Antipyretics for children are prescribed by a pediatrician. But there are emergency situations with fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?

Men who have been prescribed a semen test may wonder why they take a spermogram. ?

♦ Doctors use this test to diagnose male infertility, when a married couple cannot conceive a child for a long time. This is especially true if a man has suffered any disease of the reproductive system (prostatitis, chlamydia, varicocele).

♦ to monitor ongoing infertility treatment.

♦ before artificial insemination (ICSI or IVF).

♦ it is carried out for sperm donors and people who want to use ejaculate cryopreservation.

Normal seminal fluid levels

Doctors use several different signs of normal ejaculate to evaluate the result.

What does a semen analysis show?

Semen volume (2 ml or more).
Total sperm count (39 million or more).
Sperm concentration (15 million per ml or more).
Sperm motility (40% or more).
The number of sperm with progressive movement (from 32% and more).
Sperm viability (58% and more).
The number of normal forms of sperm (from 4% or more).

Pathology of seminal fluid

In case of male infertility, spermogram analysis makes it possible to determine pathological changes in the ejaculate. These include:

Decreased sperm concentration.
Reduced mobility.
Reduction of normal forms.
Complete absence of sperm.
Reducing the volume of ejaculate.
Lack of ejaculate.
An increase in leukocytes in the ejaculate.
Lack of sperm motility.
Lack of live sperm.
Presence of blood in seminal fluid.

What does a spermogram show and how are all laboratory tests of semen performed? First of all, it is necessary to determine the main indicators of the analysis and evaluate their results.

Semen volume

The volume is measured using a special pipette with a scale. An amount of less than 2 ml is pathological, this condition is called oligospermia. The ejaculate consists of prostate juice and seminal vesicle juice.

A decrease in value can be affected by diseases of the reproductive system (dysfunction of the seminal vesicles and prostate gland, obstruction of the vas deferens, hypogonadism) and improper preparation for the study.

Sperm count

In the laboratory, it is necessary to determine the absolute (total number) and relative (per 1 ml) sperm content. For this purpose, a microscopic method is used using special counting chambers.

The laboratory assistant makes a smear of a drop of ejaculate and counts the number of sperm in the field of view by eye. There are sperm analyzers - computerized automatic counting systems. Their advantage is the reduction of the human factor, ease of use and faster research.

After obtaining relative indicators in 1 drop, you can multiply the result by the total volume and obtain the absolute number of sperm. A decrease in these indicators is called oligozoospermia.

Sperm motility

In order for male reproductive cells to reach and fertilize the egg, they must be motile. There are 4 categories of mobility:

A – progressively actively mobile, speed more than 25 microns per second, linear movement.
B – progressive-slowly mobile, speed less than 25 µm per second, linear movement.
C – non-progressively mobile, movement is not rectilinear or in place.
D – motionless.

Motility is determined microscopically or using sperm analyzers. Normally, category A should be 25% or the sum of categories A and B 50%. The condition when these conditions do not correspond to the norm is called asthenozoospermia.

Viability

Characterized by the number of living sperm relative to dead ones. Normally, their number is at least 50% of the total number. To determine living cells in the laboratory, two methods are used:

Supravital eosin staining. Eosin is a dye that can penetrate the damaged membrane of dead sperm, but does not penetrate the wall of living ones. In this case, dead bodies turn pink. When using this method, 1 drop of seminal fluid is mixed with 1 drop of 0.5% dye solution, after which the slide with the smear is examined under a microscope and the number of stained cells is counted.
Hypoosmic test. This technique is based on the property of normal sperm to swell in a hypotonic solution. 1 drop of seminal fluid is mixed with 10 drops of an aqueous solution of fructose and sodium citrate. Then this mixture is placed in a thermostat with a temperature of 37ºC for 60 minutes. Then microscopy is performed and the number of unchanged cells is counted.

If there are no living cells in the ejaculate, it is called necrozoospermia.

Sperm morphology

In addition to motility, it is necessary to determine the number of normal-shaped sperm. A microscopy method is used, in which it is necessary to determine the proportion of normal cells. For convenience, look at a regular smear or paint with special dyes. With pathology, the head, neck or flagellum may change. Any changes in morphology are called teratozoospermia.

How to donate seminal fluid correctly

Before any medical examination, proper preparation is necessary and a spermogram is no exception.

First you need to properly prepare for sperm donation.

a man needs to observe sexual abstinence for two to four days. If less than two ejaculations have passed since the last ejaculation, then the volume may be less than actual. If more than four, then cell motility may decrease.
It is not recommended to avoid overheating for a week (bath, sauna, taking hot baths) and overcooling. Such temperature effects can negatively affect spermatogenesis.
It is undesirable to drink alcoholic beverages and, if possible, not to take medications, especially those that negatively affect the reproductive system.

It is necessary to donate sperm in specialized clinics. Delivery is made only by masturbation with ejaculation into a special sterile plastic container.

It is not allowed to donate sperm using interrupted coitus or semen from a condom.

Immediately after collection, it is necessary to deliver the ejaculate to the laboratory as soon as possible. The container must be transported carefully, without physical external influences. The analysis must be taken 2-3 times in 1 month to identify a pathological condition, and not an accidental failure in spermatogenesis.

Conclusion

Why do you need a spermogram? This is an important study that will help many couples who want to have a child, but cannot do it and do not know what the problem is. Modern medicine has the opportunity to help such people, but first you need to identify the cause of the problem, for this doctors use a spermogram. It is not difficult to pass, but to correctly interpret the result you need to prepare for it correctly.

Now you know what a spermogram shows , how to take the test and you can independently understand the meaning of the medical report. Thank you for your attention!

The diagnosis of infertility often storms the lives of many families. The reason for the absence of children may be precisely men's health problems. A spermogram (analysis of male sperm) shows various disorders in a man’s function to produce offspring. What to do and how to get pregnant if your husband has a bad spermogram? Is this really the final verdict or are there methods to return sperm to normal?

A spermogram is usually prescribed by an andrologist. The analysis allows you to evaluate the fertilizing ability of male sperm. Thanks to this study, it is possible to evaluate the qualitative and quantitative characteristics of the ejaculate. At the same time, the number of sperm, their qualitative characteristics are calculated, and pathologies of spermatogenesis are identified.

Poor spermogram - the results of which differ from WHO criteria.

A spermogram that allows you to conceive a child naturally is considered normal.

To obtain a reliable analysis, it is important for a man to follow a number of rules for collecting it. Otherwise, the analysis may turn out incorrect.

A spermogram determines the following sperm qualities:

volume;
viscosity;
pH acidity;
degree of liquefaction;
number of rounded cells;
total sperm count and motility;
sperm in 1 ml;
the presence of other inclusions (leukocytes, erythrocytes, etc.).

When is a spermogram necessary?

Most often, sperm analysis is prescribed for problems associated with the reproductive sphere of the male body.

In an infertile marriage, both spouses are examined to understand which of them is the cause of the lack of offspring.

The reasons for prescribing a spermogram are the following indications:

If male infertility is suspected due to various diseases (varicocele, trauma, prostatitis or hormonal disorders).
Infertility in marriage (if the spouses live for more than a year without protection, but pregnancy does not occur).
At the preparatory stage for artificial sperm collection (insemination) during IVF.

About sperm donation

It is very important to ensure that the sperm is collected correctly so that the results are reliable.

The best method for collecting sperm is considered to be laboratory. In rare cases, it is allowed to collect seminal fluid during interrupted intercourse. However, such an analysis is less effective due to the ingress of foreign substances into the material.

Preparatory stage

This stage includes the following points:

No later than six months before the study, it is necessary to stop taking potent drugs (hormones, cytostatics, tranquilizers, etc.)
2-3 days before the analysis, avoid all contacts with toxic substances (alcohol, chemical components). This also includes beer and energy drinks. If the work involves chemicals, then it is better to schedule the analysis after 2-3 days off.
Avoid sexual contact 5-7 days before submitting the material. Otherwise, the study may reveal female germ cells.
A day before the spermogram, it is important to completely protect yourself from overwork, stress, and hypothermia.
Visit the sauna (or steam room) no later than 10 days before the test.
It is important to stop smoking before the test (but no later than 2-3 hours before submitting the material).

You should not submit material during the treatment of urological disorders. Otherwise, the research results will be unreliable.

If necessary, the analysis is retaken after 2 months.

If the patient had a cold, it is better to do the analysis 7-10 days after recovery.

Many harmless substances destroy sperm (vaginal lubrication, water, acids, etc.) Therefore, sperm for analysis is collected in a sterile jar immediately in the laboratory.

The patient is warned not to touch the internal surfaces of the container.

How to collect an analysis?

How to collect sperm for research according to the rules? For this procedure, you must follow a number of rules:

All sperm received goes for analysis, since its quantity is important to know.
Before the study, the patient empties his bowels and bladder, and uses a shower.

During masturbation, no liquids or lubricants are used (saliva, lubricants, creams, etc.)

To collect the material, use a special laboratory container or a glass jar with a wide neck. Before collecting the ejaculate, the container is washed, boiled and covered with a lid.
When self-delivering ejaculate, it is important to observe the “temperature chain” (transportation at body temperature).
The container with the material is supplied with a piece of paper indicating the necessary data of the patient (passport data, amount of ejaculate, on which day of abstinence the material was collected).

When is a spermogram considered bad?

As with any analysis, sperm testing has its own criteria for determining the norm. A bad spermogram if the following indicators go beyond the limits:

a tiny amount of sperm occurs with reduced testicular function (due to injury or inflammation of the male genital area);
decreased sperm concentration (the most common cause of male infertility);
damaged or immobile sperm (with congenital genetic disorders, sexually transmitted diseases).

Many patients may have various abnormalities in semen tests that are difficult to understand by non-specialists. What do medical terms mean?

Most often, the following conclusions can be found in a spermogram:

– in the complete absence of sperm;
akinozoospermia – with absolute immobility of sperm;
asthenozoospermia - with low sperm motility;
hemospermia - inclusion of red blood cells;
cryptozoospermia – single spermatozoa;
leukocytospermia – ;
necrozoospermia – decrease in live sperm;
– with minor deviations that do not affect the reproductive properties of sperm.

Poor spermogram and pathologies

If the spermogram is not very good, the doctor must determine the presence or absence of existing pathologies in the patient.

Don't panic if your husband has a bad spermogram. Often, when you retake the test, the analysis turns out to be less daunting.

What exactly pathologies can abnormalities in the spermogram indicate? Most often this happens when:

genetic pathology;
autoimmune lesions;
hormonal disorders;
radiation exposure;
using tobacco or alcohol;
using drugs or strong medications;
insufficient physical activity;
stress;
wrong diet.

What do spermogram abnormalities indicate?

There is a list of normal spermogram readings:

Let's look at some cases of abnormalities in the spermogram:

Decreased sperm count

May occur with scarring of the testicles or hormonal disorders.

Treatment uses hormonal therapy, surgical excision of scars and restoration of testicular patency. In some cases, this pathology cannot be resolved naturally. Modern technologies of artificial insemination or IVF can help here.

Sperm immobility

This disorder occurs in many common diseases, genetic pathologies, bad habits (alcohol, drugs), exposure to vibration or radiation, and poor lifestyle.

Decreased sperm volume

Most often occurs with inflammatory pathologies of the testicles or previous injuries. Often the cause of a decrease in sperm is scars in the testicular area.

Such pathology is often an indication for in vitro fertilization.

Lack of sperm

In the absence of sperm, a man's chances of becoming a father are zero. This is a serious pathology that occurs when:

genetic failures;
previous mumps;
blockage of the vas deferens.

To solve the problem, restorative surgical treatment is used, testicular puncture with artificial collection of semen through a syringe.

Abnormal sperm

A high concentration of “anomalies” in the semen occurs due to autoimmune or genetic pathologies, drug use, smoking, or exposure to vibration or radiation.

This disorder is treated with stimulation therapy using IVF technologies and when only healthy sperm are selected for conception.

The phenomenon of hemospermia (blood in sperm) does not affect the ability to produce offspring. However, such a violation requires examination. Hemospermia may indicate:

urogenital infections or tumors;
vascular pathologies;
obstruction of the vas deferens;
prostatic hyperplasia.

Often streaks of blood appear after sex. In this case, control and use of a condom is important.

A large number of leukocytes

It occurs in various inflammations of the genitourinary tract and acute infections (prostatitis, urethritis, trichomoniasis, chlamydia, etc.) After identifying the cause, anti-inflammatory therapy for the underlying ailment is carried out.

How to improve your sperm count

Often on various forums on the Internet, women ask the question “how to get pregnant if your husband has a bad spermogram”?

In fact, there can be a great many reasons for such irregularities in sperm analysis:

diseases (genetic, endocrine, infectious, venereal);
lifestyle (poor diet, lack of exercise, bad habits);
external influences (radiation, vibration, intoxication).

Very common changes in the spermogram are:

pH disturbances;
change in sperm viscosity;
overestimated number of rounded cells.

With violations of this kind, pregnancy is very likely. Usually, it is enough for a man to check his hormonal levels and rule out inflammatory diseases of the genitourinary organs.

After the examination, you often have to take a course of drugs to correct men’s health (Speman, Spemoton to increase spermatogenesis).

It is important to radically change the lifestyle of a man seeking to improve his sperm analysis readings. This includes recommendations for changing your diet, eliminating underweight, stopping smoking, etc.

For a number of pathologies of men's health, patients will require long-term and serious treatment (scarring, obesity, etc.)

However, if your husband has a bad spermogram, you should not despair. Nowadays, modern reproductive methods can help almost everyone give birth to healthy offspring. Health to you and your future babies!

The most complete analysis of sperm, which allows one to evaluate its physical properties, cellular and chemical composition, is a spermogram. Thanks to a spermogram, a specialist will be able to more accurately determine the degree of male infertility.

In 1999, spermogram standards were revised, and at the moment they are as follows:

1. Volume– not less than 2.0 ml

2. Concentration– not less than 20.0 million/ml

3. Mobility:
- from 25% of sperm with fast linear progressive motility (cat. A);
- from 50% - with fast linear progressive mobility (cat. A), and slow linear or non-linear progressive mobility (cat. B).

4. Live sperm(eosin staining test) – at least 50% (according to 1999 standards)

5. Morphologically normal forms– at least 30%

6. pH = 7,2-8,0

7. The number of leukocytes in sperm- no more than 1.0 million/ml

If the sperm count decreases according to semen analysis, a diagnosis of “oligozoospermia” is made. Such a pathology may be a consequence of decreased testicular function or obstruction of the vas deferens (on the one hand). If the obstruction becomes bilateral, and the functions of the testicles are completely lost, we can talk about azoospermia, that is, the complete absence of sperm.

According to the analysis results, actively mobile individuals should make up 60-70% of the total number, weakly mobile - 10-15%, and immobile - 20-25%. In this case, in the best case, actively motile sperm should strive forward, but some of them can move chaotically.

If motile is less than 50%, this indicates a pathology such as asthenozoospermia; the absence of sperm means necrosis.

70-80% of the total number should be live sperm, the number of dead ones, according to standards, cannot exceed 20%, and individuals with pathological forms should also account for no more than 20%.

Using the morphology of sperm, you can find out the number of those that have a normal structure; they should be 50% or more. If this indicator is lower, it means that we are talking about a pathology such as teratozoospermia.

Other analysis indicators:

- leukocytes– up to 10 units. in sight;

- sperm cells(total amount) - 1-2%

A leukocyte count exceeding the norm is a sign of an acute inflammatory process developing in the urogenital tract. This could be prostatitis, orchitis, vesiculitis, epididymitis, urethritis, etc. As a rule, the patient is given a thorough examination.

- epithelium – 2-3;

- lecithin grains– in large quantities;

- red blood cells- complete absence;

- Bechter crystals– units;

- slime- absence;

- spermagglutination- No.

Agglutination contributes to a sharp decrease in sperm motility and can lead to a sharp decrease in reproductive function. Sticky pathology can arise due to dysfunction of the gonads, which often develops with vesiculitis and chronic prostatitis. Sometimes agglutination becomes a consequence of specific inflammatory diseases, irregular sex life, etc.

Aggregation is also a sign of pathological changes that can lead to decreased fertility. Areas of aggregation, that is, significant accumulation of sperm, can be seen even with the naked eye. They stand out from the total mass of ejaculate by their sharp whiteness and greater density. Against the background of aggregation, a decrease in sperm motility is often observed, which is a sign of various pathological changes and dysfunctions of the male body.

- travel speed- 3 mm/min;

- microflora- absent;

- metabolic activity- from 60 min;

- fatigue- the percentage of mobile forms after 1 hour decreases by 10%,
after 5 hours - by 40%;

- resistance test results- 120 minutes or more.

Small deviations in indicators in any direction do not necessarily indicate the development of a disease leading to a serious decrease in fertility. In order to determine a man’s ability to fertilize, it is necessary to analyze all the characteristics. Semen analysis is used in some cases not only to confirm or refute the diagnosis, but also to assess other pathological changes in the patient’s body.

Before donating sperm for analysis, the patient must adhere to certain requirements. For example, it is necessary to abstain from sexual activity for 3-4 days, a maximum of a week.

During this time, the man who is to donate sperm is prohibited from:
- use any medications;
- drink alcohol, including beer;
- to take a bath;
- visit the bathhouse.

On the eve of the test, you should not eat fatty or spicy foods; you must urinate 2 hours before taking the biomaterial.

The ejaculate is obtained in the laboratory of the medical center through masturbation or as a result of interrupted sexual intercourse. Sperm received in a condom is not suitable for analysis, since, in contact with the rubber, and especially with the substances with which it is processed, the sperm become immobile after 15-20 minutes.

Sperm are best preserved at temperatures from 20 to 37 degrees. An important condition: the biomaterial obtained through ejaculation must completely enter the prepared vessel. If part of the portion is lost, then the spermogram result will no longer be so accurate. This is especially true for older men, as well as patients with insufficient spermatogenesis.

If the indicators are good, you may not need to do a spermogram again. If any pathological abnormalities were detected, the study will need to be carried out one or two more times, at intervals of a week.

Sometimes a woman is unable to persuade her husband to do a sperm analysis. Then you can agree with the man to collect the ejaculate for analysis at home. First, you need to ask the IVF laboratory for a special container (a sterile vessel with a lid, as well as test tubes for transporting biomaterial). After the sperm is obtained, it should be delivered very quickly (up to 1.5 hours) to the clinic. It is advisable to attach the test tube to the body, for example, stick it with a plaster to the stomach, or put it in a bra - there the contents of the test tube will be provided with the required temperature.

If a spouse has problems with potency, this does not mean his inability to bear children. On the contrary, such men may have very high sperm fertility. But, as a rule, it is difficult to persuade the husband to donate seminal fluid for analysis. Advice to women: show character, because we are talking about your future.

Sperm. Morphological structure

The sperm consists of a head, body and tail. The nucleus, covered with an acrosome, occupies most of the head. The acrosome consists of two membranes - internal and external, as well as contents, which include substances rich in hydroxylases and rich in carbohydrases.

Approaching the egg, the sperm releases an energy charge that breaks through the outer membrane and allows the contents of the acrosome to leave the nuclear cavity. This is how the acrosomal reaction occurs.

The fact that the morphological structure has certain anomalies is indicated by such signs as changes in the shape of the head, its size (increase or decrease), as well as structure (double or amorphous). Its tail can be spiral or double.

Due to impaired patency of the seminal vesicle duct, which is usually a consequence of various inflammatory diseases, the concentration of fructose in the seminal plasma sharply decreases. A similar effect is observed in congenital absence of seminal vesicles.

If a spermogram shows the presence in the ejaculate of a large (more than 10x106/ml) number of leukocytes, especially neutrophils, then this usually indicates the presence of infectious diseases or an inflammatory process in the genital tract.

Determining the pH of the ejaculate allows us to identify the localization of adhesive and inflammatory areas of the urogenital sphere. According to the norm, this spermogram indicator is 5.2-7.8; in the presence of an inflammatory process, it usually increases.

Male infertility (spermogram, infertility treatment, causes of infertility, infertility in men)

Hello, unfortunately in modern society the problem of infertility is becoming more and more common, and the main reason is male infertility. According to the World Health Organization in 2013, every fifth married couple faces the problem of male infertility. Moreover, in half of the cases, male factor infertility is detected, when a man has regular sex life for a year, does not use protection, but cannot conceive a child.

Cause of infertility in men: sperm quality

The main problem of infertility in men lies in the decrease in sperm quality. Let's look at the structure of the sperm, which consists of a head, a body neck and a tail. The male reproductive cell moves through the rotational movements of its tail, which may be defective in structure, it may be short, twisted, oblique, too thin or even multiple. At the same time, the movement of the sperm naturally becomes slow and chaotic, and it becomes impossible for it to travel about 20 cm to achieve fertilization. Such sperm often die in the female environment without ever reaching the egg. There is also a complete absence of the sperm tail; naturally, such a cell is completely devoid of movement, this is the cause of infertility.

The next criterion for sperm activity is their energy reserve. Activation of sperm movement occurs in the female body, that is, the tail of the male reproductive cell normally begins to rotate vigorously in the acidic environment of the vagina, but there are also cases when this activation mechanism is disrupted when the male reproductive cell begins to move vigorously while still in the man’s body. In these cases, the sperm depletes its energy reserve, and once in the female environment it can no longer move.

Not only the quality of sperm is important, but also their quantity

Not only the quality of sperm is important, but also their quantity, because the process of fertilization of an egg is accompanied by massive death of sperm, each of which dissolves the shell of the egg into the flesh until it is completely thinned, and only when the protective barrier of the female cell is removed, one of the sperm is finally can penetrate the egg. So the process of fertilization of a female reproductive cell is a collective work of many male sperm that have traveled a considerable distance to their goal.
Based on these basic criteria for sperm movement, we can talk about male infertility in which the quality and quantity of sperm decreases.
Sperm are produced by the testicles under the influence of male sex hormones, which is why if the spermogram is bad, it is necessary to study the man’s hormonal profile. Whether he has enough hormones, it is important to study the structure of the testicles, structure, size, condition of the tissue, for which an ultrasound of the scrotum of the testicles is performed. According to this study, we can also see inflammatory processes in the testicles and epididymis, which naturally greatly affects the quality and quantity of sperm.
An important component of seminal fluid is prostate juice, which dilutes sperm and protects male reproductive cells from the aggressive acidic female environment. In cases of a decrease in the amount of prostatic juice, sperm quickly die, so disease of the prostate gland can be the cause of male infertility, and we must not forget that the prostate gland not only produces prostatic juice, but is also a gland that produces male sex hormones, so its examination for male infertility According to international medical standards, it is mandatory. To do this, a digital examination of the prostate gland is performed, in which an experienced doctor can determine by touch its density, size, shape, in addition, the patient needs to perform a trans-rectal ultrasound examination of the prostate gland, which will give us a visual idea of the condition of the prostate tissue and seminal tissue. bubbles.

Infections cause infertility

One of the very common causes of male infertility is infections that can cause inflammation of the genital organs. Therefore, a man is required to donate blood and a smear for the most common sexually transmitted infections. The detection of chlomidia and meicoplasma is often accompanied by a decrease in motility and aglucination, that is, the cohesion of sperm, and the appearance of antispermal antibodies. Microorganisms are able to attach to sperm, which reduces their motility and causes infertility. Thus, if we detect an infection, and even in high concentrations, we need to treat the man for infertility, after which a long-awaited pregnancy often occurs.

Mumps or mumps cause of male infertility

Often the cause of infertility in a man is mumps suffered in childhood, popularly known as mumps. This disease, in addition to the parotid glands, also affects the seminiferous tubules, making them partially or completely impassable for sperm, and a pronounced inflammatory process and poor circulation in the testicles can lead to local hemorrhages and necrosis of testicular tissue, after which the movement of sperm along the paths becomes partially or completely impossible.
Sexually transmitted diseases, namely syphilis and gonorrhea, can lead to infertility.

Treatment of male infertility

Let's talk about the treatment of male infertility. As you probably already guessed, it should primarily be aimed at eliminating the cause of male infertility. In some cases, it is necessary to normalize hormonal levels and spermatogenesis, that is, to qualitatively improve sperm formation. In other cases, it is necessary to eliminate the inflammatory process and infection of the male genital organs. When treating infertility, appropriate medications and physical procedures are usually prescribed. The patient often needs to change his diet, eliminate alcohol and smoking, and need healthy sleep. The medications are taken over a course of 2-3 months, after which a re-examination is carried out.
I would like to wish you to overcome the problem of male infertility and enjoy fatherhood throughout your life, until you are very old. Let the long-awaited children make you happy. All the best.

Diagnostic algorithm for male infertility

In our opinion, the diagnostic algorithm for examining a man should consist of two stages. At the first stage, medical history data are assessed, including a history of fertility and previous urogenital diseases. In addition, physical examination methods, spermogram analysis, and determination of the immunological factor of infertility are carried out.

The first stage of examination should be carried out for all patients who contact a specialist about an infertile marriage.

The optimal period of abstinence to obtain reliable results when studying ejaculate is 48-72 hours. Spermogram analysis in the presence of pathospermia should be repeated after 2 weeks. During this period, drinking alcohol, as well as using strong medications, unless they have been prescribed by a doctor, is unacceptable. It must be remembered that even low-grade fever, observed in the 3 months preceding the study, can cause serious changes in the ejaculate, including azoospermia.

Diagnosis of the immunological factor of infertility is based on testing for the presence of antisperm antibodies in the ejaculate and blood serum of the patient and his partner. Standard methods are the MAR test, which characterizes the percentage of sperm covered with antisperm antibodies (a positive test - more than 50% of motile sperm covered with antibodies) and ELISA - the titer of antisperm antibodies in the blood serum of the patient and his sexual partner (standards are established by the laboratory). Positive test results indicate the presence of an immune factor for infertility. In the absence of other pathology, a diagnosis of isolated immune infertility is established, which accounts for about 10% of infertile marriages.

At this stage it is possible to diagnose clinically significant varicocele, determine obstructive azoospermia, as well as to identify a group of patients with decreased fertility without specifying the etiology at this stage or with an immunological factor of infertility.

The information obtained during the first stage allows us to narrow the diagnostic algorithm of the second stage.

At the second stage, a patient with an unclear etiology of infertility undergoes a full range of diagnostic measures - determination of hormonal status, ultrasound examination of the scrotal organs, determination of causative agents of urogenital infections, if necessary - genetic studies, studies of centrifuged ejaculate and post-orgasmic urine.

Hormonal studies should be carried out in cases of severe pathospermia and azoospermia. In these cases, the levels of testosterone, FSH, LH, as well as sex hormone binding globulin are determined, which gives an idea not only of the amount of testosterone, but also of its biologically active fraction. It is advisable to determine prolactin if a pituitary tumor is suspected.

An ultrasound examination reveals structural changes and pathological formations in the testicles, appendages, and prostate gland. Indications for TRUS are low-volume azoospermia; this method makes it possible to detect changes in the seminal vesicles with obstruction of the distal sections of the vas deferens or their absence with congenital agenesis of the vas deferens. Color Doppler examination can detect the presence of venous reflux in the testicular vein system and the so-called subclinical varicocele.

Sowing of ejaculate is carried out in case of pyospermia (leukocyte concentration more than 1 million/ml) and in the case of idiopathic decrease in fertility and deterioration of spermogram indicators, as well as when preparing the patient during assisted reproductive technologies.

Human herpes simplex virus and chlamydia can infect sperm, leading to their immobilization, the formation of ASAT (antisperm antibodies) to them and miscarriage, as well as congenital anomalies of the fetus.

Indications for such diagnostics are the idiopathic nature of decreased fertility and pathospermia, miscarriage, as well as during the preparation of the patient in the cycle of assisted reproductive technologies. It should be noted that the diagnosis of sexually transmitted infections should be carried out using the enzyme-linked immunosorbent assay (ELISA) in combination with PCR.

Genetic studies should be undertaken in case of azoospermia and severe pathospermia. Karyotyping reveals abnormalities in the chromosome set (patient's karyotype). Recently, the study of the AZF region of the Y chromosome for the presence of microdeletions in it has become increasingly important. About 10% of all cases of severe pathospermia and non-obstructive azoospermia caused by the loss of one or more loci in the Y chromosome localized in the AZF interval. In addition to its diagnostic value, genetic studies can provide information about the possibility of transmitting this disease to male offspring, which patients should be informed about.

With non-obstructive azoospermia, it is possible to detect single spermatozoa or spermatogenesis cells when examining the ejaculate centrifugate. Therefore, such a study is indicated when carrying out differential diagnosis of the causes of azoospermia and in the cycle of reproductive technologies (search for single spermatozoa for ICSI).

The study of post-orgasmic urine is carried out during retrograde ejaculation.

The question of the advisability of a diagnostic biopsy for azoospermia remains controversial to this day. In our opinion, testicular biopsy is unacceptable for diagnostic purposes and can only be used as a method of obtaining genetic material for the purpose of including it in an IVF-ICSI cycle. It should also be taken into account that repeated surgical intervention is possible only after 6-18 months, which is associated with the need to restore the initial level of spermatogenesis and carry out conservative measures aimed at improving the process of spermatogenesis.

General issues. Spermogram

The main function of the male reproductive gland (testicle) is the formation of sperm (spermatogenesis).

The process of sperm formation begins in adolescence and continues until old age.

The maturation process of one sperm takes 74 days. For this you need:

convoluted tubule where sperm matures
involvement of Sertoli cells
high local concentration of the hormone testosterone
testicular temperature is 2 degrees lower than body temperature

Sperm acquire motility by passing through the epididymis. This process takes about 2-6 days.

The average speed of sperm movement is 3 mm/min., the maximum is up to 40 mm/min.

Sperm motility is maintained for 48 hours.

The main source of energy, metabolism and maintenance of sperm motility is fructose, which is formed in the seminal vesicles.

The path of the sperm from the testicle to the egg:

Spermatogenesis in the testes
Transition through the epididymis
Ejaculation (ejaculation)
Penetration through the cervical mucus of the cervical canal, purification of seminal plasma components
Capacitation (acquisition of fertilizing properties by sperm)
Acrosome reaction (fusion of sperm with egg)
Fertilization (fertilization) of an egg

It's called an infertile marriage marriage in which there is no pregnancy within 12 months of regular sexual activity without contraception.

“Responsibility for failure to conceive traditionally falls on the woman. This view is based on the pseudological conclusion that “if she is not pregnant, then it is her fault.”

R.J. Rowe et al. - WHO experts.

Epidemiology of infertile marriage

50% female factor infertility
35% male factor infertility
15% combined factor of infertility

Every tenth married couple is infertile.

First stage examination of a man with infertility

Taking a fertility history.
- History of childhood diseases.
- Surgical history.
- History of occupational hazards and habitual intoxications.
- History of urogenital diseases.
- The actual fertility history and the fertility of the patient's partner.
Examination and physical examination.
- General examination and physical examination of systems and organs.
- Status genitalis (physical examination of the penis, scrotum and its organs, prostate gland and seminal vesicles).
Routine spermogram examination.
Study of antisperm antibodies.
- MAR test (percentage of actively motile sperm coated with antibodies)
- Enzyme-linked immunosorbent assay (ELISA) of antibodies to sperm in the blood of men with azoospermia and sexual partners of all patients

During a physical examination (examination) of the male genital organs, the following is carried out:

Examination of the external genitalia.
Palpation of the scrotum and its organs.
Rectal examination.

Attention should be paid to the following points:

The study is carried out in a warm, bright room.
Warm hands.
Orthostasis (upright position of the patient).
Confidentiality.

When examining the external genitalia are investigated and determined:

Skin of the penis and scrotum.
The size and consistency of the penis.
Meatus (external opening of the urethra).
Erectile and non-erectile deformities of the penis.
Signs of urethritis.

When palpating the scrotum, the following are assessed:

Testicles.
Epididymis.
Elements of the spermatic cord.

Digital rectal examination evaluates:

Assessment of the shape, consistency, size and boundaries of the prostate gland.
Signs of chronic prostatitis.
Signs of prostate cancer.
Benign prostatic hyperplasia (adenoma)
Presence of seminal vesicles.

Currently, the "gold standard" for examining the prostate gland is transrectal ultrasound, not the urologist's finger.

Rules for studying ejaculate

The period of abstinence is 48-72 hours (2-3 days).
Taking strong medications, tranquilizers, and alcohol during the period of abstinence is not permissible.
Repeated examination 2 weeks later if pathospermia is detected.
Centrifugation of ejaculate during repeated examination in case of azoospermia.
Inclusion of antisperm antibodies into routine testing.

Normal spermogram indicators:

Volume	2-5 ml
pH	7.2-8
Viscosity	up to 2 cm
Liquefaction period	up to 60 min
Sperm count(million/ml)	not less than 20 million/ml
Total sperm count(million)	at least 60 million
Sperm motility
Fast forward motion (A or 4)	more than 25%
Forward movement (A + B or 3.4)	more than 50%
Morphology
Normal sperm	30%-70% (according to various authors)
Agglutination	absent
Leukocytes	no more than 106 per ml
Spermiogenesis cells	no more than 4% of the total
Epithelial cells	single
Red blood cells	none

Characteristics of sperm movement (WHO, 1992)

A- fast progressive movement.
B- slow linear and nonlinear progressive movement.
C- oscillatory or motion in place.
D- sperm are not motile.

Characteristics of Movement (AUA, 1997)

0 - lack of movement.
1 - sluggish movement in place.
2 - slow, winding movement.
3 - moderate progressive movement.
4 - pronounced progressive movement.

The result of the initial examination

Erectile disfunction.
Pathospermia (pathological changes in sperm).
Azoospermia (lack of sperm in the ejaculate).
Ejaculatory dysfunction (retrograde ejaculation or absence of ejaculation).
Varicocele.
Pyospermia and bacteriospermia.
Idiopathic infertility (infertility of unknown etiology).

Varicocele and infertility

Varicocele is an enlargement of the testicular veins due to reflux of blood through the testicular vein system. Varicocele is observed in 15% of the general male population. The combination of varicocele and primary infertility is observed in 35%, secondary infertility and varicocele in 80%. In some cases, additional ultrasonographic examination is required to determine venous reflux. It must be remembered that there is no direct correlation between the severity of varicocele and the quality of the ejaculate.

When varicocele is combined with any other clinical and laboratory changes, with the exception of obstructive symptoms and ejaculatory dysfunction, it is advisable to treat the varicocele as the first step.

Several surgical methods have been proposed for the treatment of varicocele. It is necessary to distinguish between obstructive and non-obstructive methods of surgical treatment of varicocele. The first include the Ivanissevich, Marmara, Palomo operations, laparoscopic varicocelectomy, transfemoral embolization of the testicular vein, as well as microsurgical ligation of the spermatic cord veins from a mini-access.

A non-obstructive technique includes the formation of microsurgical venous anastomoses - testicular-inferior epigastric and testicular-saphenic. The testicular-epigastric anastomosis method allows blood to be drained from the pampiniform plexus into the iliac vein system in types I, as well as types II and III, if the cause of reflux is not associated with valvular insufficiency of the veins from the discharge system into the left iliac vein.

Currently, the indications for surgical treatment of varicocele are being revised. Since there is no direct relationship between the severity of varicocele and the degree of decreased fertility, we consider the indications for surgical treatment of varicocele to be a persistent decrease in the fertility of the ejaculate, pain symptoms and a pronounced aesthetic defect in the scrotum area.

Currently, there are more and more reports in the literature that in patients with varicocele and normal spermogram after surgery, the appearance of antisperm antibodies and deterioration in ejaculate parameters are observed, which, apparently, may be associated with a deterioration in testicular trophism after obstructive surgery. In light of this, we believe that surgery using the microvascular method in order to form a venous anastomosis and normalize the outflow of blood from the testicular vein system seems preferable compared to traditional obstructive techniques.

Azoospermia. Infertility treatment

It is necessary to distinguish between obstructive azoospermia (excretory infertility) and non-obstructive (secretory infertility) azoospermia, or severe pathospermia.

For obstructive azoospermia Characterized by normal testicular size, normal hormone levels, absence of spermatogenesis cells in centrifuged ejaculate, inflammatory diseases of the genital organs, operations on the scrotum and pelvis, as well as palpation determination of pathology of the appendages and vas deferens.

At non-obstructive azoospermia there are signs of hypogonadism, single sperm or spermatogenesis cells in the ejaculate, hormonal changes, gene and chromosomal changes, a history of toxic influences, orchitis.

The optimal way to treat obstructive azoospermia is to perform microsurgical restoration of the vas deferens with simultaneous collection of sperm from the area proximal to the obstruction.

The resulting material can be simultaneously used in the IVF-ICSI cycle. In this case, part of the sperm is cryopreserved and used in case of unsuccessful surgery.

A more complex issue is the treatment of patients with non-obstructive forms of infertility in the IVF-ICSI program. The optimal way to obtain sperm for non-obstructive azoospermia in an IVF-ICSI cycle is bilateral multifocal testicular biopsy using microsurgical techniques.

It is known that with non-obstructive azoospermia, focal spermatogenesis can be preserved. Regardless of the results of hormonal and genetic studies, even with hypergonadotropic hypogonadism, bilateral multifocal microsurgical biopsy can obtain sperm (up to 65%).

In case of non-obstructive azoospermia against the background of hypogonadotropic hypogonadism, the first step should be stimulating therapy with gonadotropins.

In case of severe pathospermia against the background of genetic abnormalities, hypogonadism (except hypogonadotropic), obstructive symptoms, varicocele, absence of ASAT, empirical therapy is possible; if there is no effect (or immediately), the patient is included in the program of assisted reproductive technologies.

For non-obstructive azoospermia, Azoospermia of unknown origin, pathospermia of any severity (except for proven unilateral obstruction), the first step is to exclude varicocele, including subclinical one. Stimulating therapy is advisable after treatment of varicocele.

When non-obstructive (of unclear origin) pathospermia (azoospermia) and antisperm antibodies are combined, stimulating treatment is contraindicated.

For idiopathic infertility, treatment with gonadotropins or antiestrogens is possible, as well as vitamin therapy and herbal spermatogenesis stimulants with a balanced content of microelements. However, the effectiveness of such infertility treatment does not exceed 5%.

Reconstruction of the vas deferens for obstructive azoospermia
Restoration of the vas deferens after iatrogenic damage
Reconstruction of the vas deferens for obstructive aspermia

Immunological (autoimmune) infertility

Antisperm antibodies (ASAT) are capable of blocking spermatogenesis, disrupting sperm motility in the ejaculate, preventing penetration into the cervical mucus, disrupting capacitation, the acrosomal reaction, binding to the zona pellucida, complicating fertilization, disrupting cleavage, and even promoting termination of pregnancy in the early stages.

Treatment of immune infertility is a complex problem.

The first stage of treatment for immune male infertility is the elimination of all possible etiological factors in the development of the autoimmune process in the reproductive system: urogenital infections, varicocele, obstruction of the vas deferens, etc.

However, normalization of blood circulation, absence of sexually transmitted diseases (STDs), restoration of patency of the vas deferens (when this can be done), elimination of industrial hazards does not ensure the disappearance of ASAT when their production began. Therefore, the second stage usually requires the use of one or a complex of additional therapeutic measures: pharmacotherapy (systemic enzyme therapy, hormonal therapy), special washes followed by intrauterine or intratubal injection or IVF, including fertilization with a single sperm using microinjection into the cytoplasm (ICSI).

It must be remembered that any stimulant therapy in the presence of ACAT is contraindicated.

If the patient and/or his partner have ASAT and there is no other pathology, a diagnosis of isolated immune infertility is established. In case of isolated immune infertility, conservative empirical therapy is ineffective; the only real alternative is assisted reproductive technologies.

Assisted reproductive technologies (ART)

Assisted reproductive technologies mean:

Intrauterine insemination with husband's sperm.
In vitro fertilization.
In vitro fertilization with micromanipulation ICSI (ICSI)
Use of donor sperm in ART.

The introduction of sperm directly into the uterine cavity involves artificial passage of the cervix with sperm that could die due to cervical infertility when trying to conceive naturally.

Indications for intrauterine insemination also include ejaculatory dysfunction, immunological infertility, and oligoasthenozoospermia.

The immunological factor of infertility is overcome by pre-treatment of sperm. In case of unknown etiology of infertility, artificial insemination by intrauterine insemination is also possible if the quality of the ejaculate is satisfactory (the number of motile sperm is more than 5 million). Insemination of donor sperm allows you to avoid direct sexual intercourse.

The in vitro fertilization technique involves stimulation of superovulation, which can cause a number of complications, both directly during stimulation and as a result of multiple pregnancies. The success of the stimulation procedure largely depends on the state of the woman’s endocrine system. It is known that the pregnancy rate is higher in cases where more than 5 eggs can be aspirated during follicular puncture. Next, the oocytes are aspirated by transvaginal puncture of the ovaries. After this, in vitro fertilization occurs - exposure of eggs in the same environment with treated sperm. This is followed by transfer of embryos into the uterine cavity and reduction of some embryos.

The possibilities for correcting azoospermia remained minimal until the introduction of the intracytoplasmic sperm injection (ICSI) technique, which required only single sperm of epididymal or testicular origin for fertilization.

Indications for IVF (ICSI) are: sperm concentration below 10 million (2 million for ICSI), sperm motility 2 - less than 10% (5% for ICSI), more than 70% of pathological forms of sperm (more than 96 for ICSI), the possibility obtaining sperm only surgically, failure of other treatment methods.

The effectiveness of artificial insemination methods is about 30% per attempt.

The use of assisted reproductive technologies significantly expands the possibilities for correcting the most severe forms of male infertility, including azoospermia. Competent and effective treatment of infertile marriage is possible only with clear interaction between urologists, gynecologists and IVF specialists. It is mandatory to fully inform the patient about all possible methods of restoring fertility, indicating the percentage of successful measures and the risk of complications for himself and his wife.

Spermogram of an infertile man. Spermogram and male infertility