Infertility in men: causes, types and diagnosis

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Male infertility is one of the biggest problems today. Previously, the rate of male infertility was 30%, but today it has risen to 45%. According to statistics, the problems with the male reproductive system are increasing. Male infertility refers to the fact that a woman cannot become pregnant if she has been sexually active for the last 12 months and has not used contraceptives.

Causes of male infertility

There can be many causes of illness that deprive men of the happiness of being a father. These can be common pathologies going on in the body and diseases that occur in the male genitals. In some cases, a single cause of infertility is sufficient, sometimes as a result of several pathologies. The prognosis of the disease depends on its timely correct diagnosis and treatment.

Varicocele

Varicocele - occurs in one in every 7 infertile men. At the heart of the disease lies the dilation of veins in the seminal vesicles (ducts). Sperm fluid comes out through this channel. As a result of varicocele, the temperature in the sperm rises slightly, which affects the condition of the sperm. Only a doctor can diagnose such pathologies. Therefore, men are required to undergo a timely medical examination.

Defects in the development of the genitals and their injury

Infertility is often caused by injuries or defects in the development of the genitals.

These include:

• Cryptorchidism is the failure of the testicles (sperm) to fall into the uterus;
• Hypospadias is a developmental abnormality of the penis in which the urethra opens to a place other than the head of the penis;
• Monarchism is the presence of a single testicle;
• Epispadia;

Genetic anomalies

Such cases rarely cause infertility. Because the unborn child is simply born with birth defects, he or she may not be sexually active at all.

Infertility caused by infection

In most cases, infertility occurs due to the inflammatory process in the male genitourinary system. Due to the circulation of infections (viruses, bacteria, fungi) in the body, the number of leukocytes increases, leukocytes increase the viscosity of sperm and make them thicker. The following pathogens are often detected in the examination:

• Leaking treponema;
• Trichomonas;
• Gonococcus;
• Chlamydia;
• Infectious mumps (infection transmitted during childhood or infection during pregnancy).

Be careful: Ingestion of an infectious agent into the urinary tract causes urethritis and prostatitis. These diseases can be treated only by a doctor. Drugs are selected based on the type of pathogen and its sensitivity.

Sexual weakness

Sexual weakness is explained by premature ejaculation (premature ejaculation), impotence, or erectile dysfunction during intercourse.

Immunological system problems

Deficiencies caused by the male immune system lead to the secretion of special substances, which damage a man’s own sperm and make them lose their fertilizing properties.

Hormonal disorders

Hormonal pathologies leading to infertility include:

• Hypothalamic insufficiency;
• Testosterone deficiency;
• Diabetes mellitus;
• Deficiency of testicles (congenital or acquired);
• Hyperprolactinemia;
• Pituitary insufficiency;
• Thyroid Defects;

Surgical intervention

Infertility can occur after some surgical procedures, such as hernia, stricture of the urethra (narrowing), vasoectomy, bladder resection, sympathectomy, prostatectomy.

In the treatment of systemic diseases

Some therapies have harmful effects on the male reproductive system. They can be:

• Hormone therapy;
• Tranquilizers;
• Nitrofurans;
• Light therapy;
• Anabolic steroids;
• Chemotherapy;
• Sulfanilamides;
• Hypotensive agents;
• Drugs;
• Bronchial asthma, diabetes, tuberculosis (tuberculosis), liver cirrhosis and similar systemic diseases can also lead to male infertility.

External factors leading to infertility

• Drinking a lot of alcohol;
• Smoking;
• Drugs;
• Ecology;
• Effects of pesticides;
• Deficiency of certain minerals and vitamins;
• Hot showers, spending a lot of time in saunas, overheating of the body;
• Excessive physical exertion;
• Toxic fumes, chronic poisoning with heavy metals;
• Receiving ionizing rays.

Types of male infertility

Regardless of the type of cause of infertility, infertility is divided into the following types:

• Grade 1 infertility;
• Grade 2 infertility.

Grade 1 infertility in men

This level indicates that a woman cannot become pregnant even if men have active, unprotected sex throughout the year. The diagnosis is made only if the following conditions are detected in a man:

• Deficiencies in hormonal status;
• Genital pathologies, congenital or acquired;
• Varicocele;
• History of genital injuries;
• Genetic defects;
• Decreased immunity.

Level 1 infertility comes in 3 different types:

• Secretory - disorders in the process of spermatogenesis due to hormonal deficiencies;
• Immunological - antispermal antibodies are produced in the male body and affect the sperm, due to which sperm motility is reduced and the egg cannot fertilize the cell;
• Obstructive - obstruction of the seminal vesicles.

  

Grade 2 infertility in men

Such a diagnosis is made in men who have previously had children, but have lost the ability to fertilize by now. The cause of this disease is like 1st degree infertility:

• Taking anabolic, tranquilizers;
• Varicocele;
• Conducted surgical procedures;
• Chemotherapy and light therapy;
• Acquired seminal vesicle obstruction, prostatovezikuli, epididymitis, urethritis, as a result of injuries;
• General systemic pathologies include diabetes, liver cirrhosis, tuberculosis (tuberculosis), bronchial asthma;
• Diseases of the thyroid gland.

Symptoms of infertility in men

Usually men do not complain of infertility, only the "pain" of not being able to have children. The man feels well, becomes sexually active, plans to have a child, after giving up contraceptives, the woman is no longer pregnant and the man immediately suspects infertility.

In men, infertility is based on 3 pathological processes:

• Decreased sperm count during ejaculation;
• Inactive sperm;
• Disorders of secretion of sperm from the seminal vesicles.

Checks on infertility

Diagnosis is the first step in treating infertility. Its timely and correct conduct will play a major role in the treatment of the disease in the future. When infertility is suspected, the following tests are performed:

• Andrologist's review. The doctor conducts physical examinations, collects anamnesis, inquires about the diseases performed;
• Instrumental inspections;
• Laboratory tests;

Instrumental inspections include:

• Ultrasound examination of the testicles determines the general condition of the testicles, its structural structure, the presence of pathological changes;
• Color dopplerography reveals reflux and varicocele of the seminal and testicular veins;
• Semen (testicle) biopsy (genetic examination of testicular tissue for ECO (external fertilization)).

Laboratory tests are as follows

• The amount of hormones in the blood;
• Genetic diagnostics;
• Immunological examinations;
• Spermogram;
• Molecular testing of sperm;
• Ejaculate tank planting;
• Centrifuge analysis of ejaculate;
• Examination of genital infections;
• Hormonal screening. Testosterone, FSG (follicle stimulating hormone), LG (luteinizing hormone), globulin-binding sex hormones, prolactin (when a tumor in the pituitary gland is suspected).

Important: hyper- and hypo-secretion of hormones has an adverse effect on the body, disrupts humoral management, and can also lead to infertility in men.

Immunological examination

A special MAR-test determines the percentage of sperm, i.e., healthy sperm coated with antisperm antibodies. Serum immunoenzyme testing determines the amount of antisperm antibodies.

Planting ejaculate

This test is performed when the spermogram gives a negative result, in order to determine the causative agent if there are many leukocytes in the sperm (<1000000 1 ml).

Centrifuge analysis of ejaculate

This test is performed if there are no sperm in the sperm. Identifies each sperm in the process of spermatogenesis.

Spermogram

The most widely used and informative screening method in determining the quantity and quality of sperm. As a result of this examination, various pathologies are identified: oligospermia, azoospermia, teratospermia, asthenospermia, pyospermia, aneurysm, cryptospermia and others.

Classification of ejaculatory index

Important: The instruction to the spermogram is carried out only by a physician, approaching each patient individually.

For this verification method to be effective, the following rules must be followed:

• 2-4 days not having sex;
• Do not drink alcohol;
• Do not take strong pharmacological drugs;
• An increase in body temperature in the last 90 days may adversely affect the spermogram result.