Female and male infertility: part 2

Male infertility: The maturation of spermatozoa in the testicles occurs under the influence of gonadotropins secreted by the pituitary gland, and male sex hormones (androgens). Unlike the female body, there is no cyclicity in the regulation of the male reproductive system.

Diagnosis and treatment of male infertility

The sexual potency of a man is not an indicator of his fertility, since the ability to fertilize is determined by the quality of spermatozoa. In men, in addition to determining the level of male sex hormones and their daily rhythm, it is necessary to examine the spermogram before, during and after treatment. Male fertility is determined by the following key factors: spermatogenesis, sperm transport, the ability of the sperm to penetrate into the egg to introduce genetic material into it.

To identify the causes of infertility, it is important to know the following features of sperm transport. The seminal fluid forms a gel almost immediately after ejaculation, but after 20-30 minutes it is liquefied under the influence of enzymes coming from the prostate gland. In some cases, the seminal fluid remains viscous, retains spermatozoa and prevents them from moving into the uterus. Normally, the acidity of the seminal fluid is higher than 6 pH, which protects the spermatozoa from the harmful effects of the acidic pH of the vagina.

Male infertility

On the way from the vagina to the tubes, the number of spermatozoa decreases significantly. On average, out of 200-300 million spermatozoa that have entered the vagina, eggs reach less than 200. Some of the spermatozoa are destroyed under the influence of vaginal enzymes, as well as as a result of “squeezing” the seminal fluid from the entrance to the vagina. The largest number of spermatozoa dies during passage through the fallopian tubes. Phagocytosis of spermatozoa occurs throughout the reproductive tract.

Examination and treatment of patients to determine the cause of infertility is carried out by an andrologist or urologist.

Examination of a man with infertility begins with the analysis of a spermogram, which allows you to determine the volume of sperm, the total number of spermatozoa, the number of active and normal spermatozoa. In addition, the number of white blood cells is calculated, the viscosity of the sperm is determined, the dilution time is determined. The lack of dilution of seminal fluid is one of the causes of male infertility.

Another factor leading to male infertility may be sperm agglutination. At times, this happens in most men. However, the detection of sperm agglutination in repeated samples indicates an autoimmune reaction or infection. If a large number of abnormal spermatozoa are detected, an additional study is shown – a morphological analysis of sperm. Based on the conducted studies, the nature of the pathology of spermatozoa is established and the method of infertility treatment is determined. The maturation of spermatozoa largely depends on the impact of internal and external adverse factors. Alcohol, nicotine, occupational hazards, stress, nervous and general fatigue, acute and chronic diseases worsen the quality of sperm.

The composition of spermatozoa is resumed within three months. This should be taken into account when submitting sperm for analysis. The longer it is possible to maintain a healthy lifestyle, the better the result. Before submitting sperm for analysis, it is necessary to refrain from sexual contact for 3-5 days. Compliance with this condition allows you to get the best composition and quality of spermatozoa. Daily or more frequent ejaculations can lead to a decrease in the quality of spermatozoa, but abstinence for 5-7 days or longer is also undesirable, since an increase in the number of spermatozoa does not contribute to the “preservation of sperm” (as some patients believe), but is accompanied by a decrease in their mobility as a result of an increase in the proportion of old cells.

The most common causes of male infertility are:

  • inflammatory diseases (prostatitis, urethritis, etc.);
  • obstruction (obturation) of the vas deferens;
  • dilation of the veins of the spermatic cord (varicocele);
  • hormonal and sexual disorders.

It is not always possible to identify all possible causes of infertility. The male factor of infertility occurs in 40% of cases; unidentified causes-in 10%.

During the examination, physical disorders may be detected, for example, pronounced hypospadias, in which sperm does not enter the vagina. It is extremely rare for diabetes mellitus, neurological disorders, after prostatectomy, retrograde ejaculation of sperm into the bladder can occur.

In some cases, to find out the cause of infertility, in addition to a spermogram, a testicular biopsy should be performed. Azoospermia (the absence of spermatozoa in the sperm fluid) in the presence of spermatogenesis indicates an obstruction of the ducts. If a biopsy reveals complete hyalinization and fibrosis of the seminal tubules, the possibility of fertility is almost excluded.

The most common cause of male infertility is inflammatory processes directly in the testicles (orchitis, orchiepididymitis) and in the vas deferens (epididymitis, differentitis, vesiculitis). Approximately 15-20% of men who have suffered from mumps have orchitis, which in half of the cases ends with hypoplasia of the testicles of various degrees. If an infection of the genitourinary tract is detected, antibacterial therapy and, possibly, prostate massage should be prescribed.

25% of infertile men have varicose veins of the left internal seminal vein, the ligation of which in 50% of cases determines the possibility of fertilization. With clinically expressed varicocele, the size of the left testicle is usually reduced. It should be noted that varicocele is detected in 10-15% of men in the general population, and about half of them have violations of the spermogram. Even a weakly expressed varicocele can affect the quality of sperm, which is associated with an increase in the temperature of the testicles. Men with a normal spermogram, but who have been diagnosed with varicocele, need periodic examination, because their spermogram indicators may worsen over time.

Endocrine disorders rarely cause male infertility. Nevertheless, it is necessary to study the content of FSH, LH, testosterone and prolactin. If an increased level of prolactin is detected, a further diagnostic examination is performed to identify/exclude a pituitary tumor.

There are cases of infertile marriage, when both sexual partners are healthy, and pregnancy does not occur. This is often due to their immunological incompatibility, when antibodies to spermatozoa are produced in a woman’s body. These proteins inhibit the motility of spermatozoa and their ability to fertilize an egg.

There are special methods for diagnosing immunological incompatibility. The simplest of them – the postcoital test-allows you to get information about the absorbing ability of cervical mucus, as well as about the ability of spermatozoa to reach it and survive in it. The test is planned for the expected day of ovulation, which is determined by the previous basal temperature maps, the duration of previous cycles and the degree of humidity of the vagina. The cervical mucus is taken no later than 12 hours after coitus with the previous 48-hour abstinence; the cervical mucus is taken with tweezers. The extensibility of the mucus should be at least 8-10 cm. The mucus obtained during ovulation contains 90-95% water; it should be watery, liquid, transparent and abundant, and also should not contain cells. When drying on a slide, the mucus resembles a fern leaf. Mucus before ovulation and starting from 24-48 hours after it has a thick and viscous consistency, dries out in the form of amorphous lumps. The mucus of the optimal composition for the survival of spermatozoa usually persists for 2-3 days, but it varies from 1 to 5 days and even longer for different women. The normal number detected by a postcoital test is considered to be from 1 to 20 spermatozoa in the field of vision. If repeated tests do not detect spermatozoa or only find immobile cells, the prognosis is less favorable than when detecting live spermatozoa. Treatment becomes unsuccessful, especially in cases when repeated postcoital tests do not find spermatozoa or only dead forms are found, despite good mucus and a spermogram.

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