Treatment male infertility- one of the specialized areas medical care provided in the network of clinics "Mother and Child". Male infertility is the inability of a man to fertilize a woman, the absence of a desired pregnancy in a couple with regular attempts to conceive for 1 year. If age future mother exceeds 35 years, the absence of pregnancy for 6 months with regular sexual activity without the use of contraceptive methods can be diagnosed as infertility.
According to statistics, every fifth couple in the world is faced with infertility. Female and male factors of infertility as the causes of infertility in the family have the same ratio. However, a medical examination of the possible causes of infertility in a couple should begin with a man - basic andrological studies are absolutely painless, and their results make it possible to exclude the factor of male infertility as soon as possible.
Causes of male infertility
In modern reproduction, primary and secondary male infertility are distinguished. Primary - if a pregnancy has not occurred from a man during his entire sexual life. Secondary - if a man already has children, but conception does not occur during this period.
The reproductive abilities of a man depend, first of all, on the quality and quantity of male germ cells - spermatozoa. The process of sperm formation - spermatogenesis - normally occurs from the onset of puberty until the end of life. At the same time, male germ cells are vulnerable to negative influences, which are inflammatory diseases of the pelvic organs, infectious diseases, including sexually transmitted diseases, disruption of the endocrine system, and immunological pathological processes in the body.
A sedentary lifestyle, including smoking, excessive consumption of alcoholic beverages, the use of anabolic steroids, frequent exposure to high temperatures (regular trips to the bath or sauna) - all these factors negatively affect spermatogenesis and sperm quality. It should be noted that irregular sexual intercourse can also lead to stagnation in the accessory male gonads, which is a predisposing factor in the development of inflammation with its negative effect on spermogram parameters and the possibility of fertilization.
The reproductive abilities of a man also depend on the structure of the organs of his reproductive system. Congenital anomalies of their development, acquired pathologies of the genital tract, leading to impaired transport and ejection of sperm are common causes of infertility in men.
So, if pregnancy does not occur in your couple, you should contact a specialist - an andrologist and undergo a set of studies.
Diagnosis of male infertility
- initial examination by an andrologist;
- semen analysis: spermogram, MAR test, electron microscopic examination of spermatozoa (EMIS), DNA fragmentation study in spermatozoa;
- hormonal examination: blood test for hormone levels thyroid gland, sex hormones and the hormone "stress" - prolactin;
- genetic examination: karyotyping, the study of mutations in the CFTR gene (cystic fibrosis gene), the study of the AZF locus in the Y chromosome;
- ultrasound examination (ultrasound): scrotum, prostate gland, dopplerometry (performed as prescribed by the andrologist).
Based on the results of the diagnostics, an individual treatment program is created. Each program for the treatment of infertility in men in "Mother and Child" is created by the interaction of doctors of various specializations under the guidance of an andrologist and a reproductologist. A collegial approach allows us to achieve the best results in choosing treatment tactics and achieving pregnancy in a couple.
Treatment of male infertility
Conservative treatment of male infertility: hormonal therapy is prescribed for diagnosed endocrine disorders, antibiotic therapy - when chronic or acute sexually transmitted infections are detected.
Surgical treatment of male infertility: surgical operations are carried out with varicocele or some congenital anomalies of the male reproductive system, when spermatozoa are absent in the ejaculate, but are present in the testicle itself or its epididymis. In our center, aspiration of spermatozoa is performed from the epididymis (PESA), or from the tissue of the testicle itself (TESA). These methods are less traumatic and are performed under general intravenous anesthesia.
IVF/ICSI: one of the signs of male infertility is unsatisfactory spermogram indicators, which indicate a significant decrease in the number and motility of spermatozoa. In this case best way achievement of pregnancy - in vitro fertilization (IVF). If there are few spermatozoa, their mobility is reduced, their fertilizing ability has suffered, it is recommended to perform the procedure of intracytoplasmic sperm injection into the egg (ICSI). ICSI gives a chance of success even to those men in whom only single viable spermatozoa are found in the semen.
We successfully overcome male infertility in the vast majority of cases. Specialists of "Mother and Child" - andrologists, reproductive specialists, endocrinologists, immunologists, geneticists, embryologists - doctors of the highest qualification category, candidates and doctors medical sciences. The equipment of our infertility treatment centers allows us to apply the most effective and safe methods of diagnosing and treating infertility in men, used in international reproductive practice today. We do not use ready-made solutions, we create a fertility treatment program that helps you become a happy father of healthy children.
ICD-10
N46
General information
- a violation of the male reproductive function, expressed in the inability to have offspring. Most often, male infertility is the result of a qualitative and quantitative change in spermatozoa 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 causes a fruitless marriage. It can turn into a family breakdown and a personal tragedy.
One tenth of all couples are unable to conceive a child without the help of medicine. At the same time, female infertility accounts for 40%, and male infertility 45%, the remaining 15% account for cases of immunological incompatibility of spouses and rare forms of infertility.
The functioning of the male reproductive system
The male sex cell is a sperm cell, it contains the genetic information about the father. The genetic information is located in the head of the spermatozoon, and with the help of the tail, the spermatozoon gets the opportunity to move to reach the egg. Spermatogenesis occurs in the testicles; first, the spermatozoon passes through the convoluted tubules, which gradually pass into straight lines and then into the epididymis. The total length of the tubules is about 500 meters, due to the slow movement along the convoluted tubules, the spermatozoon matures and becomes able to fertilize the egg. In the epididymis, spermatozoa 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 spermatozoa. From the seminal vesicles, the seminal fluid is evacuated at the time of ejaculation, mixing with the secretion of the prostate gland, the resulting fluid is called semen.
From the foregoing, it becomes clear that the main causes of male infertility can be either obstruction of the canal, in which sperm cannot be ejected from the urethra due to obstacles, or violations of the secretory function at any stage.
Secretory form of male infertility
With the secretory form of male infertility, the testicles do not produce the required amount of sperm, as a result of which the fertilization of the egg is impossible. This form of infertility is also spoken of in cases where spermatozoa have impaired mobility or 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 disturbed, and testicular function is inhibited. In the main varicocele, the left testicle is affected, but over time, the process also passes 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 these spermograms are labile, if necessary, the examination is repeated in order to obtain an objective assessment of the possibility of fertilization.
Treatment of male infertility
Insemination with donor sperm is used for male infertility caused by aspermia, azoospermia, grade III oligospermia, 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 birth defects development or stillbirth of children with signs of severe hemolytic disease due to incompatibility of spouses by 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 count of a man who has undergone male infertility treatment, agrinine, 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 cryopreserved sperm is used, 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, the sperm is injected either into the cervical canal or intrauterine one day after the date of the expected ovulation.
Hormone therapy for male infertility
Hormonal therapy of male infertility is indicated for various disorders of spermatogenesis, mainly in violation of sperm motility, as a stimulation after the 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 the abolition of qualitative and quantitative characteristics spermatozoa are improving. Although this anti-fertility method for the treatment of male infertility is rarely used.
Stimulating hormone therapy for male infertility is based on the introduction 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 the help of hormones is long-term, at least 9 months, with monitoring of the effectiveness of therapy at least once every 3 months. Dosages and the choice of the drug and the regimen depend on the type of pathology and are prescribed individually. With a spermatozoa concentration of less than 5 million / ml of sperm, if the motile forms of spermatozoa are less than 20%, hormone therapy for male infertility is unpromising.
Surgical treatment of male infertility
With male infertility caused by varicocele, the outflow of venous blood from the testicles is surgically improved. As a result, congestion disappears, metabolism normalizes 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 additional drug therapy for male infertility is sometimes required.
With cryptorchidism, surgery to descend the testicles into the scrotum is performed at an early age, but Kallman syndrome and other congenital pathologies must be excluded. The earlier the orchidopexy operation is performed, the less irreversible changes in the spermatogenic epithelium and the less likely it is that male infertility treatment will be required in adulthood. If the testicles were brought down 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.
In the surgical treatment of inguinal-scrotal hernias, it is important to minimize the risk of injury to the spermatic cord, if the operation is successful, then usually further treatment of male infertility is not required, since the reproductive function is completely restored. If there are congenital anomalies of the urethra, then a plastic surgery to restore the canal with the formation of an external hole on the head is enough for sperm to fall on the cervix at the time of ejaculation. If there is an area of narrowing of the urethra, then the surgical treatment of male infertility consists in the imposition of anastomoses using endoscopic surgery. Operations on the vas deferens are used for obstructive azoospermia, additionally eliminating the cause of obturation (cyst, area of inflammatory obstruction, etc.).
A joint visit to a psychotherapist during the treatment of female or male infertility will create a favorable atmosphere for conception. Since many couples, after the news of the temporary impossibility of having children, there is 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 this 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 a man for some reason, even after undergoing treatment for male infertility, cannot become a biological father, this does not mean that he is inferior. A psychologist will help overcome this crisis without additional difficulties (depression, alcoholism, divorce), because often, resigned to 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 the same unpleasant disease as female infertility, but it has its own characteristics and causes. Male infertility is based on three problems, the first of which is a violation of the motility or viability of spermatozoa.
Inferiority of sperm is the most common problem for men, sometimes the reason for infertility is a sharp decrease in the number of spermatozoa, as well as a violation of their ejection to the outside. Infertility can be secretory, excretory, and immunological.
Ways to treat male infertility
Men's problems are dealt with by an andrologist who, after diagnosis, can prescribe an individual treatment: conservative or surgical. If it was not possible to cure infertility, then there are methods of modern medicine that help to cope with the problem.
- artificial insemination
- IVF (fertilization of an egg in a test tube and placing it directly into the uterine cavity);
- ICSI (IVF with direct injection of sperm into the egg);
- sperm donation;
- surrogacy
It is necessary to diagnose the disease in special clinics, and trust the treatment - to a professional doctor. You can find the best reproductive center in our rating, which provides not only information about clinics, but also reviews about its work, as well as the cost of the most popular treatment methods.
What is male infertility. It is customary to talk about male infertility if the pregnancy of a woman in a sexual couple does not occur within one year. At the same time, the partner is absolutely healthy and can have children, does not take contraceptives.
A man's fertility is determined by his ability to inject into a woman's body enough viable sperm to conceive.
Forms of male infertility:
- Obstructive (obstruction of the vas deferens).
- Testicular (due to testicular disease, the number of spermatozoa in the semen is significantly reduced, the processes of their production and maturation are disrupted).
- Autoimmune (due to a malfunction of the immune system, the body attacks its own spermatozoa).
- Idiopathic (the cause of the disease cannot be established).
- Ejaculatory (a situation when there are no deviations in the course of production, maturation and passage of spermatozoa through the vas deferens, but they are not ways to leave the urethra as part of the ejaculate).
- Congenital (primary).
- Secondary (caused by past illnesses).
The most common causes of male infertility
- Hormonal failure (insufficient production of testosterone).
- Infectious and inflammatory diseases of the genitourinary system (urethritis, prostatitis, vesiculitis, orchitis).
- Congenital defects of the reproductive system, injuries received in childhood.
- Tumors in testicles.
- Immune disorders.
- Accumulation of fluid around the testicle (hydrocele).
- Surgical treatment, which caused a violation of blood circulation in the testicles.
- Neurology (violated ejaculation).
- Cysts (blisters containing fluid) in the epididymis.
- psychological reasons.
- Unfavorable ecological situation.
- genetic abnormalities.
- Occupational intoxication, work in conditions of too high or too low temperatures.
A large number of causes of male infertility makes it difficult to diagnose the disease.
Symptoms of male infertility
The main sign of male infertility is the absence of pregnancy in a woman for a year with regular sexual activity, if no contraceptives are used.
If you experience similar symptoms, contact your doctor immediately.
It is easier to prevent a disease than to deal with the consequences.
Testing for infertility in men
- A conversation with the patient, during which it turns out how long it has been impossible to conceive a child with a real partner, whether there are children from other women. Clarification, whether there were operations and injuries associated with damage to the testicles or their appendages, varicocele, prostatitis. Analysis of sexual function. A fertility doctor asks:
- how intense is a man's sexual life;
- whether sexual desire has decreased recently;
- what methods of contraception the couple used before planning a child;
- how many partners the patient has, whether he had an STD.
Alternative treatments for male infertility:
If medicines and surgical treatment do not help to solve the problem, the man is offered to use alternative methods infertility treatment. This refers to IVF and intrauterine insemination.
In rare cases, male infertility can be cured with herbs or with the help of physiotherapy. It all depends on the diagnosis and age of the patient.
Why is male infertility dangerous?
The result of untreated male infertility is the absence of children.
Prevention of infertility in men
- Healthy food;
- to live an active lifestyle;
- competently and timely treat inflammatory and infectious diseases of the genitourinary system;
- have one sexual partner;
- use barrier methods of contraception;
- have regular sex life;
- give up alcoholic beverages, smoking;
- undergo an annual examination by a urologist.
Types of infertility in men
- secretory form. It develops if the testicles do not form the number of viable sperm that is necessary for fertilization.
The causes of congenital secretory infertility in men are inherited pathologies, undescended testicles into the scrotum or their complete absence. The development of this pathology is provoked by some diseases (measles, orchitis, prostatitis, mumps, influenza, etc.). These diseases can cause pathological changes in testicular tissues and appendages.
The following diseases can lead to atrophy of the spermatogenic epithelium and disruption of sperm production: varicocele, damage to the testicle, torsion of the spermatic cord.
Risk factors for the development of secretory infertility in men:
- lack of proteins, vitamins;
- ionizing radiation, exposure to toxic substances, high temperatures;
- chronic diseases (for example, diabetes);
- damage to the brain, spinal cord;
- alcohol poisoning, nicotine.
- Excretory (obstructive) form.
It develops under the influence of the following factors:
- Inflammatory diseases (vesiculitis, prostatitis, urethritis, STDs, etc.) affect the prostate, appendages, seminal vesicles and lead to a reduction in the amount of substances that are responsible for sperm motility.
- Urethral defects (epispadias, hypospadias). Due to the development of this pathology, the ejection of sperm occurs in the wrong direction.
- Inflammation of the gonads reduces the ability of sperm to overcome obstacles on the way to the egg.
- Hypoplasia of the epididymis and vas deferens.
- Cortical damage and chronic inflammatory processes can cause the release of ejaculate into the bladder.
- autoimmune form. It develops as a result of gluing of spermatozoa under the influence of antisperm antibodies. They negatively affect the mobility and viability of spermatozoa, lead to their death.
In addition, in modern medicine, mixed or idiopathic types are distinguished.
Diagnostics in the clinic "Euro-Med"
In order to make a diagnosis, identify the causes of infertility in a man and prescribe effective treatment, the specialists of the clinic "Euro-Med" carry out the following activities:
- PCR diagnostics, cultural analysis of a smear from the urogenital tract. Research can rule out the presence of sexually transmitted diseases.
- Assessment of the state of sperm, prostate gland, seminal vesicles.
- Spermogram, study of prostate secretion. Level citric acid, acrosine, fructose in the ejaculate allows you to assess the mobility and viability of spermatozoa.
- Determination of the state of the endocrine system and the functioning of the sex glands.
- Research of a hormonal status.
- Detection of antisperm antibodies in order to rule out autoimmune male infertility.
- Clinical and biochemical blood and urine tests to assess general health.
Treatment at the clinic "Euro-Med"
Specialists of the clinic "Euro-Med" use both medications and surgical methods treatment of male infertility. The choice of one method or another is determined by many factors: the form of the disease, the causes of development, the observed symptoms, the individual characteristics of the patient, etc.
Modern techniques allow for effective treatment of almost all types of diseases.
Choice of clinic
The absence of the desired pregnancy in a healthy woman can be a sign of infertility in a man. In order to solve this problem, you should undergo a comprehensive examination and the necessary treatment from a specialist. However, first you need to find a reliable clinic and determine which doctor will provide effective assistance.
To do right choice First of all pay attention to the following aspects:
- quality of diagnostic and medical equipment;
- qualification level and work experience of urologists;
- list of services provided, convenience of reception.
Now let's try to evaluate the work of the Euro-Med clinic, based on these characteristics.
- Diagnostic rooms, laboratories, operating rooms are equipped with advanced equipment. The technical base allows to carry out all types of researches and medical actions.
- Specialists are highly qualified and practice an individual approach. During the consultation, the doctor will tell you in detail about the causes of the disease, explain how infertility in men can be treated, whether there are any contraindications, and answer your questions.
- The clinic provides a wide range of medical services: from laboratory tests to complex operations. In order to get professional help, just choose a convenient time and make an appointment.
"Euro-Med" is a clinic where differential diagnostics is carried out, the causes of infertility in men are found out, and effective treatment is prescribed. As a rule, after completing a therapeutic course, a woman manages to become pregnant, endure and give birth to a healthy child.
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