molecular study of the cftr gene may be performed. this is done by a molecular "screening" method (high performance liquid chromatography under denaturing conditions (d-hplc) followed by sequencing of the exons of interest, allowing to detect nearly 95% of mutations in this gene, and even discover new mutations. after this molecular screening step, if variants of the cftr gene are detected, the geneticist will use computer databases to distinguish whether this nucleotide variant corresponds to a polymorphism of the cftr gene (without consequence on the function of the cftr protein) or to a real mutation. semen analysis a common route to diagnosis for hypospermia that may be requested for is a semen analysis. to obtain the most fresh specimen collection, a semen sample is obtained through the process of masturbation in the setting of a laboratory. an abstinence period of 3–5 days is recommended prior to collection of samples. if a semen analysis cannot be completed, an alternative route to collecting a semen is through coitus interruptus into a bottle. normally, a typical specimen displays coagulation after ejaculation due to the presence of enzymes within the seminal vesicle, followed by liquification in approximately 30 minutes. urine collection furthermore, when the semen volume is low, less than 1 ml, a urine specimen should be collected immediately after masturbation to search for sperm in the urine. two days before the urine sample is collected, one is required to drink an alkalinized water to allow the sperm cells to survive. after this preliminary preparation step, urine collection is done in a fractional way: the first milliliters of urine are collected and analyzed in isolation through centrifugation and examination under a microscope. the presence of substantial sperm in the post-ejaculatory urine specimen confirms the diagnosis of partial retrograde ejaculation, a dysfunction of the ejaculatory reflex and a known cause of hypospermia. unfortunately, even after thorough etiological assessments, an assessor many come to the conclusion of no known etiological cause to explain one's diagnosis of hypospermia. the significance of these idiopathic hypospermia cases are currently unknown and requires more research in the future. treatment although there are no existing medications on the market for the treatment of hypospermia, some medications and herbal medications have off label uses which can aid in the treatment of this condition and should be considered as soon as possible. according to a review, the use of maca has shown to improve semen volume through an unclear mechanism. in addition, some classes of medications that have been studied include both antidepressants and vessel dilators. use of pharmacological therapy is uncommon thus individual must rely on psychosexual therapy. psychosexual therapy addresses issues focused on sexual skills/techniques, self esteem, performance anxiety and interpersonal conflict. furthermore, according to a review, longer abstinences from sexual intercourse has been associated with increases in sperm count and semen volume. according to a review, the management for hypospermia will depend upon the etiology of the disease. studies have shown that functional retrograde ejaculation can be treated with oral pharmacotherapy such as imipramine and pseudoephedrine which can prevent the backflow of semen and stimulate ejaculation. in the case of structural retrograde ejaculation, pharmacotherapy might not work but surgical procedures can fix the bladder neck problem. the blockage of the ejaculatory duct can be treated via transurethral resection of the ejaculatory duct (tured) and is indicated for people with low sperm volume. tured has been shown to improve the volume of semen in men with ejaculatory duct obstruction leading to significant improvement in the fertility rate. hormonal abnormalities caused by either primary or secondary hypogonadism can be treated with off-label use of oral clomiphene citrate which has been shown to increases the level of testosterone in the body. administration of exogenous testosterone for the treatment of hypogonadism has shown to a have negative impact on the process of spermatogenesis. abnormalities in the seminal vesicle and vas deferens usually don't respond well to surgeries or medications. in such situations, sperm can be extracted along with assisted reproductive technologies (arts) such as intrauterine insemination (iui), in vitro fertilization (ivf), and intracytoplasmic sperm injection (icsi) for successful conception. these procedures can be very costly. prevention a study was done to compare the sperm outcomes of individuals with or without infection of the human papilloma virus (hpv), which currently affects 79 million americans. the study concluded that individuals who had not been infected with hpv had higher rates of sperm motility, functionality, and concentration of sperm. this study suggests that individuals who do not contract hpv or who are vaccinated against hpv have better fertility outcomes than those who are not vaccinated or who have contracted hpv. vaccination against hpv with gardasil9 can be administered by hospitals, clinics or most pharmacies in 3 doses ideally at age 11–12 in both girl and boys, but can be taken up to age 45 per center of disease control (cdc) guidelines.