Most couples can bring in eight to ten months after discontinuation of all contraceptive methods, pregnancy. Even though this period can be for some pairs a test of patience. Ten to 15 percent of couples in Germany can fulfill their desire for children not in the longer term, with the causes not only the man but the woman or can affect both simultaneously.
Causes of the sterility of the man
There are many causes that can cause sterility of the man:
Anatomical factors:
An example is not treated in time undescended testicles (cryptorchidism). The testicles are moving in most cases already in the fetus, but not later than the end of the first year from the abdomen into the scrotum. In the abdomen or the groin remaining testes are exposed to a higher temperature than in the scrotum. This can affect the formation and movement of sperm and sustainably interfere. Also, similar to varicose veins in the testicles jammed (varicocele) can cause sperm problems and hence promote infertility.
Hormonal causes:
Sperm develop under the influence of hormones such as the male sex hormone testosterone. Testosterone deficiency leads to reduced sperm count in the semen. Even the so-called prolactinoma, a hormone-producing tumor of the pituitary gland, can cause sterility in men.
Hereditary diseases:
Inherited disorders such as Klinefelter's syndrome are associated with infertility in the affected male.
Infections:
They include, among other things made by mumps after puberty infections that can attack and damage the testes. Bacterial infections, for example, Chlamydia can also cause a male infertility.
Side effects of therapy:
Radiation or certain drugs can affect the development of sperm usually temporary. In the course of operations, for example in the treatment of a hernia, can accidentally be cut through the vas deferens.
Harmful influences from the outside:
Stress, excessive smoking, alcohol, drugs, environmental toxins such as pesticides or permanent overheating of the testicles, for example by seat heaters can reduce male fertility as well.
Present in the seminal fluid antibodies against their own sperm
Retrograde ejaculation:
When retrograde ejaculation ejaculation is not discharged to the outside, but backwards through the urethra into the bladder. Diabetes mellitus, for example, is the cause in question.
Preceding sterilization (vasectomy):
About five percent of men develop after sterilization has taken place again a desire to have children.
Idiopathic infertility:
In about 15 percent, no cause for the sterility of the couple are found.
Symptoms of male sterility
In the sterility of a man, the main problem is that he can not father children. The desire for children is strong, the men involved often suffer with the time of self-doubt and feelings of inferiority.
Other symptoms may occur depending on the underlying cause. For example, is already before puberty, a lack of male sex hormones, body proportions can be changed (eunuchoid gigantism) draw attention to the shortage. The men involved are very large. Arms and legs are long, the trunk is relatively short. Penis and testicles remain small, the beard grows sparsely. In addition, there is no voice change. Creates a lack of male sex hormones after puberty, the body proportions are normal. The affected men can but feel limited in their capabilities. The beard is waning, so it is not so often have to shave as usual. Also go back libido and potency. The body fat is distributed, similar to the female body fat distribution, rather the hips and lower abdomen.
Diagnosis of sterility of the man
First, the doctor asked the couple concerned for detailed medical history and current complaints (medical history). The conversation touches including very intimate topics such as possible sexually transmitted diseases or the frequency of sexual intercourse. Even the lives of stress and lifestyle habits such as smoking or alcohol consumption are included to help isolate the cause of sterility.
The man goes in also usually in the hands of a specialist urologist or internist. On physical examination, the doctor pays special attention to signs of hormonal disturbances. In addition, the genitals are sampled. The size (volume) of the testis is determined using an ultrasound scan. Too small testicles may indicate an impaired sperm development. In addition, the ultrasound can provide evidence of inflammatory changes, for example, testicular cancer or a varicocele.
In addition, a so-called sperm is made. It is a semen analysis in men. The sperm production takes place after several days of abstinence by masturbation. It will be reviewed including number, appearance and movement of sperm. In addition, the ejaculate is examined for inflammation of the genitals or antibodies directed against their own sperm. A biopsy of the testis may depend on the outcome of semen analysis are required.
Suspected of having a hormonal cause of infertility, in addition certain hormones such as testosterone, FSH or prolactin in the blood of the affected man can be determined. May further examination, for example with MRI or chromosome analysis is needed.
Treatment of infertility in men
In some cases, the sterility of the man be treated causally. When undergoing a testosterone deficiency, for example, the men most affected by testosterone therapy. Depending on the cause of testosterone deficiency, perhaps, other hormones are used. Bacterial infections in the genital area, for example by chlamydia usually require antibiotics. Lie in the seminal fluid of antibodies against sperm, some men will benefit from corticosteroids, which suppress the body's immune system. The retrograde ejaculation in the present diabetes mellitus can be treated with so-called sympathomimetics. They ensure a tighter closure of the bladder outlet, so that the semen can no longer flow into the bladder, but to the outside again. Occurs after a sterilization surprising again for a baby, it is possible to combine the originally severed vas deferens to microsurgically again.
Can be treated the sterility of the man not the cause, various methods of artificial insemination available to increase the chance of pregnancy. In the so-called artificial insemination (insemination) are obtained by masturbation and specially prepared sperm directly into uterus or fallopian tubes. For example, limited motile sperm to the egg, save the path as far as possible. In in-vitro fertilization (IVF) of women are taken from embryos and combined with sperm outside the body of the partner. The eggs were fertilized, it is one of the doctor into the uterus. The intracytoplasmic sperm injection (ICSI) requires only a single sperm, which is injected with a tiny needle directly into an egg taken. The fertilized egg is finally introduced as with IVF in the uterus. Contains the semen of the man, for example with closed vas deferens no sperm (azoospermia), it is possible to refer to it directly from the testis or epididymis by a small operation under local anesthesia.
Course of a sterility of the man
For longer-lasting sterility of the man take off more and more opportunities to be able to treat successfully. After the expiry of twelve months, the couple should seek the advice of a doctor already.
After infertility treatment occurs in up to 20 percent pregnancy. However, since it can lead to increased infertility treatment to miscarriages and premature births, there may be only about ten percent of couples appreciate so happy to finally be parents. Multiple pregnancies are more common for infertility treatments.
After sterilization, the vas deferens are reconnected in about 85 percent successful. In just over 45 percent of cases it is the man after having a child to testify.
Men with conception problems develop in about 0.5 percent of the cases testicular tumors. The ultrasound examination is therefore of particular importance.
Can a man's infertility be prevented?
Congenital causes of sterility of the male can not be prevented. Otherwise, the couple can reduce a healthy lifestyle without excessive smoking, alcohol, drugs or stress, and through a partnership of trust, the risk of sterility. Sterilization should think through in advance of the man always good. Against sexually transmitted diseases like chlamydia infections that can lead to infertility, the man can be protected by condoms.
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