Male infertility: causes, diagnosis and treatment
Infertility in men is a disorder of reproductive function, manifested in the unreality of having offspring. Spermatozoa in the body of men begin to develop from the moment of puberty continuously. But not all of them are capable of fertilizing an egg. Some sperm have an abnormal development, others have low motility. The quality of sperm is influenced by many factors depending on the state of health of the man, postponed inflammation of the genital organs, chronic and infectious diseases, and on the natural environmental conditions. The man himself can feel great, not have erection problems and not know that he is infertile. According to medical statistics, it is believed that one tenth of all couples cannot have children without medication, 40% is due to female infertility, and the percentage of infertility in men is 45.
Classification of male infertility
In andrology, which studies diseases of the urinary organs of a man, the following forms of infertility are distinguished:
- Secretory - the testicles produce a small number of defective and sedentary sperm. Infertility occurs due to congenital or acquired defects.
- Excretory, or obstructive - male sex cells mature in the required amount, but when they encounter an obstacle on their way, they cannot get to the urethra through the vas deferens.
- Immunological - in the male body produces antibodies to the tissues of the testes. This form of infertility in men most often develops as a result of testicular injury.
- Combined - the occurrence of several types of infertility and inflammation of the excretory-sexual system.
- Relative - occurs when both spouses are completely healthy, but they cannot conceive a child. This problem has been little studied.
Causes of infertility
The issues of male infertility are dealt with by andrologists, who believe that the following factors may be its causes:
- Varicose veins of the seminal canal and testicle (varicocele) are the most common cause of infertility in men.The result of the disorder is blood stasis and poor blood circulation in the tissues of the testicle, which leads to disruption of their functioning. The problem arises when the external genitals are exposed to elevated temperature (wearing too warm and synthetic clothes, frequent visits to the sauna and bath), as well as with constant vibration (the driver's profession).
- Edema of the testicle - the accumulation of excess fluid in the scrotum. Squeezing of the testicle occurs as a result of which blood circulation is disturbed, there is a decrease or cessation of sperm production.
- The testicle does not descend into the scrotum (cryptorchidism) - the disease is diagnosed at an early age. Eliminate this violation by surgery, until the child reaches the age of seven. When this problem exists, spermatozoa are not produced and infertility occurs in a man.
- Surgical interventions - removal of an inguinal hernia, resection of the bladder, prostatectomy, sympathectomy.
- Mumps and other infectious diseases (chlamydia, syphilis, gonorrhea) - severely intoxicate the body. As a result, the epithelium of the testicles is affected, and the male sex cells cease to be produced.
- Hormonal disorders - lead to an imbalance of hormone production and disrupt the development of sperm.
- Tumors, injuries, testicular torsion - all these disorders in the reproductive system cause infertility in men.
- Premature ejaculation during intercourse, erectile dysfunction, impotence.
- Genetic and hereditary diseases also lead to male infertility.
In addition, several other adverse factors affecting infertility are noted: drugs (nitrofurans, narcotic analgesics, hormones containing estrogens), ionizing radiation, bad habits (smoking and alcohol), vitamin deficiency, excessively active sex life or rare sexual contacts .
Male infertility: signs and symptoms
A man finds out about his problems with conceiving a child quite by accident. There are no pronounced signs or symptoms of the disease. A man does not experience any discomfort, leads an active sex life. And only when the couple decides to have offspring, problems begin with the implementation of the desired.After many unsuccessful attempts, the spouses turn to the doctor and after the examination they learn that the young man is infertile. Note the following indirect signs that lead to infertility in men:
- the inability to reach orgasm;
- a decrease in the number or absolute absence of sperm;
- changes in the composition and color of seminal fluid;
- weakening of erection;
- loss of sexual abuse;
- the presence of painful sensations in the genitals;
- the emergence of signs of feminization - an increase in the mammary glands, body fat mass;
- symptoms of infectious venereal diseases (pain during urination, suspicious discharge from the urethra).
These signs of infertility in men do not always occur. Most often, male fertility (the ability of the body to take part in fertilization) falls due to a violation of the process of formation and maturation of spermatozoa or a decrease in their fertilizing ability. To timely identify the pathology of the reproductive organs - this means time to start treatment and get rid of infertility.
Diagnosis of the disease
Diagnosis is an integral part in the treatment of infertility. From the quality of its implementation depends on the ability of men to fully restore childbearing functions. How to determine infertility in men? For this you need to hold the following activities:
- The doctor collects and evaluates the data of the anamnesis: diseases in childhood, harmful conditions at the workplace, postponed diseases of the genitourinary system, surgical interventions.
- A general examination of the patient. The doctor draws attention to the physique, subcutaneous fatty tissue, the testicles are examined by palpation.
- Ultrasound scrotum - gives data on the current state, the presence of pathologies in the testicles and prostate gland.
- Scanning the veins of the testicles and scrotum - allows you to identify their expansion.
- Genetic studies - are carried out to determine the genetic abnormalities of male germ cells, which can cause infertility in men.
- Electron-molecular research - is assigned when a violation of sperm motion is detected in the spectrogram.
- Analysis for the presence of sexually transmitted diseases.
- Post-orgasm urine analysis - serves to determine the content of spermatozoa in the bladder, which enter it instead of the urethra.
- Immunological studies - are assigned to assess the content of healthy sperm.
- Determining the level of hormones in the blood - according to the results of the study is determined by the concentration in the blood of estrogen, testosterone and other hormones.
- Sowing of ejaculate - this analysis of infertility in men is carried out to determine the content of leukocytes in the semen.
- Spermogram - allows you to judge the quality and number of male germ cells.
If necessary, the doctor prescribes a consultation with a sex therapist and endocrinologist. Considering all the data of the studies performed during the diagnosis, the patient is prescribed a course of necessary therapy.
Male infertility is caused by many different diseases and factors. The risk group includes all males who:
- constantly experiencing stressful situations;
- have congenital or acquired pathologies;
- had severe infectious diseases;
- underwent surgery on the internal or external genital organs;
- have hormonal imbalance;
- abusing alcohol and smoking;
- work with harmful substances;
- injured genitals.
Symptoms of infertility in men usually do not manifest in any way, but if during systematic unprotected sex they have no conception during the reproductive period for a year, it is considered that they cannot have children.
Fertility test (ability to naturally conceive)
Most often couples who unsuccessfully fail to become parents can turn to a doctor for help. Both partners must complete a comprehensive survey. It is believed that male infertility ranges from 40 to 50%. Spermogram - this is the first test for infertility in men. To obtain reliable results, the patient is recommended to take four days before delivery of the analysis:
- refrain from sexual intercourse;
- do not drink alcohol and beer;
- reduce the use of tobacco products;
- do not visit the sauna and bath;
- Do not take a hot bath.
The collection of semen analysis with symptoms of infertility in men is conducted by the patient himself in a specially designated laboratory room.The collected material is placed in a sterile container and surrendered for research.
It is not recommended to take the analysis if the patient has:
- increased body temperature;
- bacterial or viral infection;
- exacerbation of chronic diseases of the urinary system;
- on the day of delivery great physical exertion;
- stressful condition.
The results of the analysis are given a day after their delivery. Upon receipt of doubtful data, it is redeemed in two to three weeks.
How to determine infertility in men? After receiving data on the study of sperm, the doctor conducts a transcript of the results, comparing them with the standards in order to further draw the appropriate conclusion, and in doubtful cases to conduct additional examinations. When checking the quality of sperm, macro and microscopic ejaculate values are evaluated. Microscopic standards include the following:
- color - white-gray or white;
- single volume - from 2 to 5 ml;
- transition to a liquid state from 10 to 40 minutes;
- turbidity - turbid;
- acidity - slightly alkaline pH - 7.2–8.0;
- odor - specific;
- viscosity - the length of the stretching thread up to 2 cm;
- the amount of mucus is absent.
Sperm normally contains:
- sperm in one portion of more than 39 million;
- the number of dead sperm does not exceed half of the total;
- active-mobile male germ cells at least 32% of the total;
- normal forms of morphological structure constitute more than 4%.
In addition, the spermogram determine the indicators of the general state of sexual health of a man: the presence and concentration of immature cells (no more than 4%), the presence of leukocytes (normally no more than 1 million cells per 1 ml of sperm), and clots (single groups of glues). Conduct a test of a married couple for infertility in a man and a woman, and it is recommended to begin the examination with a man. To assess its fertility, it is enough to do a sperm analysis. In determining the state of reproduction, women conduct more complex studies using laparoscopy and hysteroscopy, which allows to see the state of the uterus. It should be noted that men and women equally suffer from infertility. Only most often the woman first begins to be examined and treated, and only then decides to ask her husband to take a spermogram.
Male Infertility Treatment
The first stage of infertility treatment begins with the treatment of the underlying disease, which was the beginning of the development of the disease. If a patient has inflammatory processes in the seminal vesicles, prostate, testicle, urethra, antibacterial and anti-inflammatory drugs are prescribed. Physiotherapy, massage and acupuncture are used in conjunction with drug therapy. To stimulate the development of male germ cells, biostimulants, vitamin complexes, adaptogens that can increase the body's resistance to external and internal factors are used.
In some diseases of infertility in men apply surgery:
- Restoration of the vas deferens. The surgeon removes part of the spermatic duct and connects it to the canaliculi of the appendages.
- Varicocele - varicose veins of the spermatic cord. Sclerotherapy of the damaged vessel is done.
- Hydropsy of the testicle is a collection of fluid around one or both testicles. Fluid is removed through a scrotum incision.
- Cryptorchidism - the testicle did not descend into the scrotum. The operation is done in childhood using laparoscopy or the classical way.
Treatment of secretory infertility
For the treatment of infertility in men, caused by a decrease in the production of male hormones, is used to eliminate the primary lesion of the testicular textural tissue, Methyltestosterone, Testosterone, and Choriogonin.
To improve mobility and increase the number of sperm - use "Andriol" and "Proviron". In order to improve spermatogenesis and activate the pituitary gland, a drug of prolonged action Testenat is prescribed. To activate the potency and improve the performance of the spectrogram, Bromkriptin is prescribed.
To improve immunity and strengthen the body, the following drugs are shown:
- Vitamins and minerals - use multivitamin complexes containing vitamins K, D, E, A.
- Nootropics and sedatives - used to eliminate neurosis, irritability, relieve fatigue. To do this, recommend preparations containing bromine, valerian extract, motherwort, phosphorus, calcium.
- Hepatoprotectors - they improve the functioning of the liver: “Ovesol”, “Heptral”, “Essentiale-forte”.
- Biostimulants - stimulate metabolic processes, contribute to the revitalization of the reproductive organs, normalize blood circulation: "Pentoxyl", "PhiBS", "Apilak".
Prevention of male infertility
There are many reasons for the impaired ability of men to reproduce healthy offspring. Infertility prevention should begin with caring for men's health from an early age. Parents need to worry about the adolescent during puberty necessarily visit the surgeon and urologist. Only by careful examination can a doctor notice and identify the signs and symptoms of infertility in a man. The most basic preventive measure of infertility is the right way of life. Moderate exercise, systematic exercise significantly improves the function of the reproductive system. The male half of the population is recommended not to overheat in the bath and sauna and not to overcool the body. It is advisable to abandon the constant use of alcohol and smoking.
An important role is played by good nutrition. It should be based on natural products, rich in proteins, contain vitamins and trace elements.
To preserve reproductive function, one should try to protect oneself from stress and negative emotions, to have regular sex life with a regular partner.In case of violations of fertility, a man should seek medical help.