Infertility is the case if there is no concealability of a year despite regular sexual intercourse without any prevention method.
In our society, unfortunately, women are accused first. But in infertility cases, 40% male, 40% female, 10% male and female together, 10% idiopathic (unknown) causes are blamed. That is, about half of the infertility is caused by male reasons.
In couples who apply for infertility, it should begin to investigate. Because even with a simple sperm analysis (semen test, spermiogram), it can be determined whether the infertility is male-dependent.
What is the need for pregnancy to occur?
• The woman's Egg creation,
• The ducts are open for this egg to reach the uterus,
• Healthy and vibrant sperm that can reach healthy eggs,
• And the fertilized egg needs to be adhered to the uterus.
Male sperm production and ejaculation (ejaculation)
Sperm production begins in the canals called the seminiferous tubule in the testicles located within the scrotum (testicles enveloping bag). Sperms are stored in epididytes, which are curved organs in the immediate upper neighborhood of the testicles; the movement gains and completes its maturation. (Completes maturation in about 3 months)
During ejaculation (excretion of the semen), sperms in the epididytes enter the vas deferens (sperm duct) and pelvis (into the groin). The secreting secretors from the prostate and seminal SAC are also mixed into semen, enhancing the mobility and fertilization characteristics of sperms.
Semen (ejaculate) is excreted from the urinary tract called the urethra and ejaculation is realized.
Sperm production in men begins in puberty. FSH and LH are secreted from the pituitary gland located at the bottom of the brain. From these hormones, LH is the secretion of testosterone, which is a male hormone; FSH stimulates sperm production from testicles. This hormonal axis should work normally for Sperm production and maturation.
There is plenty of protein, minerals, vitamins and fructose in the liquid in the semen (ejaculate). The purpose of all is to provide the sperm to live and fertilises in this liquid. Infertility can also develop in the absence of these substances.
The result is a genetic formation that works great for the formation, maturation, storage, transfer and emergence of sperms, healthy organs and their environment, and the hormonal (testosterone and follicle stimulating hormone) effect is needed. A problem with this system may cause male infertility.
Causes of male infertility;
• VARICOCELE: The most frequently corrected cause of male infertility.
• SPERM DISORDERS: Problems in the production of sperms or the development of sperms are one of the most common causes of male infertility. Sperms are inadequate maturities and/or mature shape and mobility is not achieved. Or the testers may be producing fewer than normal sperms as they should be (oligospermia), no sperm production (azoospermia).
• HORMONAL CAUSES: Hormones that stimulate sperm production and testosterone production in the testes are secreted from a gland in the brain called the pituitary gland. In the production of these hormones, many hormonal causes such as the inability to detect (ENDOCRINE HYPOGONADISM) or the multiplicity of these hormones in the testes, the destruction of testosterone in the testis, can affect the sperm production in a mild or severe way. Hormonal deficiencies can be obtained by replacing drugs with the desired effect.
• IMMUNOLOGIC REASONS: It is the deterioration of sperm mobility and function by producing antibody (block substance) against the person's own sperm. Normally sperms are not in a clear contact with the person's own body. If the barrier (blood-testicular barrier) that interferes with this contact is ruined by such factors as trauma, infection, surgery, a blocking antibody is created by the defense system against sperms that directly contact the circulatory system. Even though the antibodies that block these sperms have not been revealed exactly how it disruptively fertilism, it disrupes the progression of sperm in the vagina and female reproductive systems and adhering to the egg of the woman and entering sperm into the eggs.
• Obstruction (obstruction of the ducts): recurrent infections (especially sexually transmitted infections and epididydimide) pre-transplanting surgeries (including vasectomy) cause obstruction of semen ducts and transfer of sperms Hampers. This blockage can be in any area throughout the semen channel, or in more than one area.
• RETROGRADE ejaculation (back ejaculation): In retrograde ejaculation, the semen flows into the bladder, which cannot be excreted out of the tip of the penis during ejaculation. Semen ducts are poured from the prostate gland level to the urinary tract on the right and left. If there is an imbalance or disorder in the spout function of the bladder neck and therefore the bladder neck cannot be closed, the semen flows into the bladder. It is one of the reasons that the semen cannot be transferred to the vagina and results in infertility. Diseases or conditions affecting the nervous system, pre-applied surgical intervention in the bladder neck or prostate (all types of prostate surgery: open, resection, laser-vaporization or THERMOTERAPI with internal pucky function are necessarily affected), some Drug use may disrupt the closure function of the bladder neck, causing the menu to escape back to the bladder. The most important indication for the patient is that the menu does not come or very little, the semen is not flowing as before the orgasm.
• GENETIC CAUSES: Genetic is one of the most important roles in fertility. The reason is that the half-ring structure in DNA normally has to be combined with half the DNA ring in the female egg. However, like the numerical and structural disorders of the chormosomal structure, the fractures and cuts in the Y chromosome will disrupt the fertility in the normal male and the desired development will not be achieved.
• UNLOADED TESTIS: One or two of the testicles are not inward from the infancy period.
• SEXUAL INTERCOURSE PROBLEMS: Failure to form or prevent the formation of hardening may cause male infertility in premature ejaculation, pain during sexual intercourse and problems due to psychological causes. Despite the formation of sperm production in some types of diseases, ejaculation does not occur. (Sexual problems)
• LONG-TERM MEDICATIONS: Medications and bodybuilding drugs used for cancer treatment (doping and steroid-style medications can lead to hormonal disorder) can lead to infertility. In men who have chemotherapy and want to have children in the future, other alternative therapies should be brought up to chemotherapy (e.g., retroperitoneal lymph node dissection instead of chemotherapy in testicular cancer) or before chemotherapy Sperms should be frozen.
• USE of ALCOHOL and CIGARETTES: especially smoking can make reproductive disorders in the male.
• SYSTEMIC DISEASES: Medical diseases such as diabetes, asthma, chronic kidney and liver diseases can affect male productivity.
How to diagnose male infertility?
The evaluation of a man is done by a urologist. In the study, the person is primarily asked for physiological sexual functions such as the general health status, habits (cigarettes, alcohol etc.), frequency of sexual intercourse, hardening (erection), ejaculation (ejaculation). After the receipt of the detailed story, it is done by physical examination. After that, semen analysis (spermiogram) and fertility condition are assessed. The person who will give Spermiogram is required to have 3-4 daily sexual fasting. Semen analysis is the amount, pH, viscosity and Likefaction (liquefaction) duration, sperm count, the status and ratio of sperm movements, sperm concentration, the number of leukocytes in the menu, the structural characteristics of sperms are most looked at. To be able to correct sperm analysis, at least 2 Spermiogram must be evaluated in different periods.
If there is a problem with semen analysis (spermıogram), further examinations are requested.
If sperm concentration is too low in semen analysis, your doctor will surely ask you to evaluate hormonal tests (such as FSH, LH, TESTOSTERONE). If there is a deficiency in the hormonal levels, these deficient hormones can be substituted, with a prolonged treatment, the number of sperm that may have children in normal ways.
VARICOCELE, i.e. enlargement and variculation in the veins of the testicle; it is a condition that is often encountered in the male factor. Sperm count and quality can be affected. A surgical operation may be necessary for treatment. It is the most frequently treatable cause of male infertility.
In semen analysis, this does not mean precise and irreversible infertility, even if the amount and concentration of sperm is low or no sperm. Is there an inability to do this in production or if the transmission of sperm should investigate a bottleneck in question. For example, if the amount of semen is too low and there is no reverse (retrograde ejaculation) in the semen, "is there a blockage in the main canals (ejaculator)," to investigate, your doctor will ask you to consult with Transrectal ultrasonography and the main semen channels and May require the evaluation of the prostate. It is possible to investigate with transrectal ultrasonography whether there is a calcification, cyst pressure and even stone obstruction in the main semen canal.
If there is no sperm in the analysis of semen (azoospermia) There is sperm production in the testicle, biopsy is taken from the testicle to investigate. These biopsies should be taken from several points in the testicle in the form of mapping the testis. In some limited parts of the testicle, sperm production may be involved. Only one point can be found in the tissue sample, sperm can not be encountered. That doesn't mean there's no sperm in the whole testicle.
There is a higher proportion of sperm to find the areas that are wide in the testicular (seminiferous tubule) under the microscope and obtain the tissues from here. These extracted sperms are currently available for the Microinjection method. This is called microscopic TESE (testicular sperm extraction).
How is the treatment of male infertility?
Treatment of male infertility is also specific treatments for the cause. In some severe cases, treatment may not be possible. Usually combined therapies are applied in the form of mixed therapy.
For example, a man has varicocele and the quality and intensity of sperm can be very bad, and with this sperm count, however, microinjection (ICSI) can be tried. In Microinjection, the sperm is injected into the egg outside the body in an unnatural way and fertilization occurs outside the body. Fertilized egg is placed in the uterus and the pregnancy is expected to occur. However, in this process, to obtain excess eggs, a woman is given hormone therapy (which may have serious side effects), taking out the resulting eggs requires a process, likewise the transfer of the fertilized egg to the uterus is also a process Requires. All of these are highly abrasive and costly processes and are far from natural-derived pregnancy.
However, with the surgical treatment of varicocele, sperm quality can go to normal levels, and in some patients the sperm count may not go to normal levels, but the density and quality are improved. The possibility of vaccination can be achieved with this improvement. In the process called in utero insemination, sperms are given directly into the uterus with the help of a special injector and fertilization is ensured in the uterus. This procedure does not use intensive hormone therapy and is closer and less costly to the natural formation. As stated above in Microinjection (ICSI), it will give less trouble to the patient and the family, rather than the cost of many troubles and natural roads.
In the presence of varicocele, especially in the Varicocele degree and if the development of testicles is impaired, chances of varicocele surgery are increasing. Varicocele surgery is called varicocelectomy. Nowadays varicocelectomy should be performed either under optical magnification or under the microscopic image at the level of the pubic duct. After this surgery lasting approximately 30-60 minutes, the patient is removed from the hospital the same day or the next day. To monitor Sperm quality improvement, post-operative 3. 6. and the 12th. Months, semen analysis is performed.
If the main semen duct (ejaculator duct) has a blockage and does not come with the semen attached to it, then under anesthesia the urinary tract (urethra) on the tip of the penis is entered and the obstruction of the Ejaculator channel is opened. This process is called TUR (ED), transurethral resection of the ejaculator duct.
A patient who has previously been linked to VAS deferens as a contraception method, if he wants to have children again, the process of reopening these channels is performed (vase-vasostomy).
If there is obstruction in the epididymis canal and the sperm is not transferred due to blockage in this duct, although it is produced in the testis, the Anastomotic (bridge) connection between the previous part of this duct and the vas deferens ( Epididydimo-vasostomy) can be transferred out of the sperm.
Depending on the specific condition of the disorder that causes infertility, the treatments also vary. If there is no complete closure of the bladder neck, then the semen is running back to the bladder. In this way, to prevent the semen from escaping back to the bladder is given medications that will allow the closure of the gout on the neck and the menu is not backward.
Sperm production may be affected due to deficience in the level of hormones required in sperm production. Sperm production can be gained by replacing the missing ones of these hormones. However, it should be remembered that the desired response may be at least 9-12 months after long-term treatment in such treatments.
Some vitamins and mineral remedies can also be started to increase the Sperm movement. (L-carnitine, L-arginine, vitamin E, zinc, folic acid, selenium etc.)
Assisted reproductive techniques
Intra uterine insemination (IUI)
Following the period of ovulation in the woman, during the ovulation period, the sperm obtained from the male is passed through some processes, and the whole moving sperm is given directly into the uterus (uterus) with the help of a special injector.
In vitro fartlilization (IVF)
In this method known as "IVF", the sperm obtained from the woman by the egg and the male, except the female body, in a specially prepared petri dish in a laboratory environment or in a tube, and the sperm's egg Fertilation is intended.
Intracoplasmic Injecting (ICSI)
This method is the next step in the IVF method. Here, sperm and eggs are combined in the laboratory environment. However, it is not expected that the fusion of the egg with sperm is spontaneous as in the IVF, a healthy sperm is injected into an egg with microscopic special needles under the microscope and fertilisation of the egg is monitored