Infertility in men: causes, diagnosis and treatment of infertility in men
At the time of sexual intercourse, not every man impregnates a woman, so 40% of childless marriages are due to infertility of men.
Male external and internal genital organs perform the function of copulation and reproductive. In the external organs: the penis and scrotum are erogenous zones in the form of receptors that perceive irritations. To the internal genital organs are testicles with appendages, vas deferens, prostate gland and seminal vesicles.
Through the penis, a man commits sexual intercourse and delivers ejaculate( sperm) to the female vagina, and urine is also removed from the urinary bladder. The size of the penis roughly corresponds to the size of the woman's vagina. The skin fold of the anterior part of the penis - the foreskin partially or completely covers the head.
Bridle - longitudinal crease connects the head and foreskin to the posterior part of the penis. The preputial bag( slit-shaped cavity) between the foreskin and the head( under the inner leaf of the foreskin and in the furrow of the coronary penis) accumulates the smugma - the pre-special lubricant. Grease reduces the friction of the foreskin against the head.
During ejaculation, the products of secretion of testes with appendages, seminal vesicles, ducts and prostate gland, the urethra are mixed and ejaculate - sperm composed of seminal mucus-like plasma and spermatozoa( shaped elements) is obtained. Normally, 1 ml of sperm contains 60-120 million spermatozoa. Of them, inactive can be 70%.
According to WHO, the lower limit of sperm count is 20 million in 1 ml of sperm.
In the musculoskeletal organ - scrotum are located the testicles, epididymis and the seminal cord( initial section).The scrotum is divided between the testicles by a septum, it corresponds to the embryonic seam from the outside. In the scrotum, a temperature of 34-34.5 ° C is created for the testicles, which is lower than the total body temperature. This is important for the reproductive function of the male sexual organ. Spermatozoa are formed only at testicle temperature, below body temperature by 4 °.
In testicles( testicles, testicles) - the male sexual gland produces spermatozoa, and the male sex hormones( testosterone) are released into the bloodstream. Inside the scrotum the testicles are located at different levels: the right testicle is above the left and differ in magnitude.
Through the vas deferens( vas deferens) is derived from the testicles of sperm. They continue the duct of the epididymis, connect with each other after passing through the inguinal canal, forming a single duct that ejects the seed. Passing through the prostate gland, it ends with an opening in the urethra( in its posterior part).
Thanks to wave-like contractions, the semen is advanced through the vas deferens. At the time of orgasm, it is thrown into the urethra, and then into the vagina of the woman or out. Through the spermatic cord, the paired anatomical organ, the testicle is supplied with blood and the seed is excreted from the epididymis to the duct that removes the seed.
The prostate gland or prostate is an unpaired organ and produces a secret that is part of the sperm. It is located between the rectum and the bladder. The urethra passes through the prostate.
With the help of the prostatic juice, semen is liquefied and the movement of spermatozoa is activated. With the help of the prostate gland, spermatozoa move through the vas deferens, ejaculation occurs, libido forms and orgasm occurs.
Seminal vesicles are paired glandular formations. They develop a secret for the composition of the sperm. It is a viscous protein fluid, which contains fructose - a source of energy and life for spermatozoa.
Infertility in men occurs due to the small number of spermatozoa and their lack of mobility, and also:
Read also, the causes of infertility in women.
With secretory( hormonal) form, the production of sperm and spermatozoa is reduced due to low levels of male hormones( testosterone), their mobility is disrupted, and structural defects appear.
The main cause of the secretory form of infertility is a detrimental effect on the testicles:
1) In varicocele( nodal veins widening in the inner seminal vein of the spermatic cord):
3) In inguinal hernia in men, cryptorchidism produces little sperm, with frequent heating of the scrotum( testicles) during the intake of hot baths, the ability to fertilize for half a year or more is impaired. With a sedentary lifestyle, the testes overheat from the body of a man, disrupting the ability to fertilize an egg with sperm.
The reasons for the secretory form of infertility also include:
1) Parotitis( or mumps);
2) Infectious diseases of the genitourinary system, including:
4) Medications for their long-term use;
5) Imbalance of hormones;
6) Harmful habits.
With this form, the number of spermatozoa decreases due to their passage only one way along the vas deferens or they are completely absent as a result of bilateral obstruction.
Obliteration develops( obstruction of the ducts that lead out the seed) in connection with:
With this form, antispermal and anti-tester antibodies are present in the testicles. Partners can be immunologically incompatible in the absence of diseases that lead to infertility.
The woman has an allergy to her husband's sperm, including sperm and other components.
Infertility is developing as a result of the fact that sperm does not get into the vagina of a woman because of:
When the doctor diagnoses an andrologist, the anatomical and functional state of the male reproductive organs is evaluated, for this:
Treat infertility in men with the help of empirical and pathogenetic directions.
The empirical direction uses artificial insemination, even if there is one sperm in the sperm, the cause of infertility is not being clarified.
In the pathogenetic direction, the cause of infertility is diagnosed, the appropriate treatment is selected, provided that certain recommended recommendations are followed.
Includes: dosing of sexual contacts, wearing free men's underwear, switching to a healthy diet for weight loss, testosterone and leptin - the fatty tissue hormone.
Exclude: bad habits, stressful situations, heavy physical activity, overheating in baths, steam rooms and saunas.
For treatment of the main causes of infertility apply:
Drugs with hormones are used for varicocele and infections of the genital organs.
Substitution therapy is used in the presence of hypogonadism. Treatment is carried out: Luliberin, Humegon, Menogon, Chorionic gonadotropin( Metrodine, Gonal-F).With hypogonadotropic hypogonadism and cryptorchidism - Pregnil, Prophase, Chorionic gonadotropin.
Hypogonadotropic / normogonadotropic hypogonadism and oligozoospermia are treated with anti-estrogens( Clomiphene, Clostilbegit or Tamoxifen) and preparations for empirical therapy. Hypergonadotropic hypogonadism is not always cured by a conservative method.
Hyperprolactinemia is treated with dopamine receptor agonists and the use of drugs: Bromocriptine, Dostinex, Noprolac.
With blocking( suppressive) therapy, hormones are administered to suppress the function of the corresponding gland. Large doses of testosterone inhibit the production of gonadotropins and inhibit spermatogenesis to azoospermia. With the withdrawal of the drug, spermatogenesis is restored, exceeding the baseline before treatment.
Stimulant therapy is carried out by introducing small doses of hormones for beneficial effects on the processes in the body: inflammatory, metabolic and immune. This does not occur in the hypothalamus, pituitary gland and testicles of pronounced changes. Treatment is conducted by Andriol and Proviron. These drugs are used to treat idiopathic oligozoospermia.
Male external and internal genital organs perform the function of copulation and reproductive. In the external organs: the penis and scrotum are erogenous zones in the form of receptors that perceive irritations. To the internal genital organs are testicles with appendages, vas deferens, prostate gland and seminal vesicles.
Through the penis, a man commits sexual intercourse and delivers ejaculate( sperm) to the female vagina, and urine is also removed from the urinary bladder. The size of the penis roughly corresponds to the size of the woman's vagina. The skin fold of the anterior part of the penis - the foreskin partially or completely covers the head.
Bridle - longitudinal crease connects the head and foreskin to the posterior part of the penis. The preputial bag( slit-shaped cavity) between the foreskin and the head( under the inner leaf of the foreskin and in the furrow of the coronary penis) accumulates the smugma - the pre-special lubricant. Grease reduces the friction of the foreskin against the head.
During ejaculation, the products of secretion of testes with appendages, seminal vesicles, ducts and prostate gland, the urethra are mixed and ejaculate - sperm composed of seminal mucus-like plasma and spermatozoa( shaped elements) is obtained. Normally, 1 ml of sperm contains 60-120 million spermatozoa. Of them, inactive can be 70%.
According to WHO, the lower limit of sperm count is 20 million in 1 ml of sperm.
In the musculoskeletal organ - scrotum are located the testicles, epididymis and the seminal cord( initial section).The scrotum is divided between the testicles by a septum, it corresponds to the embryonic seam from the outside. In the scrotum, a temperature of 34-34.5 ° C is created for the testicles, which is lower than the total body temperature. This is important for the reproductive function of the male sexual organ. Spermatozoa are formed only at testicle temperature, below body temperature by 4 °.
Inner genitals
In testicles( testicles, testicles) - the male sexual gland produces spermatozoa, and the male sex hormones( testosterone) are released into the bloodstream. Inside the scrotum the testicles are located at different levels: the right testicle is above the left and differ in magnitude.
Through the vas deferens( vas deferens) is derived from the testicles of sperm. They continue the duct of the epididymis, connect with each other after passing through the inguinal canal, forming a single duct that ejects the seed. Passing through the prostate gland, it ends with an opening in the urethra( in its posterior part).
Thanks to wave-like contractions, the semen is advanced through the vas deferens. At the time of orgasm, it is thrown into the urethra, and then into the vagina of the woman or out. Through the spermatic cord, the paired anatomical organ, the testicle is supplied with blood and the seed is excreted from the epididymis to the duct that removes the seed.
The prostate gland or prostate is an unpaired organ and produces a secret that is part of the sperm. It is located between the rectum and the bladder. The urethra passes through the prostate.
With the help of the prostatic juice, semen is liquefied and the movement of spermatozoa is activated. With the help of the prostate gland, spermatozoa move through the vas deferens, ejaculation occurs, libido forms and orgasm occurs.
Seminal vesicles are paired glandular formations. They develop a secret for the composition of the sperm. It is a viscous protein fluid, which contains fructose - a source of energy and life for spermatozoa.
Causes of male infertility
Infertility in men occurs due to the small number of spermatozoa and their lack of mobility, and also:
- decrease in activity and motility of spermatozoa in the presence of chronic prostatitis;
- of the inflammatory processes of the urogenital system of men.
- impairment of the functions of the genital organ and the production of spermatozoa with any adverse effect on the testicles in the fetus in the womb, boys and adult men;
- excessive craving for alcohol, nicotine or drugs. In this case, the spermatic cord is regenerated and the specific properties of the spermatozoa are violated, which entails the birth of an inferior child or infertility.
Read also, the causes of infertility in women.
Secretory form of infertility in men
With secretory( hormonal) form, the production of sperm and spermatozoa is reduced due to low levels of male hormones( testosterone), their mobility is disrupted, and structural defects appear.
The main cause of the secretory form of infertility is a detrimental effect on the testicles:
1) In varicocele( nodal veins widening in the inner seminal vein of the spermatic cord):
- a scrotal plexus of the scrotum is formed, the seminiferous tubules are convoluted;
- functions of Leydig cells are suppressed;
- there are violations in the testicles and its appendages: stagnant blood in the testicle, which leads to a decrease in the number of spermatozoa;
- affects the interstitial and connective tissue of the testicle.
3) In inguinal hernia in men, cryptorchidism produces little sperm, with frequent heating of the scrotum( testicles) during the intake of hot baths, the ability to fertilize for half a year or more is impaired. With a sedentary lifestyle, the testes overheat from the body of a man, disrupting the ability to fertilize an egg with sperm.
The reasons for the secretory form of infertility also include:
1) Parotitis( or mumps);
2) Infectious diseases of the genitourinary system, including:
- prostatitis, orchitis and vesiculitis, affecting the quality of seminal fluid, the structure of spermatozoa and their mobility;
- gonorrhea, trichomoniasis, syphilis, candidiasis and other pathogenic diseases acquired through sexual contact and reducing testicular function;
4) Medications for their long-term use;
5) Imbalance of hormones;
6) Harmful habits.
Obturation form of infertility in men
With this form, the number of spermatozoa decreases due to their passage only one way along the vas deferens or they are completely absent as a result of bilateral obstruction.
Obliteration develops( obstruction of the ducts that lead out the seed) in connection with:
- with scrotal organs injuries;
- with operations on the organs of the scrotum, ureters and bladder, rectum;
- with epididymitis( inflammation of the epididymis), cysts or tumors, congenital absence of epididymis or duct leading to the seed;
- with infections that lead to inflammation and obstruction of the ducts, including syphilis and tuberculosis.
Immunological form of infertility
With this form, antispermal and anti-tester antibodies are present in the testicles. Partners can be immunologically incompatible in the absence of diseases that lead to infertility.
The woman has an allergy to her husband's sperm, including sperm and other components.
Other forms of infertility of men
Infertility is developing as a result of the fact that sperm does not get into the vagina of a woman because of:
- of erectile dysfunction( erectile dysfunction, impotence);
- hypospadias( incorrect location of the urethral opening);
- premature ejaculation( with ejaculation before the introduction of the penis into the vagina);
- of an irregular sexual life;
- excessive sexual activity, which leads to a decrease in immunity, the emergence of bacterial and viral infections, the weakening of the general state of health;
- of sexual illiteracy.
Diagnosis of male infertility
When the doctor diagnoses an andrologist, the anatomical and functional state of the male reproductive organs is evaluated, for this:
- 1) Test male fertility in the spermogram using the masturbation method and the MAR test;
- 2) Perform ultrasound and dopplerometry for examination of testes, appendages and blood supply and exclusion( confirmation) of pathologies associated with physiology, inflammation and surgical operations;
- 3) Apply the method of TRUS for a more detailed study of the prostate gland and seminal vesicles. Consider its structure in order to determine the inflammatory processes: acute or chronic;
- 4) Check the hormonal status, analyzing blood for the presence of hormones, which is responsible for libido and spermatogenesis is normal;
- 5) At the genetic level, a study of severe pathospermia is conducted;
- 6) Infectious diseases are confirmed or excluded in the study of the smear of the urethra. In this case, the influence of infections on the quality of sperm is determined;
- 7) Masturbation is carried out by sperm seeding on bacteria and leukocytes when examining the ejaculate;
- 8) To exclude the inflammatory process - prostatitis, the juice of the prostate gland is examined( with a three-day abstinence);
- 9) The level of free radicals( ROS) is determined to determine the factor that influences the reduction of male fertility;
- 10) Chemical changes on the head of the spermatozoon, which contribute to its penetration into the egg, are carried out with the help of an acrosomal reaction;
- 11) Pathologies leading to infertility are detected using electron microscopic studies of spermatozoa: their internal structures and the composition of the seminal plasma;
- 12) The work of the prostate gland, epididymis and seminal vesicles is determined by biochemical studies of the ejaculate;
- 13) Determine the composition of the seminal plasma, including the presence in it of phosphatase acidic prostatic, alpha-glycosidase neutral, zinc, fructose and citric acid;
- 14) A more in-depth study of the morphology of spermatozoa through a routine spermogram.
Treatment of male infertility
Treat infertility in men with the help of empirical and pathogenetic directions.
The empirical direction uses artificial insemination, even if there is one sperm in the sperm, the cause of infertility is not being clarified.
In the pathogenetic direction, the cause of infertility is diagnosed, the appropriate treatment is selected, provided that certain recommended recommendations are followed.
Includes: dosing of sexual contacts, wearing free men's underwear, switching to a healthy diet for weight loss, testosterone and leptin - the fatty tissue hormone.
Exclude: bad habits, stressful situations, heavy physical activity, overheating in baths, steam rooms and saunas.
For treatment of the main causes of infertility apply:
- 1) Conservative therapy and sperm capitation;
- 2) Surgical operation - laparoscopy for varicocele;
- 3) Artificial insemination in the presence of idiopathic infertility;
- 4) IVF - in vitro fertilization;
- 5) Artificial insemination: sperm of the husband( IMSM), donor sperm( IISD), intracytoplasmic sperm injection( IVF / ICSI) and surrogate motherhood;
- 6) Complex therapy for both partners in sexual infections with the selection of drugs depending on the selected pathogen;
- 7) Antibacterial therapy and in addition: massage, physiotherapy, acupuncture from inflammatory diseases;
- 8) Surgical operation and conservative therapy with ejaculatory or sexual dysfunction, congenital anomaly of the genital organ, obstruction of the spermatic cord, hernia or dropsy testicles;
- 9) Scrotal biopsy and histological examination with azoospermia;
Endocrine treatment of infertility - hormone therapy
Drugs with hormones are used for varicocele and infections of the genital organs.
Substitution therapy is used in the presence of hypogonadism. Treatment is carried out: Luliberin, Humegon, Menogon, Chorionic gonadotropin( Metrodine, Gonal-F).With hypogonadotropic hypogonadism and cryptorchidism - Pregnil, Prophase, Chorionic gonadotropin.
Hypogonadotropic / normogonadotropic hypogonadism and oligozoospermia are treated with anti-estrogens( Clomiphene, Clostilbegit or Tamoxifen) and preparations for empirical therapy. Hypergonadotropic hypogonadism is not always cured by a conservative method.
Hyperprolactinemia is treated with dopamine receptor agonists and the use of drugs: Bromocriptine, Dostinex, Noprolac.
With blocking( suppressive) therapy, hormones are administered to suppress the function of the corresponding gland. Large doses of testosterone inhibit the production of gonadotropins and inhibit spermatogenesis to azoospermia. With the withdrawal of the drug, spermatogenesis is restored, exceeding the baseline before treatment.
Stimulant therapy is carried out by introducing small doses of hormones for beneficial effects on the processes in the body: inflammatory, metabolic and immune. This does not occur in the hypothalamus, pituitary gland and testicles of pronounced changes. Treatment is conducted by Andriol and Proviron. These drugs are used to treat idiopathic oligozoospermia.