Male infertility: causes, diagnosis and in what cases…

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Top causes of male infertility

The concept of male infertility does not differ from female – it is the inability to conceive a child with regular (optimally – 2-3 times a week) sexual life without contraception:

  • within a year if you are under 35;

  • within half a year if you are older.

Therefore, there is no need to shift the problem onto women’s shoulders – the doctor should “surrender” together. The main reason in the presence of a normal erection is the difficulty in producing spermatozoa in the testicles. What goes wrong and whether it can be overcome is a separate question, which depends on the root of the problem. And in this case, there are many options, no less than for women. You need to understand that today you can help to conceive a child (treat or use ART) up to 80-90% of such men, but it is extremely important to seek help in time.

There are statistics of the main causes of male factor infertility:

  • varicocele (dilation of some veins of the spermatic cord) – 37.4%;
  • idiopathic pathospermia (various disorders of maturation and production of spermatozoa) – 25.4%;
  • testicular dysfunction – 9.4%;
  • obstruction of the vas deferens (obstruction for various reasons) – 6.1%;
  • cryptorchidism (when the testicle did not descend into the scrotum) – 6.1%;
  • decrease in sperm volume – 4.7%;
  • increased viscosity of sperm – 1.9%;
  • other reasons – 5.9%.

In addition, infertility can develop while taking drugs that affect male fertility (the ability to conceive). These are chemotherapy, hormones (testosterone injections, antihypertensives) and much more. And of course, alcohol, anabolic steroids, cannabis and other types of drugs are extremely negative. Therefore, it is necessary to discuss the fact of their use (even if it has already been completed) with an andrologist.

What to do if the spermogram is “bad”?

Spermogram is one of the first tests that a man gives up if he is suspected of infertility. The results can be frustrating, but it’s important not to panic ahead of time. The result is influenced by a lot of factors, ranging from stress or violation of the recommended mode and ending with a long trip in a car with heated seats.

“If problems are found in the spermogram, we at the clinic recommend doing a second study, but not earlier than three months after the first one. This is due to the cycle of physiological maturation of spermatozoa, which takes just 2.5-3 months. An exception is found azoospermia (absence of spermatozoa in the ejaculate). In this option, it is recommended not to wait, but to repeat the analysis in two weeks. It should also be taken into account that when conducting a spermogram, the material should be examined after centrifugation – perhaps there are spermatozoa in the sediment.

When Medicine Fails

Another pathology may be found – azoospermia, when there are no spermatozoa in the ejaculate. It is indeed serious, although it is not common – only 10-15% of cases related to male infertility. There are two forms, each of which (or their combination) leads to infertility:

  • secretory (this is a violation or complete stop of spermatogenesis for various reasons and at different stages of sperm development);

  • obstructive – when spermatozoa are produced in the testicles, but due to obstruction (obstruction) of the vas deferens, they do not enter the sperm. There are various methods of both therapeutic and surgical treatment of azoospermia. Unfortunately, with all the achievements of medicine, there are cases when the birth of a genetically native child is impossible. In such circumstances, one must either accept or turn to sperm donation. This is a sensitive and complex topic that needs to be discussed both within the family and with the doctor.

What tests do men have for infertility?

In general, you will most likely have to go through:

  • transrectal ultrasound of the prostate (TRUS), scrotal organs with dopplerometry;
  • determination of the karyotype (genetics), the study of microdeletions of the AZF locus of the Y chromosome, as well as the presence of a mutation in the cystic fibrosis gene (CFTR);
  • analyzes for sex hormones and testicular reserve markers;
  • urine test after ejaculation;
  • biochemical analysis of semen.

Sometimes more complex manipulations are required. For example, these include epididymis biopsy, which must necessarily be combined with testicular spermatozoa extraction (TESE) and subsequent cryopreservation of spermatozoa when they are detected. This will allow in one operation to combine both diagnostic and therapeutic manipulation. And frozen spermatozoa can be further used in IVF/ICSI protocols.

Preparation for analysis

It is also worth knowing that men also have a peak fertility, which coincides with the maximum production of testosterone in the period of 25-30 years. After the age of 35, genetic problems begin to grow: the number of high-quality (with a normal chromosome set) spermatozoa decreases. Therefore, it makes sense to think about sperm cryopreservation if the work is associated with harmful factors. This approach is also important for those who suffer from diseases (oncology and others) that require the use of drugs that affect male fertility.

It would be useful to recall how to properly prepare for the analyzes voiced above. So, a biochemical blood test is taken in the morning and strictly on an empty stomach. Nothing to drink but water. Between the last meal and blood sampling should be 8-12 hours. It is more difficult with a spermogram, as you need:

  • refrain from intimacy 2-5 days before donating sperm;
  • at least seven days to completely abandon alcohol;
  • try to avoid overheating of the perineum (including not going to the bath or taking a hot bath).

In general, when referring to research, specific instructions are given on how certain analyzes or manipulations are performed and how to prepare for them. It is important not to be shy to ask a specialist if something seems incomprehensible: the accuracy of diagnosis and treatment depends on the correct implementation of the recommendations.

It is important for the future father to do his part of the examination and treatment and not to think that it is not important. If everything is fine on the male side, you need to support the partner, since various IVF protocols can cause certain health problems and a change in the woman’s behavior.


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