From the author: Medical information was provided for my book by Kuznetsky Yu.Ya. (urologist-andrologist, MD, professor) Infertility. Let's talk about the male factor Despite the fact that most of my clients are women, I also have to deal with the male factor of infertility. Some expectant mothers find themselves worried “I’m healthy, but I have to go through a bunch of procedures to get a baby... it’s hard”, doubts “with another man I could experience the happiness of motherhood”, etc. But there are women who believe that they are to blame for childlessness, although this is not the case. Here's a little story: Lena came to her first appointment in a depressed state. They had been diagnosed with infertility for about three years. She was worried about her unfulfillment as a woman, and that her husband, who was younger than Lena, might leave for someone else because of their problem. The condition was also aggravated by fatigue from endless examinations and procedures that did not bring the desired result. When understanding the situation, we always discuss the medical history. It turned out that Lena’s husband had never even taken a spermogram. The usual men’s “I’m healthy, you can’t do that,” “I won’t go, I’m sick or something,” “I won’t do this, it’s humiliating.” Lena blamed herself, although almost all of her indicators were close to normal and the doctor shrugged. Without going into details, I want to say that there was precisely a male factor in this couple. When my husband did take a spermogram, it turned out that conceiving a baby on his own with such sperm was almost impossible. Nowadays, there are fewer and fewer cases where a woman is deceived about her factor. Thanks to doctors who prescribe a spermogram almost immediately when examining a couple. Would you like to see an article about the causes of infertility? Below is the link for you See here about the causes of infertility and help But let's discuss the male factor a little. What do you need to know, what to do? Over the past 20 years, the quality of sperm of men around the world has deteriorated by 2 times. The number of infertile marriages has increased, and the importance of male pathology in the development of infertility has increased to 50%. At the same time, modern medicine makes it possible to successfully solve the problem of infertility caused by various forms that until recently were considered incurable. The effectiveness of treatment of male infertility continues to depend on a number of factors: - duration of infertility, - its form (primary or secondary), - results of sperm analysis, - age, - state of health (general and reproductive, including). The medical arsenal of assistance options includes both conservative (non-surgical) and surgical treatment methods, as well as various IVF technologies. According to world statistics, every 6-7 marriages are infertile. In Russia, given the more unfavorable environmental situation, the prevalence of sexually transmitted infections and inflammatory diseases of the male reproductive system, the state of men's health is more critical, which explains the higher frequency of infertile marriages among Russians. The main causes of male infertility We will list these factors in order of their importance.* Varicocele is a disease that occupies a leading position among the factors of male infertility (40% of male infertility cases), which is associated with varicose veins of the spermatic cord. Varicocele, as a rule, is congenital in nature, and the first manifestations are detected during puberty, when, due to the onset of active testicular activity, blood flow through the seminal vessels increases sharply. But whatever the reason leads to the development of varicocele, the main pathological mechanism that determines all the negative consequences disease is the presence of reverse blood flow through the veins. As a result, stagnation of venous blood forms in the veins of the scrotum, blood circulation in the testicles is disrupted and the temperature of the scrotum increases. All this has an extremely adverse effect on the function of the testicles, including the formation and maturation of sperm. About 60% of men with thisThe diagnosis is a violation of the spermatogenic function of the testicles. * Inflammatory diseases that affect the reproductive function of men include: inflammation of the prostate gland (chronic prostatitis) and inflammation of the seminal vesicles (chronic vesiculitis). Chronic prostatitis ranks first in prevalence among inflammatory diseases of the male genital area and one of the first places among male diseases in general. Prostatitis is more often detected in men aged 36-65 years than in men aged 18-35 years. In Russia, this disease affects up to 35% of men of working age, and in regions with low seasonal temperatures, especially in combination with significant temperature changes and high humidity, the prevalence of the disease is 72.2%. Chronic prostatitis adversely affects the reproductive function of a man, his psycho-emotional state, significantly worsens the quality of life. Chronic vesiculitis is an inflammation of the seminal vesicles, which most often occurs in combination with other inflammatory processes (prostatitis, urethritis, etc.) and is caused by certain infectious microorganisms (staphylococcus, gonococcus, etc.). * Impaired testicular function (formation and maturation of sperm) as a result of inflammation and/or trauma, cryptorchidism (anomaly of testicular development), genetic disorders, radiation therapy. * Endocrine disorders. The formation and maturation of sperm (spermatogenesis) occurs with the direct participation of the body's endocrine system. Disruption of the endocrine (hormonal) system can occur at various levels. Normally, the system functions as follows: the hypothalamus produces gonadotropin-releasing hormone, under the influence of which the pituitary gland produces gonadotropic hormones - luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In turn, LH stimulates the production of sex hormones in the testicles, including testosterone, and FSH is responsible for the formation of sperm by special cells - the spermatogenic epithelium of the testicle. Hormonal changes at any stage of spermatogenesis can lead to serious reproductive dysfunction. * Impaired passage of sperm through the genital tract can occur with the congenital absence of the vas deferens, with prostate cysts, as a result of surgical interventions in the groin area or on the organs of the scrotum, with congenital or acquired obstruction of the epididymis. * Production of antibodies to sperm. Pathology of the immune system as a factor in infertility occurs in approximately 10% of couples. The causes of the formation of antisperm antibodies (ASAT) are various conditions and diseases of the genitourinary system. * Exposure to harmful environmental factors and stress adversely affect the reproductive function of men. * Sexual function problems such as ejaculation disorders (ejaculation) can cause infertility. There are several possible options for such difficulties - delayed ejaculation, anejaculation, retrograde ejaculation, which may be based on psychogenic, congenital and acquired factors. Where should a man begin the examination? At the first stage of the examination, it is enough to do a semen analysis - a spermogram, which evaluates its fertilizing ability, the quantity and quality of sperm, and other parameters. According to the recommendation of the European Association of Urology in 2008, if a single semen examination shows spermogram parameters within the normal range, there is no need for repeated examinations. If deviations from the norm are detected in the spermogram, the study should be repeated at least twice more. If differences between sperm samples exceed 20%, then additional research is required. However, in 80% of cases, three spermograms are enough to make an initial diagnosis. How to properly prepare and take a spermogram? To obtain the most reliable results, it is necessary to prepare for such a study: 1.Sexual abstinence for 3-5 days.2. For 3-5 days, avoid drinking alcoholic beverages and coffee, taking medications (antibiotics - at least 2 weeks).3. For 3-5 days, refrain from thermal procedures - sauna, hot bath, hot shower, solarium, sunbathing. If it is necessary to re-examine the spermogram, the preparation should be absolutely the same, with a similar duration of abstinence. It is advisable to conduct research in the same laboratory. Ideally, sperm should be collected in a special container directly in the laboratory or delivered to the laboratory for analysis within the next 2 hours. There are four possible conclusions based on spermogram data: 1. Norm;2. Azoospermia - complete absence of sperm in the ejaculate; 3. Combined disorders of sperm count, their structure, motility and morphology (oligoasthenoteratozoospermia);4. Change of any one spermogram parameter. Each option determines what additional tests may be required to clarify the diagnosis: - microbiological, - hormonal, - immunological, - genetic studies, - ultrasound and x-ray diagnostics, - testicular biopsy and others. Your attending doctor will be able to prescribe additional tests. Hormonal examination of the reproductive and reproductive systems usually includes the determination of: 1. Total and free testosterone;2. Luteinizing hormone (LH);3. Follicle-stimulating hormone (FSH);4. Estradiol;5. Prolactin;6. Sex hormone binding globulin (SHBG). According to indications, hormonal examination may be performed if diabetes mellitus, dysfunction of the thyroid gland, adrenal glands, etc. are suspected. Diagnosis of immune infertility is based on testing for the presence of ASAT in the ejaculate and/or blood serum of the patient and his partner. Standard methods are: - MAR test, characterizing the percentage of sperm covered with ACAT (positive test - 10% or more motile sperm coated with ACAT); - ELISA (enzyme-linked immunosorbent assay) - titer of ACAT in the blood serum of the patient and his sexual partner. Positive results tests indicate the presence of an immune factor for infertility. Ultrasound examination of the scrotal organs allows us to identify some causes of male infertility and other pathological conditions: 1. Varicocele is a varicose vein of the spermatic cord (in 30% of infertile men). It should be noted that the subclinical form of varicocele (not detectable upon examination) can only be detected using ultrasound.2. Testicular tumor (in 0.5% of cases).3. Testicular calcifications are a sign of possible malignant degeneration (in 5% of infertile men). Ultrasound examination of the prostate (TRUS) is performed when the volume of sperm decreases (less than 1.5 ml), to identify the causes of obstruction of the vas deferens: 1. Stenosis (narrowing) of the ejaculatory ducts.2. Cysts of the central part of the prostate gland.3. Assessment of the condition of the prostate gland and seminal vesicles. What can worsen the quality of sperm? The quality of sperm can be negatively affected by various environmental, behavioral, psychological, professional and nutritional (nutritional) factors: 1. Habitual intoxication: abuse of alcohol and nicotine.2. Occupational hazards: contact with organic and inorganic substances, ionizing radiation, work in conditions of high and low temperatures.3. Trauma to the scrotal organs.4. Conflict situations in interpersonal relationships and other psychological factors.5. Nutritional factor (diet) – lack of calories and content of substances necessary for the body.6. The temperature factor is a prolonged febrile state with an increase in body temperature above 38 ° C. Modern studies have shown that the presence of cell phones at a distance of less than 30 cm. from the scrotal organs can have a negative impact on the formation and maturation of sperm. How often can a male problem be solved?