It is complex and aimed at eliminating all possible causes that lead to the development of teratozoospermia. Teratozoospermia is understood as a laboratory parameter of the spermogram, which is characterized by an increase in the number of pathological forms of spermatozoa. In accordance with WHO criteria, the number of morphologically normal spermatozoa must be at least 30%.
When determining the tactics of treating teratozoospermia, one should take into account the fact that all the causes of this condition are unknown. At the same time, teratozoospermia is more common in patients with varicocele, infectious and inflammatory diseases of the pelvic organs, with viral processes, and hormonal disorders.
In addition, teratozoospermia can occur under the influence of electromagnetic and ionizing radiation, with genetic disorders, intoxications and fermentopathy.
Before starting treatment, a standard examination is carried out, which includes a semen analysis, hormonal tests, ultrasound of the scrotum and prostate, PCR diagnostics and bacteriological studies, examination of urethral smears, microscopy of prostate secretion. If you suspect the possibility of chromosomal abnormalities and other genetic pathologies, it is recommended that the patient be examined by a geneticist.
In the case of a varicocele, the underlying disease is treated, and, as a rule, the improvement in the morphology of sperm occurs very quickly and already 2-3 months after the operation to eliminate the varicocele. If teratozoospermia is associated with prostatitis, urethritis or vesiculitis, then inflammation is treated based on the rules and principles for the treatment of such diseases (rational antibiotic therapy, physiotherapy, immunomodulatory therapy).
Hormonal disorders, in particular hyperprolactinemia, can also be the cause of a decrease in the number of spermatozoa with a normal morphological structure. In this case, prolactin-lowering drugs (Carbegolin) are used. At the same time, along with the improvement of other indicators of the spermogram, an improvement in the morphology of spermatozoa is observed.
In the presence of human viral infections, autoimmune conditions, treatment is carried out by appropriate specialists.
In the case of unclear or unexplained causes of teratozoospermia, treatment is carried out symptomatically: long-term courses of folic acid, antioxidants, drugs that improve microcirculation, L-carnitine are used.
During the treatment of teratozoospermia, patients are advised to completely stop smoking and drinking alcohol, and lead a healthy lifestyle. It is known that teratozoospermia decreases in the case of regular sexual activity. The nature of the food taken by the patient should be varied and contain the required amount of the main components, as well as trace elements. Complex preparations are also used, containing the entire spectrum of vitamins and microelements (Elevit) in long courses, at least 3 months.
Thus, the treatment of teratozoospermia can be very difficult, given the fact that all the true causes of this disease are unknown. The prognosis is favorable in situations where teratozoospermia is caused by varicocele, hyperprolactinemia, or chronic inflammatory processes in the small pelvis.
Every day, the number of couples who are unable to conceive a child is growing. This phenomenon is facilitated by many different factors, both external (ecology, harmful working conditions, stress, reduced material support, etc.) and internal (pathological disorders in the body of a man and woman planning a child). Increasingly, male infertility is being diagnosed. One of its causes is teratozoospermia - a condition in which the number of pathological forms of spermatozoa in the ejaculate (sperm released in one ejaculation) exceeds 50%.
Normal spermogram
A spermogram is an analysis of the ejaculate (the fluid released during ejaculation) in order to determine its main characteristics. The analysis allows you to identify the presence of inflammatory diseases of the male reproductive system or male infertility. A single semen analysis is not always enough to determine the cause of the disease, but it is the simplest and most affordable method that allows you to detect the problem.
The spermogram determines the number of spermatozoa, their structure, the percentage of young forms of spermatozoa, the number of leukocytes or other cells that may be present in the ejaculate. In addition to the number and percentage of cells, it is mandatory to determine the general characteristics of the semen: volume, appearance, color, viscosity, liquefaction period and pH.
In addition to the above characteristics, if necessary, determine the biochemical composition: the amount of fructose, alpha-glucosidase, zinc, L-carnitine.
According to the standards of the World Health Organization, which were published in 2010, the norm of a spermogram is:
Total volume of ejaculate - from 1.5 ml and above
The total number of spermatozoa is from 39 million and above
In one milliliter, the concentration of spermatozoa is 15 million or more
Sperm motility is 40% or more
Spermatozoa with progressive movement of 32% or more
Viable organisms from 58% and above
Morphologically normal forms from 4% and above.
Preparation for the delivery of ejaculate analysis for spermogram
A very important role in obtaining the correct spermogram results is the observance of certain rules:
1. Diet. Within a week before the spermogram, it is recommended to exclude fried, fatty foods and coffee from the diet. After all, their use can reduce the normal activity of spermatozoa and the total amount of sperm in the ejaculate. You also need to take care of taking a sufficient amount of fortified foods (fruits, vegetables, herbs, dairy products, meat and fish).2. Abstinence from sexual intercourse. Two days before the spermogram, it is recommended to exclude sexual intercourse, but it should be noted that the period of abstinence should not exceed one week. With a long absence of sexual intercourse, a large number of immobile and old forms of spermatozoa accumulate in the ejaculate, which have already lost their ability to fertilize.
3. Refusal to drink alcohol. Experts recommend a week before the spermogram to stop taking alcohol or drugs, because this leads to a change in the structure of germ cells and significantly reduces their activity. Consequently, the results of the spermogram will be underestimated.
4. Inflammatory diseases of the reproductive system in men, they are a contraindication to taking a spermogram, since the results will be erroneous. This means that you must first undergo a course of treatment, and then, in case of recovery, take a spermogram. The recommended period when you can take a spermogram after recovery is 7 days, because during this time drugs are completely removed from the body of a man and the normal functioning of the reproductive system is restored.
5. If you have colds or other respiratory infections, which were accompanied by a significant rise in temperature, carry out treatment, only after 7-10 days they take a spermogram. This is due to the fact that when the body temperature of a man rises above 37 ° C, the process of maturation of spermatozoa and the state of seminal fluid are disrupted. The normal temperature for sperm maturation is 34.6-35.6°C.
6. It is necessary to exclude visits to the sauna or bath before the analysis.
7. Significant physical activity should be excluded on the body, because they lead to the accumulation of lactic acid in the muscles and tissues, which can affect the results of the spermogram.
8. It is recommended to avoid stress on the eve of the test, because they disrupt the hormonal balance of the whole organism.
9. Cancel prostate massage session before passing the spermogram if it is prescribed to the patient.
10. On the day of the test, the patient must be well rested, because you need a normal erection.
The procedure for collecting ejaculate can be carried out both in the hospital and at home. The latter option is more acceptable, but experts recommend the first. This is due to the fact that when carrying out the procedure at home, the reliability of the results decreases. It is also worth noting that ejaculation should occur due to masturbation, because when using the technique of interrupting sexual intercourse, secrets from the female genital organs can be found in the ejaculate, which distorts the result.
Teratozoospermia in spermogram
In cases where more than 50% of pathological forms of spermatozoa are found in the spermogram, they speak of teratozoospermia. Depending on which part of the sperm is damaged (altered), There are several forms of it:
Changes in the head of the spermatozoon: too small or large, the presence of two or more heads in one spermatozoon, an altered shape of the head, disturbances in its chromatin or acrosome.
Changes in the tail of the spermatozoon: two or more in one spermatozoon, too short or twisted.
Changes in the neck of the spermatozoon: its incorrect attachment, thickening or thinning of its middle part, an obtuse angle of the neck.
Teratozoospermia: an accurate indicator of pathology
For a more accurate determination of the number of pathological forms of spermatozoa in the ejaculate, the ITZ indicator is used - the teratozoospermia index. This index is calculated by dividing the total number of spermatozoa defects by the number of all pathological forms in the ejaculate. ITZ will be equal to one in the case when one spermatozoon will have only one defect. Therefore, the ITI is 2.0 or 3.0 when the spermatozoon has two or three pathologies in its structure.
In the IVF clinic in Vladimir, you can take a spermogram, determine the ITS and carry out the IVF procedure.
Causes of teratozoospermia
There are several leading etiological factors that cause teratozoospermia in men. These include:
1. Hormonal disorders. These disorders can occur due to malfunctions in the endocrine system in a man, or in the case of taking hormonal drugs. Hormonal drugs are used for therapeutic purposes or to improve physical performance (gaining muscle mass, professional sports). But, despite this, hormonal causes are not the leading causes of teratozoospermia.2. Viral infectious diseases of the genitourinary system in men. Parotitis ("mumps") suffered in childhood, which caused orchitis - inflammation of the testicles is often the cause of male infertility. In addition to mumps, there are a large number of other diseases leading to teratozoospermia, including herpes virus infections. Their number is growing every day.
3. Inflammatory diseases of the male reproductive system, both acute and chronic.
4. Hereditary diseases, which are most often passed down through the male line. Therefore, if there was infertility in the male family, then the probability of infertility in male descendants is much higher than in the rest.
5. Impact of harmful environmental factors, including radiation exposure of varying degrees, can cause the appearance of such a pathological change as teratozoospermia.
6. Bad habits. Smoking, drinking alcohol or drugs adversely affect the functioning of the genital organs, disrupting the process of spermatogenesis (the formation and maturation of spermatozoa, as well as the formation of seminal fluid). In the event that a married couple is planning a child, it is recommended that both spouses give up bad habits in a few months.
7. Diseases of internal organs, which are accompanied by a violation of enzyme metabolism.
8. Stress. It has long been established that prolonged nervous tension and constant stress adversely affect the work of all organs and systems of the human body. The male reproductive system is no exception.
Teratozoospermia and the possibility of pregnancy
In order to determine the likelihood of becoming pregnant in the presence of teratozoospermia in a man, it is necessary to conduct a spermogram several times. The higher the percentage of spermatozoa with pathological changes, the less likely it is to conceive.
It is very important to identify the cause of teratozoospermia and undergo treatment.
In some cases, severe forms of teratozoospermia require in vitro fertilization (IVF).
Teratozoospermia: treatment
Features and effectiveness of treatment directly depend on the factors that led to its occurrence. In the event that teratozoospermia has arisen due to an inflammatory disease of the genital organs, treatment begins with the elimination of inflammatory processes. If the cause of the problem was nervous stress, the impact of external factors, then measures are taken to minimize them as much as possible and after a while the tests are repeated.
Regardless of the cause of teratozoospermia, all patients are prescribed medications that improve sperm production. These include: selenium, zinc, folic acid, verona, spermactin, tribestane, etc.
Prognostically unfavorable in the treatment of male infertility, including teratozoospermia, are advanced cases of diseases of the male genital organs, leading to atrophy of testicular tissues, or serious injuries.
Teratozospermia is a male disease in which most of the spermatozoa have structural defects.
Many couples despaired of becoming parents after they heard this diagnosis, but in the history of modern medicine there are many cases that indicate the opposite: it is possible to give birth to a husband with such a diagnosis.
Almost all specialists prescribe artificial insemination, along with the question of this procedure, it is worth asking the following question: teratozoospermia with - is success possible? There are chances to give birth to a healthy baby if you turn to a competent specialist who will guide a man throughout the illness.
Types of disease
Male infertility is a fairly common problem that appears due to a wrong lifestyle, bad habits, ecology, stress, viruses.
There are several types of disease:
- pathology of the sperm head: irregular shape, two heads instead of one;
- irregular shape of the neck of the spermatozoon: too narrow, too wide;
- double, too short or too long ponytail.
When planning a pregnancy, you should immediately consult a doctor in order to note in advance all the obstacles and be prepared for them.
Diagnosis of teratozoospermia
Successful fertilization happens in a few percent of cases, since everything depends on the number of healthy sperm.
There are several ways to study the condition of sperm:
- WHO - only the head is studied, since it is it that carries important material, attention is not paid to the neck and tail, the analysis is incomplete.
- Assessment of the entire state of spermatozoa according to the Kruger system. A more rigorous study - a specialist looks through all the material and displays deviations in all parts of the structure of the spermatozoon. The equipment for carrying out such therapy is expensive, therefore, it is available only in serious clinics. More than 200 items of material are involved in the review. After the conclusion, the study is repeated.
In the last analysis, each deviation from the norm is recorded as an anomaly, for example, the frontal zone of the spermatozoon should be one third of its size, if there are deviations, the spermatozoon will not be able to participate in fertilization.
If more than 14% of the material does not have abnormal deviations, the probability of becoming pregnant rises to 80%.
By some standards, rates from 4 to 14% also give a small chance of natural fertilization, a percentage below 4 does not give hope.
In this case, artificial insemination or enhanced treatment is prescribed. Tetrasopermia and IVF are not incompatible.
What Kruger deviations are considered abnormal?
There are some norms from which men's health should not deviate:
- a forked, twisted, short tail, which is responsible for sperm motility, otherwise it will not be able to “fight” for the egg;
- an undeveloped head of the spermatozoon, a double, thickened or deformed head does not allow it to break into the egg in order to exclude the birth of an inferior baby;
- a thick, thin, or improperly attached cervix prevents passage into the egg and makes the sperm immobile.
Some experts believe that an improperly developed sperm cell will not be able to penetrate the egg, which excludes pathologies, but modern research into the causes of the birth of children with diseases suggests otherwise.
Treatment of pathology
Teratozoospermia is not a sentence for a woman and her husband, the birth of children is possible when contacting a competent specialist.
First of all, problems should be found, due to which a man cannot have children, doctors focus on the treatment of this disease.
For example, inflammatory processes often occur in the body, the doctor prescribes a course to get rid of this problem, and the percentage of viable spermatozoa increases.
It is also often necessary to treat 3 degrees (dilation of the veins of the spermatic cord).
Sometimes it is enough to drink a course of vitamins, because beriberi can cause the production of abnormal material. Often, a small amount of vitamin D gives rise to abnormal behavior of spermatozoa.
The following drugs are usually prescribed:
- Speman;
- SpermActin;
- Speroton;
- sperm plant.
Usually, the treatment lasts three months, after which the doctor sends the spouses for re-tests.
Opportunities for successful IVF in teratozoospermia
When the treatment has not brought the desired result, the doctor prescribes IVF for teratozoospermia. What are the chances of getting pregnant and having a healthy baby?
Before the appointment of this procedure, a woman is examined, since not everyone can take the necessary drugs.
If pathologies of the structure of the pelvic organs were found, as well as diseases of the kidneys, liver and intestines, IVF is contraindicated, it is replaced.
Too thin or too full ladies are also at risk, so before deciding on artificial insemination, you need to think about your own health.
After the specialist gave the go-ahead for IVF, the woman is prepared before the procedure.
It happens like this:
- causing superovulation (production of not one, but several follicles);
- collecting material and placing it in a special environment;
- observation of spermatozoa, if they behave sluggishly, is performed;
- egg and sperm care for several days;
- transfer of the body to the uterus;
- passage control.
Sometimes several embryos take root at once, with the consent of the parents, a substance is introduced into unnecessary ones that splits its cells.
Artificial insemination for teratozoospermia is performed when the percentage of healthy spermatozoa exceeds 6.
This is a safe way to get pregnant, however, the chances are the least high compared to in vitro fertilization.
Conclusion
- this is a diagnosis that many couples are afraid of, but modern medicine has found a way out in which the most healthy spermatozoa are selected, merged with the egg and injected into the uterus - IVF and ICSI.
These methods will be effective only if they are carried out correctly, specialists from many clinics improve their skills in this area, so now men diagnosed with teratozoospermia can become dads.
Video: Video from a microscope - oligozoospermia, teratozoospermia
Teratozoospermia or teratospermia - an increase in the percentage of abnormal sperm in male semen. According to the criteria of the fifth edition of the World Health Organization (WHO) 2010 guidelines, the condition is diagnosed when more than 96% of spermatozoa with abnormal morphological features are present in the ejaculate.
Teratozoospermia is classified according to the appearance of a defect in the head, middle part or tail of the spermatozoon. In the normal state, the head has a regular oval shape 5 microns in length, which is connected to the middle part and a long straight tail. The disproportionate shape of any part of the sperm indicates a pathology, which is often the cause of infertility.
Medicine has various treatment options that help conceive a child with abnormal sperm morphology. The chances of success depend on the rest of the ejaculate parameters, since teratozoospermia is often combined with a low number or insufficient sperm motility. The simultaneous presence of three problems in the medical literature is called oligoasthenoteratozoospermia.
Causes
The causes of abnormal sperm morphology are varied and in most cases unknown.Scientists presume that changes occur at the last stage of spermatogenesis - the process of sperm production. At the last stage, sperm with already formed genetic content undergoes a process of maturation, followed by release.
Chemotherapy and radiation therapy alter sperm production, increasing the risk of teratozoospermia. Before the procedure, the doctor must advise the patient to keep the frozen sperm sample in case the man wants to become a father after undergoing treatment.
Similarly, pharmaceutical drugs that increase or decrease testosterone levels (LHRH agonists or antagonists) affect sperm production by preventing proper sperm formation.
Other possible factors affecting sperm quality:
- drugs to treat high blood pressure or depression;
- infectious diseases of the reproductive system;
- injuries and other problems with the testicles;
- smoking, excessive consumption of alcohol and drugs;
- testicular disorders (varicocele, cryptorchidism);
- diabetes mellitus and nutritional problems;
- habits that increase the temperature of the testicles (frequent visits to the bath, wearing tight clothes).
Symptoms
The main sign of teratozoospermia is the absence of pregnancy in a partner for 1 year of regular unprotected sex.Other signs and symptoms depend on the disease causing the infertility. Varicocele is manifested by the formation of a tumor on the scrotum, caused by the expansion of the veins of the spermatic cord. Cryptorchidism is the absence of one or both testicles in a man.
The number of normal spermatozoa is estimated using a morphological study. After receiving the results, the laboratory assistant determines the type and severity of teratozoospermia based on the strict Kruger criteria:
- Mild form: normal sperm count 10-14%.
- Moderate: 9% to 5% of sperm are normal.
- Severe form: less than 5% of spermatozoa have good morphology.
Teratozoospermia index
The parameter is used to determine the number of defects present in male germ cells. A spermatozoon may have an anomaly in only one or several parts at once.To calculate the teratozoospermia index (ITI), the following formula is used: TIZ = (c + p + q) / x. Variable notation:
- c = head defects;
- p = defects in the middle part;
- q = tail defects;
- x = total number of abnormal spermatozoa.
- ITI close to 1: one part affected;
- ITZ close to 2: two parts affected;
- ITZ is close to 3: the head, middle part and tail are affected.
Diagnostics
After a year of unsuccessful attempts to conceive a child, a couple should contact a family planning center for a consultation with a reproductive specialist. Additionally, a man should see an andrologist, a woman should visit a gynecologist.At the first visit, the doctor clarifies the circumstances of the appeal and conducts a physical examination. The specialist begins by looking for signs of a hormonal imbalance: a high body mass index, excess hair on the chest. The size and shape of the testicles are also examined. After the examination, a series of tests are prescribed.
Since teratozoospermia is asymptomatic, the standard analysis for a man is a seminogram - a comprehensive analysis of sperm. The laboratory assistant examines the main parameters of spermatozoa: quantity, concentration, motility and morphology.
A normal spermatozoon has an ideal oval head and a long tail responsible for its movement. WHO has established strict criteria for assessing the morphology of each part of the spermatozoa:
- Head: Should be oval in shape and well visible. The two parts of the head must be clearly differentiated: the acrosome and the nucleus. The acrosome is distal and easily separated from the rest of the head. The width and height are 3.5 and 2.5 µm.
- Middle part: has a linear position. The neck must be attached to the axial side of the head (opposite end of the acrosome). The length is 4.5 µm.
- Tail: the thinnest part of the spermatozoon, 50 microns long.
In addition to a comprehensive analysis of sperm, the attending physician may prescribe 5 additional studies:
- Blood test. It helps to exclude the influence of infectious diseases on fertility and analyze the hormonal state of the body.
- genetic tests. The genetic material is used to look for abnormal genes that can cause abnormalities in sperm.
- Venography of the scrotum. A relatively safe test to determine the location of veins in the scrotum. During the examination, a dye is injected into the patient and several x-rays are taken. The images help determine if a man has a varicocele.
- Ultrasound of the scrotum. Used to find tumors and other structural changes in the testicles or scrotum.
- MAP test. The test is indicated in the absence of significant deviations in the spermogram.
Treatment
Men with teratozoospermia have a chance of naturally conceiving a child in the absence of concomitant symptoms that affect sperm quality: a normal number and sufficient sperm motility.If there is no pregnancy for a long time, the patient should take the doctor's recommendations in an attempt to improve sperm morphology. A balanced diet, exercise, elimination of diseases that affect reproduction are the main components in the treatment of teratozoospermia.
The genetic origin of the pathology or the presence from birth reduces the chances of pregnancy to 0. The doctor is obliged to explain to the man that teratozoospermia is often not treatable, and the drugs on the market to restore fertility have unpleasant side effects and do not guarantee 100% success.
Healthy lifestyle
Men with teratospermia should exercise regularly and stop smoking and drinking alcohol.A dietitian should be consulted for a balanced diet. The diet must contain foods rich in antioxidants and essential amino acids: apples, plums, eggplant, beans and potatoes.
Omega-3 fatty acids found in seafood and green vegetables are beneficial for male reproductive health.
The effect is enhanced by the intake of biologically active additives: Spermaktin Forte, Fortezh or Profertil. The components included in their composition increase the amount of sperm, increase the fertility of spermatozoa and improve the general condition of the body. It is also recommended that men take supplements with vitamin E, which is a powerful antioxidant, and folic acid.
TOP 5 harmful products for men:
Name
Harmful properties
Reduces sperm count and reduces potency.
Smoked meats
Lead to disruption of the genital organs.
Suppresses the production of male hormones, in particular testosterone.
Fat meat
It leads to the deposition of fat in the vessels, preventing a normal erection.
Carbonated drinks
Often the use leads to the destruction of tooth enamel and impotence.
Methods of artificial insemination
The chances of natural conception in a man with teratozoospermia are extremely low. If the couple is faced with the task of pregnancy, the specialist is obliged to offer options for the use of assisted reproductive technologies.Intrauterine insemination (IUI)
A method of primary assisted insemination, which is recommended for mild teratozoospermia (3-4% of sperm is normal), with normal sperm count and motility.The IUI option is suggested by the attending physician if the woman is under 35 years of age and has no history of abortion. The procedure is painless, performed without the use of anesthesia and painkillers. The efficiency of intrauterine insemination is 9.6%.
In Vitro Fertilization (IVF)
The method of conceiving a child with IVF is recommended for men with an average degree of teratozoospermia (1-2% of spermatozoa are normal), in case of persistent failures with IUI and the age of the partner up to 42 years.The procedure consists in extracting an egg from the female body for artificial insemination. Within 5 days, the resulting embryo develops in the laboratory and is transferred using a thin catheter into the uterus. The duration of implantation takes no more than 15 minutes, anesthesia is required.
The average pregnancy rate after IVF is 30-40%.
Intracellular sperm injection (ICSI)
ICSI is used when a severe degree of teratozoospermia (less than 1% of normal spermatozoa) is detected, when other methods of fertilization have been unsuccessful.The procedure consists in selecting the fastest sperm with normal morphology for subsequent insertion into the egg using a microneedle. After artificial insemination, the resulting embryo is placed in an incubator with optimal temperature and humidity for 3-5 days.
Before the embryo transfer, the woman begins taking hormones to create a receptive environment. The transfer process takes no more than 15 minutes, after which a state of rest for 10 minutes is required. On the 15th day after the embryo transfer, you should re-appear at the treating specialist to confirm or not pregnancy.
The chance of successfully conceiving a child after ICSI is 90-95%.
Intracytoplasmic sperm injection (IMSI)
IMSI is recommended for patients with severe teratozoospermia (less than 1% of normal sperm) after 2-3 failed ICSI fertilization attempts.The advantage of the technique is the use of a microscope with a high degree of magnification for a detailed study of the morphology of spermatozoa. A special lens achieves a magnification of 6600 times, allowing the laboratory assistant to fully see the potential defects present in each sperm cell.
The fertilization procedure is similar to ICSI. The only difference is the duration, which reaches 2-5 hours.
Psychological help
The diagnosis of abnormal sperm morphology announced during the consultation with the doctor can cause serious stress, which leads to the development of concomitant complications.A man is able to throw out anger at his wife and doctor, show dissatisfaction with the need to participate in medical procedures and take tests. There is a loss of self-esteem, temporary sexual dysfunction and poor erection. Many men feel guilty about depriving their spouse of motherhood.
In Russia, social support for an infertile person is practically absent. The male gender tends not to show emotions and close in on itself.
Do not be afraid to talk about the problem with the closest relatives and people who have experienced a similar situation. In difficult cases, you should contact a psychotherapist or psychologist. Consultation with a specialist will help to identify and solve emotional problems, overcome feelings of fear and resolve the situation. Therapy is more effective when you visit a doctor together with your spouse.
Answers to frequently asked questions
Can abnormal sperm morphology cause miscarriage? Poor sperm morphology does not lead to miscarriage after fertilization of the egg, the embryo attaches to the wall of the uterus without any problems. However, if the semen contains a genetic abnormality, spontaneous abortion may occur. Can a sperm cell with an abnormal morphology fertilize an egg? Yes, if teratozoospermia is mild (normal sperm count 10-14%). In moderate or severe cases, the use of ICSI or IMSI methods will be required, when the introduction of spermatozoa into the egg is carried out artificially. What does morphology 0 mean? If the percentage of normal sperm is 0, the man is diagnosed with severe teratozoospermia. The only possible way to conceive a child is through IVF/ICSI. The content of the article:What is "teratozoospermia" andrologists and reproductologists know. This is a condition in which the number of morphologically defective spermatozoa is increased (more than 50%) in the ejaculate, one of the common causes of male infertility.
Teratozoospermia is diagnosed by semen analysis.
Why there are pathologically altered spermatozoa in the semen - the reason for each patient is different. The prognosis of pregnancy depends on the severity, the ability to eliminate the cause and a number of other factors. In some cases, teratozoospermia is considered idiopathic, i.e. Why is this happening, can not be installed. Teratozoospermia is popularly called the "malformed sperm disease".
Sometimes the disease does not manifest itself in any way and is diagnosed when the partner does not become pregnant, or there are missed pregnancies and miscarriages in the early stages.
Note that defective forms of spermatozoa are present in a small amount in seminal fluid in an absolutely healthy man, and this is not considered a pathology.
Is it possible to get pregnant with teratozoospermia? Yes, some couples succeed, but without examination and treatment, there is a certain risk.
Violation of morphology in teratozoospermia
Table. Classification of indicators of ejaculate
Teratozoospermia and other pathologies
The structure of the sperm
It is known that the sperm cell consists of a head, neck, body and tail. If in any of these parts deformation occurs, we are talking about a violation of morphology.
The worst in terms of prognosis for the treatment and onset of pregnancy is the pathology of the head. Spermatozoa with a defective head can retain a very mobile tail, have rectilinear translational movements and retain the ability to fertilize, only the resulting zygote is either not viable, or the pregnancy is self-terminated against the background of genetic pathology or possible deformities of the embryo.
That is why achieving an independent pregnancy, knowing that there are no normal forms of sperm in the seminal fluid, is a very risky undertaking. The combination of teratozoospermia with asthenospermia and oligospermia significantly reduces the onset of pregnancy.
In these cases, it is safer to resort to assisted reproductive technologies, because repeated missed pregnancies and miscarriages can lead to partner infertility. For the same reasons, insemination for teratozoospremia is not the best choice.
About what is better for this pathology: IVF, ICSI or something else, we will tell a little later.
So, what does more than 50% of spermatozoa look like with teratozoospermia:
The violation of morphology is manifested in the following:
Anomalies in the structure of the head.
Decrease, increase, bifurcation, absence of an acrosome, any abnormal forms, presence of vacuoles, alteration of chromatin.
Neck changes.
Thickening or, conversely, too thin neck, curvature - the most favorable type of pathology, the chances of independent pregnancy after appropriate treatment are quite high.
tail pathology
Doubling, shortening, absence, broken tail, elongation, too pronounced tortuosity, uneven thickening lead to the fact that spermatozoa do not move towards the egg, but stand still, or make atypical movements, sometimes in the opposite direction. They die after a certain time. Normally, the tail of male germ cells is even.
What is the Teratozoospermia Index (ITI)
Otherwise - the index of multiple defects, the index of multiple anomalies.
To obtain a numerical value, all defects are summed up and divided by the number of morphologically altered spermatozoa. The number is 1 when 1 male gamete has 1 defect, the index can be equal to 3 if there is an anomaly in the development of the head, neck and tail per spermatozoon. Normal values are from 0 to 1.6.
With the help of ITS, the fertilizing ability of sperm is predicted and management tactics are determined.
If the index is greater than 1.6, they speak of a violation of fertility.
Causes of teratozoospermia
Here we will talk, rather, about predisposing factors:
All types of venereal diseases,
Long-term diseases of the male reproductive organs, urogenital tuberculosis.
Conditions requiring surgical correction: varicocele, cryptorchidism.
Genetic diseases, which are characterized by violations in the spermogram.
Exposure to X-rays and ionizing radiation.
Prolonged intoxication of the body associated with the abuse of alcohol, nicotine, drugs.
Contact with harmful substances: aniline dyes, pesticides, salts of heavy metals.
environmental factor.
Viral lesions.
Tumor processes in the male genital organs.
Fermentopathies.
Frequent visits to saunas and baths, wearing tight underwear, trousers.
Taking certain medications that have a negative effect on spermatogenesis.
Undergoing chemotherapy for tumors.
Hormonal disorders, including those due to the use of anabolic steroids.
Diseases of the thyroid gland.
Preference for unhealthy food with a high content of preservatives and dyes.
Much depends on the compensatory capabilities of the organism. For some patients, it is enough to remove themselves from stressful situations, stop drinking alcohol, introduce foods enriched with vitamins (especially selenium and zinc) into the diet, as the spermogram records an increase in full-fledged forms of spermatozoa.
The prognosis worsens when not only the male infertility factor is present in the couple, but also the female one.
Diagnostic measures
Diagnosis of teratozoospermia occurs according to the general principle of diagnosing male infertility and includes the following activities:
KLA, OAM, blood sugar.
spermogram with teratozoospermia with the definition of ITZ,
hormonal profile,
MAP test,
special examinations before IVF (EMIS, DNA fragmentation, etc.),
sperm biochemistry,
Ultrasound of the scrotum with Doppler, TRUS,
testing for STIs, preferably PCR - diagnostics,
inoculation of biomaterial on flora,
testing for tuberculosis, HIV, syphilis,
MRI, CT, testicular biopsy as needed.
Mandatory consultation of a geneticist with the passage of special screenings.
The examination scheme is selected individually, it is possible to conduct additional tests, this is especially true for couples that are included in the IVF protocol.
Treatment of teratozoospermia
The scheme directly depends on the cause. If teratozoospermia is accompanied by varicocele or cryptorchidism, surgery is performed.
With a confirmed genetic pathology, if there are no normal forms of spermatozoa in the ejaculate, most likely, they will offer to use donor sperm.
All inflammatory diseases are treated with the appointment of antibiotics, taking into account sensitivity, immunomodulators, drugs that stimulate spermatogenesis and local therapy.
Hormonal disorders will require consultation of an andrologist - an endocrinologist.
When the cause of teratozoospermia is not clarified, multivitamin complexes with minerals are used, agents that stimulate spermatogenesis.
The most commonly prescribed drugs:
spermaktin,
Iodomarin,
Vitamins E, A and C,
Folic acid,
Gerimaks with ginseng,
Tykveol,
Verona,
carniton,
Zinc and Selenium - containing complexes, etc.
Very good reviews on the forums from the use of bee products, especially royal jelly and bee pollen, to normalize the qualitative and quantitative composition of sperm. Useful seafood, nuts, dried apricots, raisins, dates, lemons, celery. From protein products, it is useful to include in the diet lean meats, poultry, fish, milk and lactic acid products, eggs, cheese.
You can try herbal medicine.
A decoction of the root of the roots of elecampane improves spermatogenesis.
What assisted reproductive technologies are best used for teratozoospermia
Teratozoospermia and IVF
If, after the treatment, the morphology shows less than 4% of normal sperm according to Kruger, and it happens that even 1%, you should not hope for an independent resolution of the situation.
In the standards approved by WHO for assessing the quality and quantity of sperm, the Kruger assessment is preferred. The norm is a reference concept, it is believed that normal sperm should be from 30 to 85%. If the number of complete gametes is less than 4% in vitro, the probability of fertilization is reduced. This indicator is taken into account before the planned IVF.
ICSI MAX
ICSI is intracytoplasmic (intracellular) injection of sperm into an egg. If there is a risk that fertilization will not occur in vitro, the ICSI MAX method is used for teratozoospermia.
There are absolute and relative indications for this technique.
Absolute:
The number of motile spermatozoa is critically low,
the prevalence of morphologically altered forms,
the presence of only immature germ cells, but there is a possibility of obtaining normal spermatozoa using TESA when puncturing the testicle or epididymis, or isolating normal forms of spermatozoa from the urine when semen is thrown into the bladder,
after cryofreezing, there is a deterioration in morphology,
several failed IVF attempts in history with no penetration into the egg,
immunological infertility with the death of male gametes in the female genital tract.
Relative:
The borderline state of the ejaculate, when all indicators are at the lower limits of the norm.
Infertility is idiopathic (with an unknown cause).
A large number of oocytes obtained after stimulation. This occurs with polycystic changes in the ovaries, while the quality of female germ cells suffers.
After stimulation, oocytes received little. Since rather aggressive preparations are used to avoid a repeated stimulation procedure, the likelihood of pregnancy with ICSI MAX increases.
age factor.
Combined infertility.
MAX - what is it
Literally, the abbreviation stands for "microscopic analysis of the quality of spermatozoa", i.e. quality male gametes are differentiated from unusable ones.
If the sperm does not have morphological abnormalities, the probability that it has the correct set of chromosomes is much higher.
Cell evaluation is performed using state-of-the-art optical equipment. The process takes place in 3 stages:
1. All defective gametes with unsuitable shapes and sizes are rejected in transmitted light.
2. An analysis of the structures of the head takes place, acrosomal pathologies are excluded, chromatin is assessed. The study is carried out using phase contrast.
3. Using modulation contrast, the content of the sperm head is assessed.
All together leads to the fact that even cytological pathologies are cut off, and the spermatozoa selected for ICSI are of the highest quality.
What is PICSI
The technique is similar to ICSI, the selected sperm is additionally tested for the degree of maturity using hyaluronic acid.
Note that even with the most high-tech microscopes, it is impossible to give a visual assessment of the maturity of the germ cell.
IMSI
Before artificial insemination, the spermatozoon is examined at a powerful magnification of 6000 times, while with simple ICSI it is only 400 times.
Morphological parameters are evaluated. In prognostic terms, the pathology of the tail is considered more favorable than the presence of vacuoles in the head. If all gametes with pathology are visualized, it is appropriate to perform MCOME
MSOME- a method for studying the morphological features of spermatozoa, which has been used for several decades.
There is a classification based on morphology:
1. Spermatozoa not suitable for pregnancy.
2. Spermatozoa that contribute to spontaneous abortion.
3. Spermatozoa with a high probability of developing abnormalities.
4. Spermatozoa without morphological pathology.
MSOME allows you to choose the best genetic material, which increases the chances of a successful pregnancy with male factor infertility.
Summing up
Unfortunately, some couples have to go through many trials to become parents. You can not stop on the way to the goal. Medicine does not stand still, with teratozoospermia there are successes after conservative therapy. If the long-awaited pregnancy has not occurred, you can use the methods of assisted reproductive technologies. How exactly will artificial insemination be carried out for you - will be decided by a whole team of specialists - reproductologists.
