Hypospermia is defined as an ejaculate volume below the WHO lower reference limit of **1.5 mL**. Aspermia describes the complete absence of ejaculate output (anejaculation or total dry ejaculation). Differentiating these conditions is vital for planning successful surgical or medical management.
How to Read Your Semen Analysis: Ejaculate Volume & Differentiations
| Clinical Entity | Semen Volume | Semen pH | Seminal Fructose | Post-Ejaculate Urinalysis |
|---|---|---|---|---|
| Normal Ejaculate | ≥ 1.5 mL | ≥ 7.2 | Positive | Negative for Sperm |
| CBAVD / EDO | < 1.0 mL | Acidic (< 7.2) | Negative / Low | Negative for Sperm |
| Retrograde Ejaculation | < 1.0 mL or 0 mL | Variable | Variable | Positive (Sperm in centrifuged urine) |
| Central Hypogonadism | < 1.0 mL | Normal / Alkaline | Normal | Negative for Sperm |
Diagnostic Workup Logic:
- Centrifuged Post-Ejaculate Urinalysis: Centrifugation of alkaline post-ejaculatory urine; presence of spermatozoa confirms retrograde ejaculation.
- Transrectal Ultrasound (TRUS): Direct visualization of seminal vesicles and ejaculatory ducts to rule out cysts or blockages.
- Endocrine Profiling: Evaluate serum Total Testosterone to rule out hypogonadal accessory gland understimulation.
Etiological Stratification & Treatment:
Retrograde ejaculation occurs due to internal sphincter incompetence, which can be treated with sympathomimetics like pseudoephedrine. Ductal blockage (EDO) requires transurethral resection (TURED). For neurogenic anejaculation, electrical or vibratory stimulation or direct surgical retrieval is utilized to harvest sperm for ICSI.
