It constitutes approximately 40-50% of couples who complain of infertility due to male factor. Therefore, the man must also be examined. In particular, it should be evaluated whether the testicles are located in the normal sac, their size, the presence of a history of surgery for undescended testicles, the presence of varicocele, whether they have had surgery for varicocele, whether they have had mumps in adulthood, and whether sexual intercourse is normal.
Semen is formed by mixing sperm produced in the testicles, prostate and fluids secreted from some glands. Sperm production occurs as a result of a process that takes approximately 75 days. For this reason, the drugs the man has used in the last 75 days and the toxic substances he has been exposed to (such as cigarettes) may affect sperm quality and number. For this reason, it is necessary to perform sperm analysis tests 2-3 times at 2-3 month intervals before a definitive diagnosis.
Causes of InfertilityRate(%)No reason can be shown48.5%Defective sperm whose cause cannot be determined% 26.4Varicocele%12.3Infectious diseases%6.6Defense system disorders%3.1Acquired disorders%2.6Congenital (genetic) disorders%2.1Sexual problems%1.7
Tests to detect the causes of infertility:
Sperm Analysis is the most important test in determining the causes of male infertility. Sperm analysis test is a test that should be done first because it is a cheap, easy and effective test. It should be given after 3-6 days of abstinence. A sterile container is given by the laboratory where the sperm analysis will be performed, and semen is administered into this container by masturbation. No lubricant should be used during masturbation. If possible, semen should be given in special rooms within the laboratory. The process of donating semen can put the man in a very stressful situation. For this reason, problems such as erection problems may be observed normally during the semen emission process. In such cases, the man's wife can help, or if there is an erection problem, drugs such as Viagra can be used. In some cases, semen donation can also be done at home. However, the semen must be brought to the laboratory within the appropriate temperature range (body temperature) within 1 hour at most.
Normal sperm analysis:
Semen Volume (ml)1.5 -7 mlPh Value7.0-8.0Sperm Count (Million/ml)Sperm Count (Million/ml)>20 MillionMotile Sperm Rate (%)>50%Motile Sperm Rate (%)>25%Questional Cell Count (Million/ml)> <5 MillionLeukocyte Count (Million/ml)<1 MillionFigure (according to Kruger classification)>14% Normal 4%14 Subfertile <4% Infertile
Definitions
AspermiLack of semenOligospermiaLow number of sperm in semen Azoospermia Absence of sperm in the semen Asthenospermia Lack of motile sperm Teratospermia Lack of normally shaped sperm Necrospermia Lack of live sperm in the semen Leukocytospermia Presence of white blood cells in the semen Hematospermia Presence of blood cells in the semen Globospermia Presence of sperm without acrosome
Detection of normal sperm values is usually a sufficient indicator that there is no male factor. However, in abnormal cases, sperm analysis tests are required 2-3 times at 2-3 month intervals before definitive diagnosis.
Rarely used tests
Sperm analysis is usually sufficient to evaluate male infertility and does not require another test. There is no need to test. The following tests are performed very rarely.
Mixed Agglutination Reaction Test
A test in which the presence of antisperm antibodies is detected. It has no place in routine clinical practice.
Hormonal Tests
FSH, LH and testosterone values can be checked in men with azoospermia. While FSH is normal in those with obstructive type azoospermia, FSH is increased in non-obstructive azoospermia. If the FSH value is low, problems in the pituitary gland in the brain should generally be considered.
Sperm Function Tests
It has no place in routine clinical practice.
Testicular Biopsy
In patients with no sperm in the semen (Azospermia), a surgical biopsy can be performed from the testicle and it can be determined at what stage sperm production is interrupted. However, nowadays, biopsy is not recommended except for the biopsy performed during in vitro fertilization. In patients with azoospermia, very valuable testicular tissue is removed through biopsy, and even if sperm is found in this tissue, it cannot be used at this stage. For this reason, instead of performing a biopsy in patients with azoospermia, preparing the spouses of these patients for in vitro fertilization and applying one of the sperm retrieval methods to the patient with azoospermia (TESE, TES A), if sperm is released, it is most appropriate to perform microinjection directly. The remaining tissues can be sent to pathology for examination. To reiterate, testicular biopsy is definitely not recommended except for in vitro fertilization.
Examination with ultrasonography
It may be necessary to determine whether there is a varicocele or hydrocele.
Genetic Examination
Azospermia or It should be done in cases where the sperm count is very low. Chromosome analysis of the man and whether he has a Y microdeletion should be determined.
Male factor-Treatment
Treatment is planned according to the degree of the male problem. While in vitro fertilization with microinjection is necessary in severe problems, in mild cases, insemination treatment is performed first. If success is not achieved with the insemination treatment, in vitro fertilization treatment should be started.
Important warning:
Surgical removal of varicocele should be done only in the presence of pain and when it greatly impairs the aesthetic appearance. Although removal of varicocele due to infertility slightly increases sperm count, it does not increase pregnancy rates. In the presence of varicocele, treatment is usually vaccination or in vitro fertilization.
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