Male infertility: symptoms and treatment
Male infertility is such a pathology, in which the regular sexual life of conception does not occur within a period of one year or more. Male infertility, the symptoms of which, in fact, lie in determining this disorder, can be caused by many reasons, and it is precisely its causes that are the key factor in the problem.
For a long enough time it was believed that if a married couple can not conceive a child and, therefore, give birth to him, then the problem is purely feminine. And who, if not the woman in the couple in the absence of pregnancy, goes to the doctor to find out what exactly is wrong with her, why does not pregnancy come and not whether infertility or guilt. Nevertheless, medical statistics can surprise a strong gender, traditionally waiting on the sidelines, while a woman bypasses all specialists, will pass all the necessary tests and try out conceivable and unthinkable ways in attempts to conceive a baby to solve such a «my» problem. And these data indicate that in about 40 and even 50% of cases of marriages in which the problem of infertility is relevant, this problem really is in the man, and not in the woman. Thus, infertility in men — the phenomenon is not so rare and certainly not «one-sided» in its own examination.
Predominantly infertility in men arises because of the quantitative and qualitative changes to which the spermatozoa are exposed in the ejaculate. As reasons for this, we can consider previously transmitted inflammatory diseases associated with the sexual organs, as well as chronic and infectious diseases affecting the body chemical and other types of factors. It should be noted that the need to seek appropriate medical assistance in conception arises in one case out of ten. In addition to the fact that the lack of conception may be associated with a violation of male or female reproductive function, there are other options. Thus, in about 15% of cases, the reason lies in the immunological incompatibility of the couple, there are also options that consider the issue of idiopathic infertility, in which it is not possible to find out the cause, which determines the rare forms of infertility.
So, before we move on to those features that are directly related to infertility, let’s dwell on what the male reproductive system is. The reproductive organs of a man are both inside the body and outside. Testicles produce testosterone, a male hormone responsible for the formation of the corresponding sex characteristics in a man. Also, the testicles produce sperm, which subsequently enters the tubules of epididymis, that is, the organ, through which the sperm is fed and stored in accordance with the degree of its maturation. After maturation, the sperm through the vas deferens is directed to the seminal vesicles, that is, to a pair of sack-like glands in which sperm is preserved in the future.
The duration of the process of sperm formation is about 72 days. Ejaculation (ejaculation) consists in mixing the secret of seminal vesicles and fluid coming from the prostate. This liquid is thick enough, and with this mixing it forms a seminal fluid.
As the fundamental factor that determines the male ability to childbearing (male fertility), it is precisely the process in which mature and normal sperm develop, which, in other words, determines spermatogenesis. Produced and regulated the process of sperm production with three main hormones, and this is already marked testosterone, LH and FSH. The effect of LH and FSH is on the testes, while LH provides stimulation of testosterone production (Leydig cells), and FSH provides stimulation of sperm production (Sertoli cells). Sperm in these cells Sertoli, being immature, gradually ripens, eventually being transformed into spermatozoa. Meanwhile, they can become mobile only after they find themselves in the epididymis. Then, after gaining mobility, the sperm will be in the vas deferens, where it will stay until the ejaculation begins.
Male infertility: causes
Based on the above processes, it can be assumed that the main causes of male infertility can be either obstruction (blockage) of the canal, as a result of which sperm does not erupt through the urethra, or because of the disorders associated with the secretory function within the framework Any of these steps. This determines, respectively, the obturation form of infertility and its secretory form, we will discuss them below. In addition, among the possible pathologies, you can identify some of the following options associated with these pathology options:
- asthenospermia (a pathology in which spermatozoa have low mobility)
- azoospermia (lack of mobile living spermatozoa in the sperm)
- polyspermia (increased volume of seminal fluid)
- teratospermia (a pathology in which the sperm structure is disturbed)
- necrospermia (the presence of a significant number of dead sperm in the semen), etc.
After the act of ejaculation, sperm, being in the body of a woman, retains the ability for subsequent fertilization in the period of 48-72 hours. Considering this fact, the recommendation for successful conception is also explained, which is based on taking into account the relevant factors for this, in particular, this refers to intercourse every 2-3 days during the woman’s onset of ovulation. As regards the possibility of fertilization, it is important to note that sperm motility is no less important in this process than the number of spermatozoa. In the case of even a small number of male spermatozoa, he, however, does not lose his own fertility, but this statement is relevant only if his spermatozoa have a sufficient degree of mobility.
The volume of a seminal fluid in a man can also influence the ability to fertilize, as well as the peculiarities of the structure of spermatozoa. As a separate hindrance to male fertility, a disease is also considered in which varicose veins are formed in the scrotum, in particular, varicocele. This reason is quite common when considering the causes of infertility. In addition, the following factors affect reproductive function:
- testosterone deficiency of one or another nature
- Topical genetic disorders
- inflammatory diseases affecting the male reproductive system directly
- Ejaculation disorder due to various reasons (which is also relevant in the context of diabetes mellitus)
- erectile dysfunction
- abnormal development of male genital organs
- transfer of mumps in the past (mumps);
- cryptorchidism (a pathology of the location of the testicle, in which it is not left in the scrotum)
- various types of testicular neoplasm (benign, malignant)
- sexually transmitted diseases, in which not only the effect on the quality characteristics of the sperm, but also on the erection, ejaculation and pathologies associated with erection (gonorrhea, chlamydia, syphilis, trichomoniasis, etc.) is relevant
- exposure to the body during chemotherapy or radiation therapy
- long-term use of male anabolic steroids, antibiotics
- abuse of narcotic drugs and substances, alcohol
- Loneliness of a way of life;
- excessive systematic physical activity
- vitamin deficiency;
- Systematic overheating, etc.
Secretory male infertility
This form of male infertility is characterized by the fact that the testicles do not produce spermatozoa in the required amount, which, in turn, precludes the possibility of successful fertilization of the female egg. It is actual to consider this form of infertility in men when the motility of spermatozoa is impaired, as well as in the presence of structural defects.
Again, in this form of infertility, the above mentioned disease, varicocele, is already being considered. Because of the expansion of veins, there are difficulties in the outflow of venous blood, because of which there is a development of stagnant phenomena in the violation of blood supply, due to which, respectively, the function of the testicles and testicles. Defeat varicocele mainly affects the left testicle, but with the gradual progression of this pathology over time, it goes to the right, healthy testicle. Thus, the disease significantly disrupts their function, because of which the production of spermatozoa decreases, and this, in turn, leads to the development of the form of infertility considered by us.
The accumulation of fluid against the background of the actual dropsy of the testicles is also considered as a factor provoking male infertility, which occurs in part because of a violation of the blood supply of spermatogenic tissue as a result of prolonged squeezing of the testicles. Inguinal hernia leads to a similar result.
Because of cryptorchidism, in which, as we noted in the causes of infertility in men, the testicles do not descend into the scrotum, there is also a certain risk, although its relevance is considered much less frequently in this issue. Treatment of cryptorchidism is important to produce before the patient reaches the age of 7 years — this will preserve the function of the testicles, and, accordingly, reduce the risk of possible infertility in the future on this basis severalfold.
In case of epidemic parotitis, the glandular tissue is lesioned, resulting in the defeat of the sex and salivary glands in this background. Orchitis, with the development of a pronounced form of inflammation and without appropriate treatment, can also negatively affect reproductive function, thus determining this disease as one of the possible causes of infertility.
Male infertility can also develop as a result of a negative effect on the spermatogenic epithelium. Thus, penetrating radiation provoking this disorder can determine either the risk of total injury, radiation sickness, or the risk of damage to certain organs and tissues. This spermatogenic epithelium is most sensitive to the effects of radiation. Often the cause of male infertility is in electromagnetic oscillations, characterized by a similar effect, in this case it is enough to wear some kind of communication means on the belt. At the moment, scientists have not made an unequivocal verdict on this matter, which, however, is not an excuse for excluding the influence of such a factor on the problem under consideration.
The effect of high temperatures has a depressing effect on the process of spermatogenesis, therefore, over time it may become irreversible in terms of the results, resulting, respectively, in male infertility. So, in a special group of risk in this case, men who work in hot shops, as well as lovers of saunas and baths. In this case, there is the possibility of a certain compensation for the impact, which in particular is the completion of the effect of elevated temperatures on a cool shower, which makes it possible to normalize the temperature in the testicles. When wearing tight lingerie and tightening clothes (which in particular concerns, as can be understood, the perineal region), and also with the frequent transfer of injuries and strokes, dysfunction of the testicles develops, against which — and the absolute form of male infertility. It should be separately noted and professional training in cycling, which also often affects male fertility, increasing several times the risk of male infertility.
Again, the considered form of infertility refers to the impact of diseases transmitted sexually, here also includes typhoid and tuberculosis. Antiepileptic, antitumor and antibacterial medications, hormonal disorders in men — all this also determines the high risk of infertility in men. This can also be caused by long-term stress, hypovitaminosis, protein deficiency, smoking and alcohol abuse, etc.
Diagnosis of male infertility of this form can be made through biopsy, due to which it is possible to identify the condition that is relevant for testicular tissues, and also it is possible to determine what specifically infertility is provoked. In the treatment of infertility, they are guided precisely by the elimination of the underlying cause with the subsequent administration of therapy, which determines the possibility of improving the spermatogenic function.
This form of infertility determines the inability of the sperm to move through the vas deferens because of their blockage. As the main cause provoking obturation, the actual inflammatory processes, concentrated in the appendage of the testicles, are considered, which, in turn, causes either blockage or gluing of the canals. A similar result can be achieved by transferring trauma to the inguinal region or traumatic testicles ignored as part of the need to seek specialized examination and care.
In some cases, the development of the obstruction of the vas deferens occurs against a background of accidental injury, which, for example, may be accompanied by operations in the pelvic organs (rectum, ureters, bladder, etc.). The possibility of such compression is not ruled out either because of the formation of a cyst or tumor formation in the appendage of the testicle. Also, infertility of this form in men can lead to congenital absence of the vas deferens or epididymis, already noted tuberculosis and syphilis.
Diagnosis of this form requires the identification of a specific area of localization of the obturation, as well as determining its extent. Treatment is performed by excision of the corresponding site, in which obstruction is noted, or by forming an additional pathway for spermatozoa, which is provided by the application of anastomoses.
This group of cases of infertility includes marriages in which both spouses have no diseases that could lead to infertility, and there are children in previous marriages of both spouses with a similar absence of diseases that could cause infertility. In this case, as already understood from the subtitle, it is a question of immunological incompatibility, which is explained by the fact that a woman has a special type of allergy to sperm cells or other types of components that make up the sperm of the spouse.
Confirmation of this form of infertility is based on the results of a series of specialized tests. As for the treatment, it is unfortunately a serious problem today. To achieve a positive result in its solution is extremely difficult.
Psychological aspects of the problem of infertility
In most cases, even if a man is aware of any of his illnesses, as well as the complications that such diseases can provoke, the news that he is sterile becomes an absolute surprise to him. Women, having learned about their inability to conceive and give birth to a child, may experience a serious shock and shock, but often it happens that the reaction on their part is incomparable with what becomes such news for a man. The point here is that masculinity in the understanding of men is placed on a par with sexual function, accordingly, the inability to reproduce the offspring becomes a real blow, including self-esteem and self-perception. Symptoms of male infertility, moreover, are absent, the man feels himself in many cases quite normal, and hence, accordingly, there appears, and, in general, an explicable anger and irritation about such a «verdict.»
Quite often as a result of this, marriages are ruined, and this is actual even if the spouse is ready to put up with the situation and consider other measures to solve the problem. Men often take such a position that they are sure that they simply do not have the right to create a family and to enter into serious relations with women. Because of this, the problems of a somewhat different, albeit no less global scale for a man, often develop, they consist in the development of deep depressions, as well as in the exclusion from such reality through drugs, alcohol, etc.
Often men are afraid of what may be infertile, because any type of survey on this subject — the topic is almost closed, the appeal to a specialist as a result of persuasion is achieved with great difficulty, often seen as an impossible option.
Meanwhile, even the confirmed diagnosis of «male infertility» is not a definitive and irrevocable option, in many cases even comparable to a series of not always successful attempts and many, albeit not entirely natural manipulations, the long-awaited result is achieved, and «cut from Shoulder «should not be, in particular, if no steps have been taken to solve the problem.
Diagnosis of male infertility is performed through urogenital examination in combination with a spermogram, and the cytological composition of the secretion of the prostate gland and seminal vesicles is also checked. Obligatory checking is also necessary for the presence of sexual infections (herpes virus, ureaplasmosis, cytomegalovirus, mycoplasmosis, chlamydia, etc.). In addition, hormonal screening is performed, ultrasound of the thyroid gland and pelvic organs is done.
In severe cases, testicular biopsy, MRI or X-ray of the skull, kidney phlebography can be performed.
Treatment of male infertility
Conservative infertility treatment in men is based on the intake of estrogen antagonists, gonadotropin drugs, testosterone or glucocorticoids. A specific drug is selected based on a specific form of hormonal pathology.
In the presence of problems associated with the emission of sperm with an urgency in the history of surgical interventions within the bladder (its neck), collagen injections are made to this area.
In varicocele, male infertility is treated by surgical intervention. The pathologies of ejaculation or erection without spermatic disorders may require a medical sperm intake with subsequent fertilization of the egg. Sperm is used for male infertility by puncture or by microsurgical intervention. Due to the availability of supportive measures in the field of reproductive technology, couples can conceive a baby even in the most severe forms of infertility in men. The onset of pregnancy is possible with intrauterine insemination or IVF.
If you have problems with conception in men, you need to contact the urologist and endocrinologist, sex therapist and genetics.