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What is Infertility?

30 September 2022 by Op Dr Nureddin ÇELİK
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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.

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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