sperm agglutination, reduced motility and prolonged semen liquefaction.
- Rests on an assumption: Antisperm antibodies form following a breach of the blood-testis barrier, for example vasectomy, trauma or prior urogenital infection.
May combine two claims.
Premisecitation§ AntioxidantsThe Cochrane review's results on live birth and clinical pregnancy were based on only four and seven RCTs, respectively.
“However, these results were based on only four and seven RCTs, respectively.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [32]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
Interpretationreasoning§ AntioxidantsThere remain no specific recommendations on the use of antioxidants for the treatment of male infertility.
“There remain no specific recommendations on the use of antioxidants for the treatment of male infertility.”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ AntioxidantsA Cochrane review of 4179 subfertile men from 48 randomised controlled trials comparing single and combined antioxidants with placebo reported a statistically significant improvement in live birth rate and clinical pregnancy rate.
“A Cochrane review of 4179 subfertile men from 48 randomised controlled trials (RCTs), comparing single and combined antioxidants with placebo, reported a statistically significant improvement in live birth rate and clinical pregnancy rate.32”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The paper relies on this without support.
The diagnosis of asthenozoospermia must be based on at least two semen samples, collected after 3-5 days of sexual abstinence.
“As with all semen parameter abnormalities, the diagnosis of asthenozoospermia must be based on at least two semen samples, collected after 3-5 days of sexual abstinence.”
The paper relies on this without support.
Varicoceles are found on examination in approximately 25% of men with abnormal semen analysis.
“Varicoceles are found on examination in approximately 25% of men with abnormal semen analysis.”
The paper relies on this without support.
Antisperm antibodies are directed against spermatic surface antigens, causing sperm agglutination, reduced motility and prolonged semen liquefaction.
“Antisperm antibodies (ASA) are directed against spermatic surface antigens, causing sperm agglutination, reduced motility and prolonged semen liquefaction.”
The paper relies on this without support.
Antisperm antibodies form following a breach of the blood-testis barrier, for example vasectomy, trauma or prior urogenital infection.
“and form following a breach of the blood-testis barrier (for example, vasectomy, trauma or prior urogenital infection).”
The paper relies on this without support.
The success of ICSI is not usually affected by the overall quality of basic sperm parameters; however, absolute asthenozoospermia does reduce successful fertilisation after ICSI.
“The success of ICSI is not usually affected by the overall quality of basic sperm parameters; however, absolute asthenozoospermia does reduce successful fertilisation after ICSI.”
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Flagged first, then by citations
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- Chemes H. The significance of flagellar pathology in the evaluation of asthenozoospermia. In: Baccetti B, ed. Comparative Spermatology 20 Years Later. Serono Symposia Publications, vol 75. New York: Raven Press; 1991:815-9.
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Sorted by citations
Glycerol Kinase 2 as a Metabolic Sentinel for Human Sperm Motility and Male Fertility
Oliveira, J. P., Moreira, R., Martins, A. D., Alves, M. G., & Oliveira, P. F. (2025) · Biomolecules · doi:10.3390/biom15091249 · Cited by 6 · see citing works
“…spermatozoa, which show no movement; (2) spermatozoa with slow movement but lacking progressive motion; (3) spermatozoa displaying slow, meandering forward progression; (4) spermatozoa moving in a straight line at a moderate speed; and (5) spermatozoa exhibiting high-speed, linear motility [9].”
Chen, L., Zhang, K., Cui, X., et al. (2024) · Medical Hypotheses · doi:10.1016/j.mehy.2024.111377 · Cited by 6 · see citing works
Mostafa, T., & Palani, A. (2024) · Springer eBooks · doi:10.1007/978-3-031-55337-0_8 · Cited by 1 · see citing works
Case report - Acupuncture treatment for Astenozoospermia
Zhu, J., Arsovska, B., & Козовска, К. (2023) · Open Access International Journal of Academic Research UNIVERSES · doi:10.59710/oaijoaru2312014z
- Authors
- Lobo, N., & Satchi, M.
- Affiliations
- Frimley Health NHS Foundation Trust (GB)
- University College London (GB)
- ORCID
- Satchi, Maria
- Venue
- Trends in Urology & Men's Health
- Publisher
- Wiley
- Published
- 2019-09
- Volume
- 10
- Issue
- 5
- Pages
- 24-27
- ISSN
- 2044-3730 (ISSN-L)
- 2044-3749
- OpenAlex
- W2978251547
- Semantic Scholar
- dd10e5d9c3b2c9b4c35cff09ac092412f7e516d5
- Cited by
- 4
- References
- 24
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Trends in Urology & Men s Health (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
- Health Sciences › Medicine › Rheumatology › Urologic and reproductive health conditions
- Keywords
- male infertility, semen analysis, infertility diagnosis, infertility treatment
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