MALE-RELATED INFERTILITY

Fertilization begins with the union of the female egg and the male reproductive cell, the sperm, and progresses to the embryo with the cell divisions triggered by this. The number, mobility and structural features , quality, DNA damage, genetics of the sperm cell ejaculated into the vagina during ejaculation significantly affect the fertilization rate and embryo formation and quality. Sperm cells are produced and matured in the testicles and are ejaculated into the vagina during intercourse with certain substances produced by the secretory glands that increase the sperm’s mobility and fertilization ability, and provide lubrication and energy . Only a few out of every million sperm move to the uterus with tail movements and from there to the fallopian tubes where fertilization takes place, and encounter the female egg cell. The fertilization rate is not very high in humans. Therefore, the number and mobility of the sperm must be sufficient for it to pass these stages to fertilize the egg.

HOW IS MALE INFERTILITY EVALUATED?

In infertile couples, the semen and sperm characteristics are evaluated by performing a spermiogram test. The semen taken into a sterile container by external ejaculation on a day between 2-5 days of sexual abstinence after the last intercourse is separated after a series of processes in the laboratory. With special counting techniques, the number of sperm cells , their movement, shape, other cells in the semen (infection cells), the amount of semen, its acidity and fluidity are evaluated.

What are the results of sperm evaluation (spermiogram)?

Normospermia   Sperm cells are healthy in terms of all criteria. Sperm count should be 15 million/ml. In every hundred sperm counted, 31-34% should be motile, 3-4% should be normal in terms of shape and structure, and 55-63%   should be alive.

• Azoospermia  is the condition in which live sperm cells are not detected in the semen content.
• Oligospermia is the low number of sperm .
• In mild oligospermia , the count is 10-15 million/ml, in moderate it is 5-10 million/ml, and in severe oligospermia it is 5 million/ml or less.
• Asthenospermia  is inadequate sperm motility .
• Teratospermia: There are high rates of structural and shape abnormalities in sperm . The rate of sperm cells with normal shape is reduced.

WHAT IS OLIGOASTHENOSPERMIA, OLIGOASTHENOTERATOSPERMIA?

Sometimes several problems can be found together. In oligoasthenospermia, both the number and mobility of sperm are not sufficient.

In oligo astheno teratospermia, number, movement and structure problems are seen together.

WHAT ARE THE CAUSES OF OLIGOSPERMIA AND OLIGOASTENOSPERMIA?

Varicocele, hormonal disorders, past infections, sexual ejaculation problems, undescended testicles (if not treated before the age of 2), chromosomal diseases, systemic diseases (celiac disease, etc.), previous inguinal hernia operations, long-term exposure of the body to chemicals (dyestuffs, heavy metals, pesticides), uncontrolled hormone use, heat, smoking, excessive alcohol consumption, excess weight, and depression are the most obvious causes.

WHAT ARE THE TREATMENT APPROACHES?

In sperm problems, treatment is aimed at eliminating the cause. In order to determine the cause, detailed examination, hormonal tests (FSH, LH, TESTOSTERONE, PROLACTIN etc.). Testicular ultrasonography, chromosomal tests, Y chromosome deletions, some oxidative stress tests that measure DNA damage can be performed, and then the treatment is programmed.

Varicocele surgery can be performed according to the grade . Improvement can be seen in 40% of the people.

If a hormonal problem is detected, it can be corrected with hormone regulating drugs.

Chemicals , uncontrolled hormones, drugs, and smoking should be stopped. Nutrition should be regulated and weight control should be provided. Work environments that expose the testicles to heat, clothing (should not be too tight or too warm), and sitting for too long should be controlled.

Nutritional supplements containing antioxidants and essential structural proteins can sometimes provide personal benefits. However, the success rates of all these treatments vary from person to person. In vitro fertilization (microinjection) is preferred in cases where treatment is unsuccessful, infertility is long-term, in addition to problems such as low reserve and age of the woman, and in cases of severe sperm problems.

AZOOSPERMIA TREATMENT

IVF microinjection is planned.   With TESE (TESTICULAR SPERM EXTRACTION), tissue samples are taken from different parts of the testicle under anesthesia using surgical methods. Sperm is isolated from these biopsies in the laboratory.

In the MicroTESE method, sperm searching is performed through microsurgery in the testicular tissue under a microscope.

TESA (testicular sperm aspiration) is the aspiration of semen under local anesthesia with the help of a needle placed in the testicles. It can also be applied preferably in azoospermia due to obstruction in the testicular ducts or ejaculation problems.

After 2-3 hours of rest, the patient is discharged after the procedure with the area well compressed .

In line with the decision you will reach by evaluating the pros and cons with your doctor, procedures are performed before IVF treatment and if sperm is obtained, it is frozen. Or, TESE is performed before IVF treatment is started and egg collection is performed, and when sperm is obtained, eggs are collected and microinjection is performed on the same day. The remaining sperm can be frozen. In male infertility, successful results can be achieved even if there are a few sperms with the IVF microinjection method.