Types of sperm pathologies and treatment of male infertility: new and classical techniques
The process of treatment for male infertility should begin with the specification of the diagnosis.Spermogram, which is prescribed during the examination, gives the doctor a lot of information about the patient's sex cells.In most cases, the pathology that causes infertility is reflected in the test results.
Spermogram interpretation and types of sperm pathologies
The normal parameters of a spermogram are :
- acidity from 7 to 8;
- volume - at least 2.5 ml;
- liquefaction time - up to 1 hour;
- semen viscosity - 2 cm;
- the total number of spermatozoa is 60,000,000 or more;
- the level of mobility is expressed by the letter designation( A - mobile and fast spermatozoa; B - movement is present, but slow( nonlinear, linear); C - cells move only in place; D - immobile spermatozoa).
- presence of at least 25% of cells of type A and more than 50% of A + B.
- from 30 to 70% of spermatozoa without pathologies;
- leukocytes in sperm - 106 in 1ml;
- no agglutination process, erythrocytes;
- epithelial cells - in a single number, and cells of spermiogenesis - not more than 4% of the total number.
In the study, such forms of sperm pathology can be detected:
- Azoospermia - is diagnosed with complete absence of spermatozoa in the material taken.It can be of an obstructive nature( there are sperm in the testicles, but they are not erupted due to the obstruction of the vas deferens) and secretory( spermatozoa are absent in the testicles).
- Asthenospermia - sedentary male sex cells.The diagnosis is established if unhealthy sperm in the analysis are more than 60%.
- Pyospermia is the presence in the sperm of a large number of leukocytes and pus, which indicates an inflammatory process in the genitourinary system.
- Teratospermia - detection in the analysis of a large number of pathological spermatozoa from the morphological point of view.
- Anejaculation is the total absence of ejaculation in a man.
- Necrospermia - inanimate spermatozoa in the sperm.
- Oligospermia - insufficient volume of sperm during ejaculation.
- Cryptospermia is the detection in the analysis of mobile spermatozoa in a single number.
- Oligozoospermia - the number of spermatozoa in the ejaculate is less than 15 000 000 in 1 ml.
Classical methods of infertility treatment in a male
The type of treatment depends on the cause of infertility, which is divided into the following types:
- surgical;
- supportive techniques;
- hormonal;
- treatment of sexual disorders;
- is a medicament;
- physiotherapy.
Surgical treatment of infertility in men
It is resorted to if the cause of infertility is varicocele - a tumor-like swelling of the veins that provide blood outflow from the testicle.Varicose veins of the spermatic cord are removed by means of an operative intervention, whereby the blood flow in this region is normalized.
Important: operation for varicocele will be effective only if it is performed on time.When the testicles are atrophied due to a lack of normal local circulation, it is almost impossible for a man to recover his ability to conceive.
Surgical treatment is also indicated for obstructive infertility when there is obstruction of the spermatic cord because of trauma, orchitis, epidarotitis( in childhood).During this intervention, the surgeon restores the patency of the vas deferens, removing the segment with obstruction or creating a new one.The success of the operation depends entirely on the length of the pathological part of the cord, which must be removed or replaced.
Conservative infertility therapy in men
This method is used in the case of immune, hormonal or secretory infertility.Only a doctor in the competence to prescribe certain drugs and their dosage after confirmed infertility in men.
In particular, after identifying the causes of the disease, the following can be used:
-
hormones; - immunocorrective medicines;
- stimulators of spermatogenesis;
- antiestrogens;
- antibacterial drugs;
- is a non-steroidal anti-inflammatory;
- pentoxifylline;
- alpha-blockers;
- vitamin complexes with microelements.
Please note: for male infertility treatment with folk remedies can not replace basic.In particular, the hirudotherapy method is quite popular among patients in this respect.It is possible to use it only in combination with other techniques, taking into account the fact that there are quite conflicting opinions about its effectiveness among doctors.Leeches are used to improve local blood circulation and the process of spermatogenesis, but in case of male infertility treatment with folk remedies should be agreed with the attending physician.
Physiotherapy
When infertility is prescribed such local procedures:
- electrophoresis;
- laser;
- transurethal microwaves;
- phonophoresis.
Physiotherapy treatment positively affects prostatic trophism, blood supply of genital organs, productivity and quality of sperm, eliminates hidden inflammatory processes.
Treatment of sexual disorders
Erectile dysfunction is medically treated with a group of PDE-5 inhibitors such as:
- levitra;
- Viagra;
- Cialis.
Alprostadil and intracavernous injections are also practiced in the urethra.
If the drugs do not have an effect or the patient has contraindications to their admission, then they resort to a surgical solution to the problem:
- local embolization of arterio-venous shunts;
- implantation of the prosthesis of the penis;
- endovenous stenting of the arteries of the penis;
- vacuum constriction.
Premature ejaculation is treated with the "compression technique" and "stop-start"( delay ejaculation).Among the medicines use the central action( tramadol, clomipramine, fluvoxamine, fluoxetine, paraxetine, sertrolin).Locally used Vazoprostane, Emla cream, etc.As an operative treatment resort to neuroectomy of the dorsal nerve of the penis, selective resection of the spinal nerves.
Supportive reproductive methods for treating male infertility
They are used when the obstruction of the vas deferens can not be corrected, in the presence of retrograde ejaculation and other similar problems that can not be cured.Among the most popular methods most often resorted to infertility to IVF.A woman from the ovary is taken out of the egg, and under laboratory conditions, it is fertilized with sperm from a testicle or bladder of a man.
Modern reproductive technologies
It should be understood that these techniques are used for male infertility of a severe stage or incurable form.But even in this case, modern medicine can give a man a chance to become the father of his own healthy child.
Treatment of infertility in men using the TESA method
This technology is used in the complete absence of sperm in the sperm of the patient.It is performed in the form of needle biopsy under visual control in areas of active spermatogenesis.The puncture of the testicle is carried out very gently in order to take the necessary amount of materials.
ICSI
This is the procedure of selection by the embryologist of the correct taking into account the morphological parameters of the spermatozoon.It is immobilized, placed in a thin needle, which is injected into the egg.Thus, fertilization takes place.
PICSI technology for the treatment of male infertility
is considered an advanced technique, since it implies a clear and competent selection of spermatozoa for fertilization.Pre-selection of PICSI is based on the selection of sex male cells, taking into account their behavior in an environment that is as close as possible to the egg cell.The method is advisable to apply in case of male infertility, unsuccessful attempts of IVF( 2-3 times), low quality of embryos.
IMSI
Is an innovative way of fertilizing an egg in the treatment of infertility in men.Spermatozoa undergo very careful selection with selection under multiple magnification( x 6300).The embryologist chooses the best sperm through a digital image that is displayed on the monitor.After it is injected directly into the egg itself, which at times improves the success of fertilization, and the chance of pregnancy increases to 70%.
More information on sperm pathologies and modern techniques for treating male infertility is presented in the video review:
Julia Viktorova, obstetrician-gynecologist
