In modern society, approximately 10-25% of infertile families. Contrary to the traditional belief, not always a woman "guilty" in the absence of children in the family. According to statistics, from 30 to 50% of couples are unable to have children because of male infertility. The solution to this problem involved such areas of medicine, andrology and urology.
The content of the article:
How does the reproductive system in menMale sex organs located inside the pelvis, but also outside it. For the formation of secondary sexual organs of the responsible main male hormone testosterone. It is produced by the testes located in the scrotum. They also produce sperm, which comes from the testes to the epididymis for nutrition and maturation. After maturation of the sperm in the ejaculatory ducts moving in the seminal vesicles for storage. The education cycle full of sperm takes approximately 72 hours. During ejaculation it is mixed with the secret of the prostate gland, this produces the ejaculate is seminal fluid that contains sperm.
The ability of procreation (fertility) men depends on the quality of sperm, its full development and maturation.
This process occurs with the participation of hormones:
- Luteinizing hormone (LH) stimulates spermatogenesis in Leydig cells;
- Follicle stimulating hormone (FSH) - stimulates spermatogenesis in the Sertoli cells.
In Sertoli cells of immature sperm forms a sperm and Matures. Giving sperm motility occurs in the epididymis. Sperm, ready to fertilize is prior to ejaculation to be stored in the ejaculatory duct.
Characteristics of the semenNumber of sperm depends on the age of a man, his sexual activity and individual characteristics. Frequent sex reducesthe volume of semen, but he recovered after 2-3 days of abstinence.
The normal ejaculate volume is equal to 1-6 ml of semen is alkaline with a pH 7-7,6. These figures do not give the sperm to lose their mobility in the acidic environment of the vagina. They are without loss of its properties reach the cervical canal of the cervix, which is equal to pH 7.5, and there to penetrate into the uterus and fallopian tubes to fertilize the Mature oocytes.
The sperm consists of a head and tail with the intermediate part (the neck) between them. He performs straight-line and translational motion to increase the possibility of meeting with the egg. One milliliter of ejaculate contains between 40 to 120 million sperm. Of them is movable approximately 60%, fixed – 15-20%. In the same ratio in semen presents a Mature and atypical forms of spermatozoa (60% Mature, and 15-20% were atypical).
Frequent sexual intercourse (more than once every 2-3 days) semen contains large numbers of immature sperm with abstinence or in rare sex acts in the semen is a large number of deformed sperm.
The study of the composition and sperm quality (semen analysis) – analysis carried out primarily in the diagnosis of male infertility.
Classification of infertility in menThe diversity of the causes of male sterility makes it difficult in their choice of grounds for classification. Forms of infertility allocated in andrology:
Secretory infertility. Pathology is the production of eggs immobile or defective sperm, and are also insufficient to fertilize the number of motile sperm. Infertility can be caused by congenital and acquired negative factors.
Obstructive or excretory infertility. In this form of infertility Mature sperm cells in sufficient quantity, but can not get via the ejaculatory ducts into the urethra. The reason is the obstacle of transportation.
Combined infertility. The combination of several types of infertility (immunologic, secretory, obstructive) with the accession of the inflammatory process.
Immunological infertility. In the male body is the secretion of antibodies with protivoradikulitnye functions for which the testicular tissue – a foreign element. Antibodies penetrate into the cells of the testicles, disrupting gepatolentikuliarnaya barrier, provoke the formation of antibodies to sperm. The reason for this form of infertility is the trauma to the testicles.
Relative infertility. Occurs against a background of absolute health of both spouses, the problem with this form of infertility is poorly understood.
What factors lead to male infertility?
Factors in the emergence of male infertility is divided into basic, occurring more often than others, and further operating in conjunction with them. Secretory infertility (hypogonadism) is characterized by impairment of spermatogenesis and of the functioning of testicles. Hypogonadism can be primary and secondary. The primary secretory form of infertility there is an increased excretion of gonadotropins leading to the reduction of the influence of the testis on pituitary function. In secondary form gipogonadizma amazed by the pituitary adversely affects the allocation of gonadotropinov, reducing their number. There are forms of secretory infertility, hormonal disorders.
Causes of secretory infertility:
Varicocele. The most common cause of male infertility. It provokes the appearance of varicose veins of the testis and of the spermatic cord. These parts of the reproductive system of men are responsible for the excretion of semen. The result of varicocele becomes a stagnation of blood, insufficient blood supply to tissues of testicles the violation of its functioning. Factors that trigger the development of disease – increasing the temperature of the external genital organs for extended periods of time (visiting the baths and saunas, wearing too warm trousers, underwear made of synthetics), vibration as occupational hazard (profession driver).
Dropsy of the testicle. In the scrotum as a result of number of reasons (e.g., inguinal hernia) accumulates excess fluid. This circumstance provokes a squeezing of the testicle, the violation of circulation, which reduces or completely stops the production of sperm.
Cryptorchidism. This impaired development of the reproductive organs, the testes fail to descend into the scrotum and remain in the abdominal cavity. It is diagnosed at an early age and should be treated surgically to achieve a boy the age of 7 years. If you do not, the testicles can not produce sperm because of the higher temperature inside the body than in the environment. Even if the testes and produce small amounts of sperm, they will immediately die.
Mumps. Epidemic parotitis, or mumps, is an infectious disease that affects the salivary glands. It is transmitted by airborne droplets, while the body is exposed to high intoxication. A complication of mumps is orchitis, or inflammation of the testicles that affects the spermatogenic tissue of the body (epithelium).
Other infectious disease. Complications of infectious diseases transmittedsexually transmitted (syphilis, gonorrhoea, chlamydia etc. on), lead to destruction of tissue of the testis failure to produce sperms. Similar action have other infectious diseases (typhoid, brucellosis, tuberculosis), causing toxic effects on the body and significant hyperthermia.
Hormonal disturbances. In this type of infertility, impaired spermatogenesis due to an imbalance of testosterone and other sex hormones. The reason for this may be an excess of prolactin (hyperprolactinemia, tumors or inflammation of the pituitary gland secondary hypogonadism. A similar effect is pathology endocrine system: thyroid, pancreas, adrenal glands, obesity.
Genetic and hereditary diseases. There are a number of chromosomal abnormalities (syndrome Shershenevsky-Turner, Klinefelter syndrome, syndrome Nuan syndrome Kartagener), accompanied by gonadal dysgenesis, making the man infertile. A similar effect is a hereditary disease (polycystic kidney disease, cystic fibrosis).
Injuries and tumors, torsion of testes. These causes include trauma, absence, torsion of the testicles, tumors of the prostate gland and other reproductive system.
The effect of external adverse factors. In this category are:
High temperature. A visit to the sauna or bath, Cycling, wearing tight clothes or underwear made of synthetics, a profession associated with being under high ambient temperature (foundry shop, bakery, boiler room).
Chronic stress and age. The impact of these factors reduces the quality and motility of sperm.
When one or two violation of the transportationsperm in the ejaculatory ducts are talking about obstructive infertility.
The causes of obstructive (obstructive) infertility:
Epididymitis. The process is similar to the appearance of obstruction of the fallopian tubes in women. Epididymitis is a complication of the inflammation of the epididymis, when bonding occurs, and further obliteration of the ejaculatory ducts.
Injury and damage. Infertility occurs as a result of accidental damage during surgery on the ureters, prostate, bladder, rectum, and injury to the scrotum.
Tumors of the epididymis. The hypertrophy of the tissues as a result of the appearance of cysts and tumors leads to the compression of the VAS deferens.
Congenital anomalies. These include hypospadias (elimination of inflow of the urethra in the lower third of the penis), absence of the epididymis or the seed of the output channel.
Aspermatizm. The essence of true aspermatism – atypical influence of the cortex on the functioning of the sex centers. As a result, there occurs the selection of the sperm through sexual contact of any duration. About aspermatizm is characterized by the excretion of semen is not the urethra and into the bladder (retrograde ejaculation). The reason for this phenomenon – the consequences of diabetes, multiple sclerosis, inflammation of the reproductive organs, spinal cord injuries, operations on the bladder and prostate gland, side effects of antidepressants and tranquilizers.
Other reasons. Other causes of male infertility include:
Impotence (erectile dysfunction) – can not hold a full sexual intercourse.
Psychological causes of male infertility:
- Boys growing up in a family where the authoritarian parenting they had a range of physical and mental disability in adulthood occurssubconscious complex "culling".
- A man that grew up in a hyperopic, or in a family where the mother had unquestioned authority, often remains immature child who do not wish to have competitors for the attention of the wife.
- Man, replacing in a single-parent family the father may have "daddy complex" that is associated with a reluctance to endure the difficulties associated with taking care of children, subconsciously he does not want to have children.
- Among the life values of men too highly raised the bar of priorities, no room for children.
Epidemiology of male infertility
The clinical picture
Specific symptoms of male infertility no, they depend on the causes leading to this condition. The main symptom – the absence of pregnancy in a sexual partner, not having the woman are no prerequisites for this. To clarify the possible factors of infertility, the woman is examined.
If the cause of sterility is the inflammation, swelling, trauma to the male reproductive organs, manifestations of infertility is a disorder of urination, pain in the scrotum and lower abdomen, one - and bilateral increase in size of the scrotum, the expansion magnification of the veins in her skin (when varicocele).
Hormonal disturbances are manifested by gynecomastia (increase in mammary glands), decreased libido, decrease in size of testicles.
DiagnosisBefore to establish the diagnosis of "male infertility", both spouses offer undergo diagnostic tests. Start examination pair most often with men. It includes the following items:
History collection. The doctor analyzes patient complaints, the number of myocardial diseases and operations on the pelvic organs, possible industrial hazards and negative habits (Smoking, alcohol). It mustinterested in sex partner men and the number of their pregnancies.
A General inspection. Andrologist will visually assess the characteristics of the development of secondary sexual characteristics. If body hair slightly, figure belongs to evnuhoidizma type, there is gynecomastia, there is a lack of androgens. We study the presence of eggs and their size (normally, they are approximately equal to 4. 6x2. 6 cm, volume about 18 ml), the consistency of the gonads (normal photoelasticity), condition of veins of the spermatic cord and scrotum (varicocele is excluded). Conducted a rectal examination of the rectum to exclude inflammation of the seminal vesicles and prostate.
Assessment of sexual and reproductive function. According to the patient's physician records in medical history number of sexual contacts (in normal at least 2-3 per week), quality of erection, nature of ejaculation (normal, delayed, early).
After examination, the patient is sent for laboratory diagnosis. After 3 days of abstinence he donates sperm for research.
The semen in norm:
- Ejaculation volume is 2 ml or more;
- The number of sperm in 1 ml – 20 million or more;
- The Ph reaction is alkaline with an index of 7.2 and more;
- Morphology – more than 30% of sperm should have the correct form;
- Mobility – within one hour after ejaculation for more than 50% of the sperm are moving forward or 25% are moving fast translational movements;
- The viability of more than 50% of live sperm cells;
- Mar-test on the exclusion of immunological infertility is less than 50% spermatozoa with adherent particles;
- The presence of flora and agglutination – no;
- Viscosity – normal;
- Liquefaction within 60 minutes;
- Number of leukocytes in 1 ml less than 1 million;
- Number of zinc- 2.4 mmol;
- To fructose – 13 mol in the total volume;
- Number of citric acid – 52 µmol in the entire ejaculate.
Polyspermia – sperm volume higher than normal (
If there is a suspicion of inflammatory processes in the organs of reproduction or the presence of infections, the patient is infectious screening:
- PCR to exclude genital infections;
- Smear from the urethra on the definition of STDs;
- The sowing of ejaculate in the determination of the infectious agent (subject to increase in the number of leukocytes);
- Biochemical studies of prostate secretion in glucose, alkaline phosphatase, ?-glycosidase, citric acid, zinc.
Hormonal examination determines the level of the following hormones:
- FSH and LH.
Examines the level of free radicals in sperm cells, as with the case of excess production of reactive oxygen species reduced the fertilizing function of sperm cells, they become inactive, damaged cellular membrane of male germ cells. In the study acrosomal reactions occurring during the contact of the spermatozoon with the egg, determine whether the sperm dissolve the egg shell and penetrate inside. Only healthy sperm with normal morphology capable of producing on its head specific chemical transformations for such a reaction.
Microscopic examination of spermMicroscopic examination of a sperm with an electron microscope and cytogenetic analysis give an idea:
- The number of chromosomes and their quality,
- On the structure of the plasma of the ejaculate,
- About a possible violation of the internal structure of the sperm.
If this study detects abnormalities of chromosomes, the patient consults with a geneticist. A test for detecting antisperm antibodies of classes G, A, M is in the diagnosis of immunological sterility. Tests Shuvarskogo and Kuzreka-Miller will help to identify immune conflict at the level of the cervical canal.
Instrumental diagnostics of male infertility:
- X-rays of the skull and "Turkish saddle" to exclude pituitary tumors;
- Ultrasound with Doppler, transperitoneal ultrasound of the scrotum – for the diagnosis of varicocele, hydrocele, varicose veins of small pelvis;
- Transrectal and transabdominal ultrasonography for the study of appendages, prostate, size and structure of the testicles, detect changes in seminal vesicles in case of obstruction or abnormalities of the ejaculatory system;
- Thermography of the scrotum for the diagnosis of varicocele;
- Testicular biopsy – if refined the diagnosis of idiopathic azoospermia with normal testicular size and blood FSH. The result of this research can be normeperidine – for the formation of sperm cells a set of cells, hypospermatogenesis – incomplete set of cells, aspermatogenic – total absence of cells in the seminiferous tubules.
- Vasography – x-ray seed of channels and vesicles to determine the source of obstruction.
One of the methods of Express-diagnosis of infertility – sperm-chip to determine the number of sperm cells created by UC riverside researchers. It can be used at home, spending just a few drops of semen. The cost of the chip is about 40 €.
Test for male infertility at homeToday we have a unique opportunity to carry out a complete procedure for detecting infertility at home. The total cost will be about $ 25. It is much cheaper when compared with a complete study of the state of the sperm, which is conducted by the specialists of the laboratory.
The test is called SpermCheck fertility. Its developers – the specialists of the University of Virginia (USA). The test was the team of more than 200 male patients. Scientists said the accuracy will be not less than 96%. First released version, suitable for the implementation of clinical trials. It is possible to determine the effectiveness of vasectomies. The invention is successfully used for quite a long time, since 2008.
Now anyone can conduct the procedure similar to test determine pregnancy. As a result, using just a few drops of semen to make conclusions about the futility. Then have to make a choice - whether to turn to the appropriate specialists.
Normal levels is 200-500 million sperm per milliliter of semen. To make the necessary findings, it is necessary to know about the criteria of the world Health Organization. According to them, infertility obviously if you decrease this number to2 million by reducing the number of sperm up to 2 - 20 million at the same time decreases the ability to conceive. The new method is constructed based on a simple test based on the indicators - antibodies to proteins in sperm. Their volume is determined by biochemical method. Everything is done at home, close to comfortable.
Treatment of male infertility
The first stage of treatment of male infertility therapy or surgical treatment of the underlying disease, followed by a stimulation of spermatogenesis. For the treatment of infertility uses, both traditional and alternative therapies.
Restorative treatmentThe use of vitamins and minerals. To increase the production of steroids and the improvement of spermatogenesis is used in vitamins A, D, K, D, E (tocopherol). Apply multivitamin complexes Aevit (vitamins A and E), Undevit, Undevit, vitamin and mineral preparations Yunikap, Centrum.
Sedatives and nootropics. Men with reduced fertility often show irritability and reduced activity, they suffer from depression and neurosis. To prevent the overwork and exhaustion of the nervous system, improve brain activity used drugs, having in its composition the phosphorus (Lipocerin, Calcium glycerophosphate). Recommended as an anti-anxiety drugs bromine, Valerian extract, motherwort tincture of Eleutherococcus. More pronounced disorders of the Central nervous system (psychological infertility) require individual treatment plan with the involvement of a neurologist and therapist.
Hepatoprotectors. It means, improves liver function: Kars, Hofitol, Methionine, Essentiale-Forte, Heptral, Ovesol. It is advisable to follow a diet №5 (by Pevsner), restricting the diet of pickles, fatty foods, use seasonings.
Biostimulants. To improve metabolism, revitalization of reproductive organs, normalize their blood supply, accelerated regeneration of tissues and organs using biostimulators aloe, Apilak, vitreous body, Pheebs, Splenin, Methyluracil, Pentoxy.
Treatment of secretory male infertilityPrimary hypogonadism. Fortherapy primary (hypergonadotrophic of monadism) use androgens. Their function – stimulation of spermatogenesis and inhibition of the production of the gonadotropins FSH and LH. It is a testosterone, methyltestosterone, etc. At safety backup androgenic functions of the testes the drug is taken for 2-3 months. This is followed by a break for the same time, during which take luteinizing hormone horohorin.
To increase sperm count and increase their mobility are taking androgen (andriol, Proviron) in minimum doses. Men underweight recommended intake of anabolic hormones (retabolil, nerobolum et al).
To improve the performance of sperm, activation of the pituitary gland, improvement of spermatogenesis is used replacement therapy with preparations containing testosterone prolonged action (testent). Withdrawal of the drug after a two-month course gives the opposite effect with a predictable reaction.
If hyperlactaemia to increase libido, stimulation of potency, improve semen, as well as to treat gynecomastia, are inhibitors of the production of prolactin (bromocriptine).
Secondary hypogonadism. With a lack of luteinizing hormone decreases the synthesis of testosterone slows down sperm production. To treat this condition for 1.5-2 months used drugs of LH (pregnyl, horohorin), combining them with taking testosterone. If you do not have enough FSH to enhance spermatogenesis prescribed fristamin or androgen for reception within 1.5-2 months.
For stimulation of the pituitary gland and hypothalamus prescribed progestins (clomiphene) or antiestrogens (tamoxifen, sitesinin), course (month 10 days break) can be repeated up to 6 times.
Treatment of excretory male infertility.
Treatment of this kind of male sterility start with the correction of the causes of this condition. If infertility is caused by complications of prostatitis, vesiculitis, orchitis, urethritis, treatment with antibiotics and anti-inflammatory drugs. Additionally, use massage, physiotherapy, acupuncture and other methods. For the normalization of metabolism and stimulation of spermatogenesis appoint hepatoprotectors, adaptogens, biostimulators, vitamins.
Surgical treatment of male infertilitySurgery is indicated for obstructive of aspermia.
Tactics surgery to restore patency semyavyvodyaschih ways depending on the structure of the pathology:
- Vasovasostomy (deletedthe site of obstruction of the VAS deferens);
- Vasoepididymostomy (VAS deferens connect with the tubules of the appendages);
- Resection of the prostate through the urethra.
The age category for such operations – young men (under 30 years).
If aspermia are diagnosed in men older age, use different methods of extracting sperm for support of technologies of fertilization:
- Percutaneous puncture of the testicles;
- Percutaneous puncture of the epididymis;
- Open biopsy of the gonads;
- Microsurgery to retrieve the contents of the epididymis of the testicles.
When secretory infertility the following surgery:
- Embolization or sclerotherapy of the affected vein of the ovary (when varicocele);
- Needling or hardening (of hydrocele);
- Laparoscopy or using the classic method (with cryptorchidism, is in childhood).
Methods of treatment of autoimmune infertility:
- Therapy with glucocorticoids (Hydrocortisone, Desametasone) with anti-inflammatory, immunosuppressive and anti-histamine action, forms of application are tablets, ointments, physiotherapy.
- Capacitation of sperm (processing and cleaning) to prepare for IVF or ICSI.
Assisted reproductive technologiesAlternative payment methods for male infertility:
Artificial insemination. The method consists in the following – in the cervical canal of the woman or directly into the uterine cavity introduces pre-treated sperm. In cases of low concentrations in the semen of a spouse of active sperm or their complete absence is used donor sperm. Method is used when cervical factor (production of antibodies against the husband's sperm by the mucus of the cervical canal), autoimmune infertility and sterility unexplained etiology.
In-vitro fertilization. In IVF, fertilization occurs outside the female body. A few copies are removed after artificial stimulation of the ovaries in the Petri dish fertilized them with the sperm of the spouse. A few days later to select the most viable zygotes (fertilized oocytes) and transfer them tothe uterus.
ICSI. ICSI (intracytoplasmic sperm injection) is the introduction of sperm into the egg using microsurgical manipulations. The success of your procedure enough viable sperm. Male sex cells are produced by Masturbation or aspiration surgery.
Surrogacy or adoption. In the case of donor surrogate motherhood in the framework of the previously concluded contract bears a child, developing from a zygote derived from the gametes of the infertile couple.
General guidelinesThere are simple rules, doing that can greatly improve the quality of sperm. Particularly relevant this advice for men who expect the appearance of a child.
Following the principles of healthy eating. It is advisable to limit the intake of pickles, smoked meats, sweets, hot spices, fatty foods. Recommended foods: red meat, legumes, walnuts, parsley, dill, Basil, celery, fresh fruit and vegetables in large quantity, the decoction or infusion of rose hips. Very useful eating tomato in any form due to high content of such antioxidants as lycopene.
Normalization of body weight and prevention of physical inactivity. A sedentary lifestyle is provoking the stagnation of blood in the pelvic organs. The result is deterioration of sperm quality, reduced potency, the development of such diseases as varicose veins, hemorrhoids, hydrocele. The increase in body weight enhances the production of fat estrogen, the female hormone. To mitigate such risks will help physical training, marching, execution of exercises.
The physiologically useful wearing underwear and clothing. So as not to disturb the blood circulation in the pelvic organs, the scrotum, it is advisable to give up wearing tight underwear (especially if it is a synthetic), tight jeans.
Normalization mode of sexual activity. Normal sexual intercourse should be not less and not more often than once in 2-3 days. The result of too frequent contacts could be producing sperm with a large number of immature sperms, too rare – aging of male germ cells. In addition, regular sexprotect the man from the appearance of prostatitis and BPH.
Prevention of overheating of reproductive organs. Temporarily should refuse to visit the saunas and baths.
The use of folk remedies. Excellent effect in the treatment of infertility makes use of bee products: this is the pollen (pollen from honeycomb), pollen, honey, Royal jelly. The rate of consumption of pollen and pollen – 1/2 tsp daily. To normalize the blood circulation in the pelvic organs, increases secretion of testosterone and sperm quality use of medicinal plants. Plantain, fireweed, sage, knotweed brew and take 3-4 tablespoons a day.
Treatment of male infertility, its duration and the effectiveness depends on the cause of pathology, the careful observance of the recommendations of the experts, selected methods of therapy. About 45-50% of couples in which infertility "guilty" man, the treatment I find happiness to be parents.