No pregnancy after a full year of a successful marital relationship and without the use of any type of contraception. Definition: No pregnancy occurred after a full year of a successful marital relationship without the use of any type of contraception. 15% of husbands do not get pregnant in the first year of marriage, while 50% of them have a pregnancy in the second year and 14% do not get pregnant in the third year, while about 5% do not conceive and the man is responsible for about 45-50%.
One of the reasons for infertility
30% Do not know the reason (Idiopathic)
14.8% due to varicocele.
10% as a result of a lack of the male hormone (Testosterone).
8.4% as a result of both testicles.
Decreased production of FSH & LH hormone by the pituitary gland.
Increased milk hormone (Prolactin).
As a result of a defect in the chromosomes, such as (47XXY) Klinefelter Syndrome
As a result of a defect in the Y-chromosome (Y Chromosome Microdeletion)
As a result of severe inflammation of the testicles or the epididymis or both, which leads to damage to the testicles, and among the most famous of these infections is mumps, especially if it occurred during the pre-puberty period.
Congenital Bilateral absence of the Vas Defernce
Exposure to chemotherapy drugs or radiation that are used for some types of cancer.
The presence of severe sexual dysfunction or reflux of semen to the bladder.
Diagnosis
CV and clinical examination
A complete CV and a full clinical examination should be taken to assess the case.
Checks
Semen analysis
It is considered the most important examination and is read according to the latest classification from the World Health Organization (WHO Guideline), where the number of sperms is 15 million or more, the movement is 40% and more, the deformed forms 96% and less, and the Sperm DNA Integrity examination is considered the best indicator of the occurrence of pregnancy and this is done by Sperm DNA Fragmentation, which is the breakdown of the DNA material in the sperm, as it found a great relationship between the percentage of Sperm DNA Fragmentation and the occurrence of a normal pregnancy as follows: Less than 15% is considered a very high pregnancy rate 15-25% of having a good normal pregnancy More than 30% of the incidence of pregnancy is considered very low.
Hormone Investigation
Examination of the hormone FSH & LH in addition to the male hormone (Testosterone) and these hormones help us in determining the problem, is it a result of a deficiency of the pituitary gland or a result of failure in the functioning of the testicle also helps us to distinguish between cases of obstruction (Obstructive Azoospermia) and cases of testicular failure (Non Obstructive Azoospermia) And in cases of lack of sperm.
Microbiologic Assement
It is a transplantation of urine or semen, and we may need this in a simple percentage of cases and include an examination of abnormal urine, the presence of inflammation in the urinary tract, symptoms of prostatitis or indicating the presence of inflammation in the testicle or epididymis, and I would like to mention here a large error which is a diagnosis Prostanitis based on the semen examination. In fact, the incomplete growth of sperm resembles white blood cells, which indicate the presence of inflammation, especially in the prostate. Here I recommend that the semen be done in places with experience to eliminate this common mistake as I have seen many patients who have been exposed to treatment of prostate infections With antibiotics for more than two months, based on this wrong diagnosis.
Ultrasound (Ultra Sonography)
Ultrasound may help us when assessing the size of the testicles, signs indicating the presence of obstruction, enlargement of the epididymis, the presence of water sacs, the presence of calcifications in the testicle, lack of the spermatic cord, varicocele, and in some cases it is possible to discover some tumors that affect the testicle
FNA biopsy
Taking a sip from the testicle with a needle, and in the event that the sip is negative, we recommend a microscopic scan, and some doctors may take a random sample from the testicle.
treatment
Cases of deficiency of hormones from the pituitary gland
These people respond well to the treatment even if there is a lack of sperm, and the treatment depends on the administration of intramuscular injections HCG 5000 I.U and HMG 75 I.U for a period ranging between 3-6 months.
Cases of high milk hormone
Patients respond well to some medications, the most important of which is Dostinex.
Anti-estrogens
It is useful when there is a deficiency of the male hormone, as it increases the pituitary hormones FSH & LH, thus increasing the male hormone, and this is accompanied by an improvement in the semen.
Emperical treatment
It depends mainly on anti-oxidant, vitamins and minerals in people with oligospermia, and some patients may benefit from these treatments.
Surgical treatment
In some cases, the defect is repaired surgically, for example varicocele, and it is preferred here to perform the ligation of varicose veins using microscopic surgery, where the complication rate is much lower than other methods.
Vasoepididy Mostomy
Reconnect the vasovasostomy
Removing sperm from the epididymis through the skin or using microscopic microsurgery (MESA & PESA)
It is new to use some testicular stimulating drugs before the microscopic scan, as it was found that they increase the chance of obtaining sperm during the microscopic scanning process, especially for people who do not have sperm in the semen.
This is with our wishes for continued health and wellness for all ,,,
Dr. Hammoud Ali Al-Mutrafi
Andrology Consultant
Infertility and urinary tract
