Teratozoospermia is a disorder that affects sperm morphology. It is diagnosed when a very high percentage of sperm exhibit structural abnormalities, which can hinder their ability to reach and fertilize an egg, thus causing male infertility.
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What is teratozoospermia?
Also called teratospermia, it is a condition in which an abnormally high proportion of sperm The ejaculate contains defects in its shape. These defects can be located in the head, midpiece (neck), or tail of the sperm.
A sperm cell is considered morphologically normal when its head has a regular oval shape, the midpiece is straight and of uniform thickness, and the tail is single, long, and without coils. Any deviation from this ideal shape can compromise its ability to move through the female reproductive tract, penetrate the outer layer of the egg, and fertilize it.
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Classification according to the pattern of anomalies (Type)
Polymorphic teratozoospermia occurs when sperm with various types of defects coexist in the same sample. To assess it, the Teratozoospermia Index (TZI) is usually calculated, which indicates the average number of defects per abnormal sperm.
Monomorphic teratozoospermia is much rarer. Almost all sperm exhibit the same specific type of abnormality, such as globozoospermia (sperm with a round head and no acrosome, necessary to penetrate the egg) and macrozoospermia (sperm with a greatly enlarged head).
Classification according to the degree of severity (Grade)
Traditionally, the severity of teratozoospermia has been classified into three grades.
Mild is when between 10% and 14% of the sperm have normal morphology; moderate when the percentage of normal sperm is between 5% and 9%; and severe or serious when less than 5% of the sperm have a normal shape.
What is the normal teratozoospermia index?
According to current World Health Organization (WHO) criteria, a man does not have teratozoospermia if at least 4% of his sperm have normal morphology. A result above this threshold is considered within normal limits and is associated with preserved fertility potential. A value below 4% of normal morphology is diagnostic of teratozoospermia.
Some fertility laboratories still use Kruger's strict criteria as a reference, which are more demanding and consider the lower limit of normality to be 15% normal sperm.
Why it happens: causes and risk factors
The causes of teratozoospermia are diverse, including genetic and congenital factors such as chromosomal abnormalities (such as the Klinefelter's syndrome) or specific mutations that can affect spermatogenesis and lead to sperm with abnormal shapes; by environmental and lifestyle factors such as exposure to toxins; harmful habits such as tobacco use, excessive alcohol and recreational drugs; prolonged testicular heat that increases scrotal temperature or oxidative stress.
It can also be due to medical conditions such as varicocele, infections, aggressive medical treatments, systemic diseases such as uncontrolled diabetes mellitus, autoimmune diseases or severe febrile episodes, or hormonal imbalances.
Symptom
Teratozoospermia does not produce obvious physical symptoms. The only "symptom" or indicator is usually difficulty achieving pregnancy after a period of regular, unprotected sex.
When is teratozoospermia serious?
Teratozoospermia is considered clinically and reproductively severe when less than 5% (according to Kruger) or 4% (according to WHO) of sperm have normal morphology; when the Teratozoospermia Index (TZI) indicates that abnormal sperm have, on average, defects in all three parts; when globozoospermia poses an extreme difficulty for natural fertilization; or when there is an association with other seminal alterations such as oligozoospermia or asthenozoospermia.
Diagnosis and medical evaluation
It is performed using a complete semen analysis or spermogram, in which a semen sample obtained by masturbation is analyzed, after a period of sexual abstinence of 2 to 7 days.
At least 200 sperm from the sample are examined in detail to classify them as normal or abnormal, and the location of any defects is noted. It is usually recommended to repeat the semen analysis after 3 or 4 months to confirm the diagnosis. The volume, concentration, total and progressive motility, viability, and the presence of round cells or leukocytes are also evaluated.
How to get rid of teratozoospermia?
Lifestyle modifications and adjuvant treatments
It is recommended to adopt a diet rich in antioxidants, omega-3 (oily fish) and vitamins C and E. Specific supplements such as L-carnitine, coenzyme Q10, zinc, selenium and folic acid may also be recommended.
You should stop smoking, drastically reduce alcohol consumption and avoid recreational drugs, also wear loose underwear, avoid very hot immersion baths, saunas, and do not place the laptop directly on your lap.
Stress management and moderate exercise should be learned, as well as appropriate treatment of underlying medical conditions.
Assisted Reproductive Technologies (ART)
The choice of technique depends on the severity of the teratozoospermia and the presence of other infertility factors in the couple; options include:
- Artificial insemination (AI) in cases of mild teratozoospermia, when the rest of the semen parameters (concentration and motility) are good and the woman does not have fertility problems.
- In vitro fertilization with ICSI is used for most cases of moderate to severe teratozoospermia. A morphologically normal sperm is selected and injected directly into the egg.
- IMSI (Intracytoplasmic Sperm Injection) is a more advanced variant of ICSI. It uses a high-magnification microscope to select the highest quality sperm for injection. It is indicated in cases of severe teratozoospermia or after previous ICSI failures.
- Sperm donation is only used when, despite ART, it is not possible to obtain viable sperm from the male or when there is a serious genetic alteration that is not to be transmitted.
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Care and prevention
Nutritional habits
A balanced diet should be maintained, rich in fresh foods and antioxidants, adequate hydration, and the consumption of ultra-processed foods, saturated fats, and refined sugars should be limited.
Avoid environmental damage
Do not smoke and avoid exposure to tobacco smoke, limit exposure to industrial chemicals, pesticides and heavy metals, and avoid testicular heat.
General health and medical follow-up
Regular medical checkups are necessary to detect and treat conditions such as varicoceles or infections early. If you are going to undergo treatments that may affect your health, you should consult a doctor. male fertilityConsider semen cryopreservation as a preventative measure, and if you have difficulty conceiving, consult a specialist for an accurate diagnosis and an appropriate action plan.
Teratozoospermia and natural pregnancy
The possibility of a natural pregnancy with teratozoospermia is not completely ruled out, but it depends largely on its degree of severity and the state of the rest of the semen parameters.
In mild cases, and if concentration and mobility are optimal, it is possible to achieve pregnancy naturally, although it may require more time.
In moderate to severe cases, the chances of natural pregnancy decrease significantly, as the number of "competent" sperm is very low.
As a general rule, it is recommended to seek specialized medical help if, having a diagnosis of teratozoospermia, pregnancy has not been achieved after one year of unprotected intercourse (or after 6 months if the woman is 35 years or older).
Frequently Asked Questions (FAQs)
Is teratozoospermia reversible?
It is reversible when it is due to factors such as lifestyle habits, fever, treatable infections, or exposure to toxins that can be eliminated. In these cases, correcting the cause can improve morphology within 3-4 months. It is not reversible when the cause is genetic, congenital, or the result of permanent testicular damage.
What if I have 2% normal sperm?
A sperm count of 2% or lower is classified as severe teratozoospermia by any standard, making the probability of natural pregnancy very low. However, this does not mean that becoming a biological father is impossible. In these cases, assisted reproductive technologies, especially IVF with ICSI or IMSI, are highly effective.
Is it possible to have children with teratozoospermia?
Yes, thanks to assisted reproductive technologies, the vast majority of men with teratozoospermia can become biological fathers. The most appropriate technique must be determined for each individual case.
Does teratozoospermia affect libido or erection?
No. A man with teratozoospermia can have a completely normal sex life. The problems it causes are related to fertility, not sexual function.
Can stress cause teratozoospermia?
Chronic and severe stress can be a contributing factor. Stress triggers hormonal responses (such as increased cortisol) that can interfere with the hormonal axis that regulates sperm production. Furthermore, stress is often associated with unhealthy habits that also impair sperm quality. Managing stress through relaxation techniques, exercise, and, if needed, psychological support, can be beneficial for overall reproductive health.
You may also like: stress in couples.
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Conclusion
Teratozoospermia is a common cause of male infertility, and although it can cause concern in couples seeking pregnancy, there are effective options to overcome it.
An accurate diagnosis and comprehensive medical evaluation are essential to identify any treatable causes. In many cases, adopting healthier lifestyle habits can improve semen quality. When this is not enough, assisted reproductive technologies, with ICSI leading the way, offer very high success rates for achieving pregnancy, even in severe cases.
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