19Feb

Male infertility: underlying causes, symptoms and treatment

The main causes of infertility in men are inflammatory diseases, varicocele and gonadotropin deficiency. Diagnosis of the causes of male infertility begins with a PCR test. These terms denote the detection of the causative agent of the disease by a polymer chain reaction. Also for the purpose of diagnosis, the results of spermogram and biopsy are used.

Causes of male infertility can be associated with inflammatory diseases

Causes of male infertility can be associated with sexually transmitted infections. Chlamydia, mycoplasmas, ureaplasmas, herpes viruses and cytomegaloviruses cause primary chronic inflammation in the submucosal layer of the penis, scrotum, testicles, causing orchitis, epididymitis, vesiculitis, prostatitis, i.e.inflammation of the testes, appendages, seminal vesicles, prostate gland. This inflammation is asymptomatic, there are almost 45% of those who applied for infertility in a marriage. This cause of male infertility greatly impairs spermatogenesis, causing the advantage of immobile and pathological( improperly formed) spermatozoa. Sometimes, however, with a large number of penetrated microbes, inflammation can be felt, urination becomes painful, painful ejaculation may occur, and internal pain associated with prostatitis may also be troubling; in the sperm, the number of leukocytes - white blood cells reacting to inflammation, enemies of microbes - increases sharply. There is pyospermia. Deviates towards increasing or decreasing the amount of sperm.

With such symptoms, it is necessary to find out the reasons for these deviations, a urological examination is necessary, prostate massage through the rectum with extrusion of the prostate juice into repeated PCR-analyzes for sexually transmitted infections. This can help to identify a deeply hidden infection that forms chronic prostatitis.

For this reason, a test for infertility should begin with a PCR test for these infections.

The cause of male infertility: varicocele

Speaking about the causes, diagnosis and treatment of male infertility, we can not fail to mention varicocele - as called dropsy testis. The relationship of dropsy testes and violations of spermatogenesis with infertility is proved. The increased temperature in the left testis( in 90% of patients the pathology on the left), hypoxia( oxygen starvation of tissues when they are squeezed by edematous varicose veins) and the violation of the chemical composition in the testes disrupt the formation of spermatozoa - from the reduction in the production of spermatozoa to the complete stopping of the process of spermatogenesis( formation of spermatozoa).

In spermogram, such patients can be reduced the number of normally formed spermatozoa and increase the forms with the pathology of the structure of the sperm head - its conicity, increase in the number of amorphous heads of spermatozoa and immature forms. And this reduces the overall index of mobility of all spermatozoa, which is typical for such patients, although the level of hormones they have not broken.

Having diagnosed this cause and symptoms of male infertility, varicocele treatment is performed exclusively surgical. After the operation, in 75% of the patients, the fertility of the sperm increases. But patients should be observed within six to eight months after the operation, the process of spermatogenesis is long and the observation of it should also be long.

The cause of infertility in men: sperm obstruction

One of the main causes of male infertility is the obstruction of sperm. A characteristic sign of violations of the passage of sperm is aspermia, or azoospermia. In this case, the shape and size of the testes, as well as the level of hormones, usually is normal. The term denoting this disorder is obstructive aspermia. The causes of obstruction usually are specific infections - gonorrhea or tuberculosis in the testis or its appendage.

A certain percentage of this disorder is due to congenital, defects in the appendages of the testes, consisting of multiple small cysts in their tissues. Or another option: congenital absence of the terminal appendage of the testicle - the excretory duct or cyst in place of the seed tubercle.

Diagnosis is based on the detection in the spermogram of azoospermia or aspermia, again with normal hormonal results, no complaints and visible changes in the appendages. For clarification, ultrasound can be useful for male genital organs. Laboratory: a sharp decrease in fructose in semen plasma.

Having identified this cause of male infertility, the treatment is performed exclusively surgical.

Genetic cause of male infertility: deficiency of gonadotropins

Genetic causes of male infertility may be deficiency of gonadotropins. This disease is caused by the X chromosome. Gonadotropins are called LH and FSH, since the gonads are the sex glands, and tropism is the direction of action.

This is not a very common cause of male infertility. But deserves attention, identified in these patients delayed puberty, high growth( pituitary gigantism), as with the deficiency of LH and FSH "reigns" growth hormone.

With the same probability, small growth( pituitary dwarfism) can occur if there is a deficiency of all pituitary hormones, including growth hormone. There are signs of gynecomastia( mammary glands, as in women).In the spermogram - azoospermia or aspermia, with a decrease in the volume of the ejaculate( a portion of the sperm when it is ejected).

Testes biopsy reveals the underdevelopment of the seminiferous tubules, as in the adolescent. Such patients may not have sense of smell.

There are patients who have combinations of this disease with the hare lip, asymmetry of the face, with the inability to keep the balance when walking.

For the diagnosis it is enough to take an analysis of those same FSH and LH, which are so low that they are not even determined sometimes. To clarify, you may need an MPT-study of the brain, namely - the hypothalamic-pituitary system. The reason for the deficiency of guiding the sex hormones of the hormones is hidden in the pituitary tumor or the consequences of craniocerebral trauma.

The role of increased prolactin, as well as adenoma( prolactin) of the pituitary gland is great here. Prolactin is able to reduce gonadotropins - and FSH, and LH.

It is clear that, in the absence of proper guidance, testes work incorrectly and even undergo reverse development. Therefore, these patients do not have sexual desire, there is no potency, sometimes it is even difficult to get a sperm dose.

Treatment of infertility in men caused by genetic factors is performed by chorionic gonadotropin, hCG or preparations containing FSH and LH, obtained from urine. Sometimes, with the proven presence of prolactinoma, it is advisable to use antiprolactin tablets in parallel.

There are also irreversible disorders of spermatogenesis. These are conditions that are not subject to restorative treatment and do not lend themselves to it. In this case, only hormone replacement therapy is indicated.