Male problems are the only factor in approximately 20% of couples without children, and are a contributing factor in the other 30-40% of couples (50-60% in total).
The testicle, which is the male ovary, has 2 separate parts. has a duty. The first is the production of sperm, which is the male fertilization cell, and the second is the production of testosterone, the male hormone. There are two separate cell groups in the testicle to perform these functions:
- Sertoli cells (sperm production)
- Leydig cells (Testosterone production)
While the LH (Luteinizing Hormone) hormone secreted from the pituitary gland located in the middle part of the brain in men ensures the production of testosterone from Leydig cells, the other hormone secreted from the pituitary, FSH (Follicle Stimulating Hormone), stimulates the androgen receptors in the Sertoli cells and creates an androgenic (male hormone) environment in the testicle. . It also increases LH receptors in Leydig cells.
In couples applying for children, the evaluation of the man first begins with taking a detailed history and sperm examination. If there is a problem in the history during the first evaluation or if the sperm analysis results are not normal, the patient is referred to a urologist to take a full medical and reproductive history, physical examination, examination of the sexual organs and other tests.
Causes of Male Infertility
When the urologist takes the man's medical and reproductive history, he examines the risk factors that may lead to male infertility, his behavior and lifestyle, his family's reproductive health, whether the person has used any hormonal drugs in the past or currently, high-inducing drugs such as cocaine, marijuana or methamphetamine, cigarettes and alcohol, and It also questions the health symptoms of all organs and evaluates the examination findings.
- Frequency and timing of sexual intercourse
- Duration of infertility and fertility history of the previous partner, if any
- Childhood period diseases and developmental history
- Other diseases (diabetes, upper respiratory system diseases)
- Previous surgeries
- Medication use and allergies
- Environmental and chemical toxins and heat
- Sexual history-including sexually transmitted diseases
- General health status: Diet, exercise, etc.
- Congenital defects
Examination of sexual organs is performed along with the general physical examination. If sperm parameters are not normal, there are sexual dysfunctions or clinical findings suggestive of a certain hormonal disorder, endocrine examination (hormone tests) is performed. If necessary, ultrasound is requested.
Genetic disorders cause infertility by affecting sperm production or transportation, which is important as it can also affect the couple's children. The most common ones in infertile men are numerical or structural chromosomal disorders and Y-chromosome microdeletions. Chromosomal disorders are found in -15 in azoospermic men (with no sperm in their semen), in 5% of men with very low sperm count, and in 1% of men with normal sperm analysis. Sex chromosome disorders (47 XXY, Klinefelter syndrome) account for 2/3 of chromosomal disorders in infertile men. Structural disorders of chromosomes (inversions, balanced translocations) are more common in infertile men than in the normal population.
The wives of men with damaged chromosomes have a higher risk of miscarriage and of having children with chromosome disorders and congenital defects. For these reasons, men with azoospermia or severe sperm count should have their chromosomes examined before in vitro fertilization.
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