Today one of the current problems of medicine and the society is male infertility. Appears with the same frequency as women, and translates into both the personal tragedy of men, and to the disintegration of the family. The diagnosis of "infertility" that takes place in the case in which the couple strives to become pregnant, do not use any of the types of contraceptives, but in a period of 12 months, their attempts failed. In this situation, the woman and the man must be examined in order to determine the causes and its solution.
The causes of the
Cause infertility in men can be a series of pathological processes that determine the violation of the production of sex hormones, changes in the composition, the properties of the semen, the absence of means of its reflux.
- Disorders of the nervous system. Spermatogenesis is governed by physiological processes, involving the 4 of the structure: the cortex of the large hemispheres of the brain, the hypothalamo-pituitary male sex breast – testes, as well as some of the other glands of internal secretion. The first in the stress reaction of the central nervous system: the hard trauma that disrupts the hypothalamus, it reduces the formulation of a set of hormones, which leads to the reduction or total absence of sperm in the ejaculate (oligo - and azoospermia, respectively). Emotional stress can cause an imbalance in the functioning of the autonomic nervous system. This may also lead to the sterility of men, even when the satisfactory state of the testes. The damage podvzdoshno-inguinal nerve (for example, during an operation of removal of the hernia, or in the postoperative period due to rubtsovih changes in the tissues of the genital tract) often involves a degeneration and even atrophy of the testes.
- Genetic and congenital factors. The frequency of congenital malformations, diseases of the testicles today is of the order of 4% to 5%, that is to say, that take place almost every twenty men. Is cryptorchidism (popushina the testicle in the scrotum), monarchism (lack of 1 egg), Anorchia (innate lack in the scrotum both testicles), dysgenesis (disorder of the development of the sex glands and other violations.
- Of the infection.
- Intoxication. Ecology, chemistry, professional harmfulness in the context of the growing industrialization has become the cause of sterility in men increasingly. The poisoning may directly affect the testis tissue or in the nervous system in general, with the consequences described in paragraph 1.
- Food supplements, medicines, industrial products, free, pesticides – the impact of these factors, the person is subjected to daily, and many of them are mutagens and damage the embryonic epithelium of the testicle. They are also quite dangerous in this sense, the exhaust gases of vehicles and the lack of oxygen, especially in the context of stress and fatigue. Have a negative impact on the tissue of the testes that produce semen, some antibiotics and sulfonamides, nitrofurans, as well as estrogens and cytostatic drugs. Chronic poisoning by nicotine and alcohol cause significant changes of the ejaculation in the form of reduced mobility and the emergence of pathological forms of sperm cells.
- The deficit of power. Food is a factor that is also very important for the enjoyment of spermatogenesis. To a change in the tissue of the testicles can cause not only the absolute and the hunger, but the hunger part, as well as the lack of power. Special importance has the nutrition of children and adolescents. You should know that the degeneration is found not only in the tissue of the testes, but also in the axis hypothalamus-pituitary system.
- Ionizing radiation. The exposure may be a causative factor direct of infertility (the death of the cells of the embryonic epithelium), and to provide mutagenic action (give rise to anomalies in the process of production of sperm in the descendants of irradiated fuel from men).
- Pathology of the endocrine glands and of other organs. One of the manifestations of a number of diseases is the failure of testicular function. However, if the disease is not difficult, these disorders often go undiagnosed, because they are not expressed, and in the case of the main stream of the disease of the question of fertility is going on the second place and the main objective of the patient becomes the main solution of the disease under medical control. After the recovery of the same spermatogenesis, as a general rule, it is retrieved.
- Overheating. The optimum temperature for the development of the components of the sperm – 2-3 °C below the temperature of the entire body. Overheating damages the testicular tissue and leads to degeneration. Even short, the increase in body temperature to febrile values (39 °c or more) violation of the process of sperm formation, and is arranged only after 2-3 months after recovery. Here has a general value (infectious disease, work in the workshops), and local (hernia testis, varicocele) hyperthermia.
- The subcool. The impact on the egg at low temperatures, also cause damage to the cells that produce sperm. However, the cases of infertility it is for this reason sufficiently rare, as to the violation of spermatogenesis, it is necessary, so that the testicle in the scrotum to suffer from the effects of the temperature below -10 °c during at least an hour.
- Disorders of the circulation of the blood. Spermatogenic epithelium is highly sensitive even to short-term ischemia, therefore, of the disease, that violate the blood flow to the testicles (in particular, hernia, or hydrops of the egg), can be the cause of the infertility. It also contributes to the stagnation of blood in the genitals (for example, a varicocele (varicose veins testicles), anomalies of the structure of the venous plexus in the area of the organs genito-urinary and other diseases).
- Traumatic injuries of the genital organs. Depending on the nature and force of the injury, which can cause bleeding, process of inflammation, tissue necrosis, obliteration (blockage of the lumen) of the tracks, compression, and/or of the blood vessels that carry blood to testis, hematoma and other pathological changes. The results are reversible or irreversible pathological changes in the tissue of the testicles or of the pathways.
- Autoimmune processes in the field of the sexual glands. Spermatogenic epithelium works correctly thanks to the presence between the blood and the contents of the seminiferous tubules of the so-called blood-testis barrier, which omitted some of the cells and impedes the entry of others. As a result of an excess temperature, cold, infectious diseases, circulatory disorders permeability of this barrier increases, and the components of the semen can enter the bloodstream. They are, as we know, are antigens, so the body reacts to them the education of the antibodies to the cells of the seminiferous tubules, produce sperm. Develops autoimmune infertility.
Distinguish 5 forms of male infertility:
- the relative.
It is because, as a general rule, with decreased testicular function — hypogonadism. There are 2 types of this condition: primary and secondary.
In the first hypogonadism a disease process located directly in the testicular tissue. This can be as congenital anomalies of development, or an undescended testicle, as well as of damage, traumatic or infectious in nature. This form of the disease is accompanied by improved formulation of gonadotropin hormones in the blood concentration of the improvement.
Secondary hypogonadism occurs when the defeat of the pituitary gland, the hypothalamus, endocrine organs. Develops when tumors neuroinfections, brain injuries and is the dramatic decline of the formulation of the gonadotropins, which leads to the hypothyroidism of the testicles. The defeat of the prostate, seminal vesicle, bubble wrap and other endocrine glands also develops the failure of the testis. The content of gonadotropin hormones can increase, decrease, or remain within the normal values.
It is the result of disease or defects of the development of the sex glands, the urethra, the obstruction of the lumen of the irrigation channels, as well as aspermatism. Ejaculation, it loses its properties (in connection with the absence in him of the sperm or the change of their structure and properties), or is it normal, but you can not enter in the genital tract of the woman.
Aspermatism call a state characterized by the absence of ejaculation during the sexual act. Occurs, as a result of the dysfunction of the nervous system (such as the system central and peripheral) and is also considered a form of excretory infertility in men.
Can take place in the immunological conflict between the man and the woman, of development in response to the arrival of sperm, which is the antigen, in the vagina of the woman. Is the so-called iso-immune forms of infertility. The risk of developing this type of conflict can increase the violation in the system of the immunity, incompatibility of the blood groups and some other factors.
Autoimmune form of sterility occurs when the violation of the permeability of the blood-testis barrier. The causes of this state is described above.
Combined hormonal disorders and excretory component.
The relative sterility
This diagnosis is taken in the event that, after a full examination of the men and women of the pathological changes that none of them are not identified. This term is applied with great care, since the non-detection of the pathology does not mean that there are not, perhaps, this is due to the imperfection of the survey.
Signs of infertility in men
The main symptom of infertility in man is not the pregnancy in the regular services (2 times a week) sex acts on a 12-month period, provided that the contraceptives were not applied on a woman totally covered, and the pathology it is not revealed.
The amount of diagnostic activity includes:
- the collection of the medical history;
- the general recognition;
- the study of semen;
- the diagnosis of the excretion of the function of the testes and other glands;
- the biopsy of the testicle;
The principles of treatment of infertility in men
Tactics of treatment depends, in part, what are the reasons that have led to infertility.
Excretory infertility, have arisen due to the inflammation in the genital tract, is subject to conservative therapy.
The occlusion (blockage of the lumen) of the ditches is normally resolved through surgery.
The efficacy of the treatment defined by a return to the studies of the ejaculation and the performance of other diagnostic techniques.
The general activities
The patient must:
- to stop smoking;
- stop drinking alcohol;
- stop taking some medications.
- to exclude effects on the body adverse occupational, modify the conditions of work;
- avoid psychoemotional stress, excess of work;
- lead an active lifestyle;
- regularly and participate in eating.
It is also very important to respect the way of life sexual. Frequent sex reduce the ability of sperm for fertilization, since the number of mature spermatozoa in it is reduced and young people of the ways – increases. The result rare of the sexual acts becomes the increase in the number of old sperm. The optimal time of abstinence – from 3 to 5 days. You must take into account the days of ovulation, the of the companion, because it is in this period occurs the conception. After a sexual relationship the woman, it is recommended to be in a horizontal position even 30-40 minutes.
General measures medicinal
The patient may be assigned:
- treatment with vitamins;
- drugs phosphorus, glutamic acid;
- the tincture of lemongrass chinese, siberian ginseng;
- the biostimulator;
- query the profiles of professionals neurologist, the psychiatrist.
The treatment secretory infertility
- In the first hypogonadism – medications of androgens.
- In the second hypogonadism – gonadotropins, progestins, or drugs that stimulate your selection.
The treatment excretory infertility
Depends on if the illness of your cause.
- When hypospadias and epispadias – operative. In full opposition of the patient to the realization of the operation – artificial insemination (insemination).
- In chronic diseases, inflammatory diseases of the genital organs – drugs depending on the causative factor (antibiotics, sulfonamides, and others). Because these medications themselves, may depress spermatogenesis, applied in parallel with the drug, warnings of negative effects on the liver and testes.
In the surgery
A direct indication is azoospermia obstructive when confirmed by biopsy of the integrity of spermatogenesis. The goal of surgery is to restore the viability of the seed is that out of the way.
The treatment of infertility
The spouses it is recommended to perform intercourse with a condom, and only in the period of ovulation do not protect themselves. When this in the body of the woman it will reduce the amount of antigens to the sperm of men and the probability of fertilization increases. In parallel, the man or the woman (depending of violations) is prescribed for the reception of the antihistamines. Also in order to achieve an anti-allergic effect can be used by glucocorticoids.
In the inflammatory process in the body of men you may be recommended to the receipt of immunostimulyatorov.
The method of choice in the treatment of infertility, artificial insemination. When this woman in the cervical canal or in the cavity of this organ injects the sperm, only that you receive from your husband.
The prevention of the
To prevent the development of infertility, the man should pay a lot of attention to your health timely, to cure diseases, adversely affect the function of reproduction, as well as prevent your development. You must also respect the regime of work and rest, the sexual life of the substantiation of the meal, not to maintain relations sexual deviant, not to take medicines without control, to deny, or at least limit the consumption of alcohol and smoking.