Sperm disorders are defects in sperm quality or quantity and the ejaculate. The diagnosis results from studies of the seed and from genetic tests. The most effective treatment is usually in vitro fertilization (IVF) in the way of intracytoplasmic sperm injection (ICSI).
Sperm disorders are defects in sperm quality or quantity and the ejaculate. The diagnosis results from studies of the seed and from genetic tests. The most effective treatment is usually in vitro fertilization (IVF) in the way of intracytoplasmic sperm injection (ICSI). Pathophysiology spermatogenesis is continuous. Each germ cell needs 72-74 days to their full maturation. The optimum temperature for spermatogenesis is 34 ° C. Within the seminiferous tubules Sertoli cells regulate the maturation while the Leydig cells produce the necessary testosterone. Fructose is normally produced in the seminal vesicles and secreted through the vas deferens. Andrological disorders may be an insufficient sperm amount – too little (oligospermia) or no (azoospermia) – or defects in sperm quality such. B. aberrant mobility or structure, lead. Etiology Disturbed spermatogenesis Spermatogenesis may be affected by the following refer to the table causes impaired spermatogenesis), resulting in an inadequate quantity or poor sperm quality. Heat disorders (GU, endocrine or genetically) drug toxins causes impaired spermatogenesis cause Examples endocrine disorder abnormalities of the hypothalamic-pituitary-gonadal axis adrenal disorders hyperprolactinaemia hypogonadism, occasionally Genetic related to obesity hypothyroidism diseases gonadal dysgenesis Klinefelter syndrome microdeletions of portions of the Y chromosome (in 10-15% of men with severe S permatogenese) Urogenital diseases cryptorchidism infections violation of mumps orchitis testicular atrophy varicocele Heat Excessive heat within the last 3 mo fever drugs and toxins Anabolic steroids, androgens, antiandrogens (eg. As bicalutamide, cyproterone acetate, flutamide) antimalarials acetylsalicylic acid (in large quantities over a long period caffeine possibly) chlorambucil cimetidine colchicine corticosteroids cotrimoxazole cyclophosphamide ethanol estrogens gonadotropin-releasing hormone (GnRH) analogues (used to treat prostate cancer) ketoconazole Marijuana medroxyprogesterone methotrexate monoamine oxidase inhibitors nitrofurantoin opioids spironolactone sulfasalazine toxins Disturbed Spermienejakulation the Spermienejakulation may be impaired because Retrograde ejaculation into the bladder Retrograde ejaculation is often caused by diabetes Neurological disorder state after retroperitoneal surgery (z. B. in Hodgkin’s lymphoma) State after transurethral resection of the prostate The Spermienejakulation can also be affected by these conditions: obstruction of the vas deferens Congenital sided absence of the vas deferens or epididymis, common (cystic fibrosis transmembrane conductance regulator) gene on both sides lack in men with mutations in the CFTR seminal vesicles Almost all Men with symptomatic cystic fibrosis show an innate sided absence of the vas deferens (vas deferens) Other causes men can with microdeletions on the Y chromosome, depending on the particular deletion, develop oligospermia through various mechanisms. Another less common mechanism leading to infertility, is the destruction or inactivation of sperm by sperm antibodies that are normally produced by the man himself. Diagnostic genetic tests ejaculate occasionally When infertility of a couple, the man should always be examined for andrological disorders. History and physical examination will focus on possible causes (eg. As urogenital diseases). The volume of each testicle should be determined; normal is 20-25 ml. An ejaculate analysis should always be performed. If oligospermia or azoospermia be found genetic tests should be performed. These tests include standard karyotyping PCR labeled chromosomal sites (for microdeletions that affect the Y chromosome to identify) assessment for mutations of the CFTR genes married man, the bearer of a CFTR gene mutation is, or his partner trying to get pregnant to become his partner should also be investigated to rule out that it is Konduktorin for Cystic fibrosis (CF). Prior to the examination of sperm the man is usually asked to abstain for 2-3 days ejaculation. However, the available data suggest that daily ejaculation does not reduce the number of sperm in men, unless there is a fault. Since the sperm count varies, requires the examination ? 2 samples that are obtained at a distance of ? 1 week. Each sample is recovered, preferably at the premises of the laboratory, by masturbation in a glass vessel. If this method is too difficult, the man can use at home a condom; while the condom must be free of lubricants and chemicals. After stirring at room temperature for 20-30 minutes, the ejaculate is examined (see table: ejaculate). Additional computer-based measurements of sperm motility (z. B. the linear sperm velocity) are available, but if they correlate with the severity of fertility is unclear. Ejaculate factor normal volume 2-6 ml Viscosity onset of liquefaction within 30 minutes; complete liquefaction within 1 hour density and microscopic picture milky, cream, ? 1-3 leukocytes / field pH 7-8 sperm count> 20 Mio./ml sperm motility after 1 and after 3 hours,> 50% motile sperm proportion morphologic inconspicuous> 14% after strict WHO criteria of 1999 Fructose presence (proves the continuity of at least one vas deferens) If a man without hypogonadism or innate sided absence of the vas deferens has a ejaculate volume of <1 ml, the urine must be checked for sperm content after ejaculation. A disproportionately high number of sperm in the urine over the seeds suggests a retrograde ejaculation. Endocrine examination is indicated if the ejaculate is not normal and especially the sperm count <10 Mio./ml is. Initially the FSH (follicle stimulating hormone) should at least - and testosterone levels in the serum. At low testosterone and luteinizing hormone (LH) and prolactin in the serum. Men with abnormal spermatogenesis usually have normal FSH levels, but any increase in FSH is a clear sign of an abnormal spermatogenesis. Prolaktinerhöhungen require clarification to a tumor located in the anterior pituitary or pushes it, or ( "recreational drugs") to an intake of various prescription drugs or of recreational drugs. If the routine tests of both partners do not provide explanation for the infertility and embryo transfer is drawn into the fallopian tube (GIFT = gamete intrafallopian tube transfer) consider means of a specific semen analysis that are possible in some Infertilitätszentren be considered. They include the following tests: The immunobead test detects sperm antibodies. The hypoosmotic swelling test measures the structural integrity of sperm plasma membranes. The Hemizona analysis and sperm penetration analysis determine the ability of sperm to fertilize the egg in vitro. The benefit of this particular investigation is controversial and unproven. If necessary, a testicular biopsy between obstructive and non-obstructive azoospermia may help differentiate. Treatment clomiphene Assisted reproductive techniques lies in Clomifenversagen Underlying urogenital diseases are treated. Men with a sperm count of 10-20 Mio./ml and without endocrine disease received tentative clomiphene citrate (2-50 mg po 1 times / day over 25 days / month for 34 months). Clomiphene, an antiestrogen, is to stimulate sperm production, thus increasing the sperm count. However, if it improves the motility and sperm morphology is unclear; an increase in fertility has not been proven. If the number of sperm is <10 Mio./ml in a man with normal sperm motility, is usually the most effective therapy in vitro fertilization with a single sperm injection in a single egg (intracytoplasmic sperm injection). Alternatively, the intrauterine insemination by sperm treated samples is attempted in some cases, be carried out with timed ovulation. If pregnancy will occur, it usually comes after the sixth treatment cycle to it. Although the number and viability of sperm are reduced, pregnancy must not be excluded. In such cases, fertility may be increased along with an artificial insemination or of assisted reproductive technology (eg. B. In vitro fertilization, intracytoplasmic sperm injection) by a controlled ovarian hyperstimulation of the woman. If the male partner is unable to produce enough fertile sperm, the couple may consider a Insemination with donor sperm. The risk of AIDS and other sexually transmitted diseases (STD) is minimized by freezing the donor sperm over ? 6 months before the insemination takes place then, again testing the donor sperm.