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According to the data of the World Health Organization (WHO), the so-called the male factor in marital infertility accounts for about 45% of cases, of which 20% of infertility concerns only men. Andrology deals with the examination, diagnosis and treatment of the male reproductive system.
In the field of andrology research, there is the structure and physiological functions of the male reproductive system. Andrologists specialists deal with the diagnosis and treatment of men with diseases such as inflammation, functional disorders, reduced fertility or cancer, pathological defects in the endocrine, vascular and operational aspects. Gynecologists, urologists, internists and endocrinologists specialize in andrology.
The statistics of the World Health Organization (WHO) show that the so-called the male factor in infertility among couples accounts for about 45% of cases. It is estimated that 20% of all infertility cases are exclusively male, 30% are female only, 20% are both partners, and in the remaining cases the cause is often not established.
A couple trying to have a baby are an integral unit. Only the absence of sperm in the semen or complete necrospermia (i.e. lack of sperm movement and viability) is a clear diagnosis of male infertility. However, such a condition is quite rare.
Very often, the decrease in the fertility potential of a man is compensated by the high fertility potential of the woman and vice versa.
Clinical studies of the Steinberger group suggest that the fertility potential of each partner individually ranges from 0 to 100%. The state in which pregnancy appears after an average of 100 to 1,2 sexual cycles of the partner was assumed as 1,9% of the male fertility potential. Of course, when the partner shows optimal fertility potential.
According to Steinberger, one hundred percent, i.e. the maximum potential of male fertility occurs when the sperm count is equal to or higher than 60 million / ml of semen and sperm motility higher than 70% (WHO norm> 20 million / ml; mobility> 50%). Meanwhile, it has been known since the 70s that pregnancies occur in breeding pairs, where the sperm count is not only lower than 20 million / ml, but even lower than 10 million / ml. However, pregnancy occurs after a period longer than the maximum fertility potential. Thus, the assessment of the proportion of the male factor or the female factor should be expressed in terms of degrees or percentages, and not as an unequivocal recognition. This in turn makes it difficult to formulate homogeneous groups according to the division into male-dependent and female-dependent infertility.
Infertility is defined as the failure of a couple to become pregnant after one year of regular intercourse without using contraception. For both men and women, the phenomenon of fertility is complex and is the result of many causes in both partners.
Primary infertility is when the man has never conceived a partner, and the condition in which the man has developed a partner in the past but is unable to do so is called secondary infertility.
Among the factors lowering fertility in men there are:
- Infections (gonococcal orchitis, mumps complications, sexually transmitted diseases),
- Previous operations in the area of the genitourinary system,
- Diseases of other systems (cardiovascular system, nephritis, diabetes, anemia, liver and pancreatic diseases, alcoholism),
- Environmental factors (overheating of the genital area, plant protectants, aniline dyes, metals),
- Taking medications (morphine, cocaine, high doses of quinine, high doses of androgens and corticosteroids),
- Age over 40,
- Radiotherapy and chemotherapy, which generally cause irreversible damage to the testicles,
- Sexual problems (about 1%),
- Lifestyle (stress, smoking, obesity, diet).
Infertility is diagnosed on the basis of a clinical history, examination of the patient for disorders of the genital development, anatomical abnormalities, changes in appearance and body shape, etc., and then semen tests, hormonal tests, as well as genetic tests such as testicular biopsy, sperm chromatin test. During the examination, azoospermia, hypogonadism, bilateral or unilateral lack of vas deferens, and cystic fibrosis are excluded.
The process of infertility treatment adjusts to the causes of infertility using hormonal drugs (hypogonadotrophic hypogonadism, hormonal disorders), antibiotics (inflammation in the sperm removal tract), surgical procedures (obstruction of the sperm ducts, varicose veins). It is estimated that as much as 25-30% of cases of male infertility are idiopathic, i.e. of unknown cause.
In the prevention of male infertility, it is important to pay attention to a healthy lifestyle, proper diet, providing the body with a sufficient amount of vitamins A + E, selenium, zinc, and L-carnitinine.
There may be risks in the process of infertility treatment, such as misinterpretation of test results, comparison of tests among patients, and remote treatment attempts. The circulating myths about eating habits (e.g. drinking Coca-Cola) pose a threat to obtaining optimal treatment results.
The main sources of information for patients about male infertility are the Internet (about 35,500 results for the question of male fertility), friends, family and a doctor.
Causes of male infertility
| Idiopathic infertility | 30,2 % water content |
| varicocele | 5,4 % water content |
| Hypogonadyzm | 9,7 % water content |
| Infections | 8,5% |
| Undescended testicles | 8.0 % water content |
| Erectile dysfunction and ejaculation disorders | 6,7% |
| Systemic diseases | 5,2% |
| Sperm antibodies | 3,8% |
| Tumors of the testicles | 2,1% |
| Obstruction of exit roads | , 5% |
| Other | 8,90% |
Normal semen values - reference values according to the WHO
- Liquefaction time: <60 minutes
- Volume: 2,0 – 6,0 ml
- pH: 7,5 – 8,1
- Sperm count: 20 – 250 million / ml
- Total sperm count:> 40 million
- Mobility (60 min after ejaculation):> 25% of class a or> 50% of class a and b
- Morphology:> 14% normal
- Viability:> 75% alive
- Leukocytes: < 1,0 million/ml
Names used in assessing ejaculate:
Normozoospermia – normal ejaculate
Oligozospermia – sperm concentration lower than 20 x 106/ ml
Asthenozoospermia – less than 50% of sperm in normal progressive movement, both fast and slow (i.e. type A and B) or less than 25% of sperm in rapid progressive movement (type A)
Teratozoospermia – less than 30% of sperm with normal morphology
Oligo-asteno-teratozoospermia – disturbances in number, mobility and morphology (there may also be a combination of only two abnormal features)
Azoospermia – no sperm in the ejaculate
Aspermia- brackish ejaculation
Text: Robert Jarema, MD, PhD – surgeon – FEBU urologist specialist, andrology consultant
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