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What is Infertility?

What is male infertility?

Infertility is defined as infertility, that is, the inability to have children. Fertility is sexually active couples achieving spontaneous pregnancy without protection. So, what is male infertility? Male infertility is seen in about half of couples who cannot have children.

There are many causes of male infertility:

Hormonal problems

Genetic diseases and chromosome (DNA damages)

Problems with sperm production (like varicocele – enlargement of testicular veins)

Difficulty in erection or ejaculation

Urogenital (excretory and mating system) infections

Immune system diseases

Cancers

Tests and treatments vary according to the cause of infertility.

 

In case of male infertility, either semen cannot reach the egg (clogging) or the semen quality is low. In 30-40% of male infertility patients who request infertility treatment, no cause can be found. (idiopathic/unspecified male infertility).

 

Diagnosis of male infertility

Your doctor will question your medical history. Abdominal, penile and testicular examination and sometimes prostate examination. Scrotum ultrasound and semen analysis, blood and urine test are done.

 

The Medical History

It is the meeting you have with your doctor. Your doctor will try to identify your lifestyle and habits that will affect male infertility. The interview focuses on the following various reasons:

Thyroid diseases

Diabetes

Erectile dysfunction (inability to get an erection)

Life or work-related adverse events (chemical exposure, pesticide exposure, etc.)

Exposure to extreme heat (cooking, working in a bakery, iron and steel production, etc.)

Stress

Smoking or being a passive smoker

Drugs, alcohol use, steroid and androgen group drugs, narcotic drug use

Infections

Traumas to the genital area

Undescended testicles or late treated testicles

Some medications can also cause male infertility:

 

Heart treatments: beta-blockers, thiazides, calcium channel blockers, arrhythmia treatment

Hormonal therapies: antiandrogens

Pain killers: nonsteroidal anti-inflammatory drugs (NSAIDs)

Epilepsy treatments

Allergy treatments

Fungus treatments

Physical examination

Evaluations such as hypospadias, mass in the testicles, varicocele and obesity are made.

 

Negative effects of body mass index (obesity):

Erectile dysfunction

Sex hormone disorders

Scrotal temperature

Semen quality

 

In most cases, male infertility is detected, with both semen not reaching the egg and poor semen quality. The most common causes and treatment of male infertility are discussed below.

 

Blood Hormone Tests

In this test, which is performed by taking blood from the vein, the functioning of the testicles is evaluated. In addition, other analyzes that affect sperm quality can also be performed. The tests to be done are:

FSH and LH (gonadotropins, testicular enlargement hormone)

Prolactin

Inhibin b (INHBB)

Testosterone

Sex hormone binding globulin

Thyroid hormones (goiter)

Cholesterol levels

Blood sugar

Kidney and liver function tests

 

Semen analysis

It is done by evaluating the semen sample in a sterile container in the laboratory. Tests without ejaculation for 2-5 days are necessary for proper evaluation. It should be evaluated shortly after it is given. Due to the variability of semen quality, clearer results are obtained with at least two tests.

 

The laboratory evaluates the amount, color, odor and density of semen. Then, with the microscope, he can see the viability of the sperm and possible infections. The normal values ​​of semen were standardized by the World Health Organization (WHO) in 2010.

 

Ultrasound

Ultrasound evaluates tissue, cysts, and tumors of the testicles and epididymis. Transrectal ultrasound may be required if obstruction is suspected.

 

Urine test

It is made for infections.

 

Testicular biopsy

In non-obstructive azoospermia (non-obstructive azoospermia, NOA) cases, when there is no clear finding suggesting obstruction and there is no sperm in the semen, Testicular Sperm Extraction – TESE, that is, sperm extraction from the testicles, is performed. It can even be used for assisted reproductive techniques if sperm is found.

 

Genetic tests

In cases with low sperm count, karyotype count is done. Normal karyotype; 46 is known as XY. Males have an x ​​and a y chromosome. If the karyotype is not normal, fertility may be affected. Abnormal karyotype can also affect hormones. In some diseases, long arms and legs, small testicles and female type right distribution are seen characteristically. Some men require Y chromosome tests. Genetic analysis tests are performed if the urology specialist needs it according to the examination findings and symptoms.

 

Causes of male infertility

 

Azoospermia is the absence of sperm cells in semen analysis or post-ejaculation urinalysis.

If it is due to turbidity, it is defined as obstructive azoospermia (OA).

 

The path of sperm cells can be blocked in various situations:

In the testicles, that is, the production site of sperm

Epridid ​​is a ball of ducts through which the sperm are transported from the testicles to the main duct (vas deferens).

The vas deferens is the channels through which the sperm from the epididymis are transported to the prostate. Sometimes it can be discontinued as a male contraceptive method.

Ejaculatory duct: It is the last duct that carries fluids from the prostate and vas deferens to the urinary tract. Some may become blocked by cysts or inflammation.

The most common causes of obstructions are infections, (eg, gonorrhea, chlamydia, prostatitis, tuberculosis), congenital obstructions, or trauma.

 

Treatment varies depending on the severity and location of the obstruction. Semen can be collected from the testicles or epididymis by biopsy. Vas deferens occlusions can be corrected with surgery.

 

Vasectomy or vasectomy repair

Vasectomy is a method used to prevent sperm flow from the testicles/epididymis to the prostate and to provide birth control. It is a permanent application and is extremely difficult to recycle.

 

Varicocele

It is a very common disease that occurs with “enlargement” of testicular vessels. Enlarged veins negatively affect the temperature increase in the testicles and thus sperm production. Varicocelectomy, that is, varicocele surgery, is an operation performed by a urologist for pain, male infertility and hormonal disorders of the testicles.

 

Hypogonadism (testicular failure)

It is a condition in which the testicles are insufficient in both hormone production and sperm production. There are hormonal or structural causes. Diagnosis is made with advanced hormone tests and appropriate treatment is given. If the testicles are structurally inadequate, the method of obtaining sperm by biopsy (TESE) can be applied.

 

Cryptorchidism, occult testicles, undescended testicles

It is the absence of one or both testicles in the scrotum, the egg sac. It is the most common congenital disease of the male genitalia. It is present in almost 1% of 1 year old children. It should be corrected by one year. Sperm retrieval is limited in later corrections.

 

Infection of the genital tract

Urogenital infections are among the treatable causes of male infertility.

Urethritis-Urethra Infection

Prostatitis-Prostate Infection

Orchitis-Testicular Infection

Epididymitis-Epididymis Infection

 

The urologists arrange the appropriate treatment according to the semen swab and culture tests.

 

Testicular cancers

It is the most common cause of cancer in 15-40 men. It is the cause of 1% of male infertility. Testicular cancer causes a decrease in semen quality. Sperm freezing is recommended before testicular removal. Because cancer treatment will further reduce the quality of semen. It is a disease that requires many years of follow-up.

 

Testicular microcalcification (calcification)

Microcalcification is seen in 9% of patients undergoing testicular ultrasonography for any reason. Its incidence increases in patients with cancer, undescended testicles, infertility, hypogonadism and varicocele. It usually requires follow-up, but in some patients your urologist may recommend a biopsy. Self-examination (self-examination) is recommended in these patients.

 

Ejaculation (ejaculation problems)

In some cases, ejaculate (semen) may not reach the urethra. Ejaculation may be absent, delayed or may go backwards towards the bladder (retrograde ejaculation). Psychological, physical problems (like nervous system dysfunction, traumatized surgical procedures), some medications are possible causes. Treatment options are with medication or physical stimulation.

 

Semen Freezing

In some cases, semen can be frozen for later use. It is the storage of semen under special conditions by taking it under sterile conditions and cooling it at “-80 or -196°C”. When used, it should be heated to 37 degrees in a water bath and used immediately. However, there is a possibility that no living cells will be found. Usually, several semen samples are frozen. Various procedures are available, depending on the nature of the problem.

 

Semen freezing indications

In chemotherapy or radiotherapy with high sterilization potential

In case of rapid decline in semen quality

Conditions that can be achieved with electrostimulation in paralyzed patients

Finding semen with gonadotropin (testicular growth hormone) treatment.

It can be done in patients with non-occlusive azoospermia (NOA).

 

Dear patients, it was a study I did on male infertility. We have more to come. Thank you for reading.


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Varicocele

Microscopic Varicocele

Varicocele is the formation of enlargement (varicose) in the testicles. Varicose veins are usually seen on the legs and lower parts of the body. Varicocele disease, on the other hand, is the changes that occur in the testicles with the increase in fluid pressure in the testicular veins. It is the inability of the veins carrying the dirty blood coming out of the testicles in men to function well due to the disorder and thus not being able to carry the dirty blood inside the heart to the heart. Due to the dirty blood accumulating in these veins, the veins swell and become wrinkled. We call varicocele similar to the varicose veins that occur in the legs (especially in women) in the testicles.

Varicocele can cause the following negative situations that can be revealed in the spermiogram (sperm analysis) in the semen:

Decrease in sperm count

Impaired sperm motility

Sperm shape (morphology) deterioration

These negative effects are caused by the following mechanisms:

Increased temperature as a result of the accumulation of blood that cannot be expelled in the testicles

The harmful products that need to be removed from the testicles cannot be removed from the damaged vessels and return to the testicles (reflux)

Accumulation of dirty blood in the testicles.

How is varicocele diagnosed?

The most important method in diagnosis is an examination by an experienced urologist. The examination must be done standing up. Physical examination is the most valuable method. Varicocele is divided into 3 Stages according to examination:

 

Stage I: It is the mildest Stage and is palpable on outpatient examination only with maneuvers such as coughing/straining.

Stage II: It is understood in the palpation examination without the need to increase the intra-abdominal pressure in the standing examination.

Stage III: This is the most severe type and there are varicose veins visible on the foot.

It is revealed by feeling the varicose veins with the hand in cases that increase intra-abdominal pressure. The second step in the diagnosis is scrotal color Doppler ultrasonography in the presence of conditions that make the physical examination difficult. With this examination, it reveals the diameters of the sick veins, whether the dirty blood returns to these veins, and whether there is a loss of volume in the testicles.

 

Which patients benefit more from microsurgery?

Those with advanced varicocele (Stage II and Stage III varicocele)

  • Those with normal/near normal testicular volume
  • Patients with normal blood Testosterone, FSH values ​​and low inhibin B values

Patients with normal genetic tests

Patients presenting early for infertility

Those with sperm count more than 5 million

  • Patients without molecular disorders.

What should be the follow-up after varicocele surgery?

After varicocelectomy surgery, daily work can be done after 1 day of rest at home. After 1-2 weeks, sexual activation is allowed, after 2-4 weeks, heavy work and sports activities are allowed.

 

After varicocele treatment, the cases should be followed up regularly at regular intervals. Pre-puberty patients are followed up in the urology outpatient clinic with routine examination and examination once a year, and adult patients with sperm analysis every 3 months until they have a child. Even if it is not possible to have a child after varicocele surgery, assisted reproductive treatment methods such as vaccination or in vitro fertilization are also beneficial.


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What is Andropause?

It comes from the Greek words “andros” meaning man and “pausis” meaning pause. The widely accepted name is incorrect, because unlike female menopause, when reproductive and hormonal functions stop, it simply decreases. Therefore, the name used today is Testosterone Deficiency Syndrome (TDS).

 

What exactly is Andropause or Testosterone Deficiency Syndrome?

This is the period in a man’s life characterized by a decline in testosterone levels and accompanying clinical symptoms of hypogonadism, usually beginning after the age of 50. Among the symptoms of TDS,

 

decreased libido,

gynecomastia (male breast enlargement),

hair reduction,

decrease in testicular volume,

decrease in bone mineral density,

TDS and erectile dysfunction should not be confused with impotence.

decrease in muscle mass and strength,

hot flashes,

energy reduction,

mood disturbance,

memory and concentration problems

sleep problems or increased body fat levels etc…

In some cases, TDS occurs even before age 50. It depends on many factors such as genes, lifestyle, body weight, addictions, medications, stress level or mental state. It is often associated with the presence of other diseases such as Type 2 diabetes, metabolic syndrome, osteoporosis.

 

The diagnosis of testosterone deficiency syndrome is made after a detailed physical examination and an evaluation with a blood test given “hungry and in the early morning”. It can be effectively treated with testosterone replacement therapy.

 

We recommend that you consult your doctor for detailed information and evaluation, we wish you a healthy day.


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What is Varicocele?

Varicocele is the varicose veins that drain the blood in the testicles, which is seen in approximately 30-40% of those who apply to the doctor with the problem of infertility. Varicocele is the clinical name given to varicose-like enlargement of testicular veins in the legs. Deterioration of testicular temperature affects testicular functions and impairs sperm and testosterone production by accumulation of toxic substances in dirty blood in the testicles and disrupting testicular blood flow.

 

What are the Symptoms of Varicocele?

Varicocele symptoms are very important for the diagnosis and treatment of the disease. Varicocele on testicles;

– Swelling

– Fluffiness

– It may give symptoms in the form of pain in the testicles.

 

The enlargement of the veins may become so obvious that it can be seen from the outside after a while and take a form similar to varicose seen in the legs. Varicocele symptoms include swelling in the testicles, as well as sweating and a feeling of warmth. Although rare, shrinkage of the testicles, which is one of the symptoms of varicocele, can be seen in some patients.

 

How is Varicocele Treatment?

After the diagnosis of varicocele, first of all, it should be checked whether there is a difference in testicular dimensions and the consistency of the testicles. Semen analysis, in which sperm parameters are evaluated, is decisive in the treatment. If there is no problem in the sperm parameters of the patient, it is controversial whether to have surgery or not.

 

Factors that may impair sperm parameters in such patients:

– Eating habits

– Smoking and alcohol use

– Exposure to toxic substances

 

Antioxidant drugs and nutritional methods can be recommended to improve sperm parameters and the environment where sperm are found. After the diagnosis, the question of which varicocele patients should be operated on comes to the fore. It is not a correct approach to decide on surgery by looking at the varicocele grade, that is, the grade value. While even 1st degree (Grade 1) varicocele can be operated in some cases, surgery may not be decided for 3rd degree (Grade 3) varicocele in some cases. The decision of surgery is a situation that varies according to the patient.

Supportive treatments can be recommended for patients who are diagnosed with varicocele but do not have infertility problems or whose sperm parameters are on the borderline. Antioxidant agents can be given to patients who have not experienced severe sperm loss, whose sperm motility is not completely lost and whose sperm deformity is minimal. However, surgery can be recommended for patients with a diagnosis of varicocele, impaired sperm parameters and infertility. In such patients, there is no benefit to exercise, changes in diet and lifestyle to relieve the discomfort.

 

Click for an appointment.


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Genital Wart – What is HPV Virus?

Genital warts seen in men and women are the genital manifestations of sexually transmitted HPV infection. Especially in women, other HPV types can be found in the body at the same time and therefore, such as Pap Smear tests need to be done. Genital warts are light or dark brown bumps on the skin, sometimes as spots. It can be seen as one, or multiple warts can appear side by side in a cauliflower shape like warts when you look carefully, or it is not noticed at all. They may itch or cause bleeding during sexual intercourse.

 

It is known that 60 percent of women and men have encountered HPV at some point in their lives. After the virus enters the body, it is usually suppressed by the immune system. Types that cause genital warts when not suppressed show symptoms after an average of 1 year after infection.

 

Whether the virus gives symptoms or not, since it is in the body, there is a possibility of infecting other people. Therefore, it cannot be determined when and from whom the HPV virus was transmitted. The earlier genital warts are diagnosed, the easier it is to treat. Warts are treated with creams, various burning methods or surgery depending on their size.

 

Genital warts are seen in 1% of the society. In the 20s, this rate rises to 7 percent. Even if the cervical cancer vaccine is given, screening programs must be continued. From the age of 21, all women should have a smear every three years.

 

The screening Co-Test, in which HPV and PAP smear test are used together, is recommended to be done from the age of 30. If both of these results are good, the rate of developing cervical cancer or precancerous lesion within five years drops to 0.08 percent.

 

How is HPV Transmitted?

HPV virus can be seen in both sexes and is transmitted from person to person through sexual contact. In addition to vaginal and anal intercourse, HPV can be transmitted by skin contact in the genital area not covered by the condom.

Although genital warts are not visible, contact of HPV-infected skin to the genital area is sufficient for the virus to be transmitted.

  • After being infected with HPV, it can remain silent in the body for many years and does not cause genital warts in everyone. In many people, HPV is neutralized by the body’s defense system.
  • After the HPV types that cause genital warts are infected, warts may appear after a few months or years. During this period, the person becomes a carrier and can transmit the disease to others.

In pregnant women with HPV, it can be passed from mother to baby during delivery.

  • It is not possible to determine from which partner the genital warts are transmitted and how long the virus has been in the body.

In untreated patients, warts can multiply and grow in size.

Genital Warts Symptoms

What Are the Symptoms of Genital Warts?

Genital warts are the size of a pinhead, blistering and rough. When they are more than one, they can combine to take the appearance of cauliflower. Initially, they may be skin-colored or in the form of brown bumps. While warts usually do not cause any complaints, they can sometimes cause itching and bleed during sexual intercourse.

 

Warts can be single, grouped, higher than the skin, flat or “cauliflower” shaped.

The skin can be raised, rough, skin-colored, light brown or gray in color.

Usually there is no feeling of pain. However, it may be itchy.

It may bleed slightly during sexual intercourse.

It can occur within weeks or months after sexual contact with a person with warts.

HPV infection that causes genital warts can rarely cause warts in the throat if the mouth comes into contact with the genital area.

In women:

Vulva (external female genitalia)

In or around the vagina

In or around the anus

In the groin (where the genital area meets the inner thigh)

In the cervix

In men:

Penis,

Testicles,

Groins,

It occurs in one or more areas between the legs or in the anus.

Diagnostic Methods of Genital Warts

Genital warts are very typical in terms of their appearance. It can be detected in women and men, especially during the annual routine examination or by being examined by a specialist doctor when symptoms are observed.

 

If you have genital warts, do not have sexual intercourse until your treatment is finished and inform your partner as well. In women, HPV is an important risk factor for cervical cancer. Therefore, the following tests are done for the presence of other HPV types besides genital warts:

 

Pap Smear Test

During the gynecological examination, a sample is taken from the entrance of the vagina by means of a special brush or spatula. It is a painless procedure. It is determined whether there are cellular changes in the cervix. Smear test alone is not enough to diagnose cancer. A positive smear test indicates that there is a problem and diagnostic tests are needed.

 

HPV DNA test

If the Pap smear is abnormal, the possibility of HPV causing cancer is investigated.

 

Colposcopy

Examination of the vulva, vagina and cervix with a lighted magnifying glass.

 

Cervical Biopsy

Tissue is taken from the cervix and cell changes that may cause cancer are investigated.

 

Treatment Methods of Genital Warts

There is no treatment that will rid your body of the HPV infection. However, genital warts can be removed by the following methods. In the treatment, it is aimed not only to eliminate the warts, but also to completely clean the tissue where the wart is located.

 

Genital warts are treated with cream, cryotherapy (burning) or freezing, and if the wart is large, it is treated with surgery.

 

Ointment

These are drugs that provide treatment by chemically burning the wart tissue.

 

Cryotherapy

This allows the wart to freeze and disperse by spraying it with liquid nitrogen. It does not require anesthesia.

 

Electrocauterization

The warts are burned by means of electric current, the area is anesthetized with local anesthesia and the procedure is performed.

 

Surgical Treatment of Genital Warts

It is usually done under anesthesia and the warts are removed by surgery one by one by the surgeon. The main goal in treatment is to completely destroy the base tissue where the warts are located.

 

With all these treatment methods, existing warts heal. However, surrogacy can continue for years. Therefore, depending on the changes in the immune system of the person, warts may reappear.

 

Treatment of HPV/Genital Warts in Men

Currently, there is no test that can show the presence of HPV in men. Warts are usually seen on the penis, scrotum, around the anus and in the groin of men. If warts, moles, blisters, sores, ulcers, white spots or other abnormal structures are noticed on the penis and around it, then a specialist should be consulted.

 

The types of HPV that can cause warts in the genital area are not the same as the types that can cause cancer. Other types can lead to penile, anus and mouth-throat cancers. However, HPV prevention is still important for men, as the virus has been linked to rare cancers such as penile, anal, and head and neck.

 

Treatment of genital warts in men is done with medication, surgery, burning or freezing.


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What is Infertility?

What is male infertility?

Infertility is defined as infertility, that is, the inability to have children. Fertility is sexually active couples achieving spontaneous pregnancy without protection. So, what is male infertility? Male infertility is seen in about half of couples who cannot have children.

There are many causes of male infertility:

Hormonal problems

Genetic diseases and chromosome (DNA damages)

Problems with sperm production (like varicocele – enlargement of testicular veins)

Difficulty in erection or ejaculation

Urogenital (excretory and mating system) infections

Immune system diseases

Cancers

Tests and treatments vary according to the cause of infertility.

 

In case of male infertility, either semen cannot reach the egg (clogging) or the semen quality is low. In 30-40% of male infertility patients who request infertility treatment, no cause can be found. (idiopathic/unspecified male infertility).

 

Diagnosis of male infertility

Your doctor will question your medical history. Abdominal, penile and testicular examination and sometimes prostate examination. Scrotum ultrasound and semen analysis, blood and urine test are done.

 

The Medical History

It is the meeting you have with your doctor. Your doctor will try to identify your lifestyle and habits that will affect male infertility. The interview focuses on the following various reasons:

Thyroid diseases

Diabetes

Erectile dysfunction (inability to get an erection)

Life or work-related adverse events (chemical exposure, pesticide exposure, etc.)

Exposure to extreme heat (cooking, working in a bakery, iron and steel production, etc.)

Stress

Smoking or being a passive smoker

Drugs, alcohol use, steroid and androgen group drugs, narcotic drug use

Infections

Traumas to the genital area

Undescended testicles or late treated testicles

Some medications can also cause male infertility:

 

Heart treatments: beta-blockers, thiazides, calcium channel blockers, arrhythmia treatment

Hormonal therapies: antiandrogens

Pain killers: nonsteroidal anti-inflammatory drugs (NSAIDs)

Epilepsy treatments

Allergy treatments

Fungus treatments

Physical examination

Evaluations such as hypospadias, mass in the testicles, varicocele and obesity are made.

 

Negative effects of body mass index (obesity):

Erectile dysfunction

Sex hormone disorders

Scrotal temperature

Semen quality

 

In most cases, male infertility is detected, with both semen not reaching the egg and poor semen quality. The most common causes and treatment of male infertility are discussed below.

 

Blood Hormone Tests

In this test, which is performed by taking blood from the vein, the functioning of the testicles is evaluated. In addition, other analyzes that affect sperm quality can also be performed. The tests to be done are:

FSH and LH (gonadotropins, testicular enlargement hormone)

Prolactin

Inhibin b (INHBB)

Testosterone

Sex hormone binding globulin

Thyroid hormones (goiter)

Cholesterol levels

Blood sugar

Kidney and liver function tests

 

Semen analysis

It is done by evaluating the semen sample in a sterile container in the laboratory. Tests without ejaculation for 2-5 days are necessary for proper evaluation. It should be evaluated shortly after it is given. Due to the variability of semen quality, clearer results are obtained with at least two tests.

 

The laboratory evaluates the amount, color, odor and density of semen. Then, with the microscope, he can see the viability of the sperm and possible infections. The normal values ​​of semen were standardized by the World Health Organization (WHO) in 2010.

 

Ultrasound

Ultrasound evaluates tissue, cysts, and tumors of the testicles and epididymis. Transrectal ultrasound may be required if obstruction is suspected.

 

Urine test

It is made for infections.

 

Testicular biopsy

In non-obstructive azoospermia (non-obstructive azoospermia, NOA) cases, when there is no clear finding suggesting obstruction and there is no sperm in the semen, Testicular Sperm Extraction – TESE, that is, sperm extraction from the testicles, is performed. It can even be used for assisted reproductive techniques if sperm is found.

 

Genetic tests

In cases with low sperm count, karyotype count is done. Normal karyotype; 46 is known as XY. Males have an x ​​and a y chromosome. If the karyotype is not normal, fertility may be affected. Abnormal karyotype can also affect hormones. In some diseases, long arms and legs, small testicles and female type right distribution are seen characteristically. Some men require Y chromosome tests. Genetic analysis tests are performed if the urology specialist needs it according to the examination findings and symptoms.

 

Causes of male infertility

 

Azoospermia is the absence of sperm cells in semen analysis or post-ejaculation urinalysis.

If it is due to turbidity, it is defined as obstructive azoospermia (OA).

 

The path of sperm cells can be blocked in various situations:

In the testicles, that is, the production site of sperm

Epridid ​​is a ball of ducts through which the sperm are transported from the testicles to the main duct (vas deferens).

The vas deferens is the channels through which the sperm from the epididymis are transported to the prostate. Sometimes it can be discontinued as a male contraceptive method.

Ejaculatory duct: It is the last duct that carries fluids from the prostate and vas deferens to the urinary tract. Some may become blocked by cysts or inflammation.

The most common causes of obstructions are infections, (eg, gonorrhea, chlamydia, prostatitis, tuberculosis), congenital obstructions, or trauma.

 

Treatment varies depending on the severity and location of the obstruction. Semen can be collected from the testicles or epididymis by biopsy. Vas deferens occlusions can be corrected with surgery.

 

Vasectomy or vasectomy repair

Vasectomy is a method used to prevent sperm flow from the testicles/epididymis to the prostate and to provide birth control. It is a permanent application and is extremely difficult to recycle.

 

Varicocele

It is a very common disease that occurs with “enlargement” of testicular vessels. Enlarged veins negatively affect the temperature increase in the testicles and thus sperm production. Varicocelectomy, that is, varicocele surgery, is an operation performed by a urologist for pain, male infertility and hormonal disorders of the testicles.

 

Hypogonadism (testicular failure)

It is a condition in which the testicles are insufficient in both hormone production and sperm production. There are hormonal or structural causes. Diagnosis is made with advanced hormone tests and appropriate treatment is given. If the testicles are structurally inadequate, the method of obtaining sperm by biopsy (TESE) can be applied.

 

Cryptorchidism, occult testicles, undescended testicles

It is the absence of one or both testicles in the scrotum, the egg sac. It is the most common congenital disease of the male genitalia. It is present in almost 1% of 1 year old children. It should be corrected by one year. Sperm retrieval is limited in later corrections.

 

Infection of the genital tract

Urogenital infections are among the treatable causes of male infertility.

Urethritis-Urethra Infection

Prostatitis-Prostate Infection

Orchitis-Testicular Infection

Epididymitis-Epididymis Infection

 

The urologists arrange the appropriate treatment according to the semen swab and culture tests.

 

Testicular cancers

It is the most common cause of cancer in 15-40 men. It is the cause of 1% of male infertility. Testicular cancer causes a decrease in semen quality. Sperm freezing is recommended before testicular removal. Because cancer treatment will further reduce the quality of semen. It is a disease that requires many years of follow-up.

 

Testicular microcalcification (calcification)

Microcalcification is seen in 9% of patients undergoing testicular ultrasonography for any reason. Its incidence increases in patients with cancer, undescended testicles, infertility, hypogonadism and varicocele. It usually requires follow-up, but in some patients your urologist may recommend a biopsy. Self-examination (self-examination) is recommended in these patients.

 

Ejaculation (ejaculation problems)

In some cases, ejaculate (semen) may not reach the urethra. Ejaculation may be absent, delayed or may go backwards towards the bladder (retrograde ejaculation). Psychological, physical problems (like nervous system dysfunction, traumatized surgical procedures), some medications are possible causes. Treatment options are with medication or physical stimulation.

 

Semen Freezing

In some cases, semen can be frozen for later use. It is the storage of semen under special conditions by taking it under sterile conditions and cooling it at “-80 or -196°C”. When used, it should be heated to 37 degrees in a water bath and used immediately. However, there is a possibility that no living cells will be found. Usually, several semen samples are frozen. Various procedures are available, depending on the nature of the problem.

 

Semen freezing indications

In chemotherapy or radiotherapy with high sterilization potential

In case of rapid decline in semen quality

Conditions that can be achieved with electrostimulation in paralyzed patients

Finding semen with gonadotropin (testicular growth hormone) treatment.

It can be done in patients with non-occlusive azoospermia (NOA).

 

Dear patients, it was a study I did on male infertility. We have more to come. Thank you for reading.


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Vasectomy

What is a vasectomy?

Vasectomy, also known as “Voluntary Sterilization”, is the most effective, permanent and reliable method of contraception, which is becoming increasingly common in men all over the world. This method is one of the birth control methods that can be applied within family planning and the success rate is close to 100%.

Vasectomy is known as a birth control method, which has become quite common in recent years. The method, which is frequently preferred in America and Europe, is very reliable and offers a permanent solution. Long-term studies have shown that vasectomy provides almost 100% protection. It can also be defined as a permanent birth control method. The purpose here is to prevent sperm from entering the urethra and thus to prevent pregnancy from occurring.

 

In the vasectomy method, both channels of the male individual are connected. With this method, sperm do not mix with the semen and there is no sperm in the semen from the man.

 

The vasectomy method is a birth control method applied to men. It can also be defined as the binding of sperm channels. It is the equivalent version of the tube ligation method that exists in women. It is among the most widely used methods in Europe, America and China. After the method is applied, semen continues to come from the penis. However, there is no sperm in this fluid. Therefore, it does not cause pregnancy. In addition, there is no deterioration in hormones after vasectomy. This is because vasectomy has no effect on the hormone production of the testicles. The testicles continue to produce both hormones and sperm, but pregnancy does not occur because the sperm produced cannot leave the testicles.

 

How Is Vasectomy Performed?

It can be applied by cutting the sperm pathways (vas deferens). In addition, the process takes around 30 minutes on average. After the procedure is over, no hospitalization is required. In addition, it can provide full protection after an average of 3 months. In addition, married men must get permission from their husbands to have this method done.

 

It is among those known to have two different methods. The first of these is conventional vasectomy, while the other is defined as no-scalpel vasectomy.

 

To Whom Can Vasectomy Be Applied?

Who can have a vasectomy? All single and adult men can have it done as they wish. However, in order for married men to have it done, their spouse must also approve. It is forbidden to do it without the consent of the spouse. Before the procedure, individuals are informed in detail. It is very suitable for individuals who do not want children at all. However, for those who want to have children afterwards, it can cause some problems in the future. It may be necessary to perform some risky operations. For this reason, it is not recommended for people who want to have children in the next period. But it is still not unsolvable.

 

Men/couples who do not want to have children

Men/couples who have a hereditary disease and whose childbearing is dangerous for the child and/or himself

Men/couples who have as many children as they want and don’t want any more children

Men/couples who do not prefer to be protected with other contraception methods

In accordance with the law, anyone over the age of 18 can have a sterilization procedure with their own consent, or with the consent of their spouse if they are married.

 

What Are the Advantages and Disadvantages of Vasectomy?

Bleeding can occur after vasectomy, as it can be with almost any procedure. But these bleedings are of little importance. It is bleeding that does not harm the person. However, it is known that the risk of infection is very low. It must be applied in a non-sterile environment for infection to occur.

 

Since sperm production continues, sperm can accumulate in the connected channels and turn into a lump. There is no harm in this because it is taken quite easily. There is almost no risk of getting pregnant after the procedure. It does not cause any negative effects in sexual intercourse.

 

The most important advantage of vasectomy is that it is a permanent and life-long birth control method. The procedure is performed by urology specialists under local anesthesia and in practice conditions. In today’s conditions, it has become a very easy and safe process. It can be said that vasectomy has a positive effect on sexual life, since the anxiety or discomfort of other birth control methods is eliminated. Since the operations performed will not be related to semen production; there will be no change in the amount and appearance of semen in men after the procedure.

 

Likewise, since hormone production continues without any change, no physical changes in sexual desire and activity content are anticipated. On the other hand, since vasectomy is a permanent method, it progresses. Depending on the individual’s desire to have a child again in the course of time; Reopening of channels by operation may not always be successful. In such cases, surgical sperm search and microinjection may be required.

 

Effectiveness of Vasectomy Operation

Some sperm can survive in the tubes for several weeks after vasectomy. These sperm can pass into the semen for the first few weeks after the operation. For this reason, it is recommended to have a semen test approximately 12 weeks after the operation and to switch to unprotected sex only if no sperm is seen in the semen. If sperm cells are encountered as a result of the test, the sperm analysis should be repeated after 1 month. Patients should continue to use an additional method of contraception during these periods.

 

Is There a Reversal of Vasectomy?

Vasectomy is reversible, but this can become quite problematic. The recycling rate is around 50% on average. Since it is a precise and easy method, it can be applied quite simply. However, recycling is not such a simple process. Microsurgery is needed. For his return, the patient is operated under anesthesia. It is a process that takes 2 hours on average. Even if the operation is completed successfully, blockages may occur. For this reason, it is recommended that the person who has had a vasectomy think very carefully.

 

Possible Risks of Vasectomy Procedure

The possible risks of the vasectomy procedure include minor bleeding, mild swelling in the testis, and tenderness in the testicles, but they do not cause serious discomfort in the patients. Although the channels are closed with vasectomy, there is a possibility of pregnancy with unprotected intercourse in the first three months. In other words, it is necessary to continue to be protected for the first 3 months, and to confirm the success of the vasectomy with semen analysis when the 3 months are completed.

 

As with any surgical procedure, there may be a risk of complications in vasectomy procedures. It is normal to experience pain after the operation. However, pain severe enough to require painkillers is rarely seen after the first 24 hours. An allergic reaction may develop, bleeding and edema may occur after the procedure. However, these conditions are temporary and disappear on their own within 4-5 days. Postoperative pain syndrome is a chronic pain syndrome that occurs after vasectomy. It can often be treated with anti-inflammatory drugs. Rarely, there may be pain in the testicles due to the fluid and sperm accumulated after the procedure. It is seen that this situation disappears in about 6 months.

 

There may be hematoma formation. If the bleeding into the scrotum does not stop, the blood may clot and form a mass. This very rare hematoma may need to be drained with a second surgical procedure. In the past, it has been suggested that there may be an increased risk of prostate cancer after vasectomy; recent studies have shown that there is no association between vasectomy and prostate cancer.


I’ve started working as a doctor since I attended Uludağ University Faculty of Medicine. I stopped working in the hospitals in 2020 with the thought of opening my own medical clinic. At the beginning of 2022, I opened my office in Karşıyaka Mavişehir Park Yaşam Ofisleri. In our urology clinic, I deal with my patients along with my team.


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