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Human Reproduction vol.10 no.2 pp.367-368, 1995
Hyperspermia: the forgotten condition?
S.Cooke, J.P.P.Tyler1 and G.L.Driscoll
Integrated Fertility Services, 12 Caroline Street, Westmead,
NSW 2145, Australia
'To whom correspondence should be addressed
The seminal volumes of 4223 men with known periods of
abstinence of ejaculation, complete collections and with no
dysfunction known to affect production of accessary gland
secretions have been examined to define a minimum value
for hyperspermia. The 95th percentile of the skewed data
distribution was 6.3 ml and of the 229 men with values
equal to or greater than this, 113 (49.3%) had sperm
concentrations below the World Health Organization
accepted minimum 'normal' value of 20Xl06/ml. Basic
seminal parameters should not be forgotten when assessing
infertile men.
Key words: hyperspermia/ semen analysis/semen volume
Introduction
The normal range for seminal volumes produced by masturba-
tion after ~3 days of abstinence has been well established,
with the upper value being quoted as 6.0 ml (Eliasson, 1976)
and the normal range between 2.0 and 6.0 ml (Mortimer,
1994).
While every seminologist knows larger volumes can
be produced, there is little in the literature to describe the
incidence of men who consistently produce high volumes
(hyperspermia) or to define where a pathological value may
begin. Indeed, the World Health Organization (WHO, 1993)
does not include reference to an upper limit value in its
guidelines for minimal standards for semen analysis and nor
do Menkveld et al. (1993) in their recent proposal for the re-
classification of WHO semen parameters.
While Bostofte et al. (1982), in a 20 year follow-up study
of infertile couples, concluded that there was no relationship
between semen volume and ultimate attainment of
a
pregnancy,
they did, however, find a statistically significant correlation
between increasing seminal volume and the time taken for
conception to occur. This has relevance for today's infertility
clinics, where the average age of couples presenting for
investigation appears to be increasing, and their expectations
of quick success are high.
The aim of this short report was to define a seminal volume
above which hyperspermia occurred in a large group of men
who had collected semen during the routine course of their
infertility investigation, and to determine the incidence of
reduced sperm concentrations in this group.
Materials and methods
The records of every semen analysis performed at Integrated
Fertility Services for the past 10 years were reviewed (« =
6684).
Each man had been requested to abstain from ejaculation
for a period of 3 days before producing his semen by
masturbation. At sample delivery, patients were asked about
seminal fluid loss at collection and the actual period of
abstinence was recorded. For this study, only data from men
who gave an exact abstinence period (whether honest or not!)
were reviewed and values >10 days, or recorded as greater
than so-many days, were omitted because of the increased
likelihood of inaccuracy. Data were also excluded if the
patients reported loss of semen at collection or if azoospermia
was diagnosed, since congenital absence of the vas deferens
and seminal vesicles would be associated with a reduced
seminal volume. Similarly, sperm concentrations too low to
be counted accurately (<0.1X106/ml) and coincident with
hypospermia (<1.0 ml) were also excluded since partial
retrograde ejaculation might have occurred.
Results
Figure
1
shows the skewed distribution (kurtosis 2.07; skewness
1.02) of the 4223 data sets that met the above criteria. Seminal
volumes have been grouped in 0.5 ml increments. The median
value was 3.2 ml and 75% of the data (interquartile range)
fell between 2.3 and 4.5 ml. Because of the non-normal
distribution, the 95th percentile was taken as the defined
volum«((ral))
100
200 300 400 500 60(
Fig. 1. The distribution of seminal volumes after 3-10 days
abstinence for 4223 men.
© Oxford University Press367
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S.Cooke, J.P.P.Tyier and G.L.Driscoll
50.66%
23.14%
13.10%
Fig. 2. The incidence of reduced sperm concentrations in 229
hyperspermic men. M = million.
presented a statistical value in their study group of 1300 men
of proven fertility, quoting the 84th (!) percentile as 4.5 ml
(cf. 4.8 ml in this study) and 11.0 ml as the maximum.
While seminologists today are increasingly interested in
tests of sperm function and clinicians are embracing intracyto-
plasmic sperm injection, the basic parameters of a seminal
analysis should not be ignored. Thus this paper simply defines
hyperspermia in a large population as those men who produce
seminal volumes ^6.3 ml, but further demonstrates that in
almost 50% of these a sperm concentration exists which is
considered to reduce fertility potential because of dilution.
Procedures such as the split ejaculation technique, where sperm
concentration is artificially improved because of the reduction
in seminal volume delivered to the partner at coitus, may
circumvent this problem and 'high-tech' procedures may not
be required.
minimum value for hyperspermia. This value was 6.3 ml and
229 men had seminal volumes equal to or greater than this.
Of these, 113 (49.3%) had sperm concentrations below the
WHO accepted minimum 'normal' value of 20X106/ml
(Figure 2).
Discussion
The production and delivery of excessive seminal plasma to
the female partner at coitus might reduce fertility potential
by limiting the availability of spermatozoa to the female's
reproductive tract, both by dilution and loss of semen. While
this review excluded, for the reasons outlined above, 36.8%
of men presenting for routine analysis, unlike other surveys
the data in this study were less likely to be artefactual because
of incomplete ejaculation, poor or non-defined abstinence, or
spillage of the sample at collection. Similarly, larger volumes
would also mean ejaculatory preparation and delivery was
complete, thus maximizing sperm content.
Therefore the 95th percentile value quoted may be an
underestimate, as most detrimental factors would decrease,
rather than increase, seminal volumes (e.g. accessory gland
infection). Furthermore, combining data with abstinence
periods of between 3 and 10 days is valid, since studies which
have reviewed the effects of abstinence on seminal parameters
have shown the accessory glands can replenish their secretions
within 2-3 days of an ejaculation and little extra is added to
seminal volume (-0.4 ml/day) with increasing time (Jouannet
etai, 1981).
Few publications have addressed the subject of seminal
volume in recent times. While Eliasson (1976), in a description
of seminal terminology, did not note high seminal volume as
a pathology, he did recognize an upper limit value for 'normal'
as being 6.0 ml (in our study 13.0 ml was the largest volume).
Few details of seminal volume were given by Murphy (1967)
in a study of 3544 men whose analyses were performed
between 1942 and 1965, except to note that 8.9% had volumes
>8.0 ml. Similarly, MacLeod (1950), in a study of 800
fertile men, gave an incidence of 4.8% with seminal volumes
>6.5 ml, further noting that 'highest semen volumes were
associated with infertile individuals'. Only Rehan et al. (1975)
368
References
Bostofte,E., Serup.J. and Rebbe,H. (1982) Relation between sperm
count and semen volume, and pregnancies obtained during a
twenty-year follow-up period. Int. J. Androl., 5, 267-275.
Eliasson,R. (1976) Semen analysis and laboratory workup. In
Cockett.A.T.K and Urry,R.L. (eds), Male Infertility; Workup,
Treatment and Research. Grune and Stratton, New York,
pp.
169-188.
Jouannet,R, Czyglik,F., David.G., Mayaux.M.J., Spira.A.,
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MacLeod.J. (1950) What constitutes a normal semen? Fertil. Sterii,
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Received on July II, 1994; accepted on October 18, 1994
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