Sperm pathology. Basic terms. View full version

Sperm motility is the most important factor in childbirth. Many couples face the problem of being unable to conceive a child. To determine the reasons for childlessness, both partners must undergo a medical examination. The greatest attention is paid to a woman’s fertility and the composition and quality of a man’s sperm. In laboratory conditions, the composition of the secretory fluid and the structure of the sperm are studied.

Sperm structure

The sperm has mobility due to its structure. The sperm consists of four sections:

1. Top or head;
2. Neck or middle part;
3. Intermediate department;
4. Tail or flagellum.

A sperm is a male reproductive cell. Under a microscope, rapid, chaotic movement of cells can be seen. Movements can be in a circle, rectilinear and in place. Sperm that move in a straight line are suitable for conception. The remaining cells are the total mass of sperm.

The cell can move thanks to its tail. The flagellum contracts from the tip to the intermediate section and the cell moves. If there are any pathologies in the structure of the sperm, then the ability to move is lost.

Types of male reproductive cells

To study the condition of the cells, a man is prescribed an analysis - a spermogram. The liquid obtained within 20 minutes and at body temperature is studied. Before taking the test, a man must follow a number of rules:

Five days before taking a spermogram, a man must observe complete sexual rest. It is very important. The composition of the sperm will be concentrated and have all types of sperm important for fertilization. If this rule is violated, the analysis will be uninformative.

Beer and alcohol-containing drinks have a detrimental effect on the composition of ejaculate and sperm motility. Alcohol can completely kill cells and disrupt their production in the body. Abstinence from drinking alcoholic beverages must be at least 7 days. During this period of time, the sperm will have time to completely renew itself.

Before taking a spermogram, you must avoid visiting bathhouses and saunas and avoid prolonged hypothermia. When the temperature in the groin area changes, germ cells die instantly. In some cases, the structure of the sperm may be disrupted.

Laboratory technicians distinguish several types of cells: A, B, C and D. The first type includes sperm cells that have the correct shape and move straight. Cells of the first type make up 25% of the total volume of seminal fluid. The second type includes normal cells that have weak mobility in the forward direction. The third type includes cells that have a normal structure and good mobility. But the movement of such sperm is circular. They are unable to reach a woman's egg to fertilize it. Type D includes all other types of sperm. Such cells may have an irregular structure, they may lack a tail or head, and they may be immobile. Type D sperm make up 15% of the total ejaculate volume.

All types of germ cells are always present in the seminal fluid of a man. The condition of the sperm depends on the age of the cell and the hormonal background of the man. If the patient did not comply with the rules for taking tests, then the results obtained are uninformative.

Classification of seminal fluid

Seminal fluid may consist of motile or sedentary cells. In some cases, sperm are not detected in the ejaculate.
Poor sperm motility is called asthenozoospermia. Pathology is divided into three degrees.

Asthenozoospermia of the first degree is diagnosed when more than 50% of type B cells are present in the seminal fluid. This pathology is not considered dangerous and requires minor medicinal adjustments. Asthenozoospermia can occur with mild hypothermia, which went unnoticed by the man. If the fluid is analyzed in winter, then this pathology is detected in many cases.

Asthenozoospermia of the second degree is detected if the fluid consists of 60–65% of inactive germ cells. With this pathology, the ejaculate may contain damaged or mutated sperm. The second degree of the disease requires drug treatment. In 40% of patients suffering from this disease, the cause of mutation and cell death cannot be determined.

Asthenozoospermia of the third degree is the most dangerous form of pathology. The seminal fluid contains 70% or more dead and inactive cells.

In order to count the number of sperm of each type, the laboratory uses a special Goryaev chamber. The seminal fluid is located on glass, divided into squares. The initial study is carried out in four squares. The camera independently counts different types of cells. If there is an insufficient number of sperm in a square, then the microscopic field is increased to 9 squares.

Causes of pathology

Sperm motility is influenced by many factors. They are divided into two types:

1. External reasons;
2. Internal.

Internal reasons are present in all men. A decrease in the activity of germ cells may occur in patients with diabetes or insulin resistance. Disruption of the patient's hormonal system leads to pathologies in the development and formation of germ cells. Testosterone levels directly affect the concentration of sperm in the seminal fluid. The composition of the fluid is affected by pathologies of the genital organs. Asthenozoospermia occurs especially often if a man’s testicles have not descended into the scrotal cavity. As a result of this pathology, the temperature balance is disrupted and the sperm die.

The composition of ejaculate depends on the age and body weight of the person. If a man is overweight, he may develop a disease in the seminal canal area. This pathology disrupts sperm excretion; cell death occurs in the seminal canal. As the patient ages, cell activity decreases. This pathology is not amenable to drug therapy. Only hormonal medications can improve the composition of ejaculate.

Various infections are classified as internal factors. Pathogenic microorganisms cause diseases of the human genitourinary system. The most dangerous microorganisms cause sexually transmitted diseases, in which the vital activity of sperm is impossible. Treatment of infections leads to improved quality and condition of seminal fluid.

External factors pose a danger to the composition of the ejaculate. Cell viability is affected by excessive consumption of beer or alcoholic beverages and smoking. Many years of research have proven that sperm do not tolerate nicotine. Various injuries can damage a man’s reproductive system and completely eliminate the ability to conceive. Prolonged nervous stress or depression leads to a decrease in hormone synthesis, which affects the composition of the ejaculate.

Sperm motility may decrease under the influence of unfavorable magnetic radiation. In the modern world there is a lot of technology. Mobile phones, microwave ovens, and computers expose the human body to radiation. Microwaves disrupt the direction of sperm movement and disrupt their production.

Treatment of seminal fluid pathologies

There are several ways to improve the composition of the ejaculate. To treat pathologies associated with the process of production and formation of sperm, three types of therapy are used:

1. Medication exposure;
2. Medical massage;
3. Hardware therapy.

In many urological clinics, patients are offered a course of prostate massage. Men are very scrupulous about their health, but this procedure makes them feel embarrassed. This therapy should not be taken lightly. Direct massage of the prostate gland has a positive effect on the entire male reproductive system. Under the influence of massage movements, inflammation and swelling of the prostate are relieved. Blood flow in the pelvic organs accelerates. The trophism of soft tissues is significantly improved. The procedure can reduce the phenomenon of prostatitis and normalize the production of hormones.

Hardware therapy is just beginning to develop in Russian clinics. In pharmacies you can find a device for home use - “Mavit”. The device helps to carry out magnetic therapy at home. Under the influence of magnetic waves in the prostate gland, the inflammatory process is relieved and tissue nutrition is improved. In a man’s body, the production of the hormone testosterone is increased and the composition of seminal fluid is normalized.

Drug therapy can completely restore sperm motility and improve the quality of the ejaculate. Medicines must be strictly prescribed by a doctor. It is prohibited to take pills on your own, as the patient can cause severe harm to himself and worsen his health.
Many men are prescribed the drug “Speman”. The medicine consists of a complex of plant components. The medication has a positive effect on prostate hyperplasia, improves spermatogenesis, and reduces the viscosity of the ejaculate. Long-term treatment contributes to the complete restoration of reproductive function in men. The drug is taken two pills twice. The drug Spematon is popular among doctors. The drug belongs to the group of vitamin preparations. "Spematon" is prescribed to young people planning a child and to men suffering from infertility. The medicine contains the daily requirement of vitamin E and other microelements. The drug must be taken before conception. The course can be 6 months.

For the treatment of male infertility, drugs from the group of amino acids are prescribed. Doctors prescribe the tablet drug Actovegin. The base of the drug is extracted from the blood of calves. The drug has a beneficial effect on the vascular nutrition of the prostate. Thanks to the active substance, the blood is saturated with oxygen, tissue trophism is enhanced. Calf blood hemoderivat enhances cell metabolism. The energy capacity of sperm increases. The body begins to produce sperm that have a normal structure and a long period of vital activity. Doctors recommend taking the medication 1 tablet every 12 hours. The duration of treatment depends on the severity of the pathology.

In order to normalize sperm motility, a man must seek help from a specialist and undergo a full course of treatment.

The morphology of sperm is determined using spermogram analysis. This test is one of the first to be prescribed if a couple cannot become pregnant for a long time. Based on the results of the analysis, the doctor determines the reason why it is impossible to conceive a child. There can be quite a few reasons. For example, a man’s ejaculate may simply contain few sperm, or they may have various structural defects. Depending on the problem, the doctor gives recommendations and prescribes treatment.

What diseases do sperm pathologies lead to?

The sperm of a healthy man should contain no more than 50% of sperm with poor morphology. Some experts admit the possibility of natural fertilization even in the presence of 80% of abnormal sperm in the semen. So a bad spermogram is a very relative concept. Much depends on the properties of the ejaculate as a whole, for example, the ratio of the number of sperm with pathology to the total volume of sperm. If a man has too much or dead sperm that seriously predominates over sperm with normal morphology, natural conception may not occur. Much depends on how the various parameters are determined and the analysis is deciphered. Only a qualified specialist is able to establish the reasons due to which each existing pathology appeared, and then prescribe treatment.

If a man’s sperm contains a large number of sperm with a certain pathology, this can lead to the development of the following disorders.

Akinospermia. In men with this pathology, the semen does not contain motile sperm. If sperm is immobile, natural conception is impossible. The main reasons why immobile sperm appear in male sperm are as follows:

• work that is harmful to health, for example, in which a man is regularly exposed to various types of radiation;
• alcoholism, smoking and drug addiction;
• autoimmune and hormonal disorders.

When taking an analysis, sperm must be placed in a clean and specially designed container. If you donate sperm into a dirty container or condom, or if it gets too cold or too hot before the test, the test results will definitely be distorted. Therefore, in order to confirm pathology, the analysis must be taken according to all the rules and preferably in several places.

With asthenozoospermia, the ejaculate contains too many sperm with low speed and mobility. There may be varying degrees of sperm immobility. Most often, abnormal and immobile sperm appear due to hormonal problems, inflammatory, infectious and viral diseases, exposure to high temperatures and radiation, the production of antibodies that attack sperm, alcohol abuse, etc. Quite often, the reasons why the male body produces abnormal sperm remain unknown.

If there are a large number of non-viable sperm in the ejaculate, necrospermia is diagnosed. It can be irreversible and reversible, false and partial. In cases of irreversible necrospermia, the couple is most often recommended adoption or insemination with donor sperm. If it is reversible, treatment is prescribed.

With teratozoospermia, the semen contains many spermatozoa with a structural disorder. Many factors can lead to this. First of all, these are bad habits and various infectious and inflammatory processes. Most defective sperm are unable to reach the egg. If just such a sperm penetrates into her, the fetus will most likely begin to develop incorrectly, and the woman will have a miscarriage.

Various abnormalities in sperm morphology can develop if antibodies are present in the ejaculate. Such antibodies can block the process of spermatogenesis, interfere with the normal movement of sperm, disrupt cleavage and lead to many other problems. Antisperm antibodies bind to the surface of sperm and prevent them from performing their function. The production of antibodies can begin spontaneously, but in most cases it is provoked by trauma to the genital organs, viral and bacterial diseases.

What structural damage may occur?

If sperm morphology is disrupted, the following defects may be observed:

• irregular head shape;
• incorrect tail length;
• thickening and bending of the tail;
• absence of a chromosome;
• presence of vacuole cells in the head.

It is important to remember that a relatively small number of abnormal sperm is not a disorder. When taking the analysis, you can rely on the data provided on the form. However, only a doctor can make an accurate diagnosis.

The main causes of violations

Most often, the appearance of sperm with abnormal morphology is associated with the insufficient ability of the male testicles to produce high-quality sperm. Surgeries and injuries, radiation, inguinal hernia, and chemotherapy can lead to a decrease in their function.

The development of pathologies can be observed against the background of dilation of the veins of the spermatic cord and varicocele. Currently, the effect of varicocele on the process of spermatogenesis has not been fully studied, however, cases of decreased sperm morphology in men with this disease are observed quite often.

Disturbances can appear against the background of inflammation of the genitourinary system, which includes prostatitis. A variety of viruses and sexually transmitted diseases lead to the development of pathologies.

Endocrine system disorders are sometimes an indirect cause of such deviations. Against this background, its quality may decline and deteriorate.

Possibility of natural fertilization

In many cases, deterioration in sperm morphology is not an indicator of infertility, but any abnormalities have a negative impact on pregnancy. The more sperm with poor morphology in the ejaculate, the less likely it is for natural fertilization and a full pregnancy.

Problems with fertilization occur due to the fact that sperm with an abnormal structure cannot fertilize the egg normally. For example, if the structure of the tail is abnormal, the motility of the sperm is significantly reduced, which makes it difficult for it to “travel” to the egg. With pathology of the head, the consequences can be even more serious. Such sperm are not able to penetrate the egg. If the sperm succeeds, then, as a rule, the development of the fetus occurs with anomalies, and the woman has a miscarriage in the early stages.

In many cases, for natural conception it is necessary to use various assisted reproductive technologies.

Treatment Options

Before starting any actions aimed at improving sperm morphology, it is necessary to undergo a comprehensive andrological examination. It includes the following activities:

• ultrasound examination of the prostate and scrotal organs with Doppler;
• bacterioscopic analysis of sperm;
• blood test for hormone levels;
• detailed spermogram.

Having the results of all these tests in hand, the doctor will be able to determine the causes of the development of existing pathologies and draw up a treatment program.

Treatment will primarily be aimed at eliminating the causes that led to the development of pathological processes. Most often, the causes are a variety of diseases of the male genitourinary system: infections, inflammation, prostatitis, varicocele, etc.

It is very important not to neglect and treat all diseases in a timely manner, so as not to deal with their complications in the future.

In treatment aimed at, it is important to exclude congestion in the pelvis. Stagnation occurs in men who lead a sedentary lifestyle. To restore the normal formation of spermatogenesis, a man needs to be active and eliminate bad habits from his life. You need to eat right. The diet should be rich in vitamins and microelements that help improve sperm quality (zinc, selenium, etc.). It is important to exercise. Swimming, running and race walking have the most beneficial effect. It is necessary to exclude fatty foods. The diet should primarily consist of fresh fruits and vegetables, seafood, legumes, honey, and grains. The doctor may prescribe a variety of vitamin complexes and dietary supplements (speman, spemactin, folic acid, etc.). You can start taking any medications only as prescribed by your doctor, adhering to the prescribed dosages.

Quite often, treatment of male infertility, which has developed against the background of various pathologies of sperm morphology, is carried out using assisted reproductive technologies. They increase the likelihood of successful conception and normal pregnancy.

For minor deviations, the method of artificial insemination may be recommended. Before the procedure, the ejaculate undergoes special treatment, which helps to increase the quality of the seminal fluid and increases the likelihood of a successful pregnancy.

If the ejaculate contains too many pathological sperm, the use of in vitro fertilization and a number of auxiliary procedures is considered more effective and justified. Such techniques allow you to select the most mature and morphologically correct sperm from the entire ejaculate. By carefully selecting healthy sperm, the likelihood of abnormal fetal development and miscarriage is reduced.

Modern methods make it possible to effectively combat male infertility, and assisted reproductive technologies increase the likelihood of a successful pregnancy. However, even with such methods, it is highly recommended for a man to improve the quality of his sperm. Particular attention should be paid to proper, regular and balanced nutrition with a sufficient amount of essential microelements and vitamins.

Every man should undergo regular preventive medical examinations. Timely detection of the problem and treatment can prevent the development of many complications that can harm men’s health.

Boys in childhood should be shown to a surgeon. During such examinations, various abnormalities (phimosis, undescended testicle, etc.) will be excluded or promptly eliminated.

After unprotected sexual intercourse with an untested partner, if you suspect various infections, inflammations, etc., you must consult a doctor, get tested and, if necessary, undergo a full course of treatment. You should stop drinking alcohol, smoking and taking drugs.

Therefore, if your partner does not become pregnant after a year of unprotected sex, you both need to see a doctor. At the same time, you need to eliminate all bad habits and stressful situations. Maintaining a normal weight, eating a healthy diet, and getting enough (not excessive) physical activity are also very important for good sperm quality.

Follow all doctor's recommendations. Be prepared for the fact that infertility treatment is a very lengthy process. However, modern medicine has extensive experience and a rich arsenal for solving this problem, so in most cases you can count on a positive result. Be healthy!

The sperm produced in a man’s testicles, despite their huge quantity, do not all correspond to accepted standards. A spermogram helps to determine how severe the pathology is and how it is expressed. After identifying deviations and making adjustments, male infertility caused by low-quality male reproductive cells can be treated, which means the family will be replenished with a baby.

Spermatozoa: structural form of normal and pathological

Analyzes to determine sperm morphology are carried out in accordance with WHO and Kruger requirements. The latter method is more stringent. It regulates that in the studied sperm the number of ideal spermatozoa is limited to 4 percent, and normally their content should exceed 14%. The slightest deviations are considered abnormal, which makes it possible to more accurately determine a man’s fertility.
While according to Kruger spermatozoa are assessed by their appearance and shape, WHO identifies the compliance of the studied material with the norm only by the head.
However, in addition to this part, which makes up 10% of its total length, the sperm also has a body, attached by a neck and ending in a long tail. It accounts for 80% of the total size of 50-60 microns. The head, with the nucleus located in it, is equipped with an acrosome. Thanks to it, the sperm dissolves the membrane in the egg and penetrates it. Translational advancement is provided by the flagellum, which performs rotational movements in a clockwise direction. Violation of activity entails the inability of the male reproductive cell to overcome the resistance of the vaginal fluid and reach the cervix, and then the fertilized egg.

Normal structure of sperm (description)

Deviations in sperm shapes

The abnormalities affect all parts of the sperm. The following pathologies are distinguished:
Asymmetrical location of the acrosome and the junction of the middle part with the head;
Absence of acrosome;
The presence of two or more heads or tails;
Micro- and macrocephaly – excessively small and large heads, respectively;
Defective head shapes - instead of ellipsoidal ones there are spherical, pear-shaped, conical and other varieties;
The cytoplasmic drop exceeds 0.33 of the volume of the head or is absent;
The angle between the middle part and the head exceeds 90 degrees;
The middle part or tail has varying thickness throughout;
Harnesses with insufficient length, inclined or kinked, partially or completely twisted. In the latter, the forward movement is slow;
Presence of vacuoles in the head;
Violation of the ratio of the sizes of sperm parts.
Pathology can exist in one of the listed types or be any combination of them. Spermatozoa without flagella are not taken into account, but their presence is specified in the spermogram.

Types of violations

An excess in the number of sperm with pathology above the norm is called teratozoospermia. Its consequences are partial or complete infertility. The forward movement towards the egg and its fertilization by a sperm with a deviation creates a high probability that the pregnancy will proceed with complications, and the born child will have defects. In the most severe cases, the disease threatens miscarriage or frozen pregnancy.
Abnormal sperm in teratozoospermia are 70% or more. It is usually accompanied by asthenozoospermia and oligozoospermia - a reduced concentration of sperm in the seminal fluid. The first pathology is due to the fact that the forward movement of sperm slows down, but it must be fast in order to reach the egg in time. There are only a small number of sperm that are actively moving.
With akinozoospermia, the movement of sperm approaches the zero mark, but their static state is temporary. During the study, a revival procedure is used. If forward movement does not resume, then the viability of the sperm is assessed.

Causes

When identifying a disease, it is necessary to establish the causes that caused it. They can be congenital, such as genetic abnormalities, or caused by external factors. Teratozoospermia is associated with constant presence in an area of ​​increased radioactive radiation, high temperatures, other external factors, and the accumulation of toxins in the body.
Inflammatory and infectious diseases of the genitourinary system, especially those affecting the testicles and their appendages, have a negative impact. Orchitis, epididymitis, as well as their combination - orchiepididymitis - in chronic form cause serious harm to the quality of sperm. Infection occurs sexually or through blood.
Varicose veins of the testicle (varicocele) lead to blood stagnation, which can result in atrophy.
A man should pay attention to his general health and lifestyle. There should be no place for tobacco and alcohol; sports activities are a worthy alternative. Among the reasons are stressful and conflict situations.

Diagnostics

It is possible to get a complete picture of the quality of sperm and its main component – ​​spermatozoa – based on the Kruger spermogram. Only it allows you to see the shape of sperm, evaluate how they move, whether they behave actively, and observe their forward linear movement. The limit of normal mobility passes through the mark of 32%.
At the same time, the concentration of sperm is determined, the number of which in 1 ml must be at least 15 million. The spermogram reflects the viscosity and acidity of the ejaculate, its color, and the amount of sperm released during one ejaculation.
The spermogram is performed twice to avoid obtaining erroneous data; sometimes the analysis is repeated three times.
In addition to the Kruger spermogram, sperm is examined for compliance with WHO standards and a MAR test is prescribed, which supplements the existing picture with information about the presence of antisperm antibodies. A positive result indicates that there is a pathology.

Treatment

Therapeutic measures are aimed primarily at eliminating the causes that caused abnormal shapes and similar movement of sperm. Treatment is carried out in the direction where there are problems. Restore hormonal balance, get rid of PPP and infectious diseases.
Surgical intervention is used for varicocele, which increases the forward movement of sperm, makes it faster, stimulates their activity, and ensures fullness.
Along with the main course of treatment, medications containing folic acid, zinc, selenium and to strengthen the immune system are prescribed.
With advanced forms of the disease, a couple still has the opportunity to conceive a child. For this purpose, there are artificial inseminations and in vitro fertilization. The options are win-win, because only one normal sperm can cope with fertilizing the egg.

As statistics show, if a married couple cannot have a child, then only in about half of the cases is the woman “to blame.” The remaining 50% is “on the conscience” of men. This is often due to qualitative and quantitative changes in sperm.

In order for male sperm to fertilize an egg, it must be ejaculated in a certain volume and contain a certain number of sperm with a normal structure. Each sperm must be a full-fledged cell with a “tail”, which provides it with mobility. In addition, the seminal fluid must have a certain level of acidity at which sperm can remain viable.

Violations lead to the fact that a partner cannot become pregnant from a man with pathologically altered sperm. A special analysis is designed to assess the quality of seminal fluid.

Types of sperm composition disorders

Deviations in the composition and quality of sperm can be different, each of them is designated by a special term:
Aspermia– there is no sperm at all. That is, during orgasm it is not released. In this case, it is not even possible to collect seminal fluid for analysis.
Oligozoospermia– decrease in sperm content in seminal fluid. Normally, every 1 ml of semen should contain at least 20 million sperm.
Azoospermia– absence of sperm in the seminal fluid. The prostate and other sex glands produce fluid, but a man's testicles do not produce sperm.
Cryptozoospermia– very small number of sperm in semen. Naturally, this is not enough to fertilize the egg. Sperm can only be detected after the semen is placed in a centrifuge.
Asthenozoospermia– reduced sperm motility. They enter the woman's vagina, but are unable to reach the egg in the uterus.
Teratozoospermia– a high content of sperm, which have an irregular structure and are not capable of fertilization.

The consequence of all the described disorders is the inability to conceive a child. If a couple lives a regular sexual life without the use of contraceptives for more than 6 months, and the woman never became pregnant, then it can be assumed that it is associated with a violation of the reproductive system of the partner and partner: it is necessary to contact the reproductive health center for examination, including performing a spermogram.

Causes of disturbances in the composition and quality of sperm

The cause of dysfunction of the testicles can be hereditary disorders, various malformations: the testicle, its dropsy, inguinal hernia, cryptorchidism (undescended testicles into the scrotum - after birth they remain in the boy’s stomach).

During radiation exposure, it is the testicles that are primarily affected - because their cells are constantly actively multiplying. Radiation energy suppresses the production of sperm, leads to mutations and disruption of their structure. Electromagnetic vibrations from mobile phones worn on the belt lead to similar effects, although to a lesser extent.

Among infectious diseases for the testicles, the most dangerous is: the virus penetrates the gonads and causes inflammation in them, as a result of which sperm production is disrupted.

Impaired sperm maturation occurs when the testicles are constantly overheated (work in hot shops, frequent visits to saunas and steam rooms).

Disorders can be temporary during fasting, chronic fatigue, increased mental and physical stress, stress, lack, etc.

What can you do?

With functional temporary disorders, you can improve sperm quality by following some recommendations:
Good nutrition and rest.
Correct daily routine.
Elimination of occupational hazards (sometimes it’s worth changing jobs).
Sleep at least 6 – 8 hours a day.
Daily exercise, especially those that help strengthen the pelvic and abdominal muscles.

What can a doctor do?

If the qualitative and quantitative characteristics of sperm are impaired as a result of any diseases, appropriate treatment is required. A urologist may prescribe hormonal medications, antibiotics, etc. Some pathologies (cryptorchidism, testicular hydrocele) require surgical intervention.

Forecast

The prognosis depends on what disease led to the disorders. Sometimes changes in the testicles are irreversible, and their function cannot be restored.

The treatment process should begin with a clarification of the diagnosis. A spermogram, which is prescribed during the examination, gives the doctor a lot of information about the patient’s reproductive cells. In most cases, the pathology that causes infertility is reflected in the test results.

Interpretation of spermogram and types of sperm pathologies

Normal spermogram indicators are considered:

• acidity from 7 to 8;
• volume – minimum 2.5 ml;
• liquefaction time – up to 1 hour;
• sperm viscosity – 2 cm;
• total sperm count – 60,000,000 or more;
• the level of mobility is expressed by a letter designation (A – motile and fast sperm; B – movement is present, but slow (non-linear, linear); C – cells move only in place; D – immobile sperm).
• the presence of at least 25% type A cells and more than 50% A+B.
• from 30 to 70% of sperm without pathologies;
• leukocytes in sperm – 10 6 in 1 ml;
• absence of agglutination process of red blood cells;
• epithelial cells - in single numbers, and spermiogenic cells - no more than 4% of the total number.

The study may reveal the following forms of sperm pathology:

• Azoospermia– diagnosed in the complete absence of sperm in the sample taken. It can be obstructive (there are sperm in the testicles, but they are not ejaculated due to obstruction of the vas deferens) and secretory (there are no sperm in the testicles).
• Asthenospermia– sedentary male reproductive cells. The diagnosis is established if there are more than 60% unhealthy sperm in the analysis.
• Pyospermia– this is the presence of a large number of leukocytes and pus in the sperm, which indicates an inflammatory process in the genitourinary system.
• Teratospermia– detection in the analysis of a large number of pathological sperm from a morphological point of view.
• Anejaculation– this is the complete absence of ejaculation in a man.
• Necrospermia– non-living spermatozoa in semen.
• Oligospermia– insufficient sperm volume during ejaculation.
• Cryptospermia– detection of motile spermatozoa in single numbers in the analysis.
• Oligozoospermia– the number of sperm in the ejaculate is less than 15,000,000 per ml.

Classic methods of treating infertility in men

The type of treatment depends on the cause of infertility, which is divided accordingly into the following types:

• surgical;
• auxiliary techniques;
• hormonal;
• treatment of sexual disorders;
• medicinal;
• physiotherapy.

Surgical treatment of infertility in men

They resort to it if the cause of infertility is tumor-like swelling of the veins that provide blood flow from the testicle. Varicose veins of the spermatic cord are removed through surgery, due to which blood flow in this area is normalized.

Important: Surgery for varicocele will be effective only if it is performed on time. When the testicles atrophy due to the lack of normal local blood circulation, it is almost impossible to restore a man's ability to conceive.

Surgical treatment is also indicated for obstructive infertility, when there is obstruction of the spermatic cord due to trauma, orchitis (in childhood). During this intervention, the surgeon restores the patency of the vas deferens by removing the obstructed segment or creating a new one. The success of the operation depends entirely on the length of the pathological part of the cords that needs to be removed or replaced.

Conservative treatment of infertility in men

This method is used in cases of immune, hormonal or secretory infertility. Only a doctor is competent to prescribe certain drugs and their dosage after confirmed infertility in a man.

In particular, after identifying the causes of the disease, the following remedies can be used:

Note:For male infertility, treatment with folk remedies cannot replace the main one. In particular, in this regard, the method of hirudotherapy is quite popular among patients. Its use is allowed only in combination with other techniques, taking into account the fact that there are quite conflicting opinions among doctors about its effectiveness. Leeches are used to improve local blood circulation and the process of spermatogenesis, but in case of male infertility, treatment with folk remedies should be agreed with the attending physician.

Physiotherapy

For infertility, the following local procedures are prescribed:

• electrophoresis;
• laser;
• transurethal microwaves;
• phonophoresis.

Physiotherapeutic treatment has a positive effect on prostate trophism, blood supply to the genital organs, sperm productivity and quality, and eliminates hidden inflammatory processes.

Treatment of sexual disorders

Erectile dysfunction is treated with medication by taking a group of PDE-5 inhibitors, such as:

• Levitra;
• Viagra;
• Cialis.

Injection of Alprostadil into the urethra and intracavernosal injections are also practiced.

If the drugs do not have an effect or the patient has contraindications to taking them, then they resort to a surgical solution to the problem:

• local embolization of arteriovenous shunts;
• implantation of a penile prosthesis;
• endovenous stenting of penile arteries;
• vacuum constriction.

Premature ejaculation is treated using the “squeeze technique” and “stop-start” (delayed ejaculation). Among the medications, centrally acting drugs are used (tramadol, clomipramine, fluvoxamine, fluoxetine, paraxetine, sertroline). Vasoprostan, Emla cream, etc. are used topically. As surgical treatment, they resort to neurectomy of the dorsal nerve of the penis, selective resection of the spinal nerves.

Assisted reproductive techniques for treating male infertility

They are used when obstruction of the vas deferens cannot be corrected, in the presence of retrograde ejaculation and other similar problems that cannot be cured. Among the most popular methods, they most often resort to infertility. An egg is removed from a woman's ovary, and in a laboratory it is fertilized with sperm taken from the man's testicle or bladder.

Modern reproductive technologies

It should be understood that these techniques are used for severe or incurable male infertility. But even in this case, modern medicine can give a man a chance to become the father of a healthy child.

Treatment of infertility in men using the TESA method

This technology is used when there is a complete absence of sperm in the patient’s semen. It is carried out in the form of a needle biopsy under visual control in areas of active spermatogenesis. Testicular puncture is performed very carefully to take the required amount of materials.

ICSI

This is a procedure for the embryologist to select the correct one, taking into account the morphological parameters of the sperm. It is immobilized and placed in a thin needle, which is inserted into the egg. Thus, fertilization occurs.

PICSI technology in the treatment of male infertility

It is considered an advanced technique, as it implies a clear and competent selection of sperm for fertilization. Preliminary selection of PICSI is based on the selection of male germ cells, taking into account their behavioral characteristics in an environment that is as close as possible to the egg. The method is advisable to use in cases of male infertility, unsuccessful IVF attempts (2-3 times), low quality embryos.

IMSI

It is an innovative method of fertilizing an egg in the treatment of male infertility. Spermatozoa undergo very careful selection by selection under multiple magnification (x 6300). The embryologist selects the best sperm using a digital image that is displayed on a monitor. Afterwards, it is injected directly into the egg itself, which greatly increases the success of fertilization, and the chance of pregnancy increases to 70%.

More detailed information about sperm pathologies and modern methods of treating male infertility is presented in the video review:

Yulia Viktorova, obstetrician-gynecologist