Isolated asthenozoospermia: What should we know? A narrative review of literature

Abstract

Male infertility contributes to 20%-70% of infertile couple cases worldwide. One of the key challenges in this area is asthenozoospermia or reduced sperm motility. A particular subset, known as isolated asthenozoospermia (iASZ), in which low motility occurs without abnormalities in sperm count or shape, often goes unnoticed and is not well understood. This narrative review attempts to compile the state of knowledge regarding the etiology, diagnosis, and treatment of iASZ and to identify knowledge gaps that need further investigation with an emphasis on physiological, genetic, and molecular mechanisms. We conducted a focused literature search using PubMed and Web of Science, covering studies published between 2000 and 2024. We included articles that explored the structure, function, diagnosis, and treatment of iASZ. We find sperm motility is influenced by multiple factors, from structural components like mitochondria and the flagellum, to biochemical signals and genetic mutations. In men with iASZ, issues such as mitochondrial dysfunction, oxidative stress, or specific gene defects may impair motility. While routine semen analysis helps flag low motility, it often fails to explain why it occurs—highlighting the need for advanced tests like DNA fragmentation tests, genetic screening, and high-resolution imaging. As regards treatment, lifestyle changes, varicocele surgery, and antioxidants can offer some benefit. Assisted reproduction techniques, especially intracytoplasmic sperm injection (ICSI), remain central for achieving pregnancy when other options fail. iASZ deserves more attention as a distinct and treatable cause of male infertility. By improving how we diagnose and manage this condition, supported by further research, we can offer better outcomes for affected couples hoping to conceive.

Keywords

asthenozoospermia / genetics / isolated asthenozoospermia / male infertility / semen analysis / sperm motility

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