MALE INFERTILITY DISORDERS

Both men and women are equally affected by infertility in a couple. Out of every 100 infertility cases, 40 are of female origin, 40 of male origin, and 20 of both female and male origin. There are increasing levels of male infertility and it has in fact now been verified that the average concentration of sperm in seminal fluid is decreasing. The causes of increased male infertility are many: changes in lifestyle, air pollution, environmental toxicity in the working environment, smoking. Stress has also been a cause of decreases in fertility, but this figure is not quantifiable.

The first exam to test a man's fertility is the spermogram, that is, the evaluation of sperm concentration, motility, and morphology. If this is a problem, we try to investigate hormonal doses, through male genital ultrasounds.

In some cases a varicocele, or a dilatation of the veins at the level of the scrotum, is found. This causes a relative stagnation of venous blood and hence an increase in temperature resulting in testicular dysfunction. Surgery may, in some cases, lead to an improvement in the sperm.

In the case of dispermia, it is in some cases possible to intervene by means of medical treatments, which do not always yield the desired results.

When the spermogram is severely altered and medical or surgical therapies are unenforceable or have not yet yielded any results, medically assisted reproduction techniques may be used. Homologous insemination is practiced by injecting the appropriately treated seminal fluid into the female uterus. Generally this involves the preparation of a female partner with moderate hormonal stimulation.

In cases of more pronounced dispersion, ICSI (Intracitoplasmatic Sperm Injection) can be used. ICSI is an in vitro fertilization treatment that provides for stimulating ovulation a number of times. With ICSI you only need one sperm to fertilize an ovocyte; a special machine, called a micromanipulator, picks up the sperm with a needle and injects it into the egg.

Even men suffering from azoospermia may attempt to have a child through ICSI. Microsurgery techniques recover the sperm directly from the testicles. With this technique, which has revolutionized the approach to male infertility, a 35% success rate per cycle is achieved if the female partner is less than 40 years old. Often the procedure must be repeated, but many men who did not have the chance to have their own children, are today able to become fathers thanks to this technique.

WHAT IS A SPERMIOGRAM

spermiogramma

The spermogram is a seminal fluid test that allows you to count the amount of sperm and determine its quality and efficacy. The spermogram is an important examination to define the state of fertility of the patient, but it is not an exact science. In other words, one cannot say with absolute certainty whether or not a patient is fertile, hypofertile or sterile. But it provides the physician with the data needed to provide a probability.


How to Perform a Spermiogram

The seminal fluid is collected in a sterile container and brought to the laboratory within one hour of ejaculation by means of masturbation. Here it is kept at a temperature ranging between 20 and 37 degrees and examined. The sperm concentration, total number of ejaculated sperm, morphology and motility are evaluated.

The spermogram can be:

  • normal ie all parameters are within the normal limits (Normosp)
  • reduced by number of sperm (Oligospermia)
  • reduced sperm motility (Astenospermia) ie they struggle to reach the egg cell
  • of altered morphology (Teratospermia) where the patient exhibits a small number of spermatozoa

The most serious cases are called Cryptozoospermia and Azoospermia: the seminal fluid is completely absent or there are a very small number of spermatozoa. Such conditions involve sterility or the inability to conceive spontaneously.

MALE SEXUALITY

Sexual desire is generated in the oldest part of our brain, the risencephalus. In addition, sexual desire is influenced by hormones: testosterone that facilitates desire, and prolactin that inhibits it. A fall in desire may also be due to professional dissatisfaction, stress, mourning, or problems in your relationship. In these situations people often focus their attention on less pleasant or even negative aspects of sexual life. Sometimes it may be normal to have a lack of desire for sex when your partner is unavailable or when you are in a dangerous and stressful situation. Examinations: An andrological consultation is recommended. Which will then be followed by the most appropriate assessments. Usually hormonal doses are performed.

What can you do about it?

If the decrease in desire for sex is related to hormonal deficiency, it can be easily treated with targeted drugs. Psychological causes require appropriate psychotherapeutic intervention. It is very important to analyze their erotic fantasies, both to find out any psychological blocks and to free up and increase sexual desire. Erectile dysfunction Many men occasionally suffer from erectile dysfunction and this is a very negative experience for them.

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