Male infertility: causes, tests, and therapeutic approach

Male infertility: causes, tests, and therapeutic approach

There are several causes that can determine infertility in humans. The tests to be performed and the possible treatments

According to the Italian Society of Andrology and Sexuality Medicine (SIAMS), one in three men in Italy is at risk of infertility. Among the various causes that can determine a situation of infertility in men we can include diseases of the male genital system, congenital or acquired (eg genetic alterations, undescended testicles, inflammation and / or infections of the genital tract and prostate, sexually transmitted diseases, varicocele, testicular tumors), therapies that interfere with the reproductive sphere (e.g. antibiotics, antidepressants, antiandrogens, anabolic drugs, chemo-radiotherapy), as well as environmental and behavioral factors (e.g. pollutants, smoking cigarette, alcohol, improper diet or eating disorders, drugs, doping).

Tests and exams

The andrologist is the most suitable specialist doctor for the evaluation of male reproductive function and clinical conditions at risk of infertility, also for preventive purposes.

Generally, during an andrological visit, the patient's clinical history is collected, an objective evaluation of the male genital system is performed and some specialist examinations are requested. Among these, the execution of a spermiogram, ie the examination of seminal fluid, plays a fundamental role. Through this examination it is possible to evaluate the various seminal parameters (concentration and total number of spermatozoa, their degree of motility and their morphology or the percentage of normally conformed spermatozoa).

Alterations of these parameters can cause infertility; therefore, to complete the diagnosis, some hormonal evaluations may be required through a simple blood sample for the measurement of the levels of FSH and inhibin B (hormones mainly involved in the regulation of spermatogenesis, that is in the production of spermatozoa), LH and testosterone.

In selected cases, second level tests may be performed on the seminal fluid aimed at highlighting the presence or absence of alterations in the nuclear chromatin of the sperm (which contains the genetic information of the individual), alterations that may affect the fertilizing capacity of the sperm itself. In all these cases, the Andrologist specialist will better define the most appropriate diagnostic procedure.

Therapies

The therapeutic approach involves the correction of the environmental (if possible) and behavioral factors listed above, the treatment of pathologies associated with the infertility condition and the use of "supplements" and hormonal drugs based on the specific clinical picture.

In patients where there is a risk of severe and, sometimes, definitive impairment of fertility due to pathologies and / or therapies potentially damaging to reproductive function (e.g. cancer patients candidates for chemo-radiotherapy), it is possible to carry out preventive cryopreservation of the seminal fluid, that is the freezing at very low temperature of the spermatozoa that can later be used for assisted fertilization techniques in order to guarantee a hope of future paternity.

In collaboration with Doctor Cataldo Di Bisceglie

Category: Health
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