Our topic: One in every 100 men has no sperm at all

Photo: Profimedia

The diagnosis of male infertility is one of the most difficult challenges a man can face. Despite the traditional view that infertility is a female problem, science says that the male partner contributes to infertility in about half of all cases in couples where there is a problem with reproductive ability. However, nowadays, assisted reproductive technologies (ART) offer powerful new options for overcoming the problem of male infertility and achieving the long-awaited parenthood. It is best if the couple is examined for infertility together, in parallel, says assistant professor Dr. Rosa Spasova, who works at the University Clinic for Gynecology and Obstetrics - Skopje in the department of infertility and assisted reproduction.

Doctor Spasova, does the biological clock beat in men as well?

- Infertility has traditionally been considered exclusively a female problem. But, as it has been established in recent years, this is not true at all. Research shows that most men in the world believe all their lives that everything related to conception and babies is exclusively tied to the female partner. This is especially noticeable in smaller and more conservative environments like ours, where a visit to a doctor on fertility is seen as an insult to masculinity.

Namely, a kind of biological clock beats in the male organism - although in general, the male has no time limit. Numerous published results refute the belief that male reproductive ability lasts forever. Recently, the most attention is paid to lifestyle, as a factor that leads to a drastic increase in male infertility in the world.

Infertility itself is a very rough term, but it is most often used, and refers to a condition in which the couple can not achieve spontaneous conception and pregnancy, which in practice is relatively rare, so the correct term is actually infertility (infertility) or a condition that due to certain factors that lead to a reduced but not absent chance of pregnancy.

Can we talk about a serious percentage when the problem of pregnancy is male infertility?

- In about 20% of infertile couples, the problem is only in the male partner. In about 30 percent of couples, the problem is in both partners. Therefore, the man contributes to infertility in about half of all cases. One in 20 men has low sperm count, which actually causes infertility. However, only one in every 100 men has no sperm at all.

The diagnosis of male infertility can be one of the most difficult challenges a man can face. For some, it can be overwhelming. After all, the need for reproduction is one of the few things that both Darwin and the Bible agree on. The inability to fulfill the role of a father can make men feel like they are failing in one of the most important responsibilities.

Unfortunately, some men have to deal with the reality that nothing can be done about their infertility.

But for other men it must be noted that modern medicine offers many options for successful treatment.

What are the causes that lead to infertility in men, in that context can we talk about congenital damage as a cause of infertility in some men?

- The most common problems related to male infertility are related to the production and development of sperm. Namely, sperm may not develop fully, have irregular shapes, not move in the right direction or be produced in very small numbers (oligospermia) or may not be produced at all (azoospermia).

Sperm problems can be due to a man's innate traits, but lifestyle choices can also reduce sperm count. Smoking, drinking alcohol and taking certain medications are life characteristics that can reduce sperm count. Hereditary disorders such as Klinefelter syndrome - in which a man is born with two X chromosomes and one Y chromosome (instead of one X and one Y) - cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis and Kalman syndrome.

Damage to the reproductive system can cause little or no sperm production. About four out of ten men with complete sperm deficiency (azoospermia) have obstruction. Congenital defects or damage, such as infection, can cause this blockage. Some infections can interfere with the production or impede the normal transport of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections. Although some infections can result in permanent damage to the testicles, it is usually possible to get sperm.

Defect of the tubules that transmit sperm. They can be blocked for a variety of reasons, including unintentional surgery injury, previous infections, trauma, or abnormal development, such as cystic fibrosis or similar inherited conditions. Blockage can occur at any level, including the testicles, epididymis, drainage ducts, near the ejaculatory ducts, or the urethra.

In addition to the reasons you have given, can certain chronic diseases, certain health conditions како appear as an obstacle to a man's fertility…

- One of the causes of low sperm count includes chronic diseases such as renal failure, childhood infections (mumps) and chromosomal abnormalities.

Otherwise, common causes of male infertility are:

- Varicocele, which is a swelling of the veins of the testicles;

Ejaculatory disorders: most often retrograde ejaculation. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery on the bladder, prostate, or urethra;
- Antisperm antibodies - these are cells of the immune system, which mistakenly identify sperm as harmful attackers and try to eliminate them;

- Cancers and non-malignant tumors can directly affect the male reproductive organs, through the glands that release reproductive hormones, such as the pituitary gland, or for unknown reasons. In some cases, surgical treatment, radiation, or chemotherapy to treat tumors may affect male fertility;

- Problems with sexual intercourse - may include erectile dysfunction, premature ejaculation, painful sexual intercourse, anatomical abnormalities such as opening of the urethra under the penis (hypospadias) or psychological problems;

- Drug use: Anabolic steroids taken to stimulate muscle strength and growth can cause testicular shrinkage and reduced sperm production. Cocaine or marijuana use may also temporarily reduce the number and quality of male sperm;

Alcohol use: Drinking alcohol can lower testosterone levels, cause erectile dysfunction and reduce sperm production. Damage to the liver caused by excessive drinking can also lead to fertility problems;

- Cigarette smoking: Men who smoke may have lower sperm counts than those who do not smoke. Passive smoking can also affect male fertility;

Obesity: Obesity can impair fertility in several ways, including by directly affecting the sperm itself, as well as by causing hormonal changes that reduce male fertility.

What should be done from a medical point of view to diagnose possible infertility in the male partner of the couple who wants to have a baby?

- The diagnosis of male infertility usually includes:

A general physical examination, which includes an examination of the genitals and a comprehensive history of all inherited conditions, chronic health problems, diseases, injuries or surgeries that may affect fertility.

Spermogram: The sample is examined for the number of sperm present, possible irregularities in the shape (morphology) and movement (motility) of the sperm are determined. It also looks for signs of infection. Often the number of sperm varies considerably from one sample to another. In most cases, several semen tests should be performed over a period of time to ensure accurate results.

Additional tests that may need to be done include a scrotal ultrasound, hormonal and genetic tests, a testicular biopsy, a post-ejaculatory urine test, or, if necessary, specialized sperm function tests to determine how long it takes to survive a good ejaculation. can penetrate and whether they have the opportunity to attach to the egg.

Nowadays, can we talk about lifelong male infertility?

- The ultimate goal of infertility treatment in men is to create pregnancy. It is ideal when the cause of infertility is reversible and then conception can occur naturally.

Here are some common treatments for male infertility.

Varicocele is repaired surgically, this seems to result in a significant improvement in fertility, although some studies disagree. It is the most common reversible cause of male infertility. Obstructive disorders can also sometimes be corrected surgically.

In the past, if all these methods did not result in success, it meant - lifelong male infertility.

And in terms of infertility, modern medicine with new technologies constantly gives more and more hope that infertility is cured and that the hope of becoming a parent is great. Which, according to science, but also according to the experience as a doctor, do you consider to be the most effective treatments for treating male infertility?

 - Nowadays, assisted reproductive technologies (ART) offer powerful new features.

These high-tech treatments for male infertility give the sperm an artificial incentive to enter the egg. What is extremely important is that ART allows conception even for men with abnormal shapes, and even for men with extremely low sperm concentrations.

Assisted reproductive technologies are diverse and include intrauterine insemination, in vitro fertilization, intracytoplasmic sperm injection, testicular sperm extraction, and others. Studies show great success in using ART and achieving the long-awaited parenthood.

We can conclude that there is nothing shameful about seeking help for procreation. Care must also be taken for the way of life, for the diet, to avoid the use of harmful substances.

Unfortunately, it is often thought that male causes of infertility can be overcome with ART, even without a full male andrological evaluation. Consequently, in 18-27% of couples with infertility, the man is not subject to any infertility evaluation. This bias in diagnosis can lead to unnecessary prolongation of treatment time. Ideally, the couple should be examined for infertility together, in parallel. All this can prevent premature and unnecessary use of ART. Both partners should and can support each other through the stressful moments in which they face the reasons for their inability to conceive. The knowledge that they are not alone in the treatment and that together they do everything they can, reduces the burden of infertility in both men and women.

Photo: Private archive

Assistant Professor Dr. Rosa Spasova, specialist gynecologist-obstetrician

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