Effective treatment methods for male infertility, male infertility reasons.

Causes of Male Beplody:

-Gypegonadotropic hypogonadism;

-re-resistance to androgen;

Genetic causes (syndrome; clanfelter, deletion of y-chromosome);

-Bealth therapy / chemotherapy;

-pext of eggs;

Orchitis (orchiepididimitis);

Nestrumental azoospermia; infections of the genitourinary system (enterococci, streptococci, staphylococci, etc.) and STDs (chlamydia, trichomoniasis, candidiasis, gonorrhea, mycoplasmosis, ureaplasmosis, HPV, cytomegalovirus, herpes, etc.);

Inflammatory diseases (prostatitis, urethritis, vesiculitis);

-Rebid aplasia of the appendage or seed-handing duct;

-Rebent / acquired (injuries, operations) obstruction of the appendages of eggs, seed-winning ducts (obstructive azoospermia);

Vasectomy; -gipogonadotropic hypogonadism; (secondary);

-gireprolactinemia;

Piece of pituitary glands (adenoma, infection); -Antispermal antibodies; Sexual problems Erectile dysfunction;

Reduction of libido; -Ereograd ejaculation;

-anoeaculation; - Sprichins are not installed; -alcohol;

-plore;

-nriculties;

-ntibiotics;

-spirin;

-citostatics;

-tecides;

-Testosterone in high doses.

Diagnosis of male infertility:

The diagnosis of male infertility is based on a comprehensive assessment of the state of the male reproductive system, the Andrologist is examined in a certain sequence. The diagnosis starts from a minimum and as needed to expand.

Minimum monitoring algorithm for infertility: (This algorithm allows you to verify the diagnosis and identify disorders to fertilization in men, it allows you to estimate the anatomy-functional state of the reproductive system).

1. Consultation (collection of anamnesis, complaints) and inspection of an Andrologist's doctor.

2. Assessment of sperm indicators evaluate male fertility (sperm quality). It is a reference point of the need for further action (analysis is handed over by masturbation in a separate designated room, before this 3 days of abstinence from sex contacts, not drink alcohol, not to visit the bath). Types of pathosperm.

3. Mar test - exclude immune infertility (the preparation is the same as when the spermogram is passed).

4. Ultrasound + Doppler organs of the scrotum - the study of testicles, appendages and blood supply to these organs. Eliminates surgical, inflammatory and physiological pathology.

5. Prostate glands and seed bubbles are a more detailed examination of the prostate gland, which allows us to consider its structure and eliminate sharp and chronic inflammatory processes.

A complete examination algorithm for infertility: (carried out after the minimum algorithm in order to clarify the diagnosis or in the presence of complaints from the patient).

1. Hormonal status - blood test to the main hormones responsible for the normal course of spermatogenesis and male libido (blood is handed over in the morning, on an empty stomach from 9.00 to 10.00)

2. Genetic studies are carried out on the appointment of an Andrologist's doctor based on the clinical situation (a direct indication for the study is pronounced pathospermia).

3. PCR Diagnosis of infections of STDs - exclude the main infections transmitted by sexually and their possible impact on the decrease in the quality of sperm and the absence of conception, miscarriage or fading pregnancy (strokes from the urethra channel, 2 hours before the study do not urinate).

4. Summer sowing (spermogram) - the study of the ejaculate is carried out in cases of increasing leukocytes or the appearance of bacteria in sperm (analysis is handed over by masturbation into a sterile container, an abstinence is not necessary).

5. The juice of the prostate gland is (the secret of prostate) - exclude an inflammatory process in the prostate gland - prostatitis (before analysis required 3 days of sexual abstinence).

6. Determining the level of free radicals (ROS) is one of the factors capable of reduced male fertility ROS hyperproduction of the active forms of oxygen (ozone, free radicals, hydrogen peroxide). In small amounts, AFC is necessary for normal regulation of the function of spermatozoa (hyperactivation and acrosomal reaction). But excessive products of AFC damage the spermatozooid membrane, a decrease in their mobility and disruption of fertilizing ability. In addition, AFC is directly damaged by DNA chromosomes and initiate apoptosis of spermatozoa.

7. Acrosomal reaction - (these are chemical changes on the sperm head, allowing to penetrate into the egg) - when contacting the spermatozoa with a transparent region of the egg shell, the spermatozooid acrosoma undergoes an acrosomal reaction, which normally proceeds only in morphologically normal spermatozoa and allows them penetrate the eggs.

8.Electron microscopic examination of spermatozoa (NEW) is a new method for a more detailed study and detection of pathological internal structures in spermatozoa and the contents of seminal plasma.

9. Biochemistry of the ejaculate - a study of the composition of seminal plasma, reflects the work of such organs as the prostate gland, seminal vesicles and epididymis. (examine the level of fructose, citric acid, neutral alpha glycosidase, prostatic acid phosphatase, zinc).

10. Kruger morphology study is a more in-depth study of the morphology of spermatozoa when performing a regular spermogram (performed together with a spermogram). Wrapped spermogram - it includes a standard spermogram (indicators recommended by WHO) + MAR test (IgG; IgA) + Kruger morphology.

11. Kurzrock-Miller test; The Shuvarsky test reveals an immunological conflict between a man and a woman at the level of the cervix (cervical factor, postcoital test).

12.HLA - typing of a married couple (if pregnancy is not carried). It is carried out to determine the antigens of tissue compatibility in spouses. Venous blood is taken and leukocyte cells are isolated from it, on the surface of which antigens of tissue compatibility are located.

13.Diagnostic testicular biopsy - performed as prescribed by an andrologist, in cases with azoospermia (necessary for an accurate diagnosis and choice of further treatment tactics).

14. PSA - prostate specific antigen, the study is performed on all men over 45 years old.

15. Laboratory diagnostic methods - the doctor prescribes according to indications: general urinalysis, urine culture, general blood test, blood biochemistry, etc.

16. Determination of tumor markers - the appointment is performed by the doctor according to indications.

Male infertility treatment:

There are two approaches to the treatment of male infertility, in both cases, the doctor must make realistic predictions about the potential success of the treatment before starting therapy. Untested drugs and therapies should not be used in treatment. Any treatment of the male factor must be accompanied by the optimization of female sexual functions.

1. An empirical way without revealing the causes that led to infertility, for example, the use of artificial insemination methods, if there is at least one sperm, then IVF / ICSI is already possible. Since infertility is not life-threatening for a man, empiric therapies should be chosen that do not produce severe side effects.

2. The pathogenetic path first diagnoses the cause, and then selects the treatment. During the consultation, the andrologist, based on the results of the examination, provides complete information about the possible options for treating infertility, taking into account the female factor, and offers an algorithm for managing the couple.

General recommendations for patients with infertility:

! For convenience, the main therapeutic measures are presented to patients in the form of tables.