Today one of the urgent problems of medicine and society is male infertility. It occurs with the same frequency that women and leads to personal tragedy men and the breakup of the family. The diagnosis of "infertility" has a place in that case, if a couple seeks to conceive, not using any type of contraceptives, but within 12 months of unsuccessful attempts. In this situation, the woman and the man must be examined with the aim of identifying the causes and correcting them.
To cause infertility in men can a number of pathological processes, causes a violation production of sex hormones, changes in composition, properties of semen, the lack of ways of outflow.
- Violations of the nervous system. Spermatogenesis is regulated by complex physiological processes involving 4 structures: the cerebral cortex of the brain, the hypothalamic-hypophysis and male gonads – the testes and other glands of internal secretion. The first stress-responsive Central nervous system: severe trauma disrupts the hypothalamus, it reduces the production of several hormones that leads to decrease or complete absence of sperm in the ejaculate (oligo - and azoospermia, respectively). Psychoemotional stress causes an imbalance in the autonomic nervous system. It can also lead to sterility men, even when a satisfactory condition of the testicles. Damage to the ilio-inguinal nerve (e.g., during the operation for hernia, or in the postoperative period due to scarring in the tissues of the genital tract) often causes degeneration and atrophy of the testicles.
- Genetic and congenital factors. The frequency of congenital abnormalities of the testicles today is about 4-5 %, it means that they have a place in almost every twentieth man. Is cryptorchidism (undescended testicle into the scrotum), monorchism (1 no egg), Anorchia (congenital absence of the scrotum and both testicles), dysgenesis (impaired development) gonads and other violations.
- Intoxication. Environment, chemical, occupational hazards in the context of increasing industrialization cause infertility in men more often. Intoxication can act directly on testicular tissue, or the nervous system in General, with the consequences described in paragraph 1.
- Food additives, drugs, industrial compounds, pesticides – exposure to these factors a person is exposed to on a daily basis, and many of them are mutagens and damage the germinal epithelium of the testicle. Also quite dangerous in this respect the exhaust gases of vehicles and anoxia, especially on the background of stress and fatigue. Have a negative impact on the tissues of the testicles, which produce sperm, some antibiotics and sulfonamides, nitrofurans, as well as estrogens and cytostatics. Chronic intoxication with nicotine and alcohol to cause a significant change of ejaculate in the form of reduced mobility and the emergence of pathological forms of spermatozoa.
- The supply deficit. Food factor is also very important for proper spermatogenesis. To pathological changes in the tissues of testes may lead not only absolute deprivation, but partial starvation, and malnutrition. Of particular importance is a balanced diet of children and adolescents. You should know that degenerative changes occur not only in the tissues of the testes, but also in the hypothalamic-pituitary system.
- Ionizing radiation. Irradiation can be a direct causal factor of infertility (cell death of embryonic epithelium), and have a mutagenic effect (leads to abnormalities of the process of sperm production in the offspring of irradiated male).
- Pathology of endocrine glands and other organs. One of the manifestations of some diseases is dysfunction of the testicles. However, if the disease is not hard, these disorders often go undiagnosed, as found, and in the case of severe course of the underlying disease, the issue of fertility goes to the second place and the main goal of the patient is the elimination of the underlying disease under the supervision of a physician. After recovery of the spermatogenesis usually recovers.
- Overheating. The optimum temperature for the production of components of semen – 2-3 °C lower than the temperature of the whole body. Overheating damages the testicular tissue and leads to their degradation. Even a short rise in overall body temperature to febrile values (39 °C and above) disturbs the process of formation of sperm, and configured it only in 2-3 months after recovery. Importance here as the total (infectious disease, work in hot shops) and local (hernia testis, varicocele) hyperthermia.
- Hypothermia. Effects on the testis low temperatures also causes damage to the cells that produce sperm. However, the cases of infertility it is for this reason quite rare because of violation of spermatogenesis requires that the testicle in the scrotum was exposed to temperatures below -10 °C during at least an hour.
- Disorders of blood circulation. Spermatogenic epithelium is highly sensitive to even short-term ischemia, so diseases that disrupt the blood flow to the testicles (in particular, a hernia or hydrocele) may cause infertility. Also, it contributes to the stagnation of blood in sex organs (for example, a varicocele (varicose veins of the testicle), anomalies in the structure of the venous plexus in the area of genitourinary organs other diseases).
- Traumatic injuries of the genital organs. Depending on the nature and strength of the trauma, can cause bleeding, inflammation, necrosis of the affected tissue, obliteration (blockage of the lumen) of the seminal tract, compression and/or blood vessels that carry blood to testis, hematoma and other pathological changes. The result of their be reversible or irreversible pathological changes in the tissues of the testicles or seminal tract.
- Autoimmune processes in the region of the gonads. Spermatogenic epithelium functioning properly due to the presence between the blood and contents of the seminiferous tubules of the so-called haemato-testicular barrier which skips some cells and does not let others. Result in overheating, hypothermia, infectious diseases, disorders of blood circulation, the permeability of the barrier increases, and the components of semen can enter the bloodstream. They are known antigens, so the body is reacting by formation of antibodies to the cells of the seminiferous tubules that produce sperm. Developing an autoimmune infertility.
There are 5 forms of male infertility:
It is associated usually with a reduction in testicular function — hypogonadism. There are 2 types of this condition: primary and secondary.
In primary hypogonadism the pathological process is localized directly in the tissues of the testicle. It can also be congenital malformations or cryptorchidism, and damage of traumatic or infectious nature. This form of the disease is accompanied by increased secretion of gonadotropins – their concentration in the blood increased.
Secondary hypogonadism occurs when there is lesion of the pituitary gland, hypothalamus, endocrine organs. It develops in tumors, neuroinfections, traumas of the brain and is in a sharp decline in the production of gonadotropin, which leads to a hypofunction of the testes. With the defeat of the prostate, seminal vesicles and other endocrine glands is also developing testicular failure. The content of gonadotropins could increase, decrease, or remain within normal values.
Is the result of disease or malformations of the accessory genital glands of the urethra, blockage of the lumen of the VAS deferens, and aspermatism. Ejaculate either loses its properties (due to the lack of sperm or change their structure and properties) or has a normal composition, but can't get into female's genital tract.
Aspermatism is called a condition that is characterized by the absence of ejaculation during intercourse. It occurs as a result of violations of the functions of the nervous system (both Central and peripheral) and is also considered a form of excretory infertility in men.
Can occur when immunological conflict between a man and a woman, evolving in response to receipt of sperm, which is the antigen, the woman's vagina. This so-called C-immune forms of infertility. The risk of such a conflict can raise disorders in the immune system, the incompatibility of blood groups and other factors.
Autoimmune form of infertility occurs when the violation of permeability of hemato-testicular barrier. The causes of this condition described above.
Combines hormonal disorders and excretory component.
Such a diagnosis is exhibited in the case if after a complete examination men and women pathological changes, none of them have been identified. The term is applied with great caution, because it does not identify pathology does not mean that it is not – perhaps this is due to the imperfection of the survey.
Signs of infertility in men
The leading symptom of infertility in men is not pregnancy with regular (2 times per week) intercourse for 12 months, provided that the contraceptives were not used, the woman fully inspected and pathology it is not discovered.
The volume of diagnostic procedures includes:
- General survey;
- the study of sperm;
- diagnosis of excretory functions of the testes and other glands;
- a biopsy of the testicles;
Principles of treatment of infertility in men
Tactics of treatment depends on what reasons led to infertility.
Excretory infertility resulting from inflammatory processes in the genital tract, is subject to conservative therapy.
Occlusion (blockage of the lumen) of the VAS deferens is usually removed surgically.
The effectiveness of treatment is determined by re-examination of the ejaculate and other diagnostic methods.
The patient should:
- to quit Smoking;
- to give up alcohol;
- to stop taking certain medications;
- to exclude effects on the adverse occupational factors, to change working conditions;
- to avoid emotional stress, fatigue;
- lead an active lifestyle;
- regularly and fully fed.
It is also very important to respect the sexual life. Frequent sex reduces ability of sperm to fertilize, as the number of Mature sperm in it decreases, and young forms increases. The result of rare sexual acts is an increase in the number of old sperm. The optimal duration of abstinence for 3-5 days. It should take into account the days of ovulation of the female partner, because in this period, conception occurs. After intercourse the woman should stay in a horizontal position for another 30-40 minutes.
Common medical event
The patient can be assigned:
- vitamin therapy;
- preparations of phosphorus, glutamic acid;
- tincture Chinese Magnolia vine, Siberian ginseng;
- by top specialists – a neurologist, psychotherapist.
Treatment of secretory infertility
- In primary hypogonadism – androgen drugs.
- In secondary hypogonadism gonadotropins, progestins, or drugs that stimulate their secretion.
Treatment of excretory infertility
Depends on what disease it caused.
- When hypospadias and epispadias – surgery. In full disagreement patient for surgery – artificial insemination (fertilization).
- In chronic inflammatory diseases of the genital organs – drugs depending on the causative agent (antibiotics, sulfonamides, and others). Because these drugs themselves can suppress spermatogenesis, apply them in parallel with drugs, warning of the negative effects on the liver and testicles.
A direct indication to it is obstructive azoospermia, when confirmed by a biopsy of the preservation of spermatogenesis. The goal of surgery is to restore the patency of the seed of the excretory systems.
Treatment of immune infertility
Husband and wife recommended sex with condom and only for the period of ovulation, not protected. In the woman's body will decrease the number of antigens to the male sperm and the chance of fertilization increases. In parallel with this, the man or the woman (depending of violations) is prescribed to take antihistamines. Also, in order to achieve the anti-allergic effect can be used glucocorticoids.
In chronic inflammatory process in the male body it can be recommended intake of Immunostimulants.
The method of choice in treatment of immune infertility artificial insemination. The woman in the cervical canal or the cavity of this body is injected semen just received from her husband.
To prevent the development of infertility, the man should be attentive to their health, in a timely manner to treat diseases that negatively affect the reproduction function, and prevent their development. Also it is necessary to observe the regime of work and rest, sexual activity, rational feeding, not conduct indiscriminate sex, not to take drugs uncontrollably, to abandon or at least limit alcohol consumption and Smoking.