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Male Infertility

We may observe male infertility in one out of every five men. We also quite frequently observe female infertility. However, do we know enough about male infertility? Are men tested adequately? We will give you brief information on these issues…

Sperms which have the ability to fertilize mature eggs are produced in the testicles. This production cycle is completed in 80 to 90 days. Sperms that are mature and have the ability to fertilize are produced from premise sperm cells.

There are not only sperms in the semen as a result of ejaculation. A large portion of this fluid is a special liquid named seminal vesicle fluid. The remaining parts are prostate fluid, other fluids and sperm cells. In the sperm analysis, sperm numbers, motility and shapes in the semen as a total and in 1 ml are checked initially. Following sexual abstinence of 3 to 5 days, normal values would be as follows:

  • Total count 40 million
  • 15 million in 1 ml
  • Total motility at least 40%
  • Advance movement (A+B) at least 32%
  • Normally shaped ones at least 4%

If we observe a problem about these numbers, we mention male infertility. If the number is below 5 million in 1 ml or if motility is low or there are no normally shaped sperms, medical treatment might be required following various tests or intrauterine insemination/IVF may be considered.

We may sort reasons of male infertility as follows: issues regarding hormones secreted from the brain, production malfunction in the testicles, issues due to the seminal duct regarding ejaculation of produced sperms or unknown causes.

Reasons of male infertility that are most frequently observed in our daily lives are as follows:

  • Y microdeletion: genetic problems
  • Undescended testicle: displacement of testicles
  • Varicosele: enlargement in testicular arteries

If the given sperm sample does not include live sperm cells, we call it azoospermia. In such cases, we repeat the sperm analysis a few days later. We must request additional tests if azoospermia is detected once again. These tests include:

  • Testicular ultrasound
  • Chromosome analysis
  • Hormones

We generally observe azoospermia in 1% of the society and 20% in patients who apply to a hospital for possible infertility. If there are no live sperm cells in the semen, we must definitely do the second test. We make the diagnosis if we are unable to find live sperm cells once again. So, is it possible to have children even if there is azoospermia? Which tests should be performed?

In cases of azoospermia, we observe around 40% congestion in the channel. In such cases, tests related to the cause are required. Congenital absence of channels or congestion of channels due to infections may cause azoospermia. In these cases, we are able to obtain mature sperm cells. It is possible to have children, by retrieving sperms through congested vessels or if there is no channel, microinjection could be performed by obtaining sperms from the testicular tissue.

In cases of azoospermia, we observe around 60% of production malfunction in the testicles. In such cases, it might be harder to obtain mature sperms. These cases include:

  • Hypogonadism; that is congenital problems in brain hormones
  • Undescended testicle
  • Production malfunction following chemotherapy/radiotherapy
  • Individuals with Klinefelter’s syndrome
  • Individuals with Y microdeletion
  • Those who have had testicular infection called orchitis
  • Those who have had testicular surgery

In these cases, live-mature sperm cells might not be obtained in sperm analysis. After this phase, hormones should be monitored and if necessary hormone therapy could be initiated. In cases of azoospermia, several techniques are used to obtain sperms.

TESE: sperm search under microscope by taking tissue samples from testicles

TESA: getting sperms from testicular channels through a needle

We are able to find approximately 30-40% live sperm cells in men by using these methods.