Diagnosis of male infertility

Every sixth couple of reproductive age faces the problem of infertility, the causes being almost evenly distributed between the sexes. The archaic notion of infertility as a female disease has long been rejected. The male factor of infertility has become especially relevant in recent decades. The misconception that a man’s infertility is related to his sexual abilities has long been an obstacle to the correct and timely assessment of diseases and conditions leading to infertility. The rapid progress of medicine in the field of andrology now allows us to detect and treat a large part of male reproductive problems. Spermatogenesis is a long process, which takes approximately 72 days and is controlled by complex interactions between hypothalamus, pituitary and testicles. There are many diseases that can lead to the inability or serious difficulties of a man to become a biological father, some of which are:

• disorders in the production and functional suitability of sperm: hypogonadism, cryptorchidism, varicocele, infections, antisperm antibodies, torsion of the testis, etc .;
• sperm delivery disorders: erectile dysfunction, retrograde ejaculation, congenital lack of vas deferens, prostate surgery, testicular injuries, etc .;
• pathological abnormalities in some glands with internal secretion such as thyroid, pituitary, pancreatic or adrenal;
• chronic diseases or medications used for treatment (some antibiotics, steroids, etc.);
• infectious diseases;
• genetic factors, such as deletions on the Y chromosome or a different than normal number of chromosomes;
• harmful effects of the profession and the environment: occupational hazards, pesticides, chemicals, radiation, heavy metals or other industrial agents;
• anatomical problems (obstruction or abnormal external genitalia);
• abnormal morphology of spermatozoids;
• general health problems and lifestyle: diabetes, kidney and liver diseases, hypertension, testicular and male genital cancers, chemotherapy, hypovitaminosis, obesity, smoking, alcohol abuse, drug use, etc.

Tests: Spermogram (semen analysis)

– a basic test for determination of the fertilizing ability of spermatozids. The test is easy, fast, painless and extremely informative. The program includes many indicators, which are not always a deviation from a given parameter, which is a sign of the disease. Only a complete assessment of the data obtained for all parameters and dynamics in time allows the man to make a difference. The main studied parameters are the volume, viscosity and pH of the seed sample, the concentration, the motility and the morphology of the spermatozoa. It is recommended that the department be separated through mastication in a special room in the clinic. If this is not possible, the test material can be delivered to the laboratory within 20-30 minutes after ejaculation. The results of the study are usually received in the memory for one day.

Indications for performing a spermogram:

• assessment of reproductive capabilities in men attempting to become biological fathers;
• suspicion of secondary infertility;
• past sexually transmitted and other infections of the reproductive tract;
• diseases of the genitourinary system;
• spent in childhood mumps, complicated by orchitis (inflammation of the testicles);
• cryptorchidism (retained testis) or elevator testis;
• monohirzm (one testicle);
• congenital genetic syndromes that are related to reproductive abilities, e.g. Klinefelter’s syndrome, Kalman’s syndrome, Carthagener’s syndrome;
• common diseases at risk of infertility, such as diabetes, hypertension, testicular cancer, varicocele;
• before chemotherapy or radiotherapy for a malignant neoplasm, regardless of its location, in order to assess sperm counts before therapy and, if possible, to freeze sperm;
• before surgical interventions on the testis, epididymis, prostate gland, seminal vesicles, bladder and other pelvic organs, as well as postoperatively;
• athletes taking anabolic steroids and supplements with a negative effect on spermatogenesis;
• in athletes who practice contact sports, cycling, weightlifting, rowing and others with a detrimental effect on reproductive abilities;
• after injuries to the genitals, pelvis and anterior abdominal wall, as well as injuries to the spinal cord;
• exposure to environmental risk factors, e.g. pesticides, radiation, heavy and non-ferrous metals, varnishes, paints, etc.;
• in relatives with a reproductive problem, with proven or presumed heredity;
• before applying the methods of assisted reproduction;
• before cryopreservation of sperm;
• if you want to donate sperm;
• when concerned about their reproductive health.

Main requirements for conducting the research:

• sexual abstinence from 2 to 5 days;
• not to be treated with antibiotics during the last two weeks (minimum);
• not to use alcohol and narcotic substances in the days of abstinence;
• the container for the storage of the ejaculate must be sterile and for one-time use;
• it is necessary to inform the researcher about all the medicines and supplements you are taking;
• it is necessary to inform the lead researcher, in case the whole quantity of ejaculate has not fallen into the stable container. The loss of quantity would have an impact on the reliability of the results;
• It is necessary to make an appointment in advance.. The result of a single spermogram could cause mistakes in diagnosing a problem, especially when it comes to men, in whom the parameters of the ejaculate vary widely. A number of European and world reproductive medicine clinics recommend conducting 3 to 6 analyzes at appropriate intervals, thanks to which sufficient and objective information about the patient’s reproductive condition is collected.

Other tests related to semen parameters:

DNA fragmentation of spermatozoids– analysis, which provides information on the complete integrity of chromatin on spermatozoids. The integrity of the DNA of the sperm is an important parameter for quality and a map for the fertility of the semen. The quality of chromatin in sperm is a very important factor for male infertility, especially in the contribution of the genetic material of sperm in early embryonic development. Studies on the structure of chromatin have a prognostic character for the development of fertility and success in assisted reproductive technologies. The degree of abnormalities in the genetic material of spermatozoids is numerically expressed as the DNA fragmentation index (DFI). DNA may be present in fertile and infantile men. The results of the test are independent of the indicators on the program. This test is recommended in the following cases:

• idiopathic sterility;
• after many unsuccessful attempts at fertilization;
• if the quality of the embryo is bad;
• in patients with multiple recurrent spontaneous events;
• the presence of varicocele (dilation of the veins on the testicles);
• men over the age of 45;
• when freezing the ejaculate (in order to ensure that the sample is frozen at an acceptable level of DHK fragmentation);
• increase in body temperature in the last 3 months.

MAR test for anti-thermal antibody (AЅA) – The percentage of IgA and IgG forms of anti-thermal antibodies, whose increased values are an indicator of immunologicality, is considered to be a percentage. Sperm is relatively protected by the immune system through a natural defense mechanism called the blood-test barrier. A special type of tight connections between the cells lining the male reproductive tract do not allow the cells of the immune system to penetrate the testiclesIf this barrier is broken, then the cells of the immune system penetrate the testicles and antibodies are formed. Anything that damages the normal blood-testicular barrier can lead to the formation of antisperm antibodies. Reasons for this may be – recovery after vasectomy, varicocele, testicular biopsy, testicular cancer, infection (orchitis, prostatitis), surgery for inguinal hernia before puberty and others. Antisperm antibodies can prevent the interactions between the egg and the sperm that occur during fertilization. In some cases, these antibodies can damage the formation of sperm inside the testicles.

НВА (Ѕреrm-Нуаlurоnаn Віndіng Аѕѕау) test – Through this text, it determines the functional maturity of the spermatozoa. Hyalyponan is a type of zaxap – a glucosaminoglycan with a high molecular weight, which is found in many parts of the body and is a key component of the group of eggs. During the last stage of maturation, sperm acquire the ability to bind to hyaluronan. A number of studies have shown that the ability to recognize and attach to hyaluronan is an important indicator of the maturity and fertility of male gametes. It turns out that during normal conception, the attachment of sperm to hyaluronan, located in the layer of cells surrounding the egg, serves as a natural mechanism for the selection of healthy and mature sperm. The attachment of sperm to hyaluronan can be an indicator of how well the cells being analyzed can lead to a successful pregnancy.

SAT test – For the first time in Bulgaria the genetic test for chromozomic anomalies in the sperm, SAT is offered in the Specialized hospital for medicine, gynecology and preventive medicine “Sofia” together with the leading world company for preventive genetics Іgеnоmіх.

ЅАТ (Ѕреrm Аnеuрlоіdу Теѕt) is Diagnostic method for studying the genetic origin (etiology) of male sterility and is recommended for patients with high risk of spermatozoon. This is mostly the case with men with abnormalities in the seminal parameters – mainly oligozoopherapy, non-observable azoospermia and severe tepathozooppermia. The test is used to analyze the percentage of spermatozoa with xmosomal abnormalities in the seminal sample. This assessment allows the assessment of the transmission of these anomalies in the generation to be assessed. Xpomozoom cannot be analyzed, and it is most often associated with spontaneous abortion (chromozomes 13, 18, 21, X and Y).In clinical aspect the increase in the percentage of the spermatozoids with chromozomic anomalies is connected with the dicrease in the pregnancy percantage and higher abortion rate with couples choosing the ICIS method. At the embryonic level, various defects are observed according to the type of chromosomal anomaly in the spermatozoa. However, an increase in the percentage of spermatozoa with sexual dysomia leads to an increase in non-embryonic embryos with syndromes that are do not oppose a life danger, Patal syndromes, Syndrome of Dane, Syndrome of Edwards Syndrome of Kleinfelter, Syndrome of Turner and Trisomy of X and Y chromosomes). An increase in diploid spermatozoa leads to an increase in the likelihood of development of triploid embryos.. For these reasons, the TAT test is useful for genetic counseling in men with infertility and for optimal treatment. Other indications for taking the test, which are not necessarily related to violations in the seed parameters:

• In case of recurrent abortions with unknown etiology;
• With couples with many IVF cycles;
• With couples with preceiding pregnacy with chromosomopathy.  

A test for vitality – It is necessary in cases when there is a large percentage of immobile spermatozoa in the family. The study makes it possible to determine how many of these spermatozoa are viable.

Test for biological survival of spermatozoa – investigates the percentage of mobile spermatozoa after treatment with a special nutrient environment and incubation for a period of 24 hours. The study aims to determine what is most likely to be the survival rate of spermatozoa in the uterus or genital tract of a woman at the same time.

Cryotolerance of spermatozoa– test, through which it evaluates the survival of spermatozoa after freezing and subsequent spraying. Mandatory test, which accompanies the freezing of spermatozoa. Provides information on the selection of the appropriate APT pair.

Treatment:

• Treatment of the main endocrine diseases, antibiotic therapy for infection, prevention of the leading environmental factors;
• The abnormal number and motility of spermatozoa can sometimes be successfully affected by oral or operative treatment;
• The development of assistive technology techniques provides a new opportunity for couples to solve the problem of substitution. In recent years, as a basic method for the treatment of infertility caused by the so-called. The male factor requires intracytoplasmic special injection (ISI). This is a method of choosing which previous behavior is not a good thing.