Male infertility is the inability of a man to fertilize an egg and conceive a child from a fertile woman for a year or more with frequent unprotected sexual intercourse. Almost half of the cases of infertile marriages are due to the male factor. The main reason is poor sperm quality. Over the past decades, the situation has deteriorated significantly.
Etiology and pathogenesis. Scientists most often associate decline in sperm quality with the environmental pollution. This hypothesis is supported bystudies of a particularly strong drop in sperm concentration in men from developed countries of Europe and America. The lowest sperm quality was found in men that live in industrial areas. In addition, the properties of ejaculation are negatively influenced by such factors as stress, physical inactivity, unhealthy diet, alcohol consumption and smoking.
Deviations in sperm indicators from the norm are denoted by the following medical terms:
- Anejaculation: Lack (absence)of ejaculate (sperm).
- Oligospermia: Insufficient amount (volume) of sperm.
- Azoospermia: Absence of sperm in the ejaculate. A distinction is made between secretory azoospermia, when spermatozoa are not produced in the testes, and obstructive azoospermia, when spermatozoa are produced but not ejaculated due to obstruction of the vas deferens.
- Oligozoospermia: Insufficient number of sperm in the semen.
- Asthenozoospermia: Lack of sperm motility.
- Teratozoospermia(Teratospermia): An increased number of abnormal sperm.
- Necrozoospermia (Necrospermia): Presence of more than 50% of non-viable spermatozoa in the ejaculate of a man or the absence of live spermatozoa.
- ASA: Presence of Antisperm Antibodies in Semen
The main causes of male infertility are inflammatory and infectious diseases that interfere with sperm production. In addition, obstruction of the vas deferens can mechanically prevent sperm from entering the urethra. Such a defect often occurs due to trauma or epididymitis (inflammation of the epididymis). Also, impairment of spermatogenesis can cause varicocele (varicose veins of the testicle). In some cases, male infertility is associated with hormonal disorders (for example, insufficient testosterone production). A rarer disease leading to infertility is cryptorchidism – undescended testicles into the scrotum. Sometimes, male infertility is simply genetic.
Depending on the causes, male infertility is divided into secretory, excretory (also called obstructive) and autoimmune. Sometimes infertility has several causes, and then it is called combined.
* Secretory infertility, characterized by insufficient quantity and poor quality of sperm.
* Excretory infertility, when sperm are produced in sufficient quantities, but cannot enter the urethra due to obstruction of the vas deferens.
* Autoimmune infertility caused by a man’s body fighting its own sperm. The antibodies produced can lead to sperm death or decreased motility.
* Combined infertility, when there are several causes together.
Diagnostics of the causes. After examination and questioning of a man, in order to identify a history of diseases that could lead to infertility, it is necessary to make a spermogram. The test should be repeated 2-3 times, while refraining from sexual intercourse and from masturbation for 2-7 days is required before the study. Note: it is better to come to an appointment with an andrologist with ready-made examinations, which saves time on diagnostics. If both the man and the woman are tested for infertility, it is better that the examination takes place in the same clinic, so that doctors can more accurately determine the cause of the couple’s infertility and prescribe the correct treatment.
Normally, the volume of ejaculate is 2-5 ml (about one teaspoon), but if the amount of ejaculate is less than normal, then this may indicate testicular hypofunction. If the semen volume is less than 2 ml, and all spermogram indicators are within the normal range, then conception is unlikely due to the low semen volume (oligospermia). Normally, in 1 ml of sperm, there should be at least 20 million sperm(or at least 40 million in the entire volume of ejaculate), if their number is below this limit, then this indicates oligozoospermia. Oligozoospermia can develop as a result of unilateral obstruction of the vas deferens or as a result of hypofunction of the testicles, as a result of which male infertility occurs. If the patient has bilateral obstruction, then the sperm cells in the semen are completely absent, which is azoospermia. Thus, although only one sperm is needed to fertilize an egg, a decrease in sperm count to 1 million makes conception impossible: at the time of ejaculation, about 100-200 million spermatozoa enter the cervix, half of it overcomes the mucous plug of the cervical canal, but only a small part reaches the mouth of the fallopian tubes. Since the egg is in only one fallopian tube, only half of the sperm will end up in the tube with the egg. That is, the fewer sperm in the ejaculate, the less the likelihood of pregnancy, so a critical decrease in the number of sperm in the semen is one of the signs of male infertility. Most of the spermatozoa should have a rectilinear or chaotic nature of movement, but if the number of motile spermatozoa is reduced, then this is called asthenozoospermia. With the complete absence of motile spermatozoa, we are dealing with necrozoospermia. Note: The mobility and number of sperm in the ejaculate depends on the frequency of sexual intercourse, therefore, a man undergoing diagnostics of male infertility should refrain from sexual intercourse in order to obtain reliable spermogram results (with multiple consecutive intercourses, sperm loses its fertility). A false diagnosis of necrozoospermia can be made when using a lubricant that has a detrimental effect on the viability of germ cells. Couples who do not abstain before conception may also seem infertile, since with frequent contacts, immature sperm forms with low motility and viability are present in the sperm, and the maximum number of mature and viable sperm is contained in the sperm after 2-3 days of abstinence.
Treatment. Androgen replacement therapy is indicated for impaired spermatogenesis, treatment of genitourinary infections, and correction of endocrine disorders. The treatment regimen and the choice of medicine are selected individually in each case.
0 If one of the spouses has inflammatory diseases of the genital organs, then the treatment of male infertility begins with the treatment of both spouses. In this case, it is important not only to suppress microorganisms, but also to identify the root cause in order to eliminate it. After etiological and pathogenic treatment, a course of immune regulators and restorative medicine is recommended. Some infectious diseases of the genitourinary tract require long-term treatment. If pregnancy does not occur within a year after the correction of male infertility due to urinary tract infections, then hormone-stimulating therapy is indicated.
0 Artificial insemination with the husband’s sperm (homologous artificial insemination) or donor sperm (heterologous artificial insemination) is indicated in the presence of coital disorders that prevent ejaculate from entering the vagina. For many couples, artificial insemination with the husband’s sperm allows them to conceive a child with male infertility caused by mild spermatogenesis disorders or immunological aggression of the mucus of the cervical canal.
If male infertility is due to insufficient erection or premature ejaculation, then homologous artificial insemination is also indicated for these couples.
0 In the case of a large hydrocele and inguinal-scrotal hernias, severe hypospadias and grade I-II oligozoospermia, artificial insemination is also used. Note: male sperm can be cryopreserved, especially before long-term use of drugs that can cause male infertility or before the husband is sterilized. To improve sperm parameters, the ejaculate is divided into fractions, separating the mobile forms by filtration, using several different portions of cryopreserved sperm. To improve the sperm count of a man who has undergone male infertility treatment, agrinin, caffeine and prostaglandins are added to it. The effectiveness of the introduction of native sperm is several times higher than that of insemination with cryopreserved sperm, but when using cryopreserved sperm, its antigenic properties are reduced, which is used in the treatment of female or male infertility in couples in which women have antisperm antibodies. In this case, the sperm is injected either into the cervical canal, or intrauterinely every other day from the date of the expected ovulation.
0 Insemination with donor sperm is used for male infertility due to aspermia, azoospermia, grade III oligospermia and other severe spermatogenesis disorders, or if the spouse has diseases for which the birth of children is not recommended (genetic diseases, incompatibility of spouses according to the Rh factor, etc.)
Ayurveda and Male infertility.
Reproductive system disorders in men are usually given less attention, but the treatment of diseases of the genital area and the normalization of sexual behavior are very important for maintaining the health of men.
> According to Ayurveda, most often sexual impotence is a violation of Vata-dosha. At the initial stage of treatment, sexual abstinence is of great importance. Rest and relaxation are beneficial. Toning therapy is usually needed to treat impotence. Special tonics for the male reproductive system are used: Ashwagandha, Shatavari, Yashtimadhu. One of the best herbs for this is Kapikachu.
> In cases of sexual impotence associated with Pitta-dosha, when “the fire burns the semen (sperm)”, tonic treatment is also given. Aloe juice and Shatavari are recommended and should be taken with milk, sugar, or ghee.
> Sexual impotence in Kapha-dosha is characterized by lack of interest in sex, obesity, excess mucus leading to congestion, general lethargy, and the abuse of sweets as a substitute for sex. Aphrodisiac stimulants are used for treatment: pippali, garlic, cloves, yohimba, as well as tricatu compounds.