For many years it was believed that infertility is a woman's sickness. Today, however, it has been proved that cases of its occurance are divided between men and women almost equally. According to the statistics, there are about 1 million infertile couples in Ukraine, where a male infertility is the reason for the lack of children in 30-40% of the cases.
The issue of infertility arises for a couple of reproductive age when there has been no pregnancy within 12 months. In such situation, the both partners must see a medical specialist. The man must go to an andrologist who will collect the history (child and urogenital diseases, surgeries, various toxicity and occupational hazard), will examine and prescribe laboratory tests, based on which it will be possible to determine a presence and nature of the male infertility. A spermogram is mandatory and its results can reveal:
- Oligospermia, characterized by a reduced amount of sperm cells - less than 20 million sperm cells per 1 ml of sperm.
- Asthenospermia, which is a reduction of normal sperm motility in the semen.
- Teratospermia is when a low amount (less than 50%) of sperm cells with a normal head shape and tail is found in seminal fluid.
Modern medicine distinguishes three types of male infertility:
- Secretory infertility. It is the most common form of male infertility, characterized by an impaired normal operation of the testis, which leads to reduction of a number, motility and quality of sperm cells. Many diseases such as varicocele, hydrocele, inguinal hernia, cryptorchidism (when a testicle has not lowered into the scrotum), mumps (or parotitis), as well as syphilis and tuberculosis significantly influence the development of secretory male infertility. A timely and adequate treatment of those diseases may reduce the risk of male infertility
- Obturative infertility. This type of male infertility presumes inability for sperm cells to advance in deferent canals. This obstruction may only be on one or both sides. Treatment of such male infertility involves a surgical intervention. There are many causes of this form of male infertility - congenital disorder, a result of injury or consequence of diseases such as epididymitis (inflammation of the epididymis), syphilis, and tuberculosis. Cysts, tumors or scars left after the surgeries are also a very common cause of obstruction of the canals.
- Immunological infertility. It is characterized by formation in the male sperm of antisperm antibodies that contribute to disruption of normal spermatogenesis, as well as interfere with a normal fertilization of the egg. Such antibodies are often produced due to testicular injuries; moreover, their production can be affected by various urogenital infections - Chlamydia, Mycoplasma, etc.
Treatment of male infertility
We should keep in mind that in most cases successful treatment of male infertility is possible. Depending on the nature and causes of the disease doctors may prescribe various methods for dealing with the problem. The treatment should also eliminate the causes of infertility - to give up bad habits, cure infectious diseases and so on.
Main methods of treatment of male infertility include:
- Hormone therapy, which is based on taking special biologically active agents. This kind of treatment is prescribed for impaired spermatogenesis (decrease of motility and a number of sperm cells in the semen) Therapy can be used as an independent treatment, but more frequently it is prescribed as part of an integrated treatment. Hormone therapy usually lasts for at least 9 months with a regular monitoring by a doctor. Selection of the hormonal agents depends on the type of pathology. The hormonal agents can be assigned exclusively by a doctor on the basis of the test results. He also determines the dosage required to treat each individual patient.
- Stimulation of sperma cells consists in a temporary sperm quality improvement by taking medications. Hormones, homeopathic remedies of vitamins that provide a positive impact on production of sperm cells can be assigned. The choice of a drug is performed by a medical specialist, depending on individual traits and indications of the patient. The stimulation can be assigned both for natural conception and for taking sperm for in vitro fertilization or artificial insemination. After the stimulation the quality of the sperm is improved by 30-40%.
- TESA/TESE. In the absence of sperm cells in the ejaculate they may be obtained by means of testicular biopsy. That method is used for a possibility of using the derived sperm in the process of in vitro fertilization or artificial insemination. There are several methods of testicular biopsy. TESA is a needle biopsy technique, and therefore, is a less invasive method for obtaining sperm cells. But compared to TESE this method involves a small amount of retrieved tissues and, consequently, fewer sperm cells obtained. The second method - TESE represents microfocal microsurgical testicular biopsy, when a greater number of testicular tissues is taken in comparison with the previous method. The both procedures are performed under intravenous anesthesia.