Male infertility is a problem in the reproductive function of a man’s body. This means the inability of a man to fertilize a woman. There may be several reasons for infertility, but, in general, this is a change in the quantity and quality of spermatozoa in the seminal fluid, which is most often a consequence of inflammatory, infectious, chronic diseases; the influence of external factors, for example, chemical. It is this problem that causes half of infertile marriages, which is fraught with sad consequences — personal injuries, interpersonal conflicts, problems within the family.
The content of the article:
Principles of functioning of the male reproductive system
Infertility in men: secretory form
Male infertility: obturation form
Other forms of male infertility
Diagnosis of male infertility
Infertility treatment in men
Treatment of male infertility with hormones
Treatment of male infertility using surgical techniques
Male infertility
Principles of functioning of the male reproductive system
A sperm is a male germ cell containing genetic information concentrated in the head. The tail of the sperm provides a movement function that allows it to be delivered to the egg. The production of seminal fluid occurs in the testicles, where spermatozoa pass through convoluted tubules, then along straight ones. During this pathway, the cells mature. Such a sperm is able to fertilize an egg.
The last stage of sperm development occurs in the appendages of the testicles, from where they exit into the seminal vesicles, moving along the vas deferens. There they dismount with epithelial secretions, accumulate and gain nutrients.
Seminal vesicles release seminal fluid at the moment when ejaculation occurs. During ejection, the seminal fluid is mixed with the secret of the prostate, and this fluid is called sperm.
Male infertility can form and develop due to problems at any stage of sperm formation. In addition, infertility can also occur during the obstruction of the urinary canal — difficulties in the patency of sperm during ejaculation.
Infertility in men: secretory form
There is such a form of the disease as secretory male infertility, the reasons for this type of disease are that the testicles do not produce a normal number of spermatozoa, which obviously makes fertilization of the egg impossible. It can also mean disorders in the motility or structure of spermatozoa.
Male infertility of the secretory form can be caused by varicocele — the expansion of veins on the testicles of a man. For this reason, there is an outflow of venous blood, since the patient’s veins are dilated. The constant outflow of blood causes stagnation, blood supply becomes difficult, which, accordingly, causes inhibition of testicular function. Varicocele most often occurs on the left testicle, but without proper treatment, it passes to a healthy testicle. This disrupts the normal functioning of both testicles, which means a reduced level of sperm production, the secretory type of male infertility begins.
There are other causes of infertility in men. Excessive formation and retention of fluid in the membranes of the testicle is called testicular dropsy. Fluid accumulates, pressing on the testicle and blocking the normal functioning of blood circulation in the sperm-producing tissue. Inguinal hernia has the same effect.
A rarer reason for the onset of infertility in men is the non-descent of the testicles into the scrotum, otherwise known as cryptorchidism. This violation should be corrected even in childhood, boys up to 7 years old, as a rule, get rid of the problem, which excludes the further development of male infertility.
A virus such as mumps, which affects the tissue of the glands — salivary and genital, also reduces the reproductive function of a man, which means that it can cause male infertility in itself.
Spermatogenic epithelium affected by radiation sickness, radiation penetration is a serious reason to worry about the possible development of male infertility. In addition, this type of fabric, sensitive to any vibrations, is characterized by a reaction to electromagnetic vibrations. Although scientists have not finally found out how harmful it is, for example, wearing a means of communication — a mobile phone or smartphone on a belt — it is not recommended for men to do this because of the characteristics of the spermatogenic epithelium.
The influence of external factors, especially elevated temperature, negatively affects the function of the testicles. Working in hot shops, baths, saunas inhibits the process of sperm production. If the patient is exposed to these risk factors, it is strongly recommended that he carry out cool water procedures to normalize the temperature of the testicles.
The effect of the constant negative impact of elevated temperature on a man’s testicles is also manifested when using comfortable heated seats in a car, especially in winter.
In addition, to prevent male infertility, you need to pay attention to the landing of a man’s underwear. If the panties squeeze the perineum, then this negatively affects the functioning of the male reproductive system. For the same reason, as experts note, the occurrence of male infertility can be affected by prolonged professional cycling.
Serious diseases such as tuberculosis, typhoid, syphilis, as well as taking medications aimed at combating tumors, epilepsy, bacteria and endocrine disorders, also affect the possibility of male infertility. There is a possibility of temporary male infertility. This form of the disease is caused by stress, smoking, alcohol, hypovitaminosis, lack of protein in the body. Of course, doctors also note the negative impact of the environmental environment on the state of men’s health.
The treatment of infertility in men of the secretory form is based on the results of the analysis of the spermogram, cytological examination of testicular tissue. The conclusion from clinical procedures makes it possible to identify the degree of development of the disease and its cause. If male infertility is caused by a more general process or problem in the body, then it is first treated, and then a course is prescribed that resumes sperm production.
Male infertility: obturation form
The obturation form of male infertility is caused by a problem with the urethra, namely: blockage of the movement of spermatozoa through the vas deferens. The reason for this is inflammation of the appendages of the testicles, which causes gluing of the channels or their blockage.
This form of the disease is also caused by untreated injuries of the inguinal region, testicles, and pelvic organs. Also, male infertility can begin due to a cyst that will exert pressure on the vas deferens.
Among the more rare causes of male infertility are syphilis, tuberculosis, the absence of an appendage of the testicle, the vas deferens.
The diagnosis of this type of male infertility is primarily aimed at determining the characteristics of obturation — the extent and localization, in particular. This is necessary for further excision of the blockage site or the creation of a new duct for the passage of spermatozoa, which is done with the help of anastomoses. It is these manipulations that are the treatment of the obturation form of male infertility.
Other forms of male infertility
The symptoms of other forms of male infertility are manifested in an absolute minority of cases, while often partners who are trying to have offspring do not show pathology. The reason for this may be immunological incompatibility.
There is also such an influence factor on the inability to have offspring as a woman’s hypersensitivity to certain components of sperm.
Such a feature of the penis, in which the opening of the urethra is slightly lower than the tip of the penis, can lead to the fact that sperm during ejaculation will not fall on the cervix of a woman, which makes conception impossible.
If the doctor observes the frequency of sexual acts performed by a man, which is no more than once a month (this can happen for various reasons), then male infertility is diagnosed.
Diagnosis of male infertility
Treatment of male infertility must necessarily begin with a thorough diagnosis. In turn, the first stage of this process is an examination, interviewing the patient, studying his anamnesis. In addition, one of the most common tests for the diagnosis of male infertility is a spermogram. The procedure is assigned to several operations, since for a more accurate result, the analysis needs to be repeated two or three times. During the period of spermogram delivery, the patient is advised to refrain from masturbation and sexual contact.
A spermogram can also be performed at the request of the patient, without waiting for a doctor’s appointment. This can save time, because the patient comes to an appointment with a specialist andrologist of a narrower profile with ready-made results. Diagnostics in this case will be faster. If the problem of infertility is acute in the relationship of a man and a woman, it is recommended to attend doctor’s appointments together, then you can diagnose the cause of failures with attempts to conceive a child for a couple and prescribe the right course of treatment.
The normal volume of the ejaculant is about one teaspoon — 3-5 milliliters, if the amount is less, the doctor suspects the presence of hypofunction of the testicles in the patient. In the case when the rest of the spermogram indicators are completely normal, then, perhaps, problems with conception arise only because of insufficient sperm volume.
Oligozoospermia is a deviation from the norm of sperm content in one milliliter of sperm. The correct number is 20 million spermatozoa, and if their number is less, then this may indicate either obstruction of the vas deferens, or hypofunction of the testicles, which in both cases means the danger of male infertility. Bilateral obturation causes problems of a more serious nature — there are no spermatozoa in the sample at all. This phenomenon is called azoospermia.
Although fertilization of an egg, in general, requires the penetration of only one sperm, it is worth noting that even a slight deviation of their total number from the norm can seriously affect the cause of infertility in a man. Since the process of fertilization of an egg begins with the ingestion of sperm on the cervix of a woman, it is necessary that the sperm count is about 200 million. After all, only half of them will penetrate the mucous plug of the cervical canal, and an even smaller part of them gets into the fallopian tubes. There are only two fallopian tubes, the egg is in one of them, an even smaller number of spermatozoa trapped in the fertilization tube has a chance to fertilize the egg. This means that the fewer spermatozoa are contained in the seminal fluid, the less likely the process of fertilization and pregnancy becomes. Therefore, doctors diagnose male infertility with a decrease in the number of spermatozoa in the sample taken to 1 million. Such a characteristic as sperm motility is also taken into account. If the spermatozoa are not active enough, then this phenomenon is called asthenozoospermia, a complete lack of cell mobility is diagnosed as necrozoospermia.
The frequency of sexual intercourse directly depends on the mobility and quantitative characteristics of sperm. Based on this, a man undergoing research and analysis should refrain from sexual contact for a while. This is the only way to get really reliable spermogram results. It is also worth noting that if sexual acts are performed several times in a row, the sperm loses its fertility.
This means that long abstinence can radically change the situation with problematic conception of a child. Sperm after two or three days of abstinence contains a large number of mature, well-mobile, viable spermatozoa, and its fertility increases.
If male infertility is suspected, a morphological analysis of spermatozoa is also prescribed. This study allows us to assess how large a number of spermatozoa have a normal structure. As a result, when half of these cells demonstrate a full-fledged structure, the norm is diagnosed, with a decrease in their number, the doctor concludes about teratozoospermia.
Male infertility is often characterized by the presence of sperm agglutination. Also, the sperm should be homogeneous, without areas of clusters, also called aggregation of spermatozoa. Deviations from this norm are also noticeable visually: the sperm has a non-uniform texture, and the aggregation areas have a dense, bright shade. The undesirability of aggregation is understandable: this phenomenon reduces the speed of sperm movement. The presence of the above symptoms may indicate the presence of other diseases, for example, problems with the pelvic organs and the general endocrine background of a person.
If a significant number of white blood cells is detected in the semen sample, this should be interpreted as the presence of an inflammatory disease or reaction in the urogenital tract. Then the man should not only continue the examination for infertility, but also seek advice and help from other specialists, for example, a urologist. It is possible to diagnose orchitis, vesiculitis, prostatitis, epididymitis.
All of the above data on sperm and the general state of the male reproductive system are obtained from the analysis of the spermogram. In order for the results of this examination to be really indicative and effective for making a diagnosis, the spermogram is repeated several times.
Infertility treatment in men
The current state of affairs in andrology suggests that there are already many ways to diagnose and treat male infertility. Of course, the first measures should be the normalization of the work and leisure system, the overall improvement of the way of life, which includes, of course, minimizing or completely eliminating harmful factors that affect a man at work and at home.
Whatever course of treatment is prescribed to the patient by the doctor, it will always be supported additionally, for example, by vitamin therapy, sedatives and normalization of nutrition.
When additional diseases are detected, for example, genitourinary infections, problems with the endocrine background, the use of androgens as replacement therapy is shown. This helps to solve the problem of impaired spermogenesis. The course of medications and the scheme of their use are prescribed by a specialist in private.
The presence of an inflammatory disease in one of the sexual partners means that it is necessary to start a course of treatment for male infertility with drugs for both spouses. The source and cause of the infection are identified, and only after that the microorganisms are eliminated. Etiological and pathogenetic treatment should give its result, after which it is possible to prescribe drugs aimed at stimulating immunity and overall strengthening the health of partners. Treatment of infections of the genitourinary system can be quite long, the health of partners will be indicated by the presence of leukocytes in the sperm sample, but no more than two; the absence of staphylococcus, viruses of sexually transmitted diseases. The general condition of the sperm is also taken into account.
If the treatment of genitourinary infections in men and women for a long period has not brought its results, then hormone stimulation is carried out.
It is possible to prescribe such a method of treatment of male infertility as insemination with the sperm of a spouse, which is carried out after the woman has identified problems that prevent the normal penetration of sperm into the vagina. If artificial insemination is carried out with the help of a spouse’s sperm, then it is called homological; when using donor sperm, such insemination will be called heterological.
Treatment of male infertility with hormones
Disorders of sperm production, sperm motility can be effectively cured with the help of hormone therapy. It is, rather, stimulation of the male body, prescribed after the treatment of major diseases. But sometimes it can act as an independent treatment, although specialists rarely make such a decision.
Hormone replacement therapy is indicated to solve problems with hypogonadism, pathozoospersia, and hypoandrogenism. This method is also called antifertile. Its essence is that a man should take a course of drugs for a month to cause inhibition of spermatogenesis. After he finishes taking medications, there is an improvement in the process of spermatogenesis, and the characteristics of the seminal fluid increase. This method is rarely used.
Hormone therapy can also be stimulating, which implies the introduction of small doses of hormones. They have no effect on the general endocrine system of the patient, but they have a good effect on processes important for spermatogenesis, for example, metabolic.
Hormone therapy of any type is a treatment that takes quite a long time — about 9 months. It is also necessary to constantly monitor the effectiveness of the prescribed course, checking with a doctor every three months.
The amount of medications indicated for admission depends on the degree of development of the disease and is always prescribed to the patient privately. There is no universal number of drugs. However, it is known that if the concentration of spermatozoa has decreased to the number of 5 million, and the mobile forms make up only a fifth, then it makes no sense to carry out hormone therapy and it is worth trying other methods of treating male infertility.
Treatment of male infertility using surgical techniques
If male infertility is caused by mechanical factors — pressure from dropsy, outflow of blood due to varicocele, cryptorchidism and similar problems – surgical methods are most effective.
Varicocele causes venous blood outflow from the patient’s testicles. This is prevented by surgical intervention. The surgeon will improve the patency of blood vessels, which will eliminate the problem of blockage, normalize metabolic processes, restore spermatogenesis. Perhaps the veins will be bandaged, sclerosed, ligated. Unilateral varicocele is particularly effectively treated, but the bilateral variety is also amenable to healing. You will just need additional therapy with the help of medications.
Cryptorchidism is treated operably, allowing the testicles to be lowered into the scrotum. The operation should be performed at an early age up to 3 years, because this is the only way to exclude the possibility of other pathologies with age and avoid the development of male infertility. If the boy has an operation later, then the future man has a very high probability of encountering negative health consequences. Hormonal techniques are not very effective here and are poorly applicable.
Inguinal-scrotal hernia is also treated with surgical intervention, in which it is necessary to take into account the risk of injury to the spermatic cord and minimize it. Carrying out a successful operation means in most cases the complete restoration of a man’s reproductive function, which means that additional therapy with medications will not be required.
