Infertility in men occurs as a result of blockage of the sperm ducts, and the most common symptoms of infertility in men can be said to be unable to have a child.
What is male infertility, how does it occur?
The inability of married couples to have a child despite having regular sexual intercourse for a year is defined as male infertility.
If this situation is caused by disorders in men, it is called male infertility. Approximately 15% of married couples are infertile.
Infertile couples are dependent on 20-30% male, 30-40% female, and approximately 20% both male and female. In 10% of patients, the cause of infertility cannot be found despite all research.
Sperms are produced in the eggs, stored in the organ after the egg, which we call epididymis, and exit from this storage to the prostate and then through the penis via the sperm pathways.
The formation of sperms is controlled by the FSH hormone secreted from the brain from the pituitary gland and the testosterone hormone secreted from the testis.
When the sperm is reduced in the eggs, that is, when needed, the FSH hormone is secreted from the pituitary gland, from here it passes into the blood, and then comes to the egg through the blood and stimulates the Sertoli cells to produce sperm.
If there is disease in the eggs, there is a problem in sperm production. If there is inflammation in the sperm tract and there are sequelae, even if the sperm is produced in the egg, it will not be transported.
It takes an average of 65-70 days for a sperm to be produced. In cases that affect this cycle, the phenomenon we call infertility occurs in men.
If there is damage to the pituitary gland in the brain, sperm production stops or weakens because the hormone cannot be secreted. In addition, infertility may occur in many genetic disorders.
What are the symptoms of male infertility?
At the beginning of the symptoms of infertility in men, there is a failure of pregnancy despite regular weekly relationships for a year and it is an important symptom.
There are additional symptoms such as insufficient hardening due to hormonal disorders or other factors and difficulty in sexual intercourse, testicles, i.e. eggs being smaller than normal or not at all, eggs being congenitally high, i.e. not in bags, not enough beard mustache growth, thin voice.
In addition, there may be symptoms such as the presence of varicose in the bags and the pain in the groin due to this, the urinary hole outside the normal place, i.e. below.
How Does the Infertility Treatment Process in Male Work, What Are the Treatment Methods?
In Infertility Treatment, couples who cannot have a child within a year despite regular relationships should be directed to evaluation. Evaluation should be done to both men and women.
It may be more practical to start the evaluation with the male first, as the tests performed in men are easier and quicker. Unfortunately, in our society, women are evaluated first, and if there is no problem after all the tests, men are evaluated, and sometimes not even considered. For this reason, many examinations that may not be necessary for the woman are performed.
In order to prevent these, the male factor should be considered with priority. If infertility is suspected, man consults a urologist. The detailed examination process is the first thing to do after the sperm analysis. At least 2 sperm analysis should be done one month apart. If it is normal, the female factor should be considered, and the patient’s spouse should be evaluated.
If there is an abnormality in the sperm analysis, hormone analysis, Doppler ultrasonography for the eggs and genetic analysis should be done when necessary. If no sperm is found in the patient’s semen, we call it azoospermia. In this case, detailed genetic analysis and hormone analysis are required. At the end of all these evaluations, if there is no female factor, the treatment methods to be applied to the patient are determined.
If the patient has varicoceles in the eggs and affects sperm measurements, varicocelectomy should be performed with microsurgery. After the operation, 70% of the sperm values improve and 40% of the patients can have a child within 1 year. Varicocele is the most common treatable cause of male infertility. If no correctable cause has been found and sperm values are above 5 million, the patient can be given inutero insemination, i.e. vaccination.
The success rate in a trial is about 10%. If the sperm values are below 5 million and there is no correctable cause, the patient should be directed to intracytoplasmic sperm injection (ICSI), i.e. in vitro fertilization. For IVF, it is sufficient to see a few motile sperm in the semen.
If there is no sperm in the semen, that is, if the patient is azoospermic, sperm should be taken from the egg with microTESE, that is, surgery and IVF should be performed. If no sperm can be found, then either adoption should be considered or donor sperm should be used. Donor sperm use is prohibited in our country.
What Are The Factors That Increase Male Infertility?
Factors that increase male infertility are ageing, smoking or being in a smoking environment, working in excessively hot jobs, exposure to heat of eggs, having inflammatory diseases in eggs or healing by leaving sequelae, working in the paint industry, varicocele disease, surgeries for prostate, There are many factors such as the high birth rate of the eggs and the development of egg cancer.
What are the Success Rates in Male Infertility Treatment?
Varicocele is a correctable disease that should be evaluated first in infertility treatment in men. Microsurgical varicocele surgery has a high success rate. 70% sperms return to normal.
One year after the operation, 35-40% pregnancy is achieved within a year.
If there is a hormone deficiency and this is compensated, sperm values can return to normal and pregnancy will occur. Success in inuteroinsemination (IUI), i.e. vaccination, is about 10%.
Success in ICSI, ie in vitro fertilization, is about 50% in the first attempt.