Male infertility

Description:

Male infertility (Latin Sterilitas) - inability of the male of childbearing age to reproduction of posterity.
By definition of WHO (1995), marriage is considered sterile under a condition if during 1 year of regular sex life without contraception pregnancy does not occur.
In 30% of observations infertility is caused by a disease of the man (male infertility), in 35% - women (female infertility), in 15% - diseases of both partners. In other observations it is not possible to establish the reason of infertility (idiopathic infertility).

Symptoms of Male infertility:

Diagnosis of male infertility includes a complex of researches:

    1. Clinical trials:
          - The general survey (including collecting the anamnesis).
          - Urogenital inspection.
          - According to indications - consultations of the geneticist, the therapist, the sexopathologist.
    2. Laboratory and tool:
          - Spermatogramma.
          - Cytology of a secret of a prostate and seed bubbles.
          - A research on clamidiosis, ureaplasmosis, mycoplasmosis, a cytomegalovirus, a herpes simplex virus.
          - Bacteriological analysis of sperm.
          - Definition of antispermalny antibodies.
          - Hormonal screening.
          - Medicogenetic research.
          - Ultrasonography of bodies of a small pelvis.
          - Ultrasonography of a thyroid gland.
          - TRUZI, transperineal ultrasonography, UZDG.
          - MCKT.
          - Radiological techniques:
                and. a X-ray analysis (in need of MRT) skulls;
                . renal flebografiya;
                century vazografiya.
          - Small egg biopsy.

The spermogram shows the following aberrations:

1) Aneyakulyation — lack of an ejaculate (sperm).

2) An azoospermism — lack of spermatozoa in an ejaculate. Distinguish a secretory azoospermism when spermatozoa in testicles are not formed, and an obstructive azoospermism when spermatozoa are formed, but are not thrown up owing to impassability of seminiferous ways.

3) An oligospermatism — insufficient amount (volume) of sperm. On norms of WHO volume makes not less than 1.5 ml.

4) An oligozoospermia — insufficient quantity of spermatozoa in sperm. On norms of WHO concentration of spermatozoa in sperm makes not less than 15 million/ml.

5) Astenozoospermiya — insufficient mobility of spermatozoa. On norms of WHO the share of mobile spermatozoa of category A+B+C in sperm makes not less than 40%.

6) A necrospermia - lack of live spermatozoa

7) Kriptospermiya - existence of single mobile spermatozoa in an ejaculate

8) A teratozoospermia — the increased quantity of morphologically abnormal spermatozoa. On norms of WHO the share of morphologically normal spermatozoa in sperm makes not less than 4%.

9) Piospermiya - the increased quantity of leukocytes in sperm owing to inflammatory process.

The analysis of an ejaculate (spermogram) characterizes fertility of sperm and the man. With normal values of quantity, mobility and morphology of spermatozoa apply the term "normospermiya" to an ejaculate. Excess quantity of spermatozoa in an ejaculate (more than 200 million in 1 ml) designate the term "polyspermia".

Reasons of Male infertility:

Depending on an etiology male infertility happens several forms:

1. Secretory form of male infertility.

The reason of secretory male infertility is that testicles for various reasons cannot develop healthy mobile spermatozoa in the concentration sufficient to impregnate an ovum. These changes are observed at hormonal disturbances, small egg torsion, at influences of genetic factors, a hydrocele, chronic diseases, various diseases of generative organs, the varikotsel and others. To start a disease proteinaceous insufficiency of food, avitaminosis, injuries of testicles, professional factors can give an impetus.

2. Obturatsionny form of male infertility.

The mechanism of development of this form men's the beslodiya is existence of any obstacle (obturation) on the way of a spermatozoon from testicles to an urethra that can be observed пр inborn lack or narrowing of the site of the seminiferous highway, a cyst or a tumor of generative or nearby organs, commissures which remained after inflammatory or infectious process, hems after operation.

3. Immunological form of male infertility.

Male infertility of this form usually develops after a small egg injury as a result of which  to be developed antibodies to fabric of testicles. In a normality fabric of testicles and immune system do not influence at each other. But at an injury there is a contact of these two systems, and immunity of an organism perceives testicles as alien bodies. The same antibodies can be developed also to spermatozoa.

Also there is a so-called topical classification of the reasons of male infertility:
    1. Pretestikulyarny reasons.
          and. Hypothalamus diseases:
                - The isolated insufficiency of synthesis of gonadotrophins (Kallman's syndrome)
                - The isolated insufficiency of synthesis of luteinizing hormone
                - The isolated insufficiency of synthesis of follicle-stimulating hormone
                - Primary hypogonadism at some inborn syndromes (Pradera-Willie, Lorensa-Muna-Bidl)
          . Hypophysis diseases
                - Pituitary insufficiency (at tumors, an inflammation, after operations and radiation therapy)
                - Giperprolaktinemiya (for example, at micro and macroadenomas of a hypophysis)
                - Hemochromatosis (for example, at a thalassemia)
                - Interaction with other (not pituitary) hormones by the principle of feedback (ekzo-and endogenous estrogen, glucocorticoids, at hypo - or a hyperthyroidism)
    2. Testicular reasons
          - Chromosomal anomalies (Klaynfelter's syndrome, a karyotype of XX or XYY at the man)
          - Atrophic myatonia
          - Anorkhiya
          - Dysplasia of seed tubules
          - Syndrome Nunan
          - Toxic influences (some pesticides, lead, organic solvents, drugs for chemotherapy, alcohol, heroin, methadone, smoking of tobacco and marijuana)
          - Ionizing radiation (an irreversible damage at doses over 600 I am glad)
          - Orchitis
          - Injury
          - General diseases (renal failure, liver diseases, sickemia, leprosy, sarcoidosis)
          - Insufficient synthesis or activity of androgens
          - Cryptorchism
          - Varikotsele
    3. Post-testicular reasons
          and. Disturbances of passing of sperm on a seed to the taking-out ways:
                - Inborn (for example, at a mucoviscidosis)
                - Acquired (after a chlamydial infection, gonorrhea, tuberculosis, chicken pox)
                - Functional (a retrograde ejaculation after injury of a spinal cord, a transurethral prostatectomy, etc.)
    . Disturbances of mobility of spermatozoa or their ability to fertilization:
                - Inborn low-mobility of a tail of spermatozoa (idiopathic or at a syndrome of Karta-genera)
                - Anomalies of maturing of spermatozoa
                - Immune responses (at development in an organism of the woman of antispermalny antibodies, Schmidt's syndrome)
                - Infections (for example, mycoplasmosis)
                - Disturbances of sexual function

Treatment of Male infertility:

Conservative treatment of male infertility. At a hypogonadotropic hypogonadism use drugs of a chorionic and menopausal gonadotrophin of the person (pregnyl, profaz, pergonal) for compensation of a lack of LG and FSG of an organism. Antagonists of estrogen apply clomifene and Tamoxifenum which block action of the last at the level of a hypophysis to increase in products of gonadotrophins. At an inborn adrenal struma therapy by glucocorticoids can be necessary, at deficit of testosterone - exogenous administration of this hormone. At the same time it is necessary to remember a possibility of further oppression of products of testosterone in testicles. If analyses of the patient indicate the increased content of prolactin (giperprolaktinemiya), it is necessary to appoint antagonists of a dopamine (Bromocriptinum or каберголин), having considered the possibility of surgical treatment of adenoma of a hypophysis.

At the expressed negative influence of antispermalny antibodies there can be useful a course purpose of corticosteroids. At the retrograde ejaculation which is not connected with operative measures on a bladder neck Imipraminum or ss-agonists apply antidepressant. At the patients who underwent similar operations administration of collagen in a bladder neck is effective.

Surgical treatment is also widespread at male infertility.
At the varikotsel which is negatively influencing quality of sperm in connection with local temperature increase carry out open operations by retroperitoneal and transabdominal access, and also endoscopic interventions.

At disturbance of passability of semyavyvodyashchy ways imposing vazovazo-or a vazoepididimoanastomoza with imposing of 2-row seams is made. The varikotsela cannot carry out these operations along with elimination in connection with high risk of development of an atrophy of a small egg.

At obstruction of an ejaculatory channel the transurethral resection of its terminal part is shown.

Sperm capture methods. Sperm can be received from an epididymis punktsionno or an open way with use of the microsurgical equipment. For convenience of repeated capture of sperm create to a spermatotsela of natural or artificial materials.

Artificial fertilization. The simplest methods of artificial fertilization mean administration of sperm in a neck or in a cavity of the uterus with pretreatment (washing of spermatozoa, dilution by isotonic solution of sodium of chloride, fluidifying by means of chymotrypsin) or without it. At unsuccessfulness of 3-6 procedures extracorporal fertilization is shown. For this purpose take about 12 ova from the woman and place in a medium. In 3-6 h on Wednesday add spermatozoa at the rate of about 100 thousand on 1 ovum. In 48 h from two to four 3-8 - cellular embryos implant, the others freeze for further use. Spermatozoa, oospores or embryos at an early stage of development deliver in uterine tubes in the open way or during laparoscopic operation. At inefficiency of these methods, extremely adverse indicators of a spermatogramma (number of spermatozoa less 2×106/мл; a share of cells with normal morphology less than 4%) apply the most expensive method of an intracytoplasmic injection of sperm at which one men's gamete by means of a micropipet is entered in the ovum processed by hyaluronidase. After 48 h an incubation embryos implant by the above described technique. At severe forms of male infertility the frequency of approach of pregnancy after use of an intracytoplasmic injection of sperm reaches 10%. If all listed approaches do not achieve success, artificial fertilization with use of donor sperm is shown. Many authors consider that it is possible to resort to it and at earlier stages of treatment as more difficult methods are characterized by low economic efficiency, and the related ethical problems are ambiguously estimated by society.