MALE REASONS
Approximately 15-20% of married couples face infertility problem; 50% of these appear as male-related factors. In the treatment of male infertility, rapid progress has been made with the techniques applied in the last 15-20 years. In particular, many infertile couples were given the chance to be treated with the microinjection technique; By obtaining sperm by performing a biopsy from the testis, the opportunity to have children was provided to men who did not have any sperm cells in their semen. Depending on the developing diagnosis and treatment methods, the evaluation of infertile couples requires a coordinated team of gynecologists, obstetricians, urologists, embryologists and geneticists. In this team, the history of the individuals is discussed in detail with the couples, while the necessary examinations and treatment planning are planned and carried out by the doctors in their field of expertise. At this point, the evaluation of the infertile man should always be done by a specialist urologist.
a) disorders of the hypothalamus; Since the GnRH hormone released from the hypothalamus is deficient, the FSH and LH levels released from the pituitary also decrease and testicular functions are impaired. Hypothalamus pathologies are generally associated with congenital anomalies:
- Kallman's syndrome; Disturbance in the sense of smell, deformity in the development of cranial/facial bones, cleft palate and rabbit lip, color blindness, congenital deafness, and testes that do not descend into the scrotum and remain in the abdomen (cryptorchidism) frequently occur in these cases. In the genetic examination, it was shown that the patients had a defect in the 22.3 gene region in the short arm of the X chromosome.
- Prader-Willi Syndrome; It is characterized by obesity, weak and weak muscles, mental retardation, small hands and feet, and structural dwarfism. Testicular functions are affected due to the disorder in GnRH secretion.
- Lawrence-Moon Biedel Syndrome; In addition to testicular failure, there is retinitis picenmentosa (chicken black/night blindness) and multi-toed (polydactyly).
b) Pituitary diseases: The anterior part of the pituitary gland, located in the lower part of the hypothalamus, is involved in the release of hormones that control the functioning of many organs such as the thyroid gland, adrenal gland and breast tissue, not just the reproductive system. Therefore, the disorders that occur in the functioning of this gland significantly affect not only the reproductive system, but also other systems. Conditions that cause disorders in the pituitary gland include:
- Pituitary gland surgeries
- Pituitary gland tumors
- Atrophy (regression) after a disorder in the blood supply of the pituitary gland
- Radiotherapy application
- Infections
- causes related to sperm production disorder (non-obstructive) and causes related to sperm ejection disorder (obstructive).
- The second group is also considered as post-testicular causes.
The main reasons that cause defects in sperm production in the testis are as follows:
Hormonal disorders
Chromosomal disorders
Congenital absence of testicles (anorchia)
Testicular descent disorders (cryptorchidism)
Disruption of testicular blood supply (testicular torsion)
Varicocele
Infections (orchitis)
Chemotherapy
Environmental factors (radiation, high temperature, lead, arsenic, cadmium etc metals)
Drugs used
Congenital underdevelopment of the sperm duct (bilateral congenital absence of the vas deferens):In this congenital disorder, the sperm carrier channels called vas deferens, which carry sperm from the testis, are absent on one or both sides. It is often seen in the absence of the vesicula seminalis (semen vesicle) and most of the epididymis. These people may be carriers of a genetic disease called Cystic Fibrosis at a rate of 50-80%. The spouses of these people, who can have children by microinjection of the sperm obtained from the testis with a needle into the egg cell, should be examined whether they are carriers of cystic fibrosis.
Lateral duct obstructions: Infection (especially gonorrhea/gonorrhea and tuberculosis), trauma, previous surgical interventions to these organs or adjacent organs, in the presence of prostate, vesiculo-seminalis cysts or stones, although sperm production continues in the testicles, outflow may be blocked because the integrity of the canal is impaired. It is possible to relieve the obstruction (vasovasostomy, vasoepididymostomy, TURED surgeries) with various surgical intervention methods. In cases where the congenital canal is not developed, the sperm is taken from the testis with a needle and the couples have children with the microinjection method.
Causes of Infertility
The causes of male infertility are examined under three main headings, taking into account the anatomical/physiological structure of the reproductive system:Pre-testicular causes
This group of disorders is generally referred to as hormonal causes. GnRH hormone released from the hypothalamus in the lower part of the brain, which is in the first place in the physiological regulation of the reproductive system, causes the release of FSH and LH hormones by acting on the pituitary gland located in the lower part. These hormones stimulate the production of sperm from the testicles (FSH) and the secretion of the male hormone testosterone (LH). Disturbances in the release of these hormones cause infertility.a) disorders of the hypothalamus; Since the GnRH hormone released from the hypothalamus is deficient, the FSH and LH levels released from the pituitary also decrease and testicular functions are impaired. Hypothalamus pathologies are generally associated with congenital anomalies:
- Kallman's syndrome; Disturbance in the sense of smell, deformity in the development of cranial/facial bones, cleft palate and rabbit lip, color blindness, congenital deafness, and testes that do not descend into the scrotum and remain in the abdomen (cryptorchidism) frequently occur in these cases. In the genetic examination, it was shown that the patients had a defect in the 22.3 gene region in the short arm of the X chromosome.
- Prader-Willi Syndrome; It is characterized by obesity, weak and weak muscles, mental retardation, small hands and feet, and structural dwarfism. Testicular functions are affected due to the disorder in GnRH secretion.
- Lawrence-Moon Biedel Syndrome; In addition to testicular failure, there is retinitis picenmentosa (chicken black/night blindness) and multi-toed (polydactyly).
b) Pituitary diseases: The anterior part of the pituitary gland, located in the lower part of the hypothalamus, is involved in the release of hormones that control the functioning of many organs such as the thyroid gland, adrenal gland and breast tissue, not just the reproductive system. Therefore, the disorders that occur in the functioning of this gland significantly affect not only the reproductive system, but also other systems. Conditions that cause disorders in the pituitary gland include:
- Pituitary gland surgeries
- Pituitary gland tumors
- Atrophy (regression) after a disorder in the blood supply of the pituitary gland
- Radiotherapy application
- Infections
Testicular causes
Testicular causes can be grouped into two groups;- causes related to sperm production disorder (non-obstructive) and causes related to sperm ejection disorder (obstructive).
- The second group is also considered as post-testicular causes.
The main reasons that cause defects in sperm production in the testis are as follows:
Hormonal disorders
Chromosomal disorders
Congenital absence of testicles (anorchia)
Testicular descent disorders (cryptorchidism)
Disruption of testicular blood supply (testicular torsion)
Varicocele
Infections (orchitis)
Chemotherapy
Environmental factors (radiation, high temperature, lead, arsenic, cadmium etc metals)
Drugs used
Causes of Sperm Carrier Channels and Organs (Post-Testicular Causes):
The sperm produced in the testicles pass through the epididymis and are transported to the penis through the sperm carrier channels known as the vas deferens. It may be the case that the sperm cells produced cannot reach the ejaculate (semen) due to a blockage in this system.Congenital underdevelopment of the sperm duct (bilateral congenital absence of the vas deferens):In this congenital disorder, the sperm carrier channels called vas deferens, which carry sperm from the testis, are absent on one or both sides. It is often seen in the absence of the vesicula seminalis (semen vesicle) and most of the epididymis. These people may be carriers of a genetic disease called Cystic Fibrosis at a rate of 50-80%. The spouses of these people, who can have children by microinjection of the sperm obtained from the testis with a needle into the egg cell, should be examined whether they are carriers of cystic fibrosis.
Lateral duct obstructions: Infection (especially gonorrhea/gonorrhea and tuberculosis), trauma, previous surgical interventions to these organs or adjacent organs, in the presence of prostate, vesiculo-seminalis cysts or stones, although sperm production continues in the testicles, outflow may be blocked because the integrity of the canal is impaired. It is possible to relieve the obstruction (vasovasostomy, vasoepididymostomy, TURED surgeries) with various surgical intervention methods. In cases where the congenital canal is not developed, the sperm is taken from the testis with a needle and the couples have children with the microinjection method.
Other Reasons:
- Diabetes
- Neurological diseases
- Damage to the lumbar vertebrae as a result of trauma
- During ejaculation (ejaculation) after bladder or urinary canal surgeries, the ejaculation of semen back towards the bladder instead of coming from the penis
- Retrograde ejaculation (back ejaculation)
- Lack of penile erection (erectile dysfunction, impotence)
- Congenital or acquired curvature of the penis (penile curvature) and inability to have sexual intercourse due to this condition
- Urinary tract opening on the penis instead of the tip of the penis (hypospadias / Prophet's circumcision).
