User:V.Kalsi, Future UCSF Pharm.D/sandbox

Sign and Symptom
Low volume of ejaculate or semen

Complication
Infertility

Causes of Hypospermia

 * 1) Retrograde ejaculation= This means that the sperm is produced in testes but on its way out, it gets misdirected into the bladder rather than moving out of urethra.  This can be caused by either structural or functional damage in the ejaculation process.
 * 2) Absence or loss of seminal vesicle or vas deference= Absence or loss of function of seminal vesicle or vas deference can also lead to low volume of semen.
 * 3) Hypogonadism = low level of testosterone causes low volume of semen. Testosterone is produced by the testes and can be used for diagnosing hypogonadism.
 * 4) Blockage of ejaculatory duct= Obstruction of ejaculatory duct causes a state of hypospermia

Mangagement
According to a review, the management for hypospermia will depend upon the etiology of the disease. Studies have shown that functional retrograde ejaculation can be treated with oral pharmacotherapies that include imipramine and pseudoephedrine which can prevent the backflow of semen and stimulate ejaculation. Whereas in the case of structural retrograde ejaculation, pharmacotherapy might not work but surgical procedures which can fix the bladder neck problem can be considered. The blockage of the ejaculatory duct can be treated via transurethral resection of the ejaculatory duct (TURED). TURED has shown to improve the volume of semen in men with ejaculatory duct obstruction leading to significant improvement in the fertility rate among couples.

Hormonal abnormalities caused by either primary or secondary hypogonadism can be treated with off-lable use of oral clomiphene citrate which has shown to increases the level of testosterone in the body. Administration of testosterone for treatment of hypogonadism has been shown to have negative impact on the process of spermatogenesis.

Intrauterine insemination (IUI) or in vitro fertilization (IVF) may be considered if the pharmacotherapy and surgery fail.