Treatment of male infertility where to start. Causes, signs of infertility in men, treatment. Male infertility - causes

Thanks to the development of modern research methods, experts have been able to prove that infertility is caused by male factors in 50% of cases.

Why does infertility occur?

The main reasons for infertile marriages due to the male factor are:

• Genetic diseases, congenital defects of genitourinary development;
• Hormonal imbalances in the body;
• Tumors of the pituitary gland, which is responsible for the production of many hormones;
• Damage or injury to the scrotum or testicles;
• Previous surgical interventions on the scrotum area;
• Varicocele - varicose veins of the seminal ducts (as a result of this pathology, sperm overheat and die without having time to fulfill their main mission);
• Chronic infections, including hidden ones, which a man may not even be aware of;
• Past mumps (mumps);
• Obesity, arterial hypertension;
• Diabetes mellitus, lipid metabolism disorders;
• Irradiation of the body or long courses of chemotherapy;
• Constant stress - this factor in itself does not cause the development of infertility in men, but can significantly affect the quality and quantity of sperm.

In addition, one of the common causes of male infertility is the abuse of alcoholic beverages, and the amount of sperm produced may remain unchanged, but the quality of the reproductive cells is greatly affected.

Causes and treatment of male infertility

If for some reason a married couple has been unable to conceive a child for more than 1 year, then this is a serious reason to contact a specialist. The AltraVita clinic in Moscow specializes in problems with pregnancy and successfully helps married couples cope with any pathologies. We are considered one of the best reproduction centers in Moscow because we work according to American standards. Thanks to this, we successfully cope with even the most severe cases of fertility disorders in males.

Our doctors always try to restore natural reproductive function. To do this, the main etiopathogenetic factors leading to its disruption are clarified, and then, if possible, eliminated. If the treatment of the underlying disease has a favorable outcome, the quality of sperm begins to improve, and natural fertility is restored within 3-6 months.

Treatment of male infertility in our clinic begins with an examination, as well as consultation with an andrologist and urologist, who issue referrals for further laboratory examinations.

The patient undergoes a series of tests:

• spermogram – assessment of quantitative and qualitative indicators of sperm;
• MAP test - analysis for antisperm antibodies, which adhere to germ cells and deprive them of the ability to fertilize the egg;
• blood tests for hormones– the level of androgens, prolactin, thyroxine, triiodothyronine, TSH, FSH, as well as other hormones can be determined;
• tests for infections– a smear test for flora, PCR of scrapings of urethral epithelial cells, determination of antibodies in the blood;
• if necessary, instrumental studies are prescribed - Ultrasound of the prostate gland, scrotal organs.

Treatment of male infertility in Moscow is considered the best and most effective, since AltraVita employs leading specialists, in addition, our clinic is equipped with the latest diagnostic equipment and reagents for complex tests.

Our clinic uses the most effective therapeutic approaches in each situation. In the treatment of conditions associated with reproductive dysfunction in males, we use:

• Conservative methods of treatment (for infectious diseases, dyshormonal disorders).
• Spermatogenesis stimulation programs (prescription of hormonal drugs to stimulate maturation of germ cells and improve sperm quality);
• Surgical methods of treatment (for varicocele, obstruction of the vas deferens).
• Assisted reproductive technologies (fertilization of an egg with the husband's sperm in a laboratory followed by transfer of the embryo to the uterus).

Is there a cure for infertility in men?

A specialist from our center will be able to give you the answer to this question after a comprehensive examination.

If the reason for a woman’s lack of pregnancy is a deterioration in sperm quality, then the treatment of infertility in a man will be effective and safe, after which the couple will be able to begin actively planning a pregnancy naturally.

If infertility in a man is caused by congenital anomalies in the structure of the genitourinary system, then the partner’s pregnancy will only occur through IVF using the sperm of a spouse or donor, provided that doctors are unable to obtain a single high-quality germ cell.

Male infertility is treated successfully if the patient consults a doctor in the early stages of the development of problems, when everything can still be solved through high-quality conservative therapy. When establishing the cause, the main task of specialists and the patient is to completely exclude factors leading to non-pregnancy.

A man must strictly follow all the specialist’s recommendations, lead an active lifestyle, and eat a balanced and varied diet. Stress and psycho-emotional overload should also be avoided, as this leads to a deterioration in the quality of sperm, complicating the already difficult process of conception.

Here are the main reasons why you should contact our clinic:

• You will be examined to determine the cause of infertility, which will eliminate the underlying cause of fertility problems.
• The clinic is well organized, so you can undergo therapy without wasting time waiting in line, at any time convenient for you.
• You will encounter an exceptionally friendly and respectful attitude, and will receive answers to all your questions.
• Based on the results of treatment, you will be able to conceive a child in one way or another if you follow all medical recommendations (in more than 95% of cases, infertility in men is treated or overcome with the help of assisted reproductive technologies).

Our specialists will do everything possible to solve your problem. At the AltraVita clinic you can get high-quality infertility treatment for men in Moscow. All modern diagnostic and therapeutic procedures are available here, surgical interventions are performed and assisted reproductive technologies are used. If the patient wishes, all examination and treatment of male infertility is carried out anonymously.

Infertility in men today is almost as common as in women. This problem does not arise just like that - its appearance is associated with the negative impact of various factors on the human body. Reproductive dysfunction in representatives of the stronger sex can be caused by increased physical activity, the presence of chronic pathologies of the reproductive system, frequent psycho-emotional stress, and poor environmental situation in the country.

Judging by statistics, the cause of infertility in 35% of married couples who seek help is precisely the failure of men's health. If within a year the spouses have not been able to conceive a baby on their own, they are advised to visit a qualified specialist. In our article today, we will look into the issues of diagnosing this disease, and also find out whether male infertility can be cured.

Why does this disease develop?

Immediately before starting therapy, both partners must undergo a complete examination of the body. This is necessary to determine the main reason for the childlessness of spouses in order to successfully eliminate the disease in the future. Sometimes the inability to have offspring comes from the woman - such disorders can be caused by adhesions in the uterine tubes or other factors that create an obstacle to natural fertilization. If the impossibility of conceiving a child arose due to female infertility, it means that the weaker half needs to undergo treatment.

But in some cases, the absence of offspring may be due to a violation of the reproductive health of a man. An extremely important indicator in this case is the quality of the ejaculate (sperm). The main causes of male infertility are an insufficient number of living sperm in the seminal fluid, their inferiority (insufficient activity, vital capacity, the presence of germ cell mutations), the inability to progress and unhindered exit. In such a situation, it is the representatives of the stronger sex who need to undergo treatment.

Scientists have found that the following negative factors can cause infertility in men:

• Anatomical defects in the structure of the patient’s reproductive organs – this includes torsion or insufficient descent of the testicles.
• Some infectious diseases can be sexually transmitted pathologies (syphilis, trichomoniasis, gonorrhea, chlamydia), as well as some childhood diseases (mumps).
• Traumatization of the genital organs.
• The presence of inflammatory processes in the genitourinary system - often the causes of infertility in men are caused by signs of ordinary prostatitis or urethritis.
• Damage to germ cells as a result of excessive expansion of local veins of the spermatic cords and testicles (varicocele) - manifested by an increase in temperature, swelling and dysfunction of the gonads.
• Hormone imbalance – insufficient testosterone production can also lead to poor sperm quality.
• Sexual dysfunction is a set of disorders that manifest themselves during sexual contact between spouses. This group includes premature ejaculation and weak erection.
• Changes in the performance of the immune system - as a result of this phenomenon, the patient’s body can begin to produce specific substances that destroy its own germ cells.

The causes of infertility in men and women can be provoked by the harmful influence of such external factors as radiation exposure, alcohol abuse, smoking, poor nutrition, and insufficient intake of vitamins in the body. Childlessness can even occur as a result of careless handling of one’s own body, because such a problem often arises as a result of heavy physical exertion, wearing excessively tight and uncomfortable clothes, or too frequent trips to the bathhouse or sauna.

Interesting! A man’s ability to have or not have offspring depends on the quantitative and qualitative characteristics of sperm. The patient's sexual activity has virtually no effect on the process of conception. The body of the stronger sex continuously produces hundreds of thousands of sperm. But only one is needed to fertilize a female reproductive cell. The journey to the egg is quite grueling, which is why high durability and viability of sperm are so important.

How does varicocele affect reproductive function?

Many sites indicate that one of the causes of male infertility (inability to conceive) is this disease. But what is a varicocele? This pathology occurs only in representatives of the stronger sex. It affects the venous vessels of the testicles and spermatic cords, causing them to dilate excessively. Most often, this process is completely painless, and the symptoms of the disease itself are determined by the doctor by chance during the next preventive examination.

Does varicocele affect infertility, and how? Many patients of the stronger sex do not know that in normal conditions the temperature of the male gonads should be slightly lower than general temperature indicators. Due to varicose veins, blood circulation in the genital organs is significantly impaired. As a result, the process of thermal regulation of the scrotum fails, which leads to excessive heating of the testicles.

Since the gonads are quite sensitive to any change in temperature, even a slight one, the consequence of such a violation is a sharp decrease in the quality of the ejaculate released. This disease manifests itself by a decrease in the number of sperm in the seminal fluid and a deterioration in their motility.

It follows that varicocele and infertility in men are closely related. This pathology first begins to manifest itself in adolescence, when the young man goes through puberty. Usually the disease progresses over several years, but once it reaches the final stage, it does not develop further. This disease occurs in 18-20% of sexually mature men whose age exceeds 17 years, but in only 1/3 of them this problem causes infertility. Signs of varicocele can be effectively eliminated surgically. For this purpose, patients are prescribed varicocelectomy - a minor surgical intervention that allows normalizing the blood circulation process and regulating the temperature in the testicles.

Read also on the topic

What tests should be taken when examining for infertility?

Mumps as a cause of infertility

Epidemic parotitis - in common people this disease is called mumps, since as a result of this disorder the volume of the salivary glands in the patient increases so much that the neck becomes almost invisible. The reason for this is the infectious-inflammatory process occurring in these organs. Boys often suffer from this disease in childhood. But in some cases, symptoms of the disease also occur in adults.

How are mumps and infertility related, and why is such a disease considered dangerous to the health of a man’s genital area? Mumps affects not only the salivary glands, but also other glands. This virus can remain in the patient’s body for a long time without causing any symptomatic manifestations. In boys, such a pathology often causes complications in the gonads, causing serious, severe inflammation of the testicles - orchitis.

Infertility in men after mumps develops only if the patient suffered the disease at the age of 5-15 years. Infection with this virus at puberty is also very dangerous. Representatives of the stronger sex who have suffered from such an illness never complain of any sexual dysfunction. Infertility after mumps is diagnosed only after a series of unsuccessful attempts by a couple to have a child.

But this problem can be overcome if treated in a timely manner. The consequences of mumps are eliminated by conservative and surgical means. If a man does become infertile as a result of mumps, the method of artificial insemination (ICSI) can be used. In order for conception to take place safely, the healthiest and most active sperm are selected. As a result, the patient has a high chance of paternity.

Important! If a man wants to avoid infection with the mumps virus, he can go to any medical institution for vaccination. For preventive purposes, this procedure is performed every 12 years. If infection does occur, you should try to avoid complications by all available means. It is best in such a situation to seek qualified help from your doctor.

Symptoms and types of disease

There are no specific signs of male infertility. The manifestations of this pathology largely depend on the cause of reproductive dysfunction.

Often the main symptom of infertility in a man is the lack of success in numerous attempts to have children. In this case, all possible causes of childlessness on the part of the woman are first excluded. If the partner does not have any diseases, the fertility of her husband is called into question.

Signs of infertility in men can manifest themselves symptomatically only when the cause of childlessness is a serious genital disease - inflammatory, tumor processes in the testicles, injuries to these organs. In such situations, pain occurs, an increase in volume and swelling of the affected genitals, disruption of the urination process, and an increase in the venous pattern on the skin of the scrotum (this is what a varicocele looks like). If the symptoms of male infertility appear as a result of hormonal imbalance, then clinically such a disorder is manifested by a sharp decrease in libido (sexual desire), an increase in breast size (gynecomastia), and a reduction in the volume of the gonads. Deterioration in the quality or quantity of sperm can be caused by various factors: diabetes, unsuccessful surgery, psychological problems, damage to the spinal column.

Symptoms of infertility in men are extremely rare, so the clinical forms of this disease are classified based on the cause of the disease. The following types of this disease are distinguished:

• Secretory - this type of pathology is caused by a malfunction of the testicles, which in this case synthesize underdeveloped and weak germ cells.
• Relative - this type of infertility develops if the cause of the disease was an isolated incident, and the patient’s physiological sexual health is normal. Treatment of male infertility in such a situation consists of eliminating psychological obstacles to fertilization.
• Obstructive – occurs due to difficulty in the passage of sperm from the testicles. Mature germ cells move along the seminiferous tubules to the prostate gland. If an obstacle appears on their way, the quality of the ejaculate decreases. Moreover, the lack of patency on one side causes a decrease in the number of sperm in the seminal fluid by 50%, and on both sides leads to their complete disappearance.
• Immune - this type of disease is manifested by the destruction of a man’s own germ cells by the protective system of his own body. What causes this disorder is still unknown. Scientists believe that such a phenomenon can be provoked by a previous infectious-inflammatory pathology or trauma to the reproductive organs. This form of male infertility is extremely difficult to treat; patients do not always manage to achieve a complete recovery.

Diagnostic methods

Signs and symptoms of infertility in men alone are not enough to make a correct diagnosis. Therefore, in order to establish the cause of this disease, all available diagnostic methods are used.

According to the WHO definition, a couple is considered infertile when pregnancy cannot occur within 12 months with regular sexual intercourse without contraception. In 40% of cases, a man is infertile, in 45% a woman is infertile, and the remaining percentage is due to the immunological incompatibility of the couple.

Unfortunately, infertile marriages are an international medical and social problem that is only gaining momentum. In the United States, the birth rate has decreased in recent years from 33.3% to 12.3%, and these figures have brought the problem to the state level.

Previously, the cause of infertile marriages was most often considered to be a woman, but today the percentage of male and female infertility is equal. International studies show a clear decline in male fertility rates over recent decades.

The level of medical literacy in our country is sadly low, so at the first suspicion of an infertile marriage, it is mainly women who turn to a specialist. Often their partners do not even admit the idea that they may be the cause of infertility, but the sooner you see a doctor, the more successful the treatment will be.

The answer to the question: “How to cure male infertility” is to search for the cause. Initially, treatment of male infertility is aimed at restoring spermatogenesis, and for this it is necessary to identify the factors that inhibit it.

Most often, the cause of suppressed spermatogenesis is a sexually transmitted infection, which both partners have to treat. The next most common factor is prostatitis, which becomes younger and occurs even in men aged 30 years. In some cases, surgical treatment of male infertility is required, for example, with varicocele, the testicular vein is removed to restore blood flow.

After spermatogenesis has been restored, it is necessary to normalize sperm activity. For this purpose, a course of stimulating medications is prescribed, among which are selected:

• a certain set of vitamins;
• herbal medicines;
• gonadotropin preparations;
• testosterone preparations;
• antiestrogens.

Drawing up a treatment regimen for male infertility is always entirely individual, and is based on taking into account many factors.

Treatment of male infertility in Moscow

Given the urgency of the problem, many Moscow clinics claim that they know how to treat male infertility. Unfortunately, in many cases such confidence is unfounded. It is necessary to clearly understand that the success of treatment depends on many factors:

• degree of severity of spermatogenesis pathology;
• duration of infertility;
• type of male infertility;
• the age of both partners;
• presence of concomitant pathology;
• partner's fertility.

Open Clinic specialists approach the treatment of male infertility from a different angle. We do not promise to perform a miracle, but we promise to do everything possible to cope with this problem. There are many modern methods that are used by our specialists. In our clinic, treatment of male infertility in Moscow is carried out using the latest advances in medicine:

In this case, sperm can be obtained in several ways:

• By percutaneous aspiration of active sperm from the epididymis;
• Or using a special device for sperm biopsy;
• In rare cases, open access is used.

Thanks to modern techniques, male infertility can be successfully treated. Despite the seriousness of the problem, our specialists manage to achieve good results. However, the role of patients themselves in the treatment of this delicate problem cannot be underestimated. The sooner you recognize the problem and seek help, the more effective the result will be.

To treat or not to treat: that is the question.

Modern andrologists do not even face the question of whether it is necessary to treat male infertility. Unfortunately, this problem is acute in international practice, and many couples dream of a child. The possibilities of medicine have become so wide that in most percent of cases it is possible to successfully cope with the problem that has arisen.

Infertile couples can undergo treatment for years, and mostly women are tested. The fact is that it is much more difficult for men to decide to admit that they have some kind of health problems. However, the correct solution is to simultaneously examine and treat an infertile couple.

Therefore, as soon as the question arose: “Male infertility: what to do?” It is necessary to immediately contact a specialist who will identify the form of male infertility and prescribe treatment; in some cases, surgical intervention may be required. Andrologists and reproductive specialists can do a lot, but they can only help if you want it in the first place.

Open Clinic specialists remind you that only professionals should be trusted to solve this delicate problem. Unfortunately, even with ideal physical indicators, pregnancy may not occur. And our clinic practices an integrated approach with the participation of specialists from various specialties: andrologists, gynecologists, reproductive specialists, psychologists, embryologists, and even geneticists. All resources of our clinic are aimed at achieving results and maintaining the psychological comfort of our patients.

The reasons that can cause male infertility are numerous. The most common cause in andrologist practice is genital infections caused by chlamydia and ureaplasma.

The next most common cause is varicocele, which in 10-15% of cases causes disruption of male reproductive function. When interviewing, it is important to take into account genetic characteristics, occupational hazards, as well as the presence of bad habits. It is very important to find out what childhood infectious diseases are present in the anamnesis.

ICD-10

N46

General information

– a violation of male reproductive function, expressed in the inability to have offspring. Most often, male infertility is a consequence of qualitative and quantitative changes in sperm in the ejaculate due to previous inflammatory diseases of the genital organs, infectious and chronic diseases, and exposure to chemical factors on the body. In 40-50% of cases it is the cause of infertile marriage. It can result in family breakdown and personal tragedy.

One tenth of all couples are unable to conceive without medical help. At the same time, the share of female infertility accounts for 40%, and the share of male infertility 45%; the remaining 15% accounts for cases of immunological incompatibility of spouses and rare forms of infertility.

Functioning of the male reproductive system

The male reproductive cell is the sperm, it contains genetic information about the father. Genetic information is concentrated in the head of the sperm, and with the help of the tail, the sperm is able to move to reach the egg. Spermatogenesis occurs in the testes; First, the sperm passes through convoluted tubules, which gradually turn into straight tubules and then into the epididymis. The total length of the tubules is about 500 meters; thanks to the slow movement along the convoluted tubules, the sperm matures and becomes capable of fertilizing the egg. In the epididymis, sperm undergo the last stage of growth, after which they enter the seminal vesicles through the vas deferens, where they accumulate and mix with the epithelial secretion, which contains nutrients for sperm. From the seminal vesicles, seminal fluid is evacuated at the moment of ejaculation, mixing with the secretion of the prostate gland, the resulting fluid is called sperm.

From the above, it becomes clear that the main causes of male infertility can be either obstruction of the canal, in which sperm cannot be expelled from the urethra due to obstacles, or violations of secretory function at any stage.

Secretory form of male infertility

With the secretory form of male infertility, the testicles do not produce the required number of sperm, as a result of which fertilization of the egg is impossible. This form of infertility is also spoken of in cases where sperm motility is impaired or they have structural defects.

A common cause of secretory male infertility is testicular varicose veins (varicocele). The outflow of venous blood through dilated veins is difficult, so congestion develops, blood supply is disrupted and testicular function is inhibited. Mostly, varicocele affects the left testicle, but over time the process spreads to the second healthy testicle. As a result, the function of both testicles is significantly inhibited, sperm production decreases and a secretory form of male infertility develops.

Since spermogram data is labile, the examination is repeated if necessary in order to obtain an objective assessment of the possibility of fertilization.

Treatment of male infertility

Insemination with donor sperm is used in case of male infertility caused by aspermia, azoospermia, oligospermia of the third degree and other severe disorders of spermatogenesis. If the spouse has diseases for which the birth of children is not recommended, such as genetic diseases, the birth of children with severe congenital malformations, or the stillbirth of children with signs of severe hemolytic disease due to the incompatibility of the spouses with the Rh factor.

To improve sperm performance, the ejaculate is divided into fractions, separating mobile forms by filtration, using several different portions of cryopreserved sperm. To improve the sperm parameters of a man who has undergone treatment for male infertility, agrinin, caffeine and prostaglandins are added to it.

The effectiveness of the introduction of native sperm is several times higher than with insemination with cryopreserved sperm, but when using cryopreserved sperm, its antigenic properties are reduced, which is used in the treatment of female or male infertility in couples in which women have antisperm antibodies. In this case, sperm is injected either into the cervical canal or intrauterinely one day after the date of expected ovulation.

Hormone therapy for male infertility

Hormonal therapy for male infertility is indicated for various disorders of spermatogenesis, mainly in cases of impaired sperm motility, as stimulation after correction of underlying diseases, and less often as the main treatment.

Hormone replacement therapy for the treatment of male infertility is indicated for hypogonadism, idiopathic disorders of sperm motility (pathozoospermia) and hypoandrogenism. With the blocking method of treating male infertility, a man takes drugs that suppress spermatogenesis for several months; after discontinuation, the qualitative and quantitative characteristics of sperm improve. Although this antifertility method is rarely used to treat male infertility.

Stimulating hormone therapy for male infertility is based on the administration of small doses of hormones that have a beneficial effect on metabolic and other processes, but do not affect the hypothalamic-pituitary system. Treatment of male infertility with hormones is long-term, at least 9 months, with monitoring of the effectiveness of therapy at least once every 3 months. Dosages and choice of drug and dosage regimen depend on the type of pathology and are prescribed individually. If the sperm concentration is less than 5 million/ml of sperm, if the motile forms of sperm are less than 20%, hormone therapy for male infertility is futile.

Surgical treatment of male infertility

For male infertility caused by varicocele, the outflow of venous blood from the testicles is surgically improved. As a result, congestion disappears, metabolism is normalized and spermatogenesis is restored. The testicular veins are either ligated, sclerosed, or ligated. The prognosis of surgery for unilateral varicocele is favorable; if the process is bilateral, then sometimes additional drug therapy for male infertility is required.

In case of cryptorchidism, surgery to descend the testicles into the scrotum is performed at an early age, but it is necessary to exclude Kallmann syndrome and other congenital pathologies. The earlier the orchiopexy operation is performed, the fewer irreversible changes in the spermatogenic epithelium and the less likely it is that treatment for male infertility will be required in adulthood. If testicular reduction was performed after reaching the age of three, then the treatment does not give good results and many men subsequently have to undergo treatment for male infertility. Treatment of cryptorchidism with gonadotropic hormones is ineffective.

When surgically treating inguinal-scrotal hernias, it is important to minimize the risk of trauma to the spermatic cord; if the operation is successful, then usually further treatment for male infertility is not required, since reproductive function is completely restored. If there are congenital anomalies of the urethra, then plastic surgery to restore the canal with the formation of an external opening on the head is enough so that at the moment of ejaculation the sperm falls on the cervix. If there is an area of ​​narrowing of the urethra, then surgical treatment of male infertility consists of anastomosis using endoscopic surgery. Surgeries on the vas deferens are used for obstructive azoospermia, additionally eliminating the cause of obstruction (cyst, area of ​​inflammatory obstruction, etc.).

A joint visit to a psychotherapist during treatment of female or male infertility will create a favorable atmosphere for conception. Since many couples, after learning about the temporary impossibility of having children, experience a crisis based on reproaches, loss of tenderness during sexual intercourse and a feeling of inferiority. Conversations with psychotherapists and psychologists will help maintain normal relationships in the family and find a way out of the current situation, for example, adopting a child or using donor material for conception. It is important to understand that the opportunity to be a father is an opportunity to raise a child, and not at all to be his biological parent. And, if for some reason a man, even after undergoing a course of treatment for male infertility, cannot become a biological father, then this does not mean that he is inferior. A psychologist will help overcome this crisis without additional difficulties (depression, alcoholism, divorce), because often, having come to terms with the inability to conceive a child and using alternative methods to create a full-fledged family, a healthy and long-awaited child is born.

Male infertility is a pathological condition in which a man’s reproductive cells cannot fertilize an egg, and for this reason a woman cannot become pregnant. Today, the problem under consideration is very relevant. In the world, up to 15-20% of married couples cannot have children, and in more than half of the cases the reason is the infertility of the man.

Causes of pathology

The most common factors of male infertility:

• mental and sexual disorders;
• developmental anomalies, infectious diseases, genital injuries;
• medicinal, toxic, radiation effects on the genitals;
• varicose veins of the spermatic cord (varicocele);
• disorders of immunity and metabolism.

In the brain, the sex center, located in the hypothalamus, is responsible for regulating sperm production. Mental trauma, constant stress, hard work affect the sexual center, leading to a decrease in the number of cells in the ejaculate (oligozoospermia, azoospermia).

The causes of infertility in men can be a variety of congenital abnormalities, including chromosomal:

• cryptorchidism (dross of the testicles), monorchidism (presence of one testicle), anorchism (absence of testicles);
• gonadal dysgenesis;
• primary hypogonadism (Prader-Wili, Lawrence-Moon-Biedl syndromes and others);
• pituitary insufficiency.

One of the most common causes of male infertility is inflammatory diseases of the genital organs of infectious origin. These include mumps (mumps), tuberculosis, malaria, pneumonia, sepsis, sexually transmitted diseases and others. Microbes directly damage sperm, change the properties of ejaculate, and cause the formation of antisperm antibodies. Inflammatory processes lead to disruption of the vas deferens.

It is necessary to note the significance of mumps in the development of infertility. This disease often occurs in childhood, is complicated by orchitis (inflammation of the testicles) and affects all the tissue of these organs.

The main types of intoxications affecting testicular tissue:

• professional (lead, manganese, mercury, phosphorus, benzene, ammonia and others);
• medicinal (sulfonamides, nitrofurans, many antibiotics, cimetidine, calcium antagonists);
• household (alcoholism, smoking).

Ionizing radiation destroys sperm precursor cells, leading to infertility.

Varicocele (varicose veins of the spermatic cord) disrupts the function of the testicle to produce sperm. Bilateral lesions are rare, but in most cases they cause male infertility.

This condition can be caused by surgical operations on the pelvic organs and retroperitoneal space, in particular on the bladder and prostate gland. Intervention for an inguinal hernia leads to impaired fertility in one patient out of a hundred.

In addition, frequent hot baths and sauna visits inhibit sperm formation. Disposable diapers are safe in this regard, since young children do not normally produce sperm.

Classification

Types of male infertility:

• secretory;
• excretory;
• autoimmune;
• combined;
• relative.

Secretory infertility

Associated with a decrease in the production (secretion) of sperm in the testicles. The cause of this condition is primarily hypogonadism. With hypogonadism, the production of sperm and/or male sex hormones is disrupted in the testicles.

There are primary and secondary hypogonadism. Primary occurs due to diseases, injuries, or abnormalities of the testicles themselves. Secondary hypogonadism is associated with dysregulation of spermatogenesis by the central nervous system. This regulation is carried out by the hypothalamus and pituitary gland. It changes under the influence of infectious diseases of the nervous system, tumors or brain injuries. As a result, the production of gonadotropic hormones that activate the function of the genital organs is reduced.

Excretory infertility

Associated with the difficulty of sperm exiting the genital tract. The causes may be damage to the vas deferens or urethra as a result of inflammatory diseases, injuries, or congenital anomalies.

One of the types of excretory infertility is aspermatism. True aspermatism is caused by the absence of orgasm and ejaculation. It is caused by diseases of the brain or spinal cord, peripheral nerves. After prostate surgery, in particular transurethral resection, sperm may not be ejected outward, but retrogradely into the bladder. This condition is called “false aspermatism.”

Immunological infertility

In some systemic diseases, the permeability of the blood-testis barrier, which separates the blood from the testicular epithelium at the microscopic level, increases. This leads to the formation of the body's own antibodies, which destroy sperm at the earliest stages of their development. This is how male immunological infertility arises, or more precisely, autoimmune infertility.

Combined and relative form

In the combined form, hormonal disorders of various natures are combined with excretory disorders caused by inflammation of the genital organs.

Relative infertility is a term applied to those couples in whom, after a thorough examination, the cause of this condition could not be found.

With primary infertility, a man has never been capable of fertilization. Secondary infertility is acquired. Such a man previously became pregnant, but as a result of illness or injury he lost the ability to fertilize.

Diagnostics

Which doctor should I contact if a couple has not had children for a year with regular sexual intercourse and no contraception? Issues of fertility disorders are resolved by two specialists - a urologist and a gynecologist. First, the man is examined. If he is diagnosed with infertility, his partner will be examined for further use of assisted reproductive technologies. If the man is healthy, the reasons for the lack of pregnancy will be sought from the woman.

Diagnosis of male infertility begins with the collection of complaints and medical history. The doctor clarifies past illnesses, injuries, occupational hazards and many other issues. Symptoms of infertility are nonspecific and are determined by the underlying cause.

During an external examination, men determine the development of secondary sexual characteristics. An examination of the genital organs is important, during which developmental anomalies, varicoceles, testicular tumors and other diseases can be identified.

Characteristic signs of male infertility can be detected using additional methods.

Tests for male infertility:

• ejaculate examination;
• determination of the level of testosterone, prolactin, luteinizing and follicle-stimulating hormones;
• cytological examination of prostate secretion;
• tests for infections;
• bacteriological examination of sperm;
• determination of the level of antisperm antibodies in the blood using an immunological study;
• testicular biopsy.

Instrumental diagnostic methods:

• ultrasound examination of the pelvic organs and prostate gland;
• transrectal ultrasound examination to clarify the patency of the vas deferens;
• Magnetic resonance imaging;
• genitography;
• radionuclide research methods;
• X-ray of the skull and the area of ​​the sella turcica if damage to the pituitary gland is suspected.

Sparmogram

The first and most important research method for male infertility is semen analysis. A sample taken 48-72 hours after sexual intercourse is examined. You can collect sperm during masturbation or during normal sexual intercourse using a condom without spermicidal treatment. Sample containers must be clean, but not necessarily sterile. After receiving sperm, it must be delivered to the laboratory within an hour. Transportation is carried out at room temperature. If no pathology is detected in the submitted sample, the man is considered healthy. If deviations from the norm are detected, the analysis is carried out twice, after sexual abstinence for 3-7 days, in the interval from 7 to 21 days after the first analysis.

Criteria for normal ejaculate:

• the number of sperm is 50-200 million in 1 ml;
• 70-80% motile sperm;
• 70-80% apparently normal cells.

If there are deviations from these indicators, various types of spermatogenesis disorders are diagnosed:

• oligozoospermia (decrease in all indicators);
• asthenozoospermia (decrease in the number of motile sperm while maintaining other indicators within normal limits);
• necrospermia (no living sperm);
• teratozoospermia (more than 30% of degenerative cells);
• azoospermia (there are only spermatogenic cells - immature precursors of sperm);
• aspermia (no sperm or spermatogenesis cells).

If there is orgasm but no ejaculation, urine excreted after sexual intercourse is examined to confirm false aspermatism.

Many patients are advised to consult a medical geneticist.

Treatment of male infertility

Infertile couples, of course, are interested in whether male infertility can be treated? In this condition, conservative, surgical methods and assisted reproductive technologies are used. The effect of treatment is determined by the cause of infertility.

First of all, the patient must stop smoking and drinking alcohol, try to normalize his mental state, get enough sleep and avoid stress. The diet must necessarily contain animal proteins and vitamins A, E, C and others. It is necessary to eliminate occupational hazards and discontinue unnecessary medications. The man must undergo a course of treatment for identified infectious and inflammatory diseases.

To stimulate sperm production, a man is prescribed multivitamins, zinc preparations, and herbal remedies for 3 months.

Hormones are indicated for many patients:

• gonadotropin or estrogen antagonists - for hypogonadotropic gonadism;
• glucocorticoids – for congenital adrenal hyperplasia or autoimmune infertility;
• testosterone - with a decrease in its secretion in the testicles;
• dopamine antagonists - for hyperprolactinemia.

When and how to treat a patient with hormones is decided by the endocrinologist. Such therapy must take place under strict medical supervision.

Surgical interventions for infertility are performed to eliminate varicocele, restore the patency of the vas deferens, and treat false aspermatism.

If the above treatment methods are ineffective, assisted reproductive technologies are used:

1. Introduction of pre-treated sperm into the uterine cavity.
2. If several such attempts fail, male infertility is treated.
3. If the spermogram indicators are extremely unfavorable (the number of sperm is less than 2 million per milliliter, the number of morphologically normal cells is less than 4%), an intracytoplasmic sperm injection procedure is performed. To do this, one high-quality sperm is placed into the egg using a micropipette. This technique is very expensive, its effectiveness reaches 10%.
4. If all of the above methods are ineffective, artificial insemination with donor sperm is performed.

Thus, treating male infertility is a complex task. Therefore, prevention of this condition is of great importance. It includes measures aimed at eliminating the causes of the disease:

• healthy lifestyle, mental hygiene, physical activity;
• caution and forethought to avoid injury;
• prevention of colds;
• quitting smoking and drinking alcohol;
• use of personal protective equipment when working in hazardous industries;
• timely treatment of varicocele;
• effective clinical examination of the population, aimed at early detection and treatment of other diseases that can affect the development of infertility.