MALE INFERTILITY SYMPTOMS, CAUSES AND, TREATMENT
How does the reproductive system in men
Male genital organs are located not only inside the pelvis, but also outside it. The main male hormone testosterone is responsible for the formation of secondary genital organs. It is produced by the testes located in the scrotum. They produce sperm that goes from the testicles to the epididymis for nourishment and maturation. After maturation, the semen along the vas deferens is advanced into the seminal vesicles for storage. The complete sperm production cycle takes about 72 hours. When ejaculating, it mixes with the secret of the prostate gland; as a result, the ejaculate is formed - seminal fluid containing spermatozoa.
The ability to produce offspring (fertility) of men depends on the quality of sperm, its full development and maturation.
This process occurs with the participation of hormones:
- Testosterone;
- Luteinizing hormone (LG) - stimulates spermatogenesis in Leydig cells;
- Follicle-stimulating hormone (FSH) - stimulates spermatogenesis in Sertoli cells.
In Sertoli cells, an immature sperm forms spermatozoa and matures. Motility of the sperm occurs in the epididymis. The sperm, ready for fertilization, is stored before ejaculation in the vas deferens channel.
Sperm characteristics
The amount of sperm depends on the age of the man, his sexual activity and individual characteristics. Frequent sexual intercourse reduces the amount of sperm, but it is restored after 2-3 days of abstinence.
Normally, the volume of ejaculate is 1-6 ml, sperm has an alkaline reaction with a pH of 7-7.6. These indicators do not allow sperm to lose their mobility in the acidic environment of the vagina. Without losing their properties, they reach the cervical canal of the cervix, the pH of which is 7.5, and from there they penetrate into the uterus and into the fallopian tubes to fertilize a mature egg.
The sperm cell consists of a head and a tail with an intermediate part (neck) between them. He performs rectilinear and progressive movements to increase the possibility of meeting with the egg. One milliliter of ejaculate contains from 40 to 120 million sperm. About 60% of them are mobile, 15-20% are fixed. In the same ratio, the sperm contains mature and atypical forms of sperm (60% are mature, 15-20% are atypical).
With frequent sexual intercourse (more often than once every 2-3 days), seminal fluid contains a large number of immature sperm, with abstinence or with rare sexual intercourse in the sperm is a large number of deformed sperm.
The study of the composition and quality of sperm (spermogram) - an analysis conducted primarily in the diagnosis of male infertility.
Male Infertility Classification
The variety of causes of male sterility makes it difficult to choose a basis for classification. Forms of infertility allocated in andrology:
- Secretory infertility. Pathology consists in the production by the testes of sedentary or defective sperm, as well as in an insufficient number of motile sperm for fertilization. Infertility can be caused by congenital and acquired negative factors.
- Obstructive or excretory infertility. In this form of infertility, sperm cells mature in sufficient quantities, but cannot get through the vas deferens into the urethra. The reason is an obstacle in the way of their transportation.
- Combined sterility. Combining several types of infertility (immunological, secretory, obstructive) with the addition of an inflammatory process.
- Immunological infertility. In the body of a man, the secretion of antibodies with anti-testicular functions, for which the testicular tissue is an alien element, is carried out. Antibodies penetrate into the cells of the testicles, disrupting the hematotesticular barrier, provoke the formation of antibodies to spermatozoa. The cause of this form of infertility is testicular trauma.
- Relative infertility. Arises against the background of the absolute health of both spouses, the problem of this form of infertility is little studied.
What causes male infertility?
The factors of the appearance of male infertility are conventionally divided into the main ones that occur more frequently than others, and additional ones that act in conjunction with them. Secretory infertility (hypogonadism) is characterized by impaired spermatogenesis and testicular function. Hypogonadism is primary and secondary. In the primary form of secretory infertility, there is an increased urinary gonadotropin secretion, leading to a decrease in the effect of the tests on the function of the pituitary gland. In the secondary form of hypogonadism, the affected pituitary gland adversely affects the release of gonadotropins, reducing their number. There are forms of secretory infertility that are not accompanied by hormonal disorders.
Causes of secretory infertility:
Varicocele . The most common cause of male infertility. Its appearance provokes varicose veins of the testicle and spermatic cord. These parts of the reproductive system are men responsible for excreting sperm. Varicocele results in blood stasis, inadequate blood supply to testicular tissues, and disruption of its functioning. The factors provoking the development of pathology are an increase in the temperature of the external genital organs for a long time (visiting the bath and sauna, wearing too warm pants, synthetic clothes), vibration, as a professional hazard (driver's profession).
Dropsy testicle. In the scrotum as a result of a number of reasons (for example, an inguinal hernia) an excess amount of fluid accumulates. This circumstance provokes squeezing of the testicle, impaired blood circulation, which reduces or completely stops the production of spermatozoa.
Cryptorchidism. In this developmental disorder of the reproductive organs, the testicles do not descend into the scrotum but remain in the abdominal cavity. It is diagnosed at an early age and must be treated operatively until the boy reaches the age of 7 years. If this is not done, the testicles will not be able to produce spermatozoa due to the higher temperature inside the body than in the external environment. Even if the testicles produce a small amount of sperm, they will die immediately.
Mumps Epidemic parotitis, or mumps, is an infectious disease that affects the salivary glands. It is transmitted by airborne droplets, while the body undergoes high intoxication. Complications of mumps - orchitis, or inflammation of the testicles, which affects the spermatogenic tissue of this organ (epithelium).
Other infectious diseases. Complications of sexually transmitted infections (syphilis, gonorrhea, chlamydia, etc.) lead to the destruction of testicular tissue, the inability to produce sperm. Other infectious diseases (typhoid, brucellosis , tuberculosis) that cause toxic effects on the body and significant hyperthermia have a similar effect .
Hormonal disorders. In this form of infertility, spermatogenesis is disturbed due to an imbalance of testosterone and other sex hormones. The reason for this may be an excess of prolactin (hyperprolactinemia, tumor or inflammation of the pituitary gland, secondary hypogonadism. Pathology of the endocrine system has a similar effect: thyroid, pancreas, adrenal glands, obesity .
Genetic and hereditary diseases. There are a number of chromosomal abnormalities (Shershnevsky-Turner syndrome, Klinefelter syndrome, Nuan syndrome, Cartagener syndrome), accompanied by gonadal dysgenesis, which makes a man infertile. Hereditary pathologies (polycystic kidney disease, cystic fibrosis) have a similar effect.
Injuries and tumors, testicular torsion. These causes include injuries, absence, testicular torsion, tumors of the prostate gland and other parts of the reproductive system.
The action of external adverse factors. In this category are:
- Side effects of drugs of individual pharmacological groups (nitrofurans, cytostatics, acetylsalicylic acid, narcotic analgesics, antibiotics, sulfonamides, hormonal preparations containing estrogens, androgens, cortisone);
- Ionizing radiation;
- Alcohol use, smoking;
- Occupational hazards (exposure to lead, phosphorus, mercury, manganese compounds, ammonia, pesticides).
- Adverse effect on spermatogenesis hypovitaminosis, which can lead to an unbalanced diet, starvation. Lack of vitamins of groups A, C, D, E violates the potency and full spermatogenesis.
High temperatures. Visiting the sauna or bath, cycling, wearing cramped clothes or linen from synthetics, professions associated with staying in conditions of high ambient temperature (foundry, bakery, boiler room).
Chronic stress and age. The impact of these factors reduces the quality and motility of sperm.
In case of one- or two-sided violation of sperm transport via the sperm ducts, we are talking about obstructive infertility.
Causes of obstructive (obstructive) infertility :
- Epididymitis. The process is similar to the occurrence of obstruction of the fallopian tubes in women. Epididymitis is a complication of inflammation of the epididymis, when gluing and further obliteration of the spermatic ducts occurs.
- Injuries and damage. Infertility occurs as a result of accidental damage during surgery on the ureters, prostate, bladder, rectum, and as a result of injury to the scrotum.
- Tumors of the epididymis. The hypertrophy of tissues as a result of the appearance of cysts and tumors leads to squeezing of the vas deferens.
- Congenital anomalies. These include hypospadias (removal of the urethral flow in the lower third of the penis), the absence of an epididymis or a seed of the excretory canal.
- Aspermatism . The essence of true aspermatism is the atypical effect of the cerebral cortex on the functioning of the genital centers. As a result, there is no release of semen during sexual intercourse of any length. False aspermatism is not excreted into the urethra, but into the bladder (retrograde ejaculation). The cause of this phenomenon is the consequences of diabetes, multiple sclerosis , inflammation of the reproductive organs, spinal cord injuries, operations on the bladder and prostate gland, side effects of antidepressants and tranquilizers.
Other reasons. Other causes of male infertility include:
- Impotence(erectile dysfunction) - it is impossible to have full sexual intercourse.
- Premature ejaculation - the removal of sperm before the introduction of the penis into the vagina.
- Irregular go rare sexual contacts.
- Overly active sex life - with frequent sexual intercourse with different partners increases the risk of STD infection, reduces immunity, body tone, not enough time for full maturation of active sperm.
- Sexual illiteracy.
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