Infertility is a complex and unresolved medical and social problem. Statistics show that in the world from 8 to 15% of married couples are childless, not by choice. In about half of the cases, this is due to a violation of the male reproductive function.
Infertility in men, in fact, is not a nosologically form, however, due to the clear sidelining of the phenomenon, clinical and social significance, it has acquired an independent significance. Male infertility is directly or indirectly caused by a large number of diseases or factors that are very diverse in nature. This leads to a certain paradox, which consists in the fact that at present it is not difficult for a specialist to establish whether a man suffers from infertility (i.e., to determine his fertility), but it is very difficult and time-consuming to identify the cause that caused infertility, and even more so to achieve success in his treatment. In this regard, it is worth paying attention to two circumstances or Click Here for treatment and medication.
The polyetiological nature and variety of mechanisms for the growth of male infertility determine the often-arising need for participation in the supervision of this category of patients, in addition to a urologist or andrologist, as well as a general practitioner, endocrinologist, neuropathologist, geneticist and other specialists. Infertility is commonly understood as the absence of conception with regular intercourse without contraception in persons of childbearing age for at least 12 months.
Currently, there is no single, generally recognized and terminologically accurate classification of male infertility. At the same time, it remains expedient to isolate the excretory form when the excretion of spermatozoa along the vas deferens is impaired (obstruction due to an inflammatory lesion, agenesis, trauma, retrograde ejaculation, etc.) and the secretory form – a violation of spermatogenesis.
Secretory infertility may be the result of direct damage to the testicles or the result of hypothalamic-pituitary insufficiency. It is advisable to isolate and auto immune Infertility.
It is quite reasonable to distinguish between primary and secondary infertility. With primary infertility, there are no known cases of pregnancy from this man, with secondary infertility, pregnancy has previously occurred, but is absent with regular intravaginal intercourse for one year. With secondary infertility, the chances of restoring fertility are higher, congenital and gross violations of spermatogenesis are less common. It has been established that in healthy spouses with a frequency of sexual intercourse 2 times a week, the probability of conception is 20-25% per menstrual cycle, 5 times a week – 40-42%.
Physical examination
Attention is drawn to the state of secondary sexual characteristics, the formation of which occurs under the control of androgens. Their insufficient development and severity indicate androgen deficiency during puberty.
Characterizing the physique of patients, the ratio of height to the length of the lower limbs is examined. An alarming moment is excessively long limbs.
The degree of severity and topography of subcutaneous fat is determined. This is evidenced by the insufficient rate of hair growth on the body and face, the horizontal level of hair growth on the pubis. Underdevelopment of the muscular system, controlled by testosterone, is also symptomatic. Gynecomastia is characteristic of Klinefelter’s syndrome (a chromosomal abnormality leading to infertility), less often it occurs with estrogen-secreting tumors of the adrenal glands or testicles.
Next, proceed to the study of the genital organs.
The presence of inflammatory discharge from the urethra is the basis for an in-depth examination for STIs. Hypospadias and epispadias can be the cause of infertility in cases where the ejaculate does not enter the vagina or ends up in its distal section.
The examination of the testicles is performed with the patient standing. Normally, the testicles are palpable in the lower half of the scrotum. In various pathological conditions, their high location in the scrotum, inside the inguinal canal, ectopic location (i.e., outside the normal way of descending the testicle), and finally, the testicles may not be palpable in cases of their absence (agenesis) or localization in the abdominal cavity.
Normally, the testicles are located vertically in the scrotum, and the appendages are behind or medially.
The volume of the testicles of a man is about 15 cm3, various models of orchidometers are used to measure them. Determining the volume of the testicles in the diagnosis of infertility is of particular importance, given that about 97% of the volume is occupied by convoluted seminiferous tubules. Testicleless than 15 cm3 or 40 mm long are considered hypoplastic or hypertrophic. There is a clear correlation between total testicular volume and the number of spermatozoa in the ejaculate. Normally, the testicles have an elastic consistency. A soft consistency is usually combined with a decrease in spermatogenesis. The hard consistency of the testis, especially in combination with its increase, requires the exclusion of the tumor.
Normally, the epididymis has an oblong shape, soft texture. Total or local increase and compaction of the epididymis in most cases is the result of an inflammatory lesion. Often palpable cystic formations in the head of the appendage are benign in nature and do not affect fertility. The vas deferens are normally palpated up to the outer rings of the inguinal canals in the form of thin, dense tubular, smooth structures. Contact urologist for expert advice.
