What can be the reason of male infertility?
Undescended testicles and consequences of repairing surgery, hernia surgery, bladder surgery, testicular tumor and following removal of testicle, vas deferens opening surgery, any other penis, urinary tract or testicles surgeries can lead to male infertility.
Recent years it was noticed that hormones deficiency, systemic diseases, diabetes, diseases of nervous system and it's treatment in the past or the current one, diseases which go with high temperature, testicles inflammation caused by mumps in adolescence period, sexually transmitted diseases, infection such as tuberculosis all these might have a negative effect on sperm count or its quality.
The same time chemicals, gases used around, hot working conditions, radiation, alcohol and smoking might influence sperm production.
Evaluation of Male infertility factor
Any decreases either in sperm count or its mobility, changes in structure as well as absence of sperm in semen - all these might be reasons of male infertility. In addition anatomical disorders and sexual dysfunction can impede the conceiving.
Besides of impairments in sperm quality or its count sometimes there are no sperm cells found in semen. This problem is called azoospermia. It means either vas deferens are blocked or sperm production in testicles is low (might be absent at all). In each particular case the reason of azoospermia requires deep investigation.
Due to determine the diagnosis blood samples might be requested for hormone analyzes and genetic investigations (karyotype analysis, Y chromosome microdeletion analyses). Radiological examination (ultrasound of testicles) may be done as well. After receiving the results together with conclusion of urologist treatment plan will be developed and discussed with a patient.
In case of azoospermia is connected with sperm production problems, micro TESE surgical technique will be used in order to detect sperm in testicles. If the reason is blocked vas deferens, Microsurgical epididymal sperm aspiration (MESA) technique or sperm aspiration by inserting a needle in the testis (TESA) will be applied.
Obstruction in reproductive tract as a consequence of anatomic disorders which doesn't let semen to be released freely leads to infertility as well. Such disorders might be caused during parturition or might have genetic origin. Sometimes problems with urogenital tract may occur after infection or inflammatıon.
Varicocele is an enlargement of veins within the loose bag of skin that holds testicles. In this case most likely quality of sperm would be not good enough. Between 21% and 40% of men who faced with varicocele surgery might be offered to resolve this problem.
Microsurgical Testicular Sperm Extraction (Micro-TESE)
Micro TESE technique is applied in cases of azoospermia in order to obtain sperm directly from the testicular tissue. With the help of operating microscope testicles are checked for the availability of sperm, after samples are taken from the determined area. The ability to take really small pieces of testicles as well as to select production areas which leads to high chances of sperm retrieval and also less harm done to vasculars - all these are big advantages of micro TESE.
Experience of a doctor who makes surgery and how often he makes surgeries are quite important aspects for successful sperm retrieval and needs to be paid attention to.
IMSI
It's a technology of sperm selecting with help of inverted microscope that is able to provide much greater magnifying power. With 8 - 10000 fold magnification biologists try to select healthy sperm without morphological alteration which are suitable for further microinjection. Purpose of this procedure is to increase the chances of successful implantation.
Sperm DNA fragmentation test
In case of patients who faced with problems of low embryo quality, low sperm count or slight alteration in morphological sperm structure there might be possibility that reason is hidden in DNA of sperm. Advanced technique (TUNEL test) might be necessary for deep investigation. Based on the results of the test sperm for microinjection might be taken even from men with damaged sperm DNA structure.
