Approximately 15% of married couples suffer from infertility, while in half of the cases the man is “to blame”.
Many factors lead to male infertility. In most cases, the cause of the disease remains unknown (idiopathic infertility). The most common known factors include: varicocele, infectious lesions of the genital organs, hormonal disorders, genetic abnormalities, etc.
The most severe but rare manifestation of male infertility is azoospermia (absence of spermatozoa in semen). At the same time, non-obstructive azoospermia associated with impaired sperm production in the testicles is detected more often (80-85%). There is also obstructive azoospermia (15-20%) due to obstruction of the seminal ducts, most often in the epididymis.
Mandatory research method for suspected male infertility is the study of sperm (spermogram) after 3 days of sexual abstinence. With a normal result of 1 analysis, the diagnosis of infertility is refuted. If there are deviations in the semen analysis, another examination of the semen is necessary.
Hormonal, genetic tests and investigations to detect infections in the organs of the reproductive system are used in the presence of appropriate deviations in the spermogram (decrease in the number and mobility of spermatozoa as well as deterioration of their structure, increase in the count of leukocytes in semen, etc.).
In recent years, research on sperm DNA fragmentation has become popular. If this indicator is exceeded, the probability of conception is significantly reduced.
Treatment of male infertility when a causative factor is identified is to eliminate it (treatment of varicocele, hormonal disorders, infectious processes, etc.).
In cases of unidentified male infertility, the optimal result is achieved by treatment with antioxidants.
In case of non-obstructive azoospermia, microsurgical methods of spermatozoa extraction (MicroTESE) are used for their application in different variants of artificial insemination.
In obstructive azoospermia, microsurgical repair of patency of seminal ducts can be performed (vasovasostomy or vasoepididymostomy). It is also possible to perform extraction of sermatozoa from the epididymis through the skin (PESA) or the preferred microsurgical method (MESA).