When to start the examination
The standard benchmark is one year of regular sexual activity without contraception. But there are situations when you shouldn’t wait a whole year.
- The partner’s age is over 35 years - examination begins in six months
- Known problems for women: tubal obstruction, endometriosis, cycle disorders
- The man has a history of surgery for an undescended testicle, trauma, or testicular torsion
- Post-existing mumps with orchitis
- Chemotherapy or radiation therapy in the past
- Noticeable decrease in testicular size
- Established varicocele
- Erection or ejaculation problems
Spermogram: main analysis
A spermogram evaluates the volume of ejaculate, the concentration of sperm, their motility and structure. This is the first and main step in examining a man.
- Sexual abstinence before the test - usually from two to seven days; a shorter or longer period distorts the result
- Do not take the test against the background of fever, acute inflammation or shortly after it - you will need to repeat it after a while
- Avoid alcohol, overheating, baths and saunas the day before
- One bad result does not prove anything: sperm parameters fluctuate, so if there are deviations, the analysis is repeated after a few weeks
- If any abnormalities are detected, additional tests are prescribed: MAR test for antisperm antibodies, assessment of sperm DNA fragmentation, ejaculate biochemistry
Causes of male infertility
- Varicocele is one of the most common and at the same time removable causes
- Infectious and inflammatory diseases: prostatitis, epididymitis, previous STIs
- Hormonal disorders: testosterone deficiency, increased prolactin, thyroid pathology, hypogonadism
- History of cryptorchidism - even after successful surgery in childhood
- Genetic causes: Klinefelter syndrome, Y chromosome microdeletions, cystic fibrosis gene mutations
- Obstructive causes: obstruction of the vas deferens after surgery, inflammation or congenital
- Consequences of injury and testicular torsion
- Chemotherapy, radiation therapy, taking anabolic steroids and external testosterone
- Overheating: working in hot shops, frequent baths, laptop on lap, tight underwear
- Smoking, alcohol, drugs
- Obesity and diabetes
- Ejaculation disorders, including retrograde ejaculation
- Immunological factor - antisperm antibodies
Separately, it is worth emphasizing the role of anabolic steroids and testosterone preparations: they suppress the production of their own hormones and can lead to a sharp decrease or complete disappearance of sperm. This is a common and largely reversible reason, which men often keep silent about at the appointment.
Survey
- Spermogram, repeated if necessary
- Examination by an andrologist with assessment of testicular size and identification of varicocele
- Ultrasound of the scrotum with Doppler sonography
- TRUS of the prostate and seminal vesicles if obstruction is suspected
- Hormonal profile: FSH, LH, total testosterone, prolactin, estradiol, TSH
- Screening for sexually transmitted infections
- MAR test
- Assessment of sperm DNA fragmentation
- Genetic examination for severe disorders: karyotype, AZF microdeletions, CFTR gene
- Post-ejaculation urine analysis for suspected retrograde ejaculation
- Testicular biopsy - for azoospermia to determine its type
Treatment
The tactics depend entirely on the identified cause. There are no universal “sperm vitamins” that solve the problem.
- Microsurgical varicocelectomy for clinically significant varicocele often leads to improved spermogram parameters
- Antibacterial and anti-inflammatory therapy for infections
- Correction of hormonal disorders under test control
- Withdrawal of anabolic steroids and exogenous testosterone followed by recovery
- Elimination of overheating and bad habits, weight loss
- Antioxidant therapy for increased DNA fragmentation - as an addition, not the basis of treatment
- Surgical restoration of patency of the vas deferens in obstructive forms
- TUR of the spermatic tubercle with obstruction at the level of the ejaculatory ducts
- Obtaining spermatozoa surgically for azoospermia for use in IVF and ICSI programs
- Assisted reproductive technologies together with a reproductologist
What a man can do on his own
- Отказаться от курения и сократить алкоголь
- Снизить вес при его избытке
- Исключить перегрев: баня, сауна, подогрев сиденья, тесное бельё, ноутбук на коленях
- Полностью отказаться от анаболических стероидов и препаратов тестостерона без назначения
- Наладить сон и снизить уровень стресса
- Обеспечить полноценное питание с достаточным количеством овощей, рыбы, орехов
- Поддерживать регулярную половую жизнь: слишком длительное воздержание ухудшает качество спермы так же, как и слишком частые контакты
- Пролечить хронические заболевания, включая диабет
Renewal of spermatogenesis takes about three months. Therefore, the effect of lifestyle changes and treatment is assessed no earlier than this period - a repeat spermogram a few weeks after the start of therapy is not very informative.
Where to get examined in Tashkent
To examine a man, you need a laboratory that performs a spermogram according to modern standards, an ultrasound of the scrotum with Doppler, and an appointment with an andrologist.
In Tashkent, examination for male infertility and surgical treatment of varicocele are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
A reasonable course of action for a couple: first, a spermogram - it is completed within a few days and immediately sets the direction for further examination. Clinic contacts and registration are below on the page.
