The most frequent reasons for male sterility

Andrology is a science, dealing with male reproductive system lesions.
The most frequent lesions of male genitals in general could be divided into three groups: sterility, impotence and inflammatory lesions.


Andrology is a science, dealing with male reproductive system lesions.
The most frequent lesions of male genitals in general could be divided into three groups: sterility, impotence and inflammatory lesions.
Sterility reasons could be congenital lesions of male reproductive system, hormonal, surgical, inflammatory, etc.
The parents should observe if the testicles of their boys are in the scrotal sack, if they are with normal size, if there are some lumps on them as well as if the phallus is with normal size and form. After one year age, the skin on phallus head is with excoriated skin.
Appearance of sexual signs is an important moment for observation. In case of the least doubt for any deviation in the development of testicles and phallus, it is necessary to seek assistance from physician – specialist.
If the lesions of male reproductive system are not revealed in childhood, treated correctly and n time, they could prevent males from sterility and later stage.
Hormonal reasons for sterility are rare. Often they are accompanied with deviations in growth, hairiness, distribution of subcutaneous fat, body structure. It is often observed patients without deviations in some of the above parameters but with small testicles, not reproducing spermatozoa (endocrine azoospermia) but producing male reproductive hormones. The absence of spermatozoa never could be referred to existence of normal sexual life. Testicle consists, in general, from two parts: one is producing hormones and the other – spermatozoa. In endocrine azoospermia are damaged the cells, which produce spermatozoa or there is a lack of some of hypophyseal hormones, regulating the production of spermatozoa. In case of hormonal damage there could be spermatozoa but there are with bad quality. In correct diagnostics and adequate therapy with hormone-substitution therapy, the above deviations in spermogram could be corrected and to achieve pregnancy. Sometimes the therapy is long and at a high price.
The most often surgical reason for sterility is the varicose vein of testicles (varicocele). In 60% of the cases it is in the left testicle (due to anatomic peculiarity of vein, exporting the blood from the left testicle) and in 40% it is bilateral. It is very rare in the right testicle. When the vein is bigger, the patient could palpate it as a bunch above the testicle itself. This varicose vein leads to reduction of the number and motility of spermatozoa and deviation in their structure. Very often the patients come with sterility problems without any complaint till this moment but with bad result from the examination of sperm (spermogram). The examination (when necessary, Doppler examination of testicle is carried out) finds out varicocele. The only therapeutic way is the surgical intervention. The modern techniques for operation allow the patient to be discharged on the same day and he is completely recovered after one week.
Azoospermia (obstructive), caused by obstruction of vas deferens is the other reason for sterility. Often such patients have had inflammation of urinary tract (catarrh), testicles or prostate in the past. Sometimes some infections pass imperceptibly and lead to obstructive azoospermia. Treatment is surgical, trying with complex microsurgical plastic operation to avoid obstruction. If it is not successful, spermatozoa are taken from testicle epididymis and injected in woman ovulum (ICSI).
In case of inflammatory lesion of male reproductive system, causing sterility, complaints are from irritation of urinary tract to pains in testicles and prostate. Often, however, infections pass without significant complaints. The latter are very insidious because they are underestimated or not felt by patients and result in obstruction of channels and complete absence or strongly reduced count and mobility of spermatozoa. Therefore, in case of any complaint from reproductive system it is necessary to consult physician andrologist or urologist, but never attempt any self-treatment because the consequences are fatal sometimes.


Dr. M. Katzarov, M.D.




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