Understanding Hyperspermia: Signs, Symptoms and Treatment

Sperm issues are grouped as either problem with quality or quantity. Hyperspermia refers to increases in sperm volume above the normal limits.

Although previous standards set by the World Health Organization set upper limits of normal semen volume at 6 mL, the latest manual (6th edition, 2021) does not list an upper reference limit but the 97.5th percentile at 6.9 mL. Furthermore, the classic definition describes hyperspermia as semen volumes above 6mL.

Causes of hyperspermia

Semen, aka seminal fluid, consists of sperm and secretions of the accessory sex glands such as the prostate, seminal vesicles, and the bulbourethral glands. These help to protect, preserve, and nourish sperm. Hyperspermia may not necessarily be pathogenic, particularly if observed after long periods of abstinence. However, it may demonstrate a normal phenotype in the setting of high accessory sex gland secretions.

Interestingly, a recent study observed three different patterns in patients with hyperspermia:

• Those with normal sperm parameters with higher-than-normal volume.
• Those with one or more abnormal sperm parameters.
• Those with no sperm in the ejaculate.

In light of these findings, hyperspermia can be considered normal in some instances while being associated with other sperm abnormalities, possibly leading to issues with reproduction in others.

Signs and symptoms of hyperspermia

Hyperspermia doesn’t necessarily exhibit glaring signs and symptoms. However, you may notice an increase in ejaculate volume as well as possible decreased viscosity of the ejaculate owing to the increased volume.

However, some researchers theorize that increased seminal plasma volume delivered into the cervix during coitus may dilute sperm concentrations, increase sperm washout, and decrease sperm efficacy. These could lead to reproductive issues.

Furthermore, hyperspermia may be associated with abnormal sperm parameters such as oligozoospermia (low sperm count) or azoospermia (no sperm in the ejaculate).

Thus, hyperspermia may present as the inability to conceive.

Diagnosis of hyperspermia

Hyperspermia can be diagnosed by analyzing semen. Ideally, semen samples would be collected by masturbation after three to seven days of abstinence. A semen volume of more than 6mL in this context would indicate hyperspermia. Sperm’s motility, count, and morphology could help differentiate whether hyperspermia is associated with any other sperm abnormalities. However, these factors could also provide an incidental finding representing a normal phenotype with possible excess accessory sexual gland secretions.

Treatment of hyperspermia

As hyperspermia itself is not necessarily pathologic, it is not generally treated except to address male infertility. If male infertility is suspected due to hyperspermia, the semen analysis would not demonstrate any abnormalities other than hyperspermia and sperm dilution. In such cases, increasing the frequency of ejaculation or utilizing the split ejaculation technique can help reduce the volume of ejaculate.

If the sperm analysis demonstrates low sperm or no sperm counts, further testing, including genetic testing and testing for different hormones may be necessary.

After such testing is complete and possible treatable conditions are managed, assisted reproductive techniques such as intrauterine insemination or in vitro fertilization (IVF) can be utilized.

Intrauterine insemination (IUI) consists of washing and concentrating ejaculated semen and injecting the sperm concentrate into the uterine cavity through the cervix. However, because of IUI’s debated effectiveness, IVF is considered the “better” option.

In vitro fertilization is the process of fertilizing an egg with sperm outside of the body. Intracytoplasmic Sperm Injection (ICSI), on the other hand, is the injection of a single sperm into the cytoplasm of a human oocyte (egg cell) obtained directly from the female follicles in the ovary. Sperm in this context can be retrieved from either ejaculate, testicular aspiration, or biopsies.

When to see a physician

As a man, you may be naturally concerned about your semen volume as well as its possible implications on your fertility. If you’ve always had what appears to be higher than normal semen volume, you may be a high-volume ejaculator. However, if this is not the result of any condition or disease, it often goes undiagnosed and, thus, untreated. However, if you find yourself trying to conceive with no luck, further testing may be necessary, as the increased volume of semen may be contributing to conception issues.

On the other hand, if you suddenly notice your semen volume increase unrelated to long periods of sexual abstinence, this may indicate an underlying issue. A physical evaluation, as well as possible semen testing, may be appropriate.

Does hyperspermia impact sexual health?

Hyperspermia would not be expected to impact your sexual health —unless related to other semen issues which may cause fertility problems. Having hyperspermia can be as normal as being tall. Though it may be uncommon, it isn’t necessarily related to any disease or pathological process. However, as the increased volume is due to increased secretions from accessory sexual glands, your partner may comment after coitus that your semen is more watery. To counter this, you may wish to increase your ejaculatory frequency to decrease the associated volume or try the split ejaculation technique, where you split parts of your ejaculate as appropriate, whether in the cervix or outside.