Clinic "Andrlog and I": Factors influencing reproductive health of men

Author: Director of the clinic "Andrologist and Me" Rakhmatullaev B.M.

Of all the physiological systems of the body, in terms of the development of adaptive reactions, the most important and least studied is the male reproductive system (WHO 2010). Infertility in marriage is one of the most important and complex medical, socio-demographic problems. The frequency of infertile marriages in many countries of the world ranges from 8 to 29%. For example, in Europe this figure is 10%, in the USA - 15%, in Canada - 17%, and in Russia - 8 - 17.5%. The most common causes of infertile marriage are:

* 40 - 50% - pathology of the reproductive system in one of the spouses

* 25 - 30% - pathology of the reproductive system in both spouses

The influence of the following “attributes” of modern life of people in industrialized countries cannot be excluded:

- mental stress

- impact on the body of “vital factors” such as:

- water, air and soil pollution,

- chemicalization of agriculture,

- dietary supplements in food products,

- synthetic drugs.

- and the usual rhythm of life has also changed.

Over the past 20 years, there has been a consistent trend towards an increase in the number of infertile men from 30 to 50%. A real decrease in sperm count in normal men has been proven over the period from 1938 to 1990 (E. Carlsen et.al. 1992, 1993). Since 1938, average sperm count has decreased by 42%. In the 1970s, a sperm concentration of 40 million per milliliter was considered a cause of infertility, but in the 1990s, the World Health Organization set a minimum threshold of 20 million. In 8-10% of cases, it is not possible to establish the cause of infertility, which is due to a large number of different factors affecting the reproductive process. (International Congress of Andrology, 2009). In 30% of cases, idiopathic infertility in men is observed, associated with the still insufficiently studied genetic aspects of the regulation of spermatogenesis (Shi Y.C. et al., 2010).

It should be noted in more detail about the influence of the following factors on the reproductive system: STRESS is a proven risk factor for the development of dysfunction of the hypothalamic-pituitary-gonadal system, leading to androgen deficiency and a decrease in the number of sperm in the ejaculate. In stressful situations, testosterone levels are below the statistical average, while FSH and LH values ​​remain within normal limits. A decrease in the level of sex hormones leads to further inhibition of spermatogenesis processes

Smoking - many people underestimate the impact of this factor; smoking leads to

* Degenerative changes in the germinal epithelium of the testicles.

* Nutrition of the testicular parenchyma deteriorates.

* The tone of the muscles of the vas deferens and accessory sex glands decreases.

* The secretion of testosterone by the testicles, the concentration of sperm in the ejaculate, their motility, fertilizing ability, and the proportion of morphologically, genetically and functionally normal cells decrease.

* The activities of Sertoli and Leydig cells are disrupted

* Direct cytotoxic effect of nicotine on spermatogenic cells

The influence of ALCOHOL is a direct toxic effect on the testicles and spermatogenic epithelial cells. The number of functioning tubules decreases. There is atrophy of Leydig cells, convoluted seminiferous tubules with loss of spermatogenic cells, with the manifestation of the “Sertoli cells only” syndrome. The number of mature sperm, the proportion of their motile and morphologically complete forms decreases, and testicular fibrosis develops. According to statistics, more than 80% of alcoholics are sterile!!!

Drugs are a problem in modern developed countries, leading to severe disorders of spermatogenesis, often manifested by oligoasthenozoospermia and necrozoospermia. Pronounced degenerative changes in almost all mature sperm.

Radiation - when exposed to low doses of radiation (LDR), much more tissue is affected than with radiation sickness. Proven. significant changes in seminal fluid with chronic doses of radiation and an increase in the level of autoantibodies to testicular tissue. (Gercenstock C.L., 1993)

Temperature - an increase in body temperature (due to the influence of production factors, during a feverish state, taking hot baths, visiting saunas) suppresses spermatogenesis. With varicocele and cryptorchidism, accompanied by an increase in intratesticular temperature, spermatogenesis is suppressed.

Vibration is an occupational hazard factor for drivers, machine operators, miners, etc. When exposed to it, the frequency of oligozoospermia and azoospermia increases. The volume of ejaculate and the proportion of motile sperm decreases. The frequency of morphologically abnormal sperm increases.

Industrialpoisons and chemicals have estrogenic and antiandrogenic activity (Yun J.K., 1997). People who not only directly work with such compounds are at risk, but also residents of surrounding areas: toxicants can enter the human body with food, water and inhaled air.

Car exhaust gases are a mixture of approximately 200 compounds (aldehydes, formaldehyde, aromatic hydrocarbons, inorganic lead compounds, etc.)

The gonadotoxic effect of urban dust has been established, which includes a complex of metals such as lead, nickel, copper, zinc, beryllium, tin, cobalt, manganese, tungsten, titanium, selenium (Namazbaeva Z.I., 2005)

In urban air, compared to the clean air of mountainous areas, there is 10 times more cadmium, 7.5 times more arsenic, 48 times more chromium, 12.7 times more copper, 5 times more mercury, 46 times more cobalt (Nieschlag E., 2006).

All these factors and lifestyle contribute to the disruption of the reproductive health of men, in addition to all of the above, the following diseases also have an impact:

* Diabetes

* Tuberculosis

* Chronic diseases of the upper respiratory tract

* Endocrinopathies

* Congenital diseases

* Hyperthermia

And due to the increase in incidence, people are taking a large number of drugs without even knowing about their effects on fertility, these include:

* Hormones

* Psychoactive

* Hypotensive

* Nitrofurans

* Sulfasalazine

* Radiation, chemotherapy

* Cytostatics

* Histamine receptor blockers (anti-ulcer drugs)

* Sedatives and tranquilizers

We must not forget about surgical interventions

* Surgery of the urethra, bladder, scrotum

* Hypospadias, epispadias

* Hydrocele

* Hernioplasty

* Sympathectomy

*Vasectomy

* Urinary tract infection and sexually transmitted diseases. The ability of some STD pathogens (chlamydia, trichomanas, gonococci) to cause sperm immobilization has been proven (Segnini et al., 2003; Zhang et al., 2011)

In some men, pathologies of the scrotal organs can be detected, which negatively affect reproductive function:

* Orchitis, orchiepididymitis, testicular torsion

* Orchitis associated with mumps

* Trauma

* Varicocele

* Cryptorchidism

With untreated bilateral cryptorchidism, infertility occurs in 100% of cases, and with unilateral cryptorchidism, azospermia or oligozoospermia is present in 30-70% of cases. Risk of malignancy. It is especially necessary to say about varicocele - this is an enlargement of the veins of the spermatic cord, a disease of adolescence, entailing a violation of spermatogenesis and leading to infertility. Signs of varicocele occur in 4.4-30.7% of men aged 15 to 25 years. The causal connection between varicocele and pathological changes in sperm was established in the early 40s. When examining men with varicocele, pathological changes in sperm were detected in 50% of cases. Among the various causes of male infertility, varicocele accounts for about 30%. Improvement in semen analysis after surgical treatment of varicocele is observed in 50-85% of cases. There are several hypotheses regarding the negative effect of varicocele on the reproductive function of men. Based on the fact that an increase in temperature leads to damage to the spermatogenic epithelium, a number of authors, having discovered an increase in the temperature of the left testicle with varicocele, suggested that hyperthermia is a leading factor in the occurrence of infertility. Impaired fertility in patients with varicocele occurs in 20–80% of cases. Among patients suffering from infertility, varicocele was detected in 30–40% of those examined (Veltishchev Yu.B., 1994; Ledda A., 1996).

Source of material

Clinic "Andrologist and Me"

Address: Tashkent, st. Foziltepa, 14-quarter, 28 A

Tel: (+99898) 809-91-77, (+99890) 917-17-99, (+99897) 157-17-99, (+99871) 275-82-73

e.mail: info@andrologi.uz

As an advertisement. Services are licensed