infertility
Causes of Male Infertility
The man's study should include a complete medical and reproductive history, a physical examination by an andrologist, and at least two spermograms.
The objectives of this assessment are to identify potentially correctable situations, irreversible situations that can be resolved by Medically Assisted Procreation techniques and irreversible conditions for which sperm donation may be an option. Serious medical conditions that have manifested as an infertility problem can also be detected.
Absence of sperm in ejaculate (azoospermia)
This problem, which affects 1% of all men (and 10 to 15% of infertile men), can be due to two causes:
• Non-obstructive azoospermia: the testicle is unable to produce sperm.
• Obstructive azoospermia: there is a blockage to the passage of sperm (congenital absence or obstruction of the vas deferens).
In the case of non-obstructive azoospermia it is necessary to carry out some hormonal measurements (FSH, LH, testosterone):
- High FSH values are an indication to continue the study by carrying out a karyotype and research for microdeletions of the Y chromosome;
- Low FSH and testosterone values require prolactin measurement and imaging assessment of the pituitary gland.
In the case of obstructive azoospermia, due to the congenital absence of the vas deferens, 2/3 of men have the cystic fibrosis gene, which also implies research for the mutation in women.
Testicular biopsy may be indicated in patients with azoospermia with normal testicular volume, with at least one palpable vas deferens and normal FSH, and also to confirm the presence of obstruction in patients with low ejaculate volume and palpable vas deferens.
Deficiencies in sperm quantity and/or quality
These deficiencies can have several causes: hormonal problems, varicocele, infection, some medications and drugs.
Varicocele represents a condition of dilated veins, similar to varicose veins, within the scrotum and is found in 15% of the general population and in 40% of men with infertility. Its presence is attributed to a deleterious effect on spermatogenesis. Although controversial, varicocele treatment (surgical or percutaneous embolization) is advised when it is palpable, when the couple has documented infertility, and when the woman has normal or potentially correctable fertility and the male spouse has changes in the spermogram.
Instead of surgical treatment for varicocele, IVF/ICSI can be used immediately if these techniques are necessary to treat female causes or when the woman's age makes it impossible to postpone treatments.
Deficiencies in sperm fertilization capacity
The origin of these deficiencies may be problems at the acrosome level, leading to the inability of sperm to penetrate the zona pellucida.
Inability to ejaculate
The inability to ejaculate inside the vagina may be due to premature ejaculation, retrograde ejaculation or the inability to reach orgasm.
Sperm retrieval methods - TESE
In cases of obstructive azoospermia (and beyond), sperm collection can be carried out in several ways, the most used being TESE (Testicular Sperm Extraction), which consists of extracting sperm directly from the testicle by surgical biopsy, using local anesthesia. Sperm obtained through this method can only be used with ICSI.
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