I’m 36 y.o. On december 2012, I noticed a drastic decrease in semen volume while masturbating. Two months later (February 2013) a sudden (it happened overnight) and severe decrease in sex drive and pleasure sensations with some ED followed.
I saw an urologist. He noticed I have a hydrocele on my left testicle (I think I have it for the last 2-3 years now) and asked me for a spermogram that confirmed the low semen volume and showed also a low spermatozoid mobility. He then suspected a varicocele and asked me for a Doppler that could not clearly confirm the varicocele because the hydrocele blocks the view. The urologist then asked me to redo a spermogram in six months.
Now, the ED almost disappeared, low sex drive and lack of pleasure improved a little but far from normal, and semen volume is almost as low. Obviously, this is making me feel depressed.
My question is:
what might be the reason(s) of this? Hydrocele? Varicocele? Low testosterone? High estrogen? Thyroids? Dopamine levels? Something else?
And what should I do about it?
On a side note, I have genital herpes for the last 3 years that I successfully treated with Valtrex suppressive daily therapy (I’ve never had outbreaks since). I stopped the pills a few months ago and I’m doing fine.
I don’t smoke, rarely drink, not super athletic but not overweight either. I recently changed my country of residence; I left north-america for my country of origin in the middle-east last year.
I’d like to add that I’m looking for a second urologist for a second opinion but also because I didn’t like my current urologist’s approach.
I can understand your concern. The normal sperm count is over 15 million sperms and volumes between 1.0 mL and 6.5 mL are normal. Motility is the percentage of moving sperm in a sample and an evaluation of their rate and direction of travel. At least 50% should be motile one hour after ejaculation.
Usually in such cases, we do another semen test after four to six weeks to see whether sperm quality has improved on its own. If there are still large numbers of abnormal sperm or a low sperm count, then we check for any infection. Some infections can interfere with sperm production and sperm health or can cause scarring that blocks the passage of sperm and these include Chlamydia, Gonorrhea, prostatitis and orchitis. Out of the possibilities that you have mentioned, varicocele is the causative factor for both low semen volume as well as reduced motility. This may prevent normal cooling of the testicle, leading to reduced sperm count and fewer moving sperm.
Secondly hormonal imbalance can also cause such semen abnormalities and effect sperm production. The hypothalamus, pituitary and testicles produce hormones that are necessary to create sperm. Alterations in these hormones, as well as from other systems such as the thyroid and adrenal can affect sperm health.
Herpes is less likely to affect semen volume and motility. But to be on the positive side, any form of mental stress can also affect sperm health and semen volume. So please check if you have any psychological stress since the past few days.
I agree with your urologist to get a repeat semen analysis done after 6 months.
Till then consume more of whole grains, legumes, vegetables, fruits, nuts, and seed. Avoid alcohol, smoking, take more of proteins and fresh vegetables. Minerals like zinc & selenium, amino acids like l-carnitine, and antioxidants like Vitamin C and Vitamin E are very crucial to sperm health.
Hope that this information helps and hope that you will get better soon.
Hello Dr Kaur, and thank you for your quick response.
After reading your comments, I noticed you only addressed the sperm issue. I would like to read your opinion about the low sex drive issue as well because honestly, I’m more concerned about it than the sperm one.
Here are some more information that I thought they would help after reading your comments:
Sperm exam results: Low volume (1ml), Low ph (6.5), low 1h mobility (fast 12%; slow 15%; moving in the same spot 21% and immobile 52%); low 4h mobility (fast 7%; slow 9%; moving in the same spot 13% and immobile 71%); Low vitality (48%); the rest is within standard ranges.
Doppler results: the radiologist thinks that the hydrocele is big and should be removed and reperform the Doppler.
Chlamydia Gonorrhea: recently got tested and never performed any unprotected sex (oral included).
Prostatitis and orchitis: I thing urologist said no prostatis after first examination, I don’t know about orchitis but radiologist report said testicles are in normal size, right location and regular contour.
About mental stress: I went through depression when I first got infected with herpes 3 years ago and I feel much better now, even if my low sex drive causes psychological stress. However, even during depression, both my sex drive and semen were absolutely normal. My urologist first thought about a psychological cause as well, but after seeing the sperm test results, he said that psychological factors can’t impact sperm to this extent. Also, the sudden nature of the low semen volume and decrease in sex drive suggest more physiological causes.
I forgot to mention that I almost lost morning erections.
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