What is Male Infertility?
If no pregnancy occurs despite one year’s regular sexual intercourse, one talks about infertility. 35% of infertility owes to the male, 35% owes to the female and 30% owes to both the male and the female.
Reasons of Male Infertility
Reasons of infertility include disorders solely associated with the testis (30-40 percent), disorders related to occlusions in the sperm channels (10-20 percent), disorders related to the pituitary gland and hypothalamic region in the brain (1-2 percent) and unknown causes (40-50 percent). As it is understood, unknown reasons represent the majority of cases in male infertility.
Sperm induced infertility;
3.5-4 months elapse from the production of sperm in the testis until its discharge via semen. The main reason for male infertility is the abnormal structure of sperm in numbers, quality and mobility or the absence of sperm. The adjacent visual shows sperm abnormalities. Cases where the sperm cannot be discharged through the penis represent a separate chapter of infertility. Even if the sperm has formed normally, it cannot merge into the semen due to occlusion in the channels. And although the development and hormone balance in the testis is fully normal, sperm production in the testis may be very insufficient or absent. Non-production of sperm due to genetic reasons represents the most challenging case in male infertility. Very extensive researches are required. Apart from a limited number patients, the success rate is low.
Testis Induced Infertility;
Inflammations of the testis, sexually transmitted diseases, enlargement in testis veins called varicosele, undescended testis, and congenital small testis are amongst the reasons of testis infertility.
Infertility Associated with Semen Discharge;
Ejaculation (semen discharge) occurs when the sperm is ejected into woman’s vagina by the flexion of the prostate, testes and the seminal vesicles during orgasm. Premature ejaculation may be a cause of infertility as the sperm is not thrust into the depths of vagina.
The mechanism on the bladder neck, which retains urine, is closed during ejaculation. This prevents the semen and the sperm therein slipping into the bladder and discharged from the penis. As this mechanism is disrupted especially during closed procedures on the prostate, the semen slips into the bladder and isn’t discharged from the penis. For this reason, spermatozoa that are needed for pregnancy cannot reach the depths of vagina. This is called Retrograde Ejaculation. Unnecessary prostate interventions should be avoided for patients that don’t have children. Furthermore, some drugs that are used for treating strictures in the prostate also widen the bladder neck and cause the semen to slip into the bladder.
Other Causes of Infertility;
Infertility can also be caused by alcohol and tobacco use, some drugs continuously used, surgery-associated damages on the vasa efferentia channel that convey the sperm, hormonal disorders, Radiotherapy applied for other disorders, wearing tight underwear, surgeries on the groin region, and the occlusion of the sperm-carrying channels by sexually transmitted diseases that are left untreated.
Diagnosis of Male Infertility
Couples should be queried together if no pregnancy occurs after one year’s of regular sexual intercourse. A sperm analysis is made. After 3-5 days of non-ejaculation, semen is given to laboratory under appropriate conditions by masturbation. The submitted semen should be at least 2 cc. Lesser amounts indicate problems in the seminal vesicle or the prostate. The number of sperms in 1 cc should be between 20-300 million. Numbers below 10 million in 1 cc indicate serious infertility. It shows that the spermatozoa don’t possess the ability to fertilize the female egg due to malformations such as double-head or double-tail. Another important parameter during sperm analysis is the mobility speeds of sperms. Sperm speed is rated between 0-4. Sperm speeds rating 3 and 4 indicate good sperm mobility. Among these sperms, 50% of the sperms should rate 3 and 4.
Treatment of Male Infertility
Traditional Methods in Infertility;
Drugs that increase sperm production are prescribed to the patient. Inflammations in the urinary channel and the genital organ should be treated. Treatment is applied for hormonal disorders.
The patient is advised to keep away from long-time heat. The temperature inside the testis sacs is 3-4 degrees lower than the normal body value. Sperm can only be produced at this temperature. Going to sauna and natural springs, wearing tight underwear, and working in hot environments such as bakeries can impact this temperature and therefore cause infertility.
The varicosele disorder may negatively impact sperm generation as the blood vessels that carry the venous blood in the testis are blocked and the temperature in the testis is therefore increased. Varicosele should be treated with surgery when needed. Unfortunately, many unnecessary varicosele surgeries take place. Varicosele is present in 20/100 of men. And only 20% of these 20 percent men suffer infertility. This shows that many varicoseles don’t lead to infertility. For this reason, only a physician experienced on the subject should decide on varicosele surgery.
Conscious application of classical treatment methods and especially the planning of hormone treatment by experienced physicians bear vital importance. Hormone treatments unnecessarily applied can worsen infertility, let alone treating it.
Methods that Facilitate Fertilization (Artificial Insemination);
If the sperm number of the patient is low, he submits sperm several times by masturbation. Sperms so collected are sent to the woman’s womb by an injector inside a special liquid. This method is unbeneficial for patients that have very low sperm numbers. It shouldn’t be repeated again if the initial 2-3 attempts have failed. Couples should be told that the success rate is low.
Tube Baby (In-Vitro-Fertilization);
In method called In Vitro Fertilization, generally known as tube baby by the public, the sperm cells taken from the male and the ovum (egg) taken from the female are fertilized under laboratory environment. The most quality sperm is chosen. The egg taken from the female is punctured by microinjection and the sperm is placed inside of it. This is called artificial insemination. Sperm’s entry into and fertilization of the egg is entirely performed externally under laboratory environment. When the egg, which is fertilized by this sperms, reaches a certain number of cell divisions, it is taken outside. And placed inside the woman’s womb.
Sperm Bank - Sperm Donor;
The male sperm can be collected, frozen in a sperm bank and can wait there for many years. Especially persons that undergo treatment because of testis cancer leave sperms to the sperm bank prior to surgery. His sperms can be used later when he wants to have children.
In case of donor sperm, the male has no sperms or cannot produce it. Sperms taken from another male and stored in sperm banks are used for impregnation. As in many countries, this is forbidden in our country too. The health system in some countries has permitted this.
TESE and Similar Method;
In cases where the testes produce very low number of sperms or when normally produced sperms cannot be discharged through the penis, the testis is taken outside the scrotum (testis sac). The testis is incised, samples are taken from the micro channels inside and sperms are found under laboratory environment using microscope. This is injected to the ovum that is taken from the female by injection method. With major developments in the in vitro fertilization method during the last 10-15 years, the possibility of pregnancy and having children has increased.