MALE INFERTILITY

NORTHWESTERN MEDICAL AND IVF CENTER SARAJEVO

MALE INFERTILITY

If a woman does not become pregnant after a year of regular unprotected sex, consider talking to a doctor about it. Infertility is present in almost 15% of couples who desire pregnancy. The percentage indicating the infertility of the female and male partners is equal (slightly more than 40%), while in 10% of cases the cause is the infertility of both partners or it is impossible to find out why exactly the desired pregnancy does not occur. Infertility is most often the result of many factors and in many cases is treated with lifestyle changes or medication. One of the advances in the treatment of infertility was the inclusion of the male partner in the routine examination of infertile couples. The first step that should be taken then is to send the male partner for a spermogram.

The causes of infertility in men are diseases, infections or congenital disorders that lead to a decrease in the number or absence of sperm in the ejaculate, insufficient sperm motility or vas deferens, but are most often directly or indirectly related to spermatogenesis. Although the most common cause of infertility in men is varicocele, there are a number of other reasons that can cause infertility. Some of them cause a decrease in sperm count, and some cause sperm abnormalities. Newer research indicates that the average number of sperm in the ejaculate has decreased by almost 50% over the past half century, and the fact that the already numerically weakened ejaculate contains more and more weak or immobile as well as morphologically abnormal sperm is of additional concern. The annual decline in the total number of sperm in the ejaculate, the number of motile sperm and morphologically normal sperm is:

sperm concentration 2.6%

motile sperm percentage 0.3%

percentage of morphologically normal sperm 0.7%

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A decrease in the number of sperm occurs during inflammation of the testicles and prostate, when treated with chemotherapy or hormonal drugs, when there are genetic abnormalities of the seminiferous tubules, but also when excessive alcohol intake, smoking and wearing tight clothing. Special mention should be made of long-term sitting, during which the testicles heat up, which directly negatively affects the number and mobility of sperm. Changes in the spermiogram are not related to sexual drive or potency. If the number of sperm is reduced, take care that even too frequent sexual intercourse is not conducive to pregnancy, because after each ejaculation it takes at least 2 days for the level of sperm in the ejaculate to return to the previous level. If you and your partner want a child, try to coordinate your sexual relations with the period of ovulation, because it is known that fertilization can occur only 2 days before ovulation and 24 hours after ovulation.

Causes of male infertility

Varicocele

This term refers to the expansion of the venous plexus (plexus pampiniformis) that supplies the testicle with blood. The frequency of varicocele in the general population is 13%, and in infertile men 36%. The reason for the expansion of this venous plexus is of a mechanical nature, due to the lack or improper function of the valve of the spermatic vein at the point where it flows into the renal vein. Due to the retention of blood in the enlarged veins, the temperature in the testicle rises, and the cells from which sperm develop can be damaged. In 90% of men with varicocele, sperm motility is reduced. Varicocele is treated surgically, and sperm quality often improves after surgery.

Orchitis

Inflammation of the testicles most often occurs as a severe complication of mumps. The consequences are more severe if the disease is cured and not remitted, and if it appears at an older age. There is a reduced number to the complete absence of spermatozoa in the seminal fluid or, due to inflammation, the seminal ducts are blocked.

Sexually transmitted diseases

Some sexually transmitted diseases can lead to secondary infertility in men: damage to the testicles or blockage of the vas deferens. Therefore, it is necessary to perform a bacteriological examination of urine, ejaculate and prostate secretions to determine the presence of infection and enable adequate treatment. The most common sexually transmitted diseases are chlamydia, gonococcus, trichomonas, urea-plasma and mycoplasma.

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Immunological causes

Sperm antibodies are produced in some men after a viral infection of the prostate or epididymis, during injury or surgery in the testicle area, and most often as a result of damage to the blood-testicular barrier. It is assumed that in such cases parts of the sperm enter the circulation, and the immune system is sensitized to the creation of autoantibodies against them. The presence of antibodies against sperm does not definitely mean male infertility. It is considered that it affects fertility if it interferes with one of the tasks that sperm perform during fertilization (about 2-13% of infertile men). Sperm antibodies cause sperm agglutination and reduce sperm motility, thus causing infertility.

Another possibility is that sperm binding to ZP-3 receptors of the zona pellucida is prevented. Under normal conditions, this contact is achieved with the help of receptors on the apical part of the sperm head, and if there are none or if they are covered by antibodies, there is no interaction between the sex cells. In addition to the three main types of antibodies of the class IgG, IgM and IgA, it is possible to determine the density and spatial distribution of antibodies on the sperm surface. If the antibodies are predominantly located on the head of the sperm, then the weak interaction of the sperm with the zona pellucida of the egg cell is most likely the main cause of the absence of fertilization, and if they are present mainly on the tail, the mobility of the sperm is reduced and there is extensive agglutination of the sperm.

Other damage to the gonads

Damage to the testicles can occur as a result of radiation (ionizing and electronic), as well as the toxic effect of various poisons and drugs. High temperature at the workplace, contact with certain chemicals such as organic solvents (toluene, benzene, xylene), lead, cadmium, mercury and other heavy metals, anesthetic gases, pesticides, herbicides, dioxin, as well as excessive alcohol consumption, smoking and a messy lifestyle can harm fertility. Therefore, in some cases, lifestyle change therapy is sufficient.

Irregular development of sexual organs

Improperly developed testicles will not be able to produce sperm or perform their endocrine function.

Cryptorchidism: Occurs in about 4% of boys, and indicates a delay in the descent of the testes from the abdominal cavity into the scrotum. Infertility occurs due to damage to the germinal epithelium caused by elevated temperature in the abdominal cavity. Treatment is very successful: hormonally or surgically.

Hypogonadism: It is a genetically predetermined, congenital anomaly in which there is a weaker development (and consequently weaker functionality) of the testicles. They are mainly chromosomal abnormalities.

How to improve spermogram?

Amino acids

Arginineis a non-essential amino acid that is necessary for the formation of healthy sperm. As the physiological production of arginine decreases with age, this supplement is necessary especially in elderly patients. Coenzyme Q10 helps to increase the number and mobility of sperm. L-carnitine is necessary for the normal function of sperm.

Minerals

Selenium is good for increasing sperm motility. Approximately 50% of selenium in men is found in the testicles and seminal ducts, so men lose selenium through the seminal fluid, so supplementation is necessary. Zinc serves to maintain the health of the male reproductive system and stimulates sperm production and maintaining the volume of seminal fluid. It is also necessary for the normal production of testosterone. Zinc deficiency is associated with numerous sexual problems, including sperm abnormalities and prostate disease. Manganese: lack of this mineral leads to inadequate synthesis of male sex hormones, testicular degeneration, loss of libido and sterility.

Vitamin supplements

Folic acid: it is necessary for the production of sperm, maintaining their number and motility, and its deficiency leads to morphological abnormalities of sperm. Vitamin B12: lack of vitamin B 12 leads to weaker sperm motility and a decrease in their number. Since the lack of this vitamin is very common, adequate supplementation is necessary. Vitamin B6: together with zinc, it participates in the creation of male sex hormones. Certain studies indicate that its deficiency can lead to infertility. Vitamin E and vitamin C: with their antioxidant effect (reducing the number of free radical molecules that can damage sperm), they support the general health of the sperm cell.

Highly unsaturated fatty acids

Omega fatty acids: omega 3 fatty acids found in fish oil and flax seed oil and omega 6 fatty acids (evening oil, borage oil) improve the fluidity of the sperm membrane and male fertility

Other substances:

Astragalus: stimulates the effect of sperm production and improves sperm motility Ginseng (Panax ginseng): increases testosterone levels, quantity and quality of sperm.

If you want to become parents, but you assume that there are some problems, please visit us and discuss all issues with our expert doctors.

You can visit us in Sarajevo and make your appointment at the following phone numbers:

+387 33 781 735

+33 62 048 119

or send us an e-mail at:

info@northwesternmedicalctr.com

or visit us at the following address:

Bulevar Meše Selimovića 17a, Sarajevo

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