Spermogram and men's infertility. How to decipher the results of the spermogram? Can there be a normal sperm but infertility

The treatment process from should begin with a diagnosis. The spermogram, which is prescribed during the survey, gives a doctor a lot of information about the patient's genital cells. In most cases, pathology, which causes infertility, is reflected in the results of the tests.

Decryption of sperm and types of sperm pathologies

Spermogram Normal Indicators are considered:

• acidness from 7 to 8;
• volume - minimum of 2.5 ml;
• location time - up to 1 hour;
• sperm viscosity - 2 cm;
• the number of spermatozoa is total - 60 000 000 and more;
• the level of mobility is expressed by alphabetic designation (A - movable and fast spermatozoa; in - the movement is present, but slow (nonlinear, linear); C - cells are moving only in place; D - fixed spermatozoa).
• presence of at least 25% of type A cells and more than 50% a + c.
• from 30 to 70% spermatozoa without pathologies;
• leukocytes in sperm - 10 6 in 1 ml;
• lack of agglutination process, red blood cells;
• epithelial cells - in a single number, and sperm cells are not more than 4% of the total number.

In the study, such forms of sperm pathology can be revealed:

• Azoospermia - Diagnosed with the complete absence of spermatozoa in the taking material. It can be obstructive (spermatozoa is in the testicles, but they are not erupted due to the obstruction of the seedy ways) and the secretory (spermatozoa no in the testicles).
• Asthenospermia. - Low-moving men's germ cells. The diagnosis is established if unhealthy spermatozoa in the analysis of more than 60%.
• PIOSPERMY - This is the presence of a large number of leukocytes and pus, which indicates the inflammatory process in the urinary system.
• TeratOsPhermia - Detection in the analysis of a large number of pathological spermatozoa from a morphological point of view.
• Aneeakulation - This is a complete lack of ejacked by a man.
• Nonospermia - Non-fat spermatozoa in sperm.
• Oligospermia - Insufficient sperm volume with seeds.
• Cryptospermia - Detection in the analysis of movable spermatozoa in a single number.
• Oligozoospermia - The amount of spermatozoa in ejaculate less than 15,000,000 per 1 ml.

Classic methods of treating infertility in a man

The type of treatment depends on the cause of infertility, which is divided according to such types:

• surgical;
• auxiliary techniques;
• hormonal;
• treatment of sexual disorders;
• drug;
• physiotherapy.

Surgical treatment of infertility in men

It is resorted to it, if the cause of infractility is - a tumor-like swollen veins, providing blood outflow from the egg. Vicious veins of seed catalyst are removed by operational intervention, due to which the blood flow in this area is normalized.

Important: the operation on varicocele will be effective only if it was performed on time. When the testicles are atrophy due to the lack of normal local blood circulation, return the man's ability to conceive almost impossible.

Operational treatment is also shown in obstructive infertility, when there is obstruction of seed cakes due to injury, orchita, (in childhood). During this intervention, the surgeon restores the passability of seven-way paths by removing a segment with obstruction or creating a new one. The success of the operation is completely dependent on the length of the pathological part of the rockets that you want to remove or replace.

Conservative therapy of infertility in men

This method is used in the case of immune, hormonal or secretory infantality. Only a doctor in competence to prescribe certain drugs and their dosage after confirmed infertility in a man.

In particular, after identifying the causes of the disease, the following means can be applied:

Note:with men's infertility treatment folk remedies Cannot replace the main one. In particular, in this regard, among patients, the method of highherapy is quite popular. Its use is allowed only in a complex with other techniques, taking into account the fact that there are rather controversial opinions among the doctors. The leeches are used to improve local blood circulation and spermatogenesis process, but with men's infertility, treatment with folk remedies should be coordinated with the attending physician.

Physiotherapy

When infertility, local procedures are prescribed:

• electrophoresis;
• laser;
• transurel microwaves;
• phonophoresis.

Physiotherapeutic treatment has a positive effect on the prostate trophy, the blood supply to the genital organs, the productivity and quality of sperm, eliminates hidden inflammatory processes.

Treatment of sexual disorders

Erectile dysfunction of drugs is treated with a group of FDE-5 heiBields, such as:

• levitra;
• viagra;
• cialis.

Also practiced in urethra alprostadyl and intracavernous injections.

If the drugs do not give effect or the patient has contraindications to their admission, then they resort to surgical solution of the problem:

• local embolization of arterio-venous shunts;
• immusion of the prosthesis of a penis;
• endovenous stenting of the arteries of the penis;
• vacuum content.

Premature ejaculation is treated with the "Compression Technique" and "Stop Start" (ejaculation delay). Among the medicines are used by means of central action (tramadol, clomipramine, fluvoxamine, fluoxetine, paraxetin, serroline). Vasoprostan, cream Emla, etc. apply. As operational treatment, the neuroectomy of the dorsal nerve of the penis, selective resection of spinal nerves, is resorted.

Auxiliary reproductive techniques for the treatment of male infertility

They are used when the obstruction of the seed-airing ducts is not amenable to correction, in the presence of retrograde ejaculation and other similar problems that cannot be cured. Among the most popular techniques are most often resorted by infertility to. A woman from the ovary is made of an egg, and in the conditions of the laboratory fertilize it with a sperm of a man with a bubble or bladder.

Modern reproductive technologies

It should be understood that these techniques are used in the male infertility of the heavy stage or incurable form. But even in this case, modern medicine can give a man a chance to become the father of a native healthy child.

Treatment of infertility in men by TESA

This technology is used with the complete absence in sperm patient spermatozoa. It is carried out in the form of a needle biopsy under visual control in areas of active spermatogenesis. The jacket puncture is performed very carefully to take the required amount of materials.

ICSI

This is the extraction procedure of the embryologist correct, taking into account the morphological parameters of the spermatozoa. It is immobilized, placed in a thin needle, which is injected into the egg. Thus, fertilization occurs.

PICSI technology in the treatment of male infertility

It is considered an advanced technique, as it implies a clear and competent selection of spermatozoa for fertilization. PICSI pre-selection is based on the selection of genital male cells, taking into account their characteristics of behavior in the medium, which is as close as possible to the egg. The method is advisable to apply in the case of male infertility, unsuccessful attempts to eco (2-3 times), low quality embryos.

IMSI

It is an innovative way to fertilize eggs in the treatment of infertility of men. Spermatozoa with it is very thorough selection by selecting a multiple increase (x 6300). The embryologist selects a better spermatozoa by means of a digital image that is displayed on the monitor. After it is introduced directly to the egg itself, which at times increases the success of fertilization, and the chance for pregnancy increases to 70%.

More detailed information On the pathologies of sperm and modern methods of treating male infertility are presented in a video review:

Yulia Viktorova, obstetrician gynecologist

The spermogram is called a laboratory study of the ejaculate, which allows you to estimate the possibility of male sperm to fertilize the female egg. The results of the spermogram help to identify and determine its causes. How to pass the analysis? Is it possible to decipher its result yourself? What are the main rules and research indicators?

Exploring the ejaculate, the doctor has the opportunity to assess the degree of male health. In addition, the spermogram helps to identify a number of diseases. gOOD SYSTEM (prostatitis, varicocele, diseases that are transmitted by sexual path, etc.).

It is mainly prescribed to men who have a suspicion of infertility. Modern reproductive technologies make it possible to solve the problem even when the result of the spermogram will be bad.

In order for the analysis to be as accurate as possible, it is important to prepare correctly for its conduct. Next:

• It is possible to collect material for the study only by masturbation, since after sexual contact in the material under study may be elements of the vaginal microflora.
• Use the condom is prohibited, as the product contains artificial lubrication.
• At least 2 weeks before the alleged analysis is forbidden to take any drug. This is especially true of antibacterial drugs that are able to influence the decoding of the analysis.

How to prepare for the analysis will tell the urologist Alexander Nikolaevich Appears:

• Collect material for research can be used only in laboratory conditions. In some cases it is allowed to do it at home. However, in this case, it is important to comply with hygienic standards, and ejaculate to collect in a sterile plastic container. During transportation, the container must be at a temperature of about 37 degrees. Alternatively, to transfer it under the arm. Transportation time should not exceed 1 hour.
• Within 3-4 days before collecting the material, it is important to observe the sexual abstinence, refuse to visit the bath, making a hot bath and drinking alcoholic beverages.

So that you can argue about the accuracy of the decryption of the spermogram, it must be made at least 2-3 times. This is due to the fact that a lot of factors can affect sperm, such as used products, drugs, stressful situations, high physical exercise etc.

There are such situations when after orgasm, sperm is not allocated in the usual way. This state is called retrograde ejaculation, when the seeds occurs in the bladder. At the same time, the spermatozoa can be detected in urine analysis.

Retrograde ejaculation

A bad result after the first delivery of the spermogram should not be caused for a disorder of a man. To talk about this or that issue, the analysis must be carried out at least 2-3 times. Decode decoding may be different.

Specogram varieties

There are several analysis varieties:

1. Basic - performed in accordance with the standards approved by WHO and consists of the main indicators.
2. MAR test. Deciphering the mar test allows you to identify antispermal bodies that are able to destroy spermatozoa.
3. Spermograms on the krunel is a study of the morphology of spermatozoa.

What makes the mar-test shows Tatyana's embryologist Vladimirovna Dubko:

At the same time, the three listed analyzes are called an extended spermogram. It is usually recommended to be carried out in the case when the decoding of the basic study has any deviations from the norm.

Sometimes men prescribe a biochemical study of the ejaculate (determining the level of glucosidase, l-carnitine, fructose and other indicators). A phase-contrast study is used to assess the structure and functioning of sperm.

Decryption of spermogram

Deciphering the analysis of the spermogram should be carried out by a doctor based on the norms and indicators of the study.

Terms used

To describe sperm, doctors use such concepts:

• - Full absence of sperm in the ejaculate presented.
• Acinderospermia - sperm in the sample is, but they are still fixed.
• - Sperm has reduced mobility.
• Antispermal antibodies - antibodies that a male body produces to counteract sponmyoids.
• Hemospermia - the presence of erythrocytes in the presented sample ejaculate.

• Leukocytospermia - identification of excess leukocytes.
• Non-Simpermia - the absence of living sperms in the presented sample study.
• Normozoospermia - identification of any abnormalities from the norm, which can affect the possibility of conception.
• Nimosmond - all the indicators specified in the decoding turn out to be within the normal range, healthy state.
• Oligozoospermia - the volume of the selected sperm is insufficient (below 2 ml).
• - The number of sperms with an abnormal structure or functioning in the resulting result is too high (more than half).

Norms spermogram

When deciphering the analysis, the doctor draws attention to the basic spermogram indicators, comparing them with the norm.

Table 1. Spermogram rates for sperm evaluation

Table 2. Spermogram Norms for Sperm Evaluation

Features of decryption spermogram

When deciphering a sperm, the doctor draws attention to a number of features:

1. Local time. A condition is considered normal when a period of sperm is less than 10 minutes and no more than 1 hour from the moment of ejaculation, after which it is viscous. In the seed fluid there are enzymes produced by the prostate, which contribute to this process. If after 1 hour viscosity remains at the initial level, this may indicate problems in the work of the prostate gland. That's why chemical composition Ejaculate will be wrong. This can affect the mobility of spermatozoa.
2. Acidness level. In the female vagina, an acidic medium prevails, which can negatively affect the state of spermatozoa. Consequently, they lose the opportunity to fertilize the egg. To sperm had the opportunity to do this, it requires a protection that has seed fluid. Due to the unique composition, it reduces the acidic medium of the vagina and allows the spermatozoa to achieve the uterus. If this indicator is the only one that does not correspond to the norm, then such a state does not consider pathology. If there are other deviations, it may indicate a certain diagnosis.
3. Sperm volume. Normal is the indicator that is in the range from 2 to 6 ml. If this volume was lower, then the number of sperm contained here will also be below the norm. This may be the cause of male infertility. The insufficient ejaculate volume is also not able to protect the sexual cells when they hit the vagina cavity. If during the first crossing of the spermogram, the volume of sperm turned out to be below the norm it is not a reason for concern. In this case, the patient is recommended to undergo a re-examination and compare the decodents.

1. Sperm color. Typically, the seed fluid has a white and gray shade. Normal is also a dairy or yellowish sperm shade. If the color turned out to be pink or even brown, it may be a consequence of an elevated level of erythrocytes. There are no sex cells in transparent sperm.
2. Leukocyte levels. If their number does not exceed 1 million per 1 ml, this is considered the norm. If they are more, this indicates the presence of an inflammatory process in the genitals.
3. The level of erythrocytes. In the normal state, they should not be. They may appear as a result of the development of the inflammatory process, the presence of a tumor or after injury. The presence of blood in a spermograph indicates a disease of the urethra or suffered injury.
4. The presence of mucus. In a normal spermogram, it should not be. If in the decoding you can see its presence, this indicates the presence of an inflammatory process.
5. Concentration of spermatozoa in the spermogram.

Sergei Gennadyevich Lenkin, Sergey, will tell about normal diagnostic performance:

1. Mobility of spermatozoa in the spermogram. Allocate 4 categories:

• Category A - sperm moves in a straight line and take about 0.025 mm in 1 second. Most of these cells are recently educated.
• Category B - movement occurs in a straight line, but at a speed below 0.025 mm in 1 second. There are about 10-15% of such cells in the spermogram. They are aging or have disorders in the structure.
• Category C - movement occurs in a circle or in one place. There will be 5-15% of such cells in decoding.
• Category D - completely immobilized spermatozoa. Half of such cells old or already dead.

Even when deciphering a normal spermogram, cells will be detected of all 4 types. If the decryptions of several sperms carried out show the presence of necrospermia, the only possibility of pair to become parents are artificial insemination or eco using donor sperm.

1. Morphology of cells. By making deciphering for Eco or definition of infertility, it is important to determine the amount of genital cells with the correct and abnormal structure. This can be done by tapping them.
2. Agglutination is the process of gluing genital cells. The cause of such a state may be a violation of the work of the immune system or the presence of an inflammatory process in the genitals.
3. Asat - immunoglobulin protein, which is produced by both male and female organism. The presence of a protein in the decoding of the sperm can cause male infertility.

On our site there online calculatorwhich makes it possible to decipher the spermogram:

Violations in spermogram

The cumogram rate assumes no less than 50% of active sex cells in its composition. Causes of the presence in deciphering a large number of immobilized sperms may be such:

• The presence of diseases of the genital organs.
• Drinking alcoholic beverages.
• Smoking.

• Wearing cramped linen.
• Use intimate lubricants.
• Frequent stress.
• Hyovitaminosis.

Deciphering the spermogram on the krunel can reveal a small mobility of sperm due to disorders in the structure of cells.

When deciphering the sperm, it is important to know in what conditions a study was conducted. It is noted that at elevated body temperatures in the ejaculate, the mobility of sperms is enhanced, while at room temperature, it decreases. Therefore, if in the room where the study is carried out, the temperature is within +10 degrees, then even healthy spermatozoa will have a minor mobility. In order for the interpretation of the analysis as reliable as possible, special thermostats are used in laboratories, which make it possible to explore the material in conditions of temperature as close as possible to human body indicators.

The reason for reducing the number of genital cells in the ejaculate may be one of these states:

1. Violations in work endocrine system (adrenal dysfunction or thyroid gland, diabetesViolations in the hypophys-hypotalamus system).
2. Disease of the urogenital system ( , Prostatitis, varicocele, etc.).
3. Increase body temperature.

The causes, symptoms, diagnosis and treatment of varicocele tells the immunologist Georgy Alexandrovich Ermakov:

1. Long-term presence in conditions of elevated temperature (in the workshop, etc.).
2. Impairment of genetic nature (syndrome of Klinfelter, etc.).
3. Action on the body of toxic substances (alcohol, some medicinal preparations, such as sleeping pills, steroids, etc.).

Determining the fertility index, the doctor pays special attention to the amount and mobility of sperm. If, after deciphering the study, the man is diagnosed with asthenosospermia, then its chance to become a father is significantly reduced. However, the increase in the mobility of the genital cell is not yet a guarantee of the occurrence of pregnancy.

What affects the quality of the spermogram?

Many factors are able to influence the functioning of the men's reproductive system. The main thing is stress. It was noted that when complying with the regime of the day, increasing physical activity and minimizing the impact on the body of harmful factors, the quality of the seed fluid is gradually improved. Doctors associate this with the ability of the human body to self-healing. To do this, they recommend:

• Choose regions with a normal environmental situation.
• Observe the mode of the day.

• Refuse any bad habits.
• Pay attention to the quality of food.
• Move an active lifestyle and play sports regularly.

Compliance with these rules helps in a short time to restore sperm indicators, which in decoding could contain some deviations from the norm. If the cause of negative changes in sperm was the change in the hormonal background of a man, the doctor will appoint it a reception of certain drugs that can quickly restore the situation.

How to improve the indicators?

If the mobility indicator turned out to be below the norm, the doctor can tell what can be taken to improve it. A good effect gives the use of antioxidant drugs, which are able to bind free radicals in the body. Studies have shown that if a man is twice a day drinking 1 cup of fresh fruit or vegetable juice, then after 3-4 months, the indicators in the decoding of the spermogram are significantly improved.

In order to, in the end, get a good result of the spermogram, doctors recommend to men completely revise their diet. It is based on food with a high content of vitamins and minerals. At the same time, the number of such products that can contain toxins (meat, fish, eggs, coffee, smoked, etc.) should be reduced.

What needs to be done to improve diagnostic indicators tells the urologist Andrei Aleksandrovich Lukin:

The base of the diet should consist of fresh vegetables, fruits, greenery and dairy products. A good effect showed regular use of such products: foiled oil, cheese, nuts, honey, beans, natural yogurt, fruit, greens, dried fruits, sweet seasonings.

One of the necessary for male health is Vitamin B11, which can be obtained from special food additivesthat will recommend using a doctor. They are always prescribed to men before carrying out artificial insemination or eco, cryopreservation of biological material or during the preparation for donation.

Having received a deciphering of the spermogram with disappointing indicators, a man must understand that it does not always mean a violation of the work of the reproductive system and the inability to have children. Today, medicine has learned to successfully solve many problems. For this, the attending physician will appoint a man to receive hormonal or supporting medicinesThe use of which will allow and increase the chance of the onset of long-awaited pregnancy.

Semenogram is an analysis of male seed (ejaculate). A properly decrypted sperm program gives information about the state of the reproductive system of men and on possible diseases of the urine-sex system.

The spermogram is performed according to the standards adopted by WHO (World Health Organization). An increase under a microscope is a maximum of 900 times.

Along with the spermogram, the MAR-test ejaculate, detecting availability antispermal antibodieswho speakers the immune factor of infertility.

Morphological is also carried out sperm Studies on the Crupeand EMIS (electron microscopic examination of spermatozoa with an increase in the microscope 100,000 times).

To obtain the correct analysis of the sperm, when leaving the ejaculate, it is necessary to comply with the following conditions:

• Abstinence from ejaculation for 2-7 days (optimal period of 4 days). When re-examination, it is desirable to set the same periods of abstinence to reduce the oscillations of the result.
• The admission of alcohol is prohibited, including beer, sleeping pills and soothing drugs during this period. The rest of the power can not be changed, because Spermatozoa is formed a few months earlier.
• To refrain from the reception of hot baths, from visiting a bath, saunas for 2-7 days.
• Ejaculats are obtained by masturbation. Collected in a special container, which must be predefined in the medical office. It is forbidden to use the usual condom for collecting sperm, because It contains substances affecting the mobility of spermatozoa.
• On the container you must specify the last name, date and exact time of the ejaculate.
• During transport, it is coated at a temperature of + 27 ° C ... + 37 ° C.
• Reception of ejaculate is carried out only in those medical offices, where there is a "spermogram" service, since the study should begin no later than 1 hour after receiving the biomaterial.

MAR Test

From 30 to 40% of the reasons for infertility may be problems of male pathology. One of these problems is immunological infertility, due to the formation of the antispermal shell on the surface of the sperm.

Antispermal antibodies- Immunoglobulins of IGG, IgA and / or IgM isotypes. In men, they are formed in the testicles, their appendages, in the seed-handing flows and are directed against the antigen of the membrane of different parts of the sperm - heads, tail, middle part or their combination.

MAR-TEST (Mixed Agglutination Reaction) determines the ratio (percentage) of normal active-moving spermatozoa, but covered antispermal antibodies, To the total number of sperm. In a standard spermogram, such spermatozoa (antibodies coated) are regarded as completely normal. But, in fact, they do not participate in fertilization.

Positive Mar-Testit is the conditional criterion of immunological infertility in men. The type of antibodies under study is divided into MAR IGA and MAR IGG. The criterion of a positive MAR test is the excess of 50% of the indicator. The study is advisable only at normal concentration and mobility of spermatozoa. In case of violation of these indicators, a man's blood serum is examined for the presence of antispermal antibodies (IFA method).

Ejaculate for the Mar test is assembled in the same way as for the study of the spermogram.

Electron microscopic examination of spermatozoa (EMIS)

Emis allows you to explore cum in more detail, and also to make a diagnosis more accurately. This method uses a microscope with an increase of 100,000 times, which allows you to explore all the components of the ejaculate in more detail. The EMIS method makes it possible to explore the genetic and anatomical causes of infertility, allows you to determine the risk of their transfer by inheritance and the impact on the development of the embryo. It is advisable to use this study before making artificial insemination or ECO / ICSI procedures, as well as to determine the causes of the failure of previous extracorporeal fertilization.

With the help of emis, you can consider the spermatozooid structure:

The presence on the acrosoma sperm head (nuclear cap, containing enzymes dissolving the membrane of the egg). In the absence of an acrosoma, the spermatozoa cannot penetrate the egg.

Core head spermatozoacontaining chromatin (genetic material consisting of DNA). During the ripening of sperm chromatin, it is compacted, which is important for the successful transmission of genetic information. An increase in the number of sperm with immature chromatin can lead to the inability to fertilize the egg cell.

Centril is the basal body of the connecting department of the sperm flavor. In fertilization, the centril along with the sperm core is transferred to the egg cell and causes its division. In the fertilization of the egg sperm with anomalous basal division, the embryo does not occur in development.

The movement of the spermatozooid burning is provided fibrillar structureswhich stretch from the neck to the tip of the flavor. Anomalies of fibrillar structures of the burning lead to the immobility of spermatozoa.

Mitochondria - provide energy to move the harness. It is possible to determine the morphological congenital anomalies of mitochondria, which are treated only with the help of auxiliary reproduction methods (ICSI).

When EMIS is used

To clarify the causes of male infertility at normal spermogram.

Single / repeated abortion of pregnancy early timing (miscarriage or fading pregnancy).

Preparation for artificial fertilization - Insemination, Eco / Ixi.

With oligospermia, asthenospermia, teratozoospermia.

When (in the absence of spermatozoa), the EMIS method is not used.

Sperrogram for eco

Before conducting the Eco procedure, a man will need to be sperm at least twice: for the analysis of the spermogram and directly for the ECO procedure. Spermogram indicators for ECO, which are recorded primarily - this is the amount of spermatozoa, the viscosity of the seminal fluid, the size and shape of the spermatozoa (morphology), the volume of ejaculate, mobility and gluing spermatozoa.

Spermogram, rules for Eco, may differ in accordance with WHO recommendations. Norms spermogram for Eco will depend on internal politicians Selected clinic. However, the better the spermogram indicators, the greater the likelihood of the child's conception.

Spermogram norms adopted in 2010

The diagnosis of infertility is often a hurricane invade the life of many families. The reason for the absence of children can be the problems of male health. About various disorders in the function of a man to produce offspring shows a sperm (analysis of men's sperm). What to do and how to get pregnant if your husband has a bad spermogram? Surely this final sentence or there are methods for returning sperm to normal?

The spermogram is usually assigned by an andrologist. The analysis allows you to estimate the fertilizing ability of male sperm. Thanks to this study, you can estimate the qualitative and quantitative characteristics of the ejaculate. At the same time, the amount of spermatozoa is calculated, their qualitative characteristics, spermatogenesis pathologies are detected.

Bad spermogram - the results of which differ from the WHO criteria.

Such a spermogram is considered normal, which allows you to conceive a child in a natural way.

To obtain reliable analysis, man is important to comply with a number of rules for its collection. Otherwise, the analysis may be wrong.

Spermogram defines sperm quality such as:

• volume;
• viscosity;
• pH acidity;
• degree of bodybake;
• number of rounded cells;
• the total number of spermatozoa and their mobility;
• spermatozoa in 1 ml;
• the presence of other inclusions (leukocytes, erythrocytes, etc.).

When the spermogram is needed

Most often, sperm analysis is appointed with the problems associated with the reproductive sphere of the male organism.

With a fruitless marriage, they explore both spouses to understand who of them is the cause of the lack of offspring.

The reasons for the purpose of the spermogram are indications:

1. With suspected male infertility because of various diseases (varicocele, injuries, prostatitis or hormonal disorders).
2. Infertility in marriage (if the spouses live more than a year without protection, but pregnancy does not happen).
3. At the preparatory stage to the artificial collection of sperm (insemination) in Eco.

About the hand of sperm

It is very important to comply with the correctness of the fence of sperm so that the results are reliable.

Laboratory is considered the best method of collecting sperm. In rare cases, it is allowed to collect seed fluid when interrupted by the sexual act. However, such an analysis is less effective due to foreign substances entering the material.

Preparatory stage

This stage includes the following points:

1. No later than half a year before the study, it is necessary to stop the reception of potent drugs (hormones, cytostatics, tranquilizers, etc.)
2. 2-3 days before the analysis, exclude all contacts with toxic substances (alcohol, chemical components). This also includes beer and energy. If the work is related to chemicals, then the analysis is better assigned after 2-3 days a week.
3. Eliminate sexual contacts for 5-7 days before delivery. Otherwise, during the study, female sex cells can identify.
4. During the day before the spermogram, it is important to fully protect yourself from overwork, stress, supercooling.
5. To visit the sauna (or steam room) no later than 10 days before the analysis.
6. It is important to stop smoking before the study (but no later than 2-3 hours before the delivery of the material).

It is not worth passing the material during the treatment of urological disorders. Otherwise, research results will be unreliable.

If necessary, the analysis is relocated after 2 months.

If the patient had a cold, the analysis is better to do 7-10 days after recovery.

Many harmless substances destroy spermatozoa (vaginal lubricant, water, acid, etc.) Therefore, sperm for analysis is collected in a sterile jar immediately in the laboratory.

The patient is warned not to touch the inner surfaces of the container.

How to collect analysis?

How according to the rules to collect sperm for the study? For this procedure, a number of rules must be observed:

1. All the resulting sperm goes to the analysis, since its amount is important to know.
2. Before studying the patient empties the intestines and the bladder, uses shower.

During masturbation, no liquids or lubricants (saliva, lubricants, cream, etc.) are used.

1. A special laboratory container or a glass jar with a wide neck is taken to collect material. Before collecting the ejaculate, the container is washed, boiled and closed with a lid.
2. With self-delivery of the ejaculate, it is important to observe the "temperature chain" (transportation at body temperature).
3. The container with the material is supplied with a piece of paper with an indication of the necessary patient data (passport details, the amount of ejaculate, on what an abstinence day the material is assembled).

When a spermogram is considered bad

As for any analysis, the criteria for the development of the sperm have developed their criteria for determining the norm. Bad spermogram if the following indicators go beyond:

• the meager amount of sperm occurs with the reduced function of the testicles (in injuries or inflammation of the male sexual sphere);
• decrease in sperm concentration (the most frequent cause male infertility);
• damaged or fixed spermatozoa (with congenital genetic disorders, venereal ailments).

In many patients, in sperm analyzes there may be various deviations, uninterrupted by non-specialists. What do medical terms say?

Most often, such conclusions may occur in spermogram:

• - with the absence of spermatozoa;
• acinderospermia - with absolute immobility of spermatozoa;
• asthenozoospermia, with a small mobility of sperm;
• hemospermia - the inclusion of red blood cells;
• cryptozoospermia - single spermatozoa;
• leukocyteospermia -;
• non-Simpermia - a decrease in living spermatozoa;
• - with small deviations that do not affect the reproductive properties of sperm.

Bad spermogram and pathology

If the spermogram was not very good, the doctor must determine the presence or absence of a patient existing pathologies.

Do not panic if the husband has a bad spermogram. Often, when returned, the analysis is not so frightening.

What kind of pathologies may indicate the deviations in the sperm? Most often it happens when:

• genetic pathology;
• autoimmune lesions;
• hormonal disorders;
• radiation impacts;
• tobacco or alcohol;
• use of drugs or severe drugs;
• insufficient physical activity;
• stress;
• incorrect diet.

What do spermogram disorders say

There is a list of normal sperm readings:

Consider some cases of deviations in the spermogram:

Reducing the number of spermatozoa

May meet with camp changes in eggs or hormonal disorders.

In the treatment is used hormonal therapy, Surgical excision of scars and restoration of testicles. In some cases, this pathology natural way unresolved. Modern technologies of artificial insemination or Eco can help here.

Still of spermatozoa

Such a violation is found in many common diseases, genetic pathologies, bad habits (alcohol, drugs), the effects of vibration or radiation, improper lifestyle.

Reduced sperm volume

Most often occurs when inflammatory pathologies of testicles or preceding injuries. Often, the scars in the field of eggs are often the cause of sperm.

Such pathology is often an indication for vitro incense.

Lack of spermatozoa

In the absence of spermatozoa, the chances of becoming a father in a man are zero. This is a serious pathology that meets when:

• genetic failures;
• prior vapotitis;
• the blockage of seed-air ducts.

To solve the problem, reducing surgical treatment, egg puncture with artificial seed fence through the syringe are used.

Abnormal spermatozoa

The high concentration of "anomalnes" in the seed occurs with autoimmune or genetic pathologies, drug use, smoking, when exposed to vibration or radiation.

Such disorder is treated with the help of stimulating therapy using Eco technologies and, when only healthy spermatozoa is selected for conception.

The ability to make a phenomenon of hemospermia (blood in sperm) does not affect. However, with such a violation, a survey is necessary. Hemospermia may indicate:

• urogenital infections or tumors;
• vascular pathologies;
• obstruction of seeding tract;
• prostate hyperplasia.

Often, blood streaks appear after sex. This is important control and use of a condom.

Large number of leukocytes

It is found at various inflammation of the urinary and acute infections (, prostatitis, urethritis, trichomoniasis, chlamydia, etc.) After identifying the cause, anti-inflammatory therapy is carried out.

How to Improve Spermogram Indicators

Often, on various forums on the Internet, women ask a question "How to get pregnant if a husband has a bad spermogram"?

In fact, the causes of such violations in sperm analysis can be a great set:

• diseases (genetic, endocrine, infectious, venereal);
• lifestyle (improper nutrition, low-speed, bad habits);
• external impacts (radiation, vibration, intoxication).

Very common changes in spermogram are:

• pH violations;
• changing the viscosity of sperm;
• illuminated number of rounded cells.

With violations of this kind, pregnancy is very likely. Usually a man is enough to check the hormonal background and eliminate the inflammatory ailments of the urinary organs.

After the examination, it is often necessary to put the course of drugs for male health correction ("Spreman", "Spemotone" to increase spermatogenesis).

It is important to radically change the way of life a man seeking to improve the testimony of sperm analysis. This includes recommendations for changing the diet, eliminating low-altitude, combating smoking, etc.

With a number of male health pathologies, patients will need long and serious treatment (scar changes, obesity, etc.)

However, if the husband has a bad spermogram despair not worth it. Nowadays, modern reproductive methods are able to help almost everyone in the birth of a healthy offspring. Health to you and your future kids!

According to the definition of WHO, the marriage is called, in which there is no pregnancy for 12 months of sexual life without protection.

Infertility in the population as a whole is found in 10% of cases. Normally, a healthy pair occurs during the first 3 months of unprotected regular sexual life. According to statistical data, the fraction of a male factor in the structure of a fruitless marriage accounted for from 30 to 60%.

Diagnostic algorithm for men's infertility

In our opinion, the diagnostic algorithm of the man's examination should consist of two stages. In the first stage, anamnesis data is estimated, including history of fertility and transferred urogenital diseases. In addition, physical research methods are carried out, the analysis of the spermogram, the definition of the immunological factor of infertility.

The first stage, the survey should be carried out to all patients who applied to a precious trafficking specialist.

Optimal abstinence deadlines to obtain reliable results in the study of ejaculate 48-72 hours. Analysis of the sperm in the presence of pathospermium should be duplicated in 2 weeks. During this period, the admission of alcohol, as well as the use of potent drugs, if they were not prescribed by a doctor, invalid. It must be remembered that even a subfebrile fever, which noted in previous studies of 3 months, can cause serious changes in the ejaculate right up to azoospermia.

The diagnosis of immunological infertility factor is based on tests for the presence of antispermal antibodies in the ejaculate and serum of the patient's blood and its partners. The standard methods are a MAR test, which characterizes the percentage of sperm coated with antispermal antibodies (a positive test - more than 50% of mobile sperm coated with antibodies) and ELISA - the titer of antispermal antibodies in the patient's blood serum and its sexual partner (norms are established by the laboratory). Positive test results indicate the presence of an immune factor of infertility. In the absence of another pathology, a diagnosis of isolated immune infertility is established, which accounts for about 10% of fruitless marriages.

At this stage it is possible to diagnose the clinically pronounced varicocele, determine obstructive azoospermia, as well as reveal a group of patients with a decrease in fertility without clarifying etiology at this stage or with an immunological factor infertility.

The information obtained during the first stage can narrow the diagnostic algorithm of the second stage.

At the second stage, the patient with an unclear etiology of infertility is carried out a full range of diagnostic measures - the definition of hormonal status, ultrasound examination of the scrotum authorities, determination of causative agents of urogenital infections, if necessary, genetic studies, studies of centrifunted ejaculate and postgraduate urine.

Hormonal studies should be carried out with pronounced patospermia and Azoospermia. In these cases, testosterone levels, FSH, LH, as well as sex hormone binding globulin, which gives an idea not only about the number of testosterone, but also about its biologically active fraction. The definition of prolactin is advisable to conduct a pituitary tumor suspected.

With ultrasound examination, structural changes and pathological formations are determined in the testicles, appendages, prostate gland. Indications for carrying out the couragees - low-consumable azoospermia, this method allows you to detect changes in seed bubbles in the obstruction of the distal seven-way paths or their absence in congenital agentsia. Color Doppler Research allows you to identify the presence of venous reflux in the system of the testicular veins and the so-called subclinical varicocele.

Ejaculate sowing is produced in pyrospermia (concentration of leukocytes more than 1 million / ml) and in the case of an idiopathic nature of the decline in fertility and deterioration of spermogram indicators, as well as in the preparation of the patient in the course of auxiliary reproductive technologies.

A simple herpes virus of a man, chlamydia may affect spermatozoa, leading to their immobilization, formation of AsaT (antispermal antibodies) to them and non-obscure pregnancy, as well as congenital abnormalities of the fetus.

The testimony for such a diagnosis is the idiopathic nature of the decline in fertility and pathospermia, unbearabizing pregnancy, as well as during the preparation of the patient in the cycle of auxiliary reproductive technologies. It should be noted that the diagnosis of sexually transmitted infections should be carried out by the method of immununimal analysis (IFA) in combination with PCR.

Genetic studies should be made under azoospermia and pronounced pathosperm. Karotyping reveals anomalies of a chromosomal kit (patient karyotype). Recently, the AZF section of the Y-chromosome site is becoming increasingly important for the presence of micride in it. About 10% of all cases expressed patosperm and unstructive azoospermia due to the loss of one or more loci in the Y-chromosome localized on the AZF interval. In addition to the diagnostic value, genetic studies can provide information on the possibility of transmitting this disease to the offspring of male, which must be informed by patients.

In the unstructive azoospermia, single spermatozoa or spermatogenesis cells may be detected during the study of the ejaculate centrifitution. Therefore, such a study is shown during the differential diagnosis of the causes of azoospermia and in the reproductive technologies cycle (search for single spermatozoa for ICSI).

The study of the Poshorgazmenny urine is carried out at retrograde ejaculation.

The question of the feasibility of the diagnostic biopsy under azoospermia to the present moment remains discountable. In our opinion, the biopsy of the testicle is unacceptable with a diagnostic purpose and can be used only as a method for producing genetic material in order to turn it on into the Eco-ICSI cycle. It should also be borne in mind that repeated surgical intervention is possible only after 6-18 months, which is due to the need to restore the initial level of spermatogenesis and conducting conservative measures aimed at improving the spermatogenesis process.

General issues. Spermogram

The main function of the male dietary gland (eggs) is the formation of spermatozoa (spermatogenesis).

The process of spermatozoa formation begins in adolescence And proceeds to deep old age.

The process of ripening one spermatozoa takes 74 days. This requires:

• convolving channels where spermatozoa maturation occurs
• participation of cells of sertoli
• testosterone High Local Hormone Concentration
• temperature of eggs for 2 degrees is lower than body temperature

The mobility of spermatozoa acquires the appendage of eggs. This process takes about 2-6 days.

The average speed of the spermatozoa movement is 3 mm / min., Maximum - up to 40 mm / min.

The mobility of the spermatozoa is preserved within 48 hours.

The main source of energy, metabolism and maintaining the mobility of spermatozoa is fructose, which is formed in the seed bubbles.

Sperm Path from Eggs to Egg:

• Spermatogenesis in the testicles
• Transition through the appendage of eggs
• Ejaculation (ejaculation)
• Penetration cervical mucus Channel cervix, cleansing from seed plasma components
• Capacitution (acquisition of spermatozooma fertilizing properties)
• Acrosomic reaction (spermatozoa fusion with egg)
• Ferilization (fertilization) egg cell

The fruitless marriage is called marriage in which there is no pregnancy within 12 months of regular sex without contraception.

"The woman traditionally decides responsibility for failure in conception. Such a look is based on the pseudological conclusion that" if it is not pregnant, that means it is to blame for this. "

R.j. Rowe et al. - WHO experts.

Epidemiology of fruitless marriage

• 50% female infertility factor
• 35% male infertility factor
• 15% combined infertility factor

Each tenth married couple fruitless.

First stage men surveys with infertility

• Collection of anamnesis fertility.
  • Anamnesis of child diseases.
  • Surgical history.
  • Anamnesis of professional harm and familiar intoxication.
  • Anamnesis of urogenital diseases.
  • Actually a history of fertility and fertility of the patient's partner.
• Inspection and physical research.
  • General inspection and physical research of systems and organs.
  • Status Genitalis (physical research of penis, scrotum and its organs, prostate gland and seed bubbles).
• Routine examination of the spermogram.
• Study of antispermal antibodies.
  • Mar-test (percentage of active-moving spermatozoa coated with antibodies)
  • Immuno enzyme analysis (ELISA) antibodies to spermatozoa in the blood of men with azoospermia and sexual partners of all patients

In physical research (inspection), men's genital organs are held:

• Inspection of external genital organs.
• Palpation of scrotum and its organs.
• Rectal study.

Attention should be given to the following items:

• The study is carried out in a warm light room.
• Warm hands.
• Ortostasis (vertical patient position).
• Confidentiality.

When examining outdoor genital organs Study and determined:

• Leather of penis and scrotum.
• The magnitude and consistency of the penis.
• Meatos (outer opening of urethra).
• Erectile and non-selective deformations of the penis.
• Signs of urethritis.

When palpation, the scrotum is estimated:

• Eggs.
• Panking eggs.
• Elements of seed rope.

When finger rectal research is estimated:

• Evaluation of the shape, consistency, size and borders of the prostate gland.
• Signs of chronic prostatitis.
• Signs of prostate cancer.
• Benign prostate gland hyperplasia (adenoma)
• The presence of seed bubbles.

Currently, the "gold standard" during the examination of the prostate gland is a transrectal ultrasound study, and not a finger of the urologist.

Rules of research ejaculate

• The term of abstinence is 48-72 hours (2-3 days).
• The reception of potent drugs, tranquilizers, alcohol during the abstinence period will not allow.
• Research after 2 weeks when detecting pathospermia.
• Centrifugation of ejaculate during a re-study during azoospermia.
• The inclusion in the routine methodology of the study of antispermal antibodies.

Normal Spermogram Indicators:

Characteristics of the movement of spermatozoa (WHO, 1992)

• A. - Fast progressive movement.
• B. - Slow linear and non-linear progressive movement.
• C. - oscillatory or movement in place.
• D. - Sperm not moving spermatozoa.

Traffic characteristics (AUA, 1997)

• 0 - Lack of movement.
• 1 - sluggish movement in place.
• 2 - Slow winding movement.
• 3 - Moderate progressive movement.
• 4 - severe progressive movement.

The result of the primary survey

• Erectile dysfunction.
• Pathospermia (pathological changes in sperm).
• Azoospermia (lack of spermatozoa in ejaculate).
• Ejaculator dysfunction (retrograde ejaculation or no ejaculation).
• Varicocele.
• Pyographs and bacteriospermia.
• Idiopathic infertility (infertility of unclear etiology).

Varicocele and infertility

Varicocele - extension of the veins of the eggs due to the reflux of the blood according to the system of the testicular vein. Varicocele is observed in 15% of the general population of men. The combination of varicocele and primary infertility is observed in 35%, secondary infertility and varicocele in 80%. In some cases, an additional ultrasonographic study is required to determine venous reflux. It must be remembered that there is no direct correlation between the degree of severity of varicocele and the quality of the ejaculate.

With a combination of varicocele and any other clinical and laboratory changes, with the exception of obstructive symptoms and ejaculatory dysfunction, the first step is to be treated with varicocele.

For the treatment of varicocele several operational methods are proposed. It is necessary to distinguish between obstructive and unstructive techniques of surgical treatment of varicocele. The first is the Operation of Ivanissyevich, Marmara, Palomo, Laparoscopic Varicotelectomy, Transfemoral Emboliization of the Temple Vienna, as well as the microsurgical ligation of the veins of the seed rope from the mini-seater.

The formation of microsurgical venous anastomoses is the formation of microsurgical venous anastomoses - the Lower Epigigastric TestCulo-Safenne. The method of testicular and epigastric anastromosisation allows you to drain the blood from the border shaking into the system of the iliac vein at i, as well as at the II and III types, if the cause of the reflux is not associated with the valve insufficiency of the veins from the reset system into the left iliac venu.

Currently reading to surgical treatment Varicocele is revised. Since between the degree of severity of varicocele and the degree of fertility, direct addiction is absent, we consider to indicate operational treatment Varicocele resistant decrease in ejaculate fertility, painful symptoms and a pronounced aesthetic defect in the scrotum area.

Currently, there are more and more messages in the literature that in patients with varicocele and normal spermograms after the operation there is an appearance of antispermal antibodies and the deterioration of the ejaculate parameters, which, apparently, can be associated with the deterioration of the troops of the testicle after the obstructive operation. In the light of this, we believe that the operation using a microvascular method for the formation of venous anastomosis and the normalization of blood outflow from the testicular vein system is preferable compared to traditional obstructive techniques.

Azoospermia. Treatment of infertility

It is necessary to distinguish between obstructive azoospermia (excretory infertility) and the unstructive (secretory infertility) azoospermia, or pronounced pathosperm.

For obstructive azoospermia The normal sizes of the testicles, the normal level of hormones, the absence of spermatogenesis cells in a centrifuged ejaculate, inflammatory diseases genital organs, operations on the organs of the scrotum and small pelvis, as well as the palpator definition of the pathology of the appendages and seed-winning ducts.

For upholstered Azoospermia Signs of hypogonadism are observed, single sperm or spermatogenesis cells in ejaculate, hormonal shifts, gene and chromosomal changes, a history of toxic influences, orchitis.

The optimal method of treatment of obstructive azoospermia is the implementation of microsurgical recovery of seven-way paths with the simultaneous formation of spermatozoa from the zone, located proximalous obstruction.

The material obtained can be simultaneously used in the ECO-ICSI cycle. In this case, part of the spermatozoa is subject to cryopreservation and is used in case of a non-successive operation.

A more difficult issue is treatment in the program of Eco-ICSI patients with unstructive forms of infertility. The optimal method of obtaining sperm in the unstructive azoospermia in the ECO-ICSI cycle is the bilateral multifocal biopsy of the testicles using microsurgical techniques.

It is known that in the unstructive azoospermia, focal spermatogenesis can be preserved. In independence from the results obtained, the results of hormonal and genetic research, even with hypergronadotropic hypogonadism, with bilateral multifocal microsurgical biopsy, it is possible to obtain sperm (up to 65%).

In the abstruse azoospermia, against the background of hypogonadotropic hypogonadism, the first step should be conducted by gonadotropin stimulating therapy.

With pronounced pathospermia against the background of genetic anomalies, hypogonadism (except hypogonadotropic), obstructive symptoms, varicocele, the absence of ASAT - it is possible to carry out empirical therapy, in the absence of an effect (or immediately) the patient is included in the program of reproductive reproductive technologies.

In the unstructive azoospermia, azoospermia Unclear Genesis, pathospermia of any degree of severity (with the exception of proven one-sided obstruction), the first stage must be excluded by varicocele, including subclinical. Conducting stimulating therapy is advisable after the treatment of varicocele.

With a combination of the unstructive (unclear genesis) of pathospermia (azoospermia) and antispermal antibodies, the conduct of stimulating treatment is contraindicated.

With idiopathic infertility, treatment with gonadotropin or anti-estrogen treatment is possible, as well as vitamin therapy and vegetable spermatogenesis stimulants with a balanced content of trace elements. However, the effectiveness of such treatment of infertility does not exceed 5%.

• Reconstruction of the seedy ways during obtaceous azoospermia
• Restoration of the seed-winning duct after yathedral damage
• Reconstruction of the seedy ways during obtuctive aspermia

Immunological (autoimmune) infertility

Antispermal antibodies (AsaT) are able to block spermatogenesis, disrupt the mobility of spermatozoa in ejaculate, prevent the penetration into cervical mucus, violate a vaccination, acrosomal reaction, binding to Zona Pellucida, make it difficult to fertilize, violate crushing and even contribute to the interruption of pregnancy in early time.

The treatment of immune infertility is a complex problem.

The first stage of the therapy of immune male infertility is to eliminate all possible etiological factors for the development of an autoimmune process in a sexual system: urogenital infections, varicocele, the obturation of the seed-making tract, etc.

However, the normalization of blood circulation, the lack of sexually transmitted diseases (STDs), restoring the passability of the seven-way paths (when it is possible to do), the elimination of production intimacy does not ensure the disappearance of the AsaT when their products began. Therefore, at the second stage, it is usually necessary to use one or a set of additional medical measures: pharmacotherapy (systemic enzymepicherapy, hormonal therapy), special washes, followed by intrauterine or inner-tube administration or ECO, including fertilization by a single spermatozooma by microjunction in the cytoplasm (ICSI).

It must be remembered that any stimulating therapy in the presence of AsaT is contraindicated.

In the presence of AsaT, the patient and / or its partner and the absence of another pathology establishes the diagnosis of isolated immune infertility. With an isolated immune infertility, conservative empirical therapy is ineffective by the only real alternative are auxiliary reproductive technologies.

Auxiliary Reproductive Technologies (HRD)

Under the auxiliary reproductive technologies implies:

• Intrauterine insemination sperm husband.
• Extracorporeal fertilization.
• Extracorporeal fertilization with ICSI micromation (ICSI)
• Using the sperm of the donor in the AGC.

The introduction of spermatozoa directly into the uterine cavity provides for artificial passage of the cervix with spermatozoa, which could die at the cervical factor of infertility when trying to be an estimated conception.

Indicatives of intrauterine insemination are also ejaculatory dysfunction, immunological infertility, oligostenozoospermia.

The immunological factor of infertility is overcome by pre-processing spermatozoa. In the case of an unknown etiology, infertility is also possible artificial fertilization by intrauterine insemination in satisfactory indicators of the ejaculate (the number of movable spermatozoa more than 5 million). Insemination of donor sperm avoids direct sexual intercourse.

The method of extracorporeal fertilization provides for the stimulation of superstulation, which can cause a number of complications, as directly during stimulation, so due to multiple pregnancy. The success of the stimulation procedure is largely dependent on the state of the woman's endocrine system. It is known that the frequency of the occurrence of pregnancy is higher in cases where the functions of follicles are able to aspirate more than 5 eggs. Next, oocytes are aspiring through transvaginal puncture of the ovaries. After that, in vitro fertilization occurs - the exposition of eggs in one medium with treated spermatozoa. Then the transfer of embryos to the uterine cavity and the reduction of part of the embryos.

The possibilities of correction of azoospermism remained minimal to the introduction of the method of injection of a sperm in the cytoplasm of a mature egg (ICSI), requiring only single spermatozoa epididymal or testicular origin for fertilization.

Indications to Eco (ICSI) is: the concentration of spermatozoa is below 10 million (2 million for ICSI), the mobility of spermatozoa 2 is less than 10% (5% for ICSI), more than 70% of the pathological forms of sperm (more than 96 for ICSI), the possibility The preparation of sperm only surgically, the unsuccessfulness of other treatment methods.

The effectiveness of artificial fertilization methods is about 30% for one attempt.

The use of auxiliary reproductive technologies is significantly expanding the possibilities of correction of the most severe forms of male infertility, including azoosperm. Competent I. effective treatment Basic marriage is possible only when performing a clear interaction between urologists, gynecologists and Eco specialists. It is obligatory to complete the patient about all possible methods for restoring fertility with an indication of the percentage of successful events and the risk of developing complications of himself and his spouse.