Causes of male infertility and its treatment

In the recent past, a woman was recognized as the culprit for the fact that there are no children in a marriage. Male infertility was excluded if the spouse did not suffer from erectile dysfunction. If he is able to perform normal sexual intercourse, culminating in ejaculation, then he can become a father.

Thanks to the development of medical science, justice has been restored.

Symptoms

There is only one symptom – no woman can get pregnant from him.

• If this has not happened even once from the beginning of sexual activity, then they speak of primary infertility.
• If a man is reliably the father of a child born earlier, and the attempt fails to repeat, this is secondary infertility.

Another criterion that allows us to consider a man infertile.

• This is the duration of regular sexual life without contraception. Statistics have established that the absence of pregnancy in a partner during this period (provided that her fertility is preserved) suggests infertility in a man.

These terms are relative, depending on the age of the couple. Most young and healthy couples get pregnant within the first 3 months of regular sex.

Diagnostics

The diagnosis begins with a questioning of the patient. When collecting an anamnesis, a man finds out the presence of:

• somatic pathology;
• urological diseases;
• transferred surgical interventions on the organs of the genitourinary sphere or in connection with an inguinal hernia.

1. Questions are asked about the age at which sexual activity began, the degree of erection, ejaculation problems (premature, retrograde), the intensity of intercourse, the means of contraception used by the man.
2. The next step is a general inspection. The structure, degree and nature of hair growth, the presence of gynecomastia are assessed, the body mass index is calculated.
3. Proceed to the urological examination. Particular attention is paid to the testicles, their volume. Norm – 15 ml.
4. It’s time for the detection of sexually transmitted infections. Urethral smears, prostatic juice, bakposevy , PCR are being examined. In 60% of infertile marriages, chlamydial infection is detected in partners. Often a man and a woman find associations of chlamydia and another 3-4 pathogens (gonorrhea, trichomoniasis, fungi, viruses).
5. An obligatory stage is the study of male sperm. A large number of indicators are studied, among which the most important are:
   1. the total volume of ejaculate (the norm is not less than 2 ml);
   2. the content of spermatozoa in a milliliter of ejaculate (about 20 million);
   3. the number of spermatozoa with forward movement. There are 4 degrees of mobility (A – fast translational movement, B – slow, C – non-translational, D – motionless). Sperm is considered fertile if there are 25% A-motile or 50% A and B in total.
6. Hormonal examination of a man – with a decrease in the concentration of spermatozoa in 1 ml to 5 million, but the volume of the testicles is preserved.
7. Instrumental diagnostic methods – ultrasound, tomography of the scrotum and prostate, dopplerography. This is how hernias, varicocele, prostatitis and other male diseases are detected.
8. The duration of infertility over 5 years and sperm agglutination are indications for immunological examination. A MAP test is performed for the presence of antisperm antibodies and immunoglobulins of class G and A.
9. This is followed by medical genetic counseling, which is carried out when oligospermia , teratozoospermia or azoospermia is detected in the spermogram .
10. testicular biopsy is done for azoospermia seen with normal testicular volume and standard male hormone levels.
11. Deviations indicating problems in the hypothalamic-pituitary zone are an indication for an x-ray of the skull and the sella turcica.

In the vast majority, after such an examination, it is possible to accurately determine the cause of a male fertility disorder.

Forms of infertility

After a complex of diagnostic measures for infertility in marriage, its form can be established. The following are distinguished:

• secretory – impaired secretion of spermatozoa (they are not formed) due to a congenital anomaly, testicular pathology or damage at the level of brain structures;
• excretory or obstructive – spermatozoa are formed, but there are obstacles in the vas deferens of various origins (obliteration, scarring, compression);
• immune – spermatozoa are produced, there are no obstacles for passage, but the body of the spouse produces antibodies. If a woman reacts like an allergen, this is an isoimmune form; if a man develops antibodies to his sperm, it is an autoimmune form;
• combined – all three factors are present;
• idiopathic – the cause could not be established. This form occurs in about 5% of cases.

Is a cure possible?

Medicine usually gives a positive answer. The prognosis depends on the form of infertility.

1. Hormone therapy is used in the secretory form of male infertility.
2. Surgical treatment removes the obstruction in the vas deferens, restores the passage of spermatozoa.
3. Immunological infertility requires an integrated approach.
4. Psychotherapy has a positive effect on idiopathic infertility.

Correction of a man’s life is important for every form of infertility. Refusal of bad habits – smoking, drinking alcohol. Sports, a balanced diet, proper healthy sleep, work and rest regimen are mandatory conditions for the complex treatment of male infertility.

Which doctor to contact

The examination should begin with a visit to a urologist or andrologist in a private or district clinic. It is possible to involve other specialists:

• endocrinologist;
• immunologist;
• medical genetics;
• psychotherapist.

In the process of restoring the male ability to conceive, the identified disease is treated.

Causes

The causes of infertility in men are well studied and are as follows.

Sexual infections or STDs

ureaplasma , mycoplasma, gonococcus, trichomonas, herpes virus, HPV, candida play their role . Weakening male immunity, it opens the way for the addition of other sexual infections, mixed forms arise.

It is impossible to detect some of them with bacterioscopy of a conventional smear. It is necessary to apply bakposev or detection by DNA (polymerase chain reaction).

In the chronic course of STDs, they are hidden, without pronounced clinical symptoms. The availability and uncontrolled use of antibiotics led to such a blurring of the manifestations of the disease.

Identified STDs in one of the partners require mandatory treatment in the other.

Inflammatory diseases

Organs of the male genital area, caused by banal or conditionally pathogenic flora. These are orchitis, epididymitis, prostatitis. A chronic disease can occur without an infectious agent.

Anomalies in the development of the genital organs

Pathology concerns the testicles. Both or one of them may be absent, underdeveloped, in the wrong place.

• In newborn premature boys, the testicles do not have time to descend into the scrotum, they are located in the abdominal cavity, in the inguinal canal.
• For normal spermatogenesis, the temperature regime of the testicles is of great importance. Overheating is fatal – that’s why nature brought them out, placing the scrotum. This pathology is called cryptorchidism.
• Rarely, other types of ectopias occur when the testicle is not found in the scrotum. It is eliminated by surgery in early childhood.
• Hypoplasia is treated with hormone replacement therapy.
• Anomalies in the development of the penis. Phimosis is more common. Up to three years of a boy’s life, this is a physiological phenomenon. In the future, the man undergoes an operation – circumcision.

Vascular diseases of arteries and veins

• The most common is a venous problem. This is a varicocele, or enlargement of the veins in the testicles. The disease does not cause discomfort, the only problem is the inability to get pregnant from such a man. The cause of infertility in this case is venous congestion. The testicle sinks into the “perinka”, overheats and stops producing spermatozoa. Treatment is surgery.
• Atherosclerosis of the arteries leads to a lack of blood supply and a decrease in male function.

Previous infectious diseases

Many mothers know how dangerous it is for a boy to get sick with infectious parotitis. People call him pig.

The infection affects the testicles on one or both sides, causing orchitis. Extremely unfavorable bilateral disease during puberty.

A caring mother will not miss the time of her son’s vaccination against childhood infections

Injuries

May relate to damage or traumatic amputation of the testicle.

Occupational hazards and adverse effects

Violation of spermatogenesis lead to:

• radiation,
• poisoning with lead, phosphorus, manganese, benzene.
• Working in hot shops, in the kitchen at the stove and other activities associated with overheating of the testicles can be fatal for a man.

Bad habits

The toxic effects of nicotine, alcohol and drugs are known to everyone, but few people know how they affect the quality of male sperm.

Diseases of the endocrine system

All endocrine glands:

• thyroid;
• adrenal glands;
• pancreas;
• pituitary;
• epiphysis

are interconnected by a complex system of regulation, direct and feedback connections that ensure the production of male sex hormones.

Therefore, diseases

• hypothyroidism,
• diabetes

can cause a decrease in the level of the main male sex hormone – testosterone, without which conception becomes problematic.

Underwear and clothing leading to overheating of the testicles

Tight synthetic shorts, excessive wrapping of the boy are fraught with a decrease in fertility.

Medicines

Some drugs, especially when taken for a long time, can negatively affect the formation of spermatozoa or their motility. These are antibiotics, cytostatics , anabolic hormones.

Unbalanced diet

Flaw

• vitamins of the antioxidant group;
• V;
• D in combination with iron and zinc deficiency

unfavorable for a man of any age, especially against the background of fast food, fatty fried foods, smoked meats and sweets.

stress

You don’t have to fight with your wife or boss. There is a man-made stress associated with the benefits of civilization, from which humanity cannot refuse.

Not every man will prefer a bike ride to “sitting” on the phone.

The vicious circle cannot be discounted – the absence of pregnancy becomes an independent stress factor for both. The couple frantically calculates the timing of ovulation, has sex with the only thought “it will work – it will not work.” This is characteristic of the idiopathic form of infertility.

Autoimmune disorders

Their nature is not fully understood. The immune system ceases to distinguish between self and non-self. It is assumed that some kind of genetic breakdown causes the body of a man to produce antibodies against his own germ cells, depriving them of the ability to fertilize an egg.

Male sperm becomes sterile. Similar processes occur with other organs – autoimmune thyroiditis, hepatitis, encephalitis.

Prevention of infertility from early childhood

A boy was born in the family. This is not only a reason for joy and pride for parents. It is a responsibility to grow a man out of him.

• Some deviations in development will be indicated by the micropediatricians of the maternity hospital. If there is cryptorchidism, especially in a premature baby, it is necessary to monitor the descent of the testicle into the scrotum so as not to miss the timing of the operation.
• No need to get carried away wrapping the baby and constantly finding him in diapers, although advertising insists that they are breathable. For a walk, dress the child according to the weather, avoiding overheating of the body.

Strictly follow the rule – no synthetic underwear!

• When washing and bathing a boy under 3 years old, do not try to forcefully open the head of the penis. If after this age the head does not open, consult a surgeon or urologist to rule out phimosis.
• Give the boy preventive vaccinations according to the calendar.
• From early childhood, pay attention to hardening and shaping the foundations of a healthy lifestyle in a child. Physical activity, walks in the fresh air, in the park, in the forest are good for you and your children.
• Organize proper nutrition for the baby, do not form his addiction to sweets.

Adults themselves do not notice that when stimulating a child for a good deed or simply visiting him, they present him with sweets or chocolate. Bring fruits, nuts, berries! Follow the recommendations of the pediatrician, give the child vitamin and mineral complexes according to age.

As the boy grows, do not overload him: “Drama circle, photo circle, and even hunting to sing …” The child should have a good rest.

Prevention should begin not from childhood, but from the decision to conceive. Those couples for whom pregnancy does not occur by “flight” do the right thing.

Examination and preparation for pregnancy should become the rule for future parents. Carry out the pregnancy under the supervision of a doctor, follow all the recommendations. This is the key to the birth of a healthy baby – a fertile man.

Reproduction

Russia is among the top ten countries in the development and improvement of new reproductive technologies. This is a chance for everyone to experience the happiness of motherhood and fatherhood. Despite many religious, moral and legislative problems, this area of medicine is developing by leaps and bounds.

There are more than 200 reproduction centers in Russia. Most of them are in Moscow, but regional and regional Centers are being created on a budgetary or private basis, working in the field of compulsory medical insurance and voluntary insurance. Services can be provided free of charge on a quota basis.

Name	How is it carried out	Approximate price/thous. rubles
ECO	conception in vitro. Medical stimulation of the ovaries is carried out, the egg is withdrawn, fertilized in a test tube, the embryos are placed in the uterus. One third of patients get pregnant on the first try	within 100,000
Embryo transfer as a stage of IVF	Delayed, embryos are cryopreserved . Expectant mother takes care of her health at this time	20 000
artificial insemination	It solves the problem of obstruction of the meeting of the egg with the spermatozoa. The sperm is introduced into the uterine cavity through a catheter.	12 000
ICSI	The most active spermatozoa are injected directly into the egg	20 000
sperm bank	It makes it possible to select a donor with the desired external data, while guaranteeing complete anonymity. IVF is carried out with the selected sample.	Donor sperm price 20 000

Surrogate motherhood solves the problem of female absolute infertility.

Everyone has the chance to become parents. Today, the problem of fatal male infertility simply does not exist. Look for the cause and eliminate it with modern methods.