After couples intend to have a child, if there is still no pregnancy within 1 year, although they have a regular sexual life and do not use any contraception, then infertility is in question. If the woman is over 35 or has significant risk factors, this period should not exceed 6 months. In other words, it means that it is now at the stage of examination and treatment to reveal the cause.
In male related infertility research, first, a sperm analysis is requested in men. Seminal parameters may be normal or impaired. If there is a decrease in sperm concentration, we call it oligozoospermia, weak motility as asthenozoospermia, and if there are higher than normal percentages of abnormality in sperm morphology, we call it teratozoospermia. If no sperm, dead or alive, is seen as a result of the analysis, it is called azoospermia.
Approximately 10-15% of couples of reproductive age face infertility concerns. In the general population, 12% of men experience this problem. In 80% of these, deterioration in number and motility are seen together, and there is no problem in morphology. Infertility is more common in men over the age of 40.
One of the reasons for the deterioration in sperm values may be low levels of FSH and LH hormones secreted from the pituitary gland or an increase in prolactin hormone. Sometimes the problem is inborn genetic deficiencies. Among them, the most common one is Klinefelter syndrome, which is an extra one of the "X" chromosomes that should normally have one. Deletions in the AZFa, AZFb and AZFc region genes responsible for sperm production can also be considered among genetic causes. In men who carry mutations in the genes responsible for cystic fibrosis disease, sperm ducts may not develop congenitally, and azoospermia may be found in the tests. We call this “vas agenesis”. Although it is possible to have a child with TESE/ICSI, genetic counseling should be obtained against the risk of developing cystic fibrosis in the newborn.
A more common situation is past infections. Damage to the testicles may develop due to microbial contamination during infection. In addition, as a result of obstruction in the epididymis or sperm transport channels, sperm production may decrease, or azoospermia may occur with its complete disappearance. Delayed testicular descent after birth, torsion of the spermatic cord due to the rotation of the testicles, or reflux of venous blood flow to the testicles in the presence of varicocele may also cause infertility.
In some men, the volume of ejaculated semen is very low. There may even be no ejaculation at all. Embryonic residual cysts in the prostate gland can block the passage through the ejaculatory ducts, thereby reducing semen output. Sometimes, semen can ejaculate retrogradely into the bladder. Then, plenty of sperm cells will be seen in the urinalysis.
Of course, pregnancy is not expected if sexual intercourse is not possible due to impotence or penile deformities.
Most of the reasons listed above can be diagnosed by physical examination. If necessary, other tests such as hormone analysis, oxidative stress measurement, determination of DNA damage, infection research, and spermatogenesis markers may be requested in addition to sperm analysis. Sometimes testicular and transrectal ultrasound help in the diagnosis.
With current technology, the cause of most male infertility cases can be revealed. But unfortunately, it is not possible to cure all of them. Most of them are directed to assisted reproductive techniques. No matter what, we can see a natural pregnancy in one fifth of couples after trying all possible treatment methods and waiting for the natural way for a while. In azoospermic men with hormone deficiency and seminal duct obstruction, sperm values return to normal after treatment and pregnancy can be achieved naturally.
TESE, testicular sperm extraction, in which sperm are obtained from the testicles by microsurgery, gives the chance of pregnancy on average in half of azoospermic men. The new ROSI technique, which has been put into practice in recent years, has paved the way for a small group of couples to have a baby. If not, adoption or foster parents are invaluable options for all remaining couples to embrace their child.
You can send your questions to
Prof.Dr. Kaan Aydos
Mahatma Gandhi Caddesi, 19/7 06700 Cankaya, Ankara / TURKEY
+90 312 437 3121 +90 312 508 2258