Do you want to become a father, but the desired conception does not occur? Sign up for an examination at the K + 31 multidisciplinary clinic in Moscow. Diagnostics and treatment of male infertility in a private medical center are carried out using the latest advances in medicine. The solution to the problem of reducing male fertility is in the competence of an andrologist.
A preliminary diagnosis of "infertility" in men is made if conception does not occur for a year, although no measures are taken to prevent pregnancy, sexual life is regular, and the partner is absolutely healthy.
Signs, symptoms and causes of infertility in men
In the course of a comprehensive examination of childless couples, it turns out that in about 40% of cases the inability to conceive a child is due to disorders in the male body. The statistical error can be very large, because for various reasons, women are afraid to hint to their partner that he needs to be examined.
Important: Patients need to understand that underfertility in men is by no means a sign of insolvency (weak potency). Quite often quite "high-quality" ejaculate occurs in persons suffering from erectile dysfunction.
The leading sign of infertility in men is the inability to conceive for 1 year, subject to regular sexual activity (from 3 times a month). There may or may not be other clinical symptoms. In recent decades, there has been a decrease in fertility in patients under the age of 35 years.
The most common causes of infertility in men:
- malnutrition (lack of proteins and hypovitaminosis);
- metabolic disorders (overweight and obesity);
- inflammation of the prostate gland (acute and chronic prostatitis);
- prostate adenoma;
- hormonal imbalance (decreased androgen levels);
- varicocele (varicose veins of the pampiniform plexus of the spermatic cord);
- erectile dysfunction (problems with potency);
- bad habits (nicotine and alcohol addiction);
- hazards associated with professional activities (physical inactivity, chronic intoxication, etc.);
- infectious diseases of the reproductive system (sexually transmitted diseases);
- constant use of certain pharmacological agents (in particular, steroid hormones).
Important: External factors such as constant exposure to electromagnetic fields, gamma radiation and a high concentration of salts of heavy metals in the environment lead to a decrease in fertility (the ability to conceive).
The ability to conceive is reduced if there is a deterioration in thermoregulation in the scrotum. It can be caused by wearing too tight underwear (especially with an admixture of synthetic fibers), frequent hot baths and regular visits to saunas.
How to check for infertility in a man
Male infertility can be primary and secondary. They say about the primary if the pregnancy from the patient has never occurred. Secondary infertility is a situation where there was at least one conception (regardless of how the pregnancy ended).
General inspection
When diagnosing, the doctor evaluates the following factors:
- the presence of somatic pathologies that may adversely affect fertility;
- signs of varicocele and cryptorchidism (undescended gonads into the scrotum);
- corresponding to the size of the testicles to the reference values (30-50 mm by 20-30 mm);
- patency of the vas deferens and condition of the testicular appendages.
When collecting an anamnesis, the andrologist additionally evaluates the frequency of sexual intercourse and the specifics of the sexual life of partners. Be sure to take into account the abuse of alcohol and smoking.
Laboratory research
The gold standard for diagnosing pathology is a spermogram - a qualitative and quantitative analysis of seminal fluid. Laboratory testing of ejaculate allows you to identify male infertility, regardless of the cause of its development.
Types of male infertility depending on the etiology and pathogenesis:
- immunological;
- secretory;
- excretory;
- combined;
- idiopathic.
Immunological (occurs in 10% of cases) is caused by damage to reproductive cells as a result of an autoimmune process. Secretory (with a lack of viable germ cells) is due to testicular dysfunction. Excretory infertility is caused by an obstruction to the movement of spermatozoa in the vas deferens.
The combined form is a combination of problems with sperm production and their promotion; additional causes may be immunological problems and the inflammatory process. Idiopathic impossibility of conception is a pathology, the true causes of which do not allow us to identify modern diagnostic methods.
The causes of immunological infertility can be traumatic damage to the testicles, inflammation or long-term obstruction of the vas deferens. The testicular tissue is separated from the immune system by the hematotesticular barrier. When it is damaged, the body's defense system fails and produces antibodies, leading to the death of gametes.
Possible causes of secretory infertility:
- hormonal disorders (particularly low androgen levels);
- anomalies of gonosomes (sex chromosomes);
- inflammation of the testicles (against the background of parotitis, tuberculous epididymitis or orchitis of viral origin);
- severe general diseases (atherosclerosis, hypertension, diabetes, heart failure in the stage of decompensation);
- varicocele;
- hydrocele (dropsy, i.e. the presence of fluid between the membranes of the gonads).
The excretory form of pathology can develop with congenital anomalies of the structure, obstruction (narrowing) or adhesions of the vas deferens. Tumors or cystic neoplasms can also impede the progress of spermatozoa.
Each of the mentioned factors leads to the launch of a pathogenetic mechanism that negatively affects male fertility (quantity and quality of ejaculate).
Gametes may be present in seminal fluid in small quantities, which reduces the likelihood of fertilization of the egg. When analyzing the ejaculate, morphological disorders (improper structure) or immobility of spermatozoa are often detected.
Before submitting the biomaterial for analysis, the patient is prescribed sexual abstinence for 3 days. 1-2 weeks before the test, it is advisable to exclude the use of alcoholic beverages (including low alcohol) and stop smoking. It is strongly recommended not to take medicines (except for life-saving ones).
In addition to the spermogram, clinics use the MAR test, which shows the ratio of gametes without deviations from the norm and sperm containing antisperm antibodies (in percent).
To visualize the condition of the tissues of the genitourinary system, sonography is used - ultrasound scanning. It is during the ultrasound of the small pelvis and scrotum that it is possible to identify / exclude most of the risk factors for excretory infertility. Special preparation for the procedure is not required (with the exception of hygienic treatment of the external genitalia).
Immunodiagnostics makes it possible to detect the presence of antisperm antibodies in the patient's body. When determining the hormonal background, the levels of luteinizing and follicle-stimulating hormones, testosterone and prolactin are assessed. Blood for testing is taken from a vein on an empty stomach in the morning. To prevent distortion of the results, the subject is advised to avoid psycho-emotional overload the day before and sleep well.
Standard diagnostics includes general clinical and biochemical blood tests to detect / exclude metabolic disorders and pathologies of infectious and inflammatory origin. For the study of urine, the material is taken immediately after ejaculation. Additionally, Doppler ultrasound is performed to assess blood flow in the penis and scrotum.
