Infertility in men - Causes, symptoms and treatment. MF.

Infertility in men - Lack of conception with regular sexual activity throughout the year.

Diagnosis of the causes of male infertility is expedient to conduct the first stage for any reason of infertile marriage, including female infertility, which avoids tactical mistakes, unnecessary temporary and financial losses.

Male Reproductive System

Male reproductive organs are located both inside the body and outside. The testes produce sperm and the hormone testosterone, which is responsible for the formation of sexual characteristics. From the testicles, sperm enters the spiral tubules of epididymis, an organ that preserves and feeds sperm as it ripens. Ripened sperm along the vas deferens( vas deferens) enters the seminal vesicles - two saccular glands that retain sperm.

The entire process of sperm formation until full maturation takes about 72 days. With ejaculation, the secret of seminal vesicles is mixed with a thick liquid from the prostate, forming a seminal fluid.

Spermatogenesis in a male

Development of normal and mature sperm( spermatogenesis) is a fundamental factor of male fertility, i.e.ability to procreate. Sperm production is carried out and regulated by three hormones: FSH, LH and testosterone. In men and FSH, and LH affect the testicles - the hormone FSH stimulates the production of sperm in Sertoli cells, and the hormone LH - testosterone in Leydig cells. In Sertoli cells, immature sperm gradually ripen and turns into spermatozoa. However, these spermatozoa will not acquire mobility until they pass through epididymis. The mobile sperm that has become mobile is then stored in the vas deferens until it ejaculates.

Causes of male infertility

After ejaculation, sperm lives in the body of a woman and retains the ability to fertilize an egg for 48 to 72 hours. That is why the most favorable for the conception of a child are considered intercourse every 2 or 3 days during the period of ovulation.

From the point of view of fertilization, sperm motility is as important as the number of spermatozoa. Men with a small number of spermatozoa can nevertheless be fertile, however, provided that their spermatozoa have high mobility.

The capacity for fertilization can also be affected by the volume of the semen and the morphology( structure) of the spermatozoa.

In addition, the fertility of men can suffer because of the presence in the scrotum of varicose veins - varicocele. By the way, this is one of the most common causes of infertility in men. And finally, reproductive health in men can be affected by factors such as obstruction in the reproductive organs, difficulty with ejaculation, drug use, or impaired function or development of the testicles.

There are two main forms of male infertility - secretory and obturational. With the secretory form, the formation of spermatozoa in the convoluted tubules of the testicles is impaired, with obstructive obstruction on their way to the urethra.

Secretion form of male infertility

With this form, the testicles do not produce enough sperm to achieve and fertilize the egg, or the spermatozoa are impaired mobility, or most spermatozoa have structural defects.

At the heart of the secretory form of infertility is always a certain effect on the testicles. The most common disease leading to a violation of sperm production is varicose veins of the testicle, or varicocele. With this disease, the excessively dilated testic veins are unable to give a full flow of blood from the testicle, as a result of which its stasis develops, blood supply to the testicle tissue is disrupted and its function is inhibited. In the vast majority of cases, varicocele is left-sided, but after a while the blood supply of another healthy testicle is disrupted, and some other mechanisms are attached. The result of this disease can be a significant decrease in the production of spermatozoa by both testicles, and, accordingly, the secretory form of infertility.

Similar phenomena are possible with dropsy. In this disease in the scrotum, a significant amount of fluid accumulates, which squeezes the testicle. With prolonged absence of treatment, this compression can lead to a disruption of the blood supply to the testicle tissue, which in the end may result in such an unfavorable outcome. A similar result can be given by inguinal hernia.

A more rare disease leading to infertility is cryptorchidism - undescended testicles in the scrotum. Modern approaches to the treatment of cryptorchidism suggest that by the age of 7 its treatment should be fully completed, and the testicles must necessarily be in the scrotum. If this does not happen, the function of the testicles can be significantly reduced.

Another disease that often leads to the same result is mumps, or, more simply, mumps. The virus that causes this disease is used to infect the various glands of the body. Almost always begins inflammation of the salivary glands, the patient's face acquires a rounded shape, for which the disease and received its second name. Last but not least, the sex glands, especially the testicles in boys, are involved in the process. If the inflammation of the testicles was strong enough, and the necessary treatment was not provided, a significant disruption of their function is possible.

Damage to the spermatogenic epithelium can be caused by various external factors. Long-term exposure to penetrating radiation can cause not only radiation sickness and a variety of disorders of the body, but also severely damage the spermatogenic epithelium of the testicles, which will lead to a significant decrease in spermatozoa. Significant intensity or duration of exposure to electromagnetic oscillations can lead to the same outcome. This is especially true for fans of wearing modern means of communication on the belt. Studies on the impact of mobile phones on this function, men have not yet given an unambiguous answer to this question, but it is possible that their result will not be encouraging.

It is also worth noting the depressing effect on the function of testicles of high temperatures. This is important not only for welders and stokers, but also for those who like to soar in the sauna or take a hot bath. Such procedures are best to end with a cool shower or at least let the body cool down before dressing, if you are not indifferent to this issue. Very unfavorable to the function of the genitals are the regular cycling exercises, especially those of a professional nature. Pressures and constant perineal strokes can easily lead to a decrease or complete disruption of the function of the testicles, so when treating this form of infertility from cycling, and even more training is better to abstain. Violating the thermoregulation of the testicles can be a tight underwear, tightly pressing the testicles to the body.

Sick diseases such as syphilis, tuberculosis, typhoid, hormonal disorders, long-term antineoplastic, antiepileptic drugs, certain antibiotics, steroid hormones and antiandrogens may lead to impairment of the spermatogenic function of the testicles. Reducing the number of spermatozoa can also cause such factors as prolonged stress, lack of protein and vitamin content in food, adverse environmental factors, chronic lack of sleep, abuse of cigarettes, alcoholic beverages, drugs.

To diagnose this form of infertility, in addition to the spermogram, a testicular biopsy is often necessary. This allows not only to determine the condition of testicular tissue, but often also to find out the root cause of the disease.

When treating the secretory form of male infertility, the cause of the disease should be eliminated as much as possible-treatment of varicocele, dropsy, mumps, elimination of an unfavorable factor, drug discontinuation, etc. After eliminating the cause, a general course of therapy is carried out, aimed at improving the spermatogenic function of the testicle. It includes not only adequate nutrition and normalization of lifestyle, but also vitamin therapy and taking medications that improve the blood supply to the scrotum organs. In some cases, it is necessary to use stimulating hormone therapy.

In general, the treatment of the secretory form of male infertility is a very long, complex and painstaking, but by no means hopeless process.

Obturation form of male infertility

With this form of infertility, the promotion of spermatozoa along the vas deferens from one or both sides becomes impossible. With unilateral impairment of permeability in sperm, there is a decrease in the number of spermatozoa, with a bilateral one - their total absence.

The development of obliteration, that is, the obstruction of the vas deferens, is possible for a variety of reasons. Most often this develops as a result of the transferred epididymitis - inflammation of the epididymis. After the subsidence of the inflammation, the ducts of the epididymis are glued or clogged, as a result of which no sperm from the testicle can get into the seminal vesicles.

To the same result can result and traumas of testicles or inguinal areas, especially those left without examination and treatment by a doctor. Often, the obstruction of the vas deferens develops as a result of accidental damage to them during surgery on the pelvic organs - the bladder, ureters, rectum, etc. There are cases of compression of the vas deferens or a tumor of the epididymis. Not the least place in the development of this form of infertility is the congenital absence of the epididymis or the vas deferens. Other diseases that can give such an unpleasant complication are syphilis and tuberculosis.

To diagnose the obstruction of the vas deferens, special methods are used to determine the presence, location and extent of the obliteration site. Treatment of obturational form of male infertility is the operative restoration of patency of the vas deferens. The success of the operation depends to the greatest extent on the length of the site of obliteration. Depending on this, either excision of the impenetrable for spermatozoa is performed, or the formation of a new pathway for spermatozoa. Sometimes, for this purpose, an anastomosis is used with the opposite vas deferens.

Immunological incompatibility of

partners In 10% of all infertile marriages, none of the spouses have any diseases that could lead to infertility. Moreover, both of them may have children from other marriages. The cause of infertility in such cases is most often the immunological incompatibility of partners, or, in other words, the woman's allergy to sperm or other components of her husband's sperm. To diagnose this form of infertility, a number of tests and tests are used, including an allergy test with the ejaculate of the spouse. Unfortunately, the treatment of this form of infertility is today a serious problem for andrologists and gynecologists around the world, and it is not always possible to achieve a favorable outcome in the usual way.

The basis for the diagnosis of male infertility is spermogram.

Psychological aspects of infertility

In the vast majority of cases, even if a man knew about his illnesses and was aware of possible complications, the news of his own infertility is a complete surprise to him. Any woman will experience a shock and a heavy shock, learning that she can not have children, but often this does not go to any comparison with the tragedy that a man experiences with such news. In the subconscious of the majority of the stronger sex, the concept of masculinity is almost identical to sexual function, and the inability to have children sometimes inflicts an irreparable blow to the painful masculine self-esteem.

There are many cases where men left families only because they were not able to have children, even though their spouses were ready to put up with the situation or to solve the problem in another way, for example, to adopt a child. Many of them after that considered themselves not in the right to create a family and even enter into serious relations with women, which eventually led them to alcoholism or drug addiction. But even with the preservation of the family and the beginning of treatment, the relationship between the spouses can irreparably change.

Many men are so afraid to receive news that they are infertile, that they refuse all medical examinations on this subject, and to persuade or force them to seek advice from a specialist becomes extremely difficult, if at all possible.

Possible causes of infertility:

- testosterone deficiency of various etiologies;
- inflammatory diseases of the reproductive system;
- genetic disorders;
- erectile dysfunction;
- violation of ejaculation( including with diabetes)
- history parotitis in history;
- anomalies of development of genital organs.

In what conditions does Infertility occur in men:

• Erectile dysfunction
• Epidemiologic parotitis
• Diabetes
• varicocele

To which doctors are treated for male infertility

• Urologist andrologist
• Endocrinologist andrologist