Spermatogenesis processes continuously occur in the ovaries of men, starting from puberty. A huge number of sperm are formed, some of which even normally contain certain defects and structural abnormalities. In the study form they are indicated as pathological forms of sperm. Let's look at the main characteristics and what can affect conception.
Macroscopic examination of sperm
The initial evaluation of sperm is carried out without the use of a microscope. This way you can evaluate:
- Liquefaction of the ejaculate.
When semen is released from the urethra, it is liquid. The secretion of the seminal vesicles is added to it, which gives its consistency a certain thickness. The secretion of the prostate gland works in such a way that normally, after 10-30 minutes, the ejaculate is almost completely liquefied.
If after an hour the liquefaction of sperm has not occurred, this may indicate a pathology of the prostate gland, which does not produce enough enzymes. Such a viscous consistency of sperm reduces the mobility of sperm; they practically do not move and during sexual intercourse they will die in the vagina, never reaching the uterus and fallopian tubes.
Important! If the container with sperm is shaken for a long time, spontaneous liquefaction of the ejaculate may occur. This should be taken into account by men who are not tested in a laboratory. When transporting the container with ejaculate, do not shake it, otherwise the results may be incorrect.
- Viscosity.
How to determine viscosity: a glass rod is dipped into the ejaculate and the length of the resulting thread is measured. In addition, viscosity can be determined with a wide-base pipette. The ejaculate is collected into a pipette and the length of the thread is measured as it passively flows out of the pipette hole. Normal viscosity is no more than 20 mm. Increased viscosity is when the length of the thread is more than the specified value.
Increased viscosity of sperm indicates that male reproductive cells cannot move normally in such sperm. They are immobile or inactive and, therefore, there is practically no chance of natural conception.
Important!Recent research indicates that increased viscosity may be associated with certain urogenital tract infections in men.
- Volume.
A spermogram is taken after 3-5 days of sexual abstinence. Under such conditions, the volume of sperm obtained should be in the range of 3-6 ml.
A decrease in sperm count may indicate:
- blockage or narrowing of the vas deferens;
- inflammation of the prostate;
- testicular diseases;
- hormone imbalance, etc.
A decrease in sperm volume is called oligospermia, and its absence is called aspermia.
- Blood in the ejaculate.
Blood (red blood cells) or its breakdown products give sperm a pink, brown or red hue. If the shade of semen changes and blood is suspected, the ejaculate is examined using special test strips.
These test strips contain a special reagent. Red blood cells or hemoglobin cause the test area to turn a certain shade, which makes it possible to detect blood in the semen.
When are there red blood cells in the ejaculate:
- benign and malignant neoplasms of this area;
- inflammation of the prostate and seminal vesicles;
- infections of the genitourinary system, etc.
Normally, there is no blood in semen. Its presence in the ejaculate is called hemospermia. It can be false (with microtraumas) and true (with inflammation and tumors).
Important! Blood in semen is an alarming symptom that requires additional research to determine the cause of the problem.
- Leukocytes.
Normally, semen may contain single neutrophils. With any inflammatory process, their number progressively increases.
This can be diagnosed by applying ejaculate to a test strip with a certain reagent. Upon contact with neutrophils, the color of this strip changes.
- In addition, the spermogram is checked for the acidity level (pH), the presence of bilirubin, and the color and smell are assessed. Some of these parameters do not have diagnostic value (smell, color) and are performed as a tribute to traditional sperm examination.
Microscopic analysis
Evaluation of sperm parameters under a microscope is carried out after its liquefaction. It is performed in several stages. For research, a device with special permission is required. This study evaluates the following ejaculate parameters:
- Sperm motility.
Male reproductive cells, depending on their mobility, are divided into 4 classes. According to WHO criteria, the presence of more than 50% of class A and B sperm or more than 25% of class A is considered normal.
- Agglutination.
This is the process of sperm gluing together in different areas (tails, heads, etc.). Normally this process should not occur. The appearance of agglutination is associated with immunological reasons.
- Aggregation (pseudoagglutination).
This is an accumulation of immobile sperm along with mucus and other pathological inclusions. This and the previous indicator are calculated and recorded separately.
- Presence of mucus.
There is normally no mucus in the spermogram. It appears during inflammatory processes in the testicles, seminal glands and ducts. Mucus prevents sperm from moving normally, which leads to decreased motility and infertility.
- Amyloid and lipoid bodies.
With the secretion of the prostate, various bodies (grains) enter the sperm: amyloid, lipoid (lecithin) and spermine crystals.
(or lecithin grains) are small shiny grains that are normally found in large quantities in sperm. During inflammatory processes in the prostate, their number decreases or disappears altogether. Lecithin grains (lipoid bodies) are an indicator of normal prostate function.
Amyloid bodies- round formations, the appearance of which may indicate chronic inflammation of the prostate.
These bodies can be examined by performing a special staining of the sperm under a high-resolution microscope.
- Bacteria and protozoa.
Under a microscope, you can see Trichomonas - these are round protozoa that cause trichomoniasis in humans.
Single cocci can normally be found in the spermogram. If their number increases and other microflora (pyogenic cocci and anaerobes) are found in the ejaculate, this is a sign of an inflammatory process.
- Macrophages.
Macrophages are large round cells. Normally, macrophages are absent from sperm. Single and multiple macrophages can be found in the ejaculate of patients with acute and chronic infectious diseases of the reproductive organs. When a patient develops macrophages in the ejaculate, he is first examined for the presence of hidden genitourinary tract infections.
Sperm morphology
Male reproductive cells have a certain structure. The specialist knows how this or that area should look and what dimensions it should have. Any deviations from the norm are considered to be a pathological form of sperm. The following defects of male reproductive gametes are distinguished:
- Head defects.
Pathology of the head can be different: abnormalities in the shape of the head (pear-shaped, conical, etc.), problems with the size of the head (large or small), double and multiple heads, heads with an abnormal location of the nucleus, heads with an acrosome abnormality, etc.
Male germ cells with pathology of the head according to WHO criteria and morphology according to Kruger are pathological forms that cannot fertilize an egg. Exceeding their quantity creates problems with conception and causes male infertility.
- Cervical and body defects.
Incorrect attachment, size or shape - all this is a pathology.
- Tail pathology.
Short, long, double, widened and other abnormalities of the tail prevent the sperm from moving normally and reaching the egg.
Questions for the doctor
Question: What are the “round cells” in ejaculate?
Answer: Blood, cocci, epithelium, macrophages and others. All cells except sperm cells are collectively called “round” cells.
Question: My husband’s spermogram revealed cocci. After treatment of prostate inflammation, analysis showed single cocci. This is fine?
Answer: Single cocci can be present in healthy sperm. If multiple cocci, anaerobes and other microflora are found in the ejaculate, this is a sign of inflammation.
Question: How to correctly lipoid bodies or lecithin grains
Answer: Lecithin grains are a synonym for the term lipoid bodies. These formations are contained in the prostate secretion in large quantities. A decrease in their level indicates inflammation of the prostate gland.
Normal sperm contains a certain amount of pathological forms of sperm, which can be detected after a spermogram. It is important that the number of these forms does not exceed the established parameters and that there are no “harmful” inclusions in the sperm. If a problem is detected, additional tests are performed and the cause of the disease is treated.
Pathological forms of sperm are determined using a spermogram. Today you will find out the reasons for the development of the abnormal structure of gametes and what is the likelihood of conceiving a child in a married couple.
Statistics now, unfortunately, show sad reproductive rates for the strong half of humanity.
Only 60% of men, after conservative treatment of various abnormalities associated with seminal fluid, can restore the ability to conceive.
The composition of live bait is influenced by many factors, among the main ones are poor ecology, poor lifestyle, bad habits and substances. Let's look at it in detail below.
Why does abnormal sperm development occur?
The fact that a man has poor seminal fluid with developmental abnormalities can only be revealed when planning a pregnancy and if a married couple is unable to conceive a child.
The defectiveness of gametes is determined using a spermogram.
It can be taken in all medical institutions specializing in pregnancy planning, or in independent laboratories.
A spermogram shows the pathology of sperm, their structure, structure, mobility and how likely it is to prevent infertility through conservative treatment. It is necessary to prepare for it so that the results of the analysis are not distorted.
How to take a spermogram correctly:
- Avoid sexual intercourse for 5 days, do not masturbate.
- The collection of ejaculate is carried out in specialized laboratories with special rooms where a man collects it through masturbation.
- You can collect the analysis at home, but provided that you have time to bring it within 1 hour in a special container (take it in advance).
It is with the help of analysis that the diagnosis and picture of sperm pathology will be determined. There are several types of the disease - aspermia, oligospermia, azoospermia, ostenozoospermia, teratozoospermia.
Deformed cells can occur for the following reasons:
- Disruptions in the endocrine system and hormonal background of men.
- Stress, prolonged depression, psychological shock.
- Heredity and location at the genetic level.
- Age-related changes. A man over 38 years of age has a risk of developing anomalies.
- STIs, viral and bacterial infections can adversely affect the results.
- Bad habits, alcoholism and drug addiction, as everyone knows, destroy the structure and structure of sperm.
- Testicular injuries, inflammatory processes of the scrotum.
- Varicocele, hydrocele, orchitis and even an inguinal hernia can affect the seminal fluid.
- Working with harmful substances and chemicals.
Therefore, it is necessary to take care of your health at any age in order to avoid infertility or the birth of a long-awaited child with severe disabilities.
Teratozoospermia
One of the causes of infertility in men is head and tail defects, which means “ugly sperm” and the percentage of such specimens in the ejaculate should be no more than 15-20%.
This pathology can be either temporary or fraught with the risk that a man will remain infertile forever. Therefore, the help of a qualified doctor is necessary when planning a pregnancy.
With this anomaly, sperm in large numbers have a defective morphology, i.e. irregular shape of the head and tail. At what time does the anomaly appear?
Sperm abnormalities occur regardless of age-related changes (although this is also an important factor); many reasons influence the development of sperm in the ejaculate.
Above we described the main ones. With teratozoospermia, the conception of a child is reduced to zero; often with this pathology, IVF (artificial insemination) is offered if conservative treatment does not help.
With this method, the healthiest and most active are selected, there is no risk of conceiving a baby with pathologies. This type of abnormal development is difficult to treat. The prognosis is bleak; according to statistics, 10% of couples remain infertile.
Tests and diagnostics
The norm of living creatures per 2 ml of ejaculate is only 40 million. Of these, there are a large number of defective, inactive and dead ones. When the ejaculate decreases, there is a possibility of infertility.
To do this, a spermogram is prescribed in several stages to exclude the presence of problems with reproductive function in a man, as well as other additional tests. You need to contact an andrologist for advice.
What to take?
- Ultrasound of the testicles and genitourinary system.
- Blood for hormones.
- STIs, HIV, syphilis.
- Analysis of genetics and heredity, for the presence/absence of extra chromosomes.
Decoding the norm of sperm in the ejaculate
Table of sperm norms in ejaculate
| Indicators | Norm |
| Volume | 2 or more ml |
| Color | Grey, white-gray |
| Smell | Specific (raw chestnut) |
| pH (hydrogen value) | 7-8 |
| Liquefaction | Up to 1 hour |
| Structure of ejaculate (viscosity) | Up to 0.5 cm |
| Density | Per 1 ml/120 million |
| Total sperm count | 40-600 million (Density P x Volume V) |
| Sperm motility | Category A - normal sperm (>50%); Category B - slow sperm (up to 20%); Category C - lazy sperm with oscillatory movements (up to 20%); Category D - immotile sperm (up to 20%). |
| Morphologically normal sperm | Capable of fertilization, according to scientists, should be at least 50% |
| Live (motile) sperm | >50% |
| Immature sperm | No more than 5% |
| Sperm agglutination | Sperm glued together should not appear in the spermogram at all. |
| Leukocytes | Up to 4 in sight |
| Red blood cells | No |
| Amyloid bodies | No |
| Lecithin grains | No |
| Slime | No |
It is quite important that the spermogram is read by a qualified laboratory assistant-spermiologist; the diagnosis and prescription of treatment depend on the correct interpretation. Therefore, if you have been diagnosed with infertility, do not despair; retake it in another independent laboratory.
Treatment
Treatment of a disease in which abnormal sperm develops requires a professional and conservative approach. First of all, the technique is aimed at preventing the occurrence of deformation and death of sperm in the ejaculate.
Quite common when interpreting a spermogram is the following dynamics of frequently identified sperm pathologies:
- inactive – up to 80% of detected deviations;
- dead – 40%;
- sluggish – 40-50%;
- deformed – up to 20%.
For severe infertility in men, artificial methods are offered (IVF PIXI and ICSI).
Types of therapy:
- Surgical intervention (for example, for varicocele).
- Stimulating sperm production with the help of medications - “Spematon”, “Spermaktin”, “Speman”, “Tribestan”, “Verona”, “Viardo”.
- Micro-TESE testicular biopsy to obtain sperm using an invasive method.
- Vitamin therapy.
In many cases, when the underlying disease is eliminated, the number and quality of cells returns to normal.
In parallel with treatment, it is necessary to lead a healthy lifestyle, give up bad habits and, if possible, prevent working with chemicals and radioactive substances. Subscribe to our website. Learn a lot of new information. Be healthy!
Typically, during ejaculation, a man releases from 2 to 10 ml of sperm - its volume depends on the frequency of sexual intercourse, constitution, emotional state and other factors. In a healthy man, 1 ml of ejaculate contains 60-120 million sperm. In addition to the sperm themselves, it contains spermatogonia and spermatids, the precursor cells of sperm. Among the noncellular elements, lecithin bodies, prostatic crystals, pigment grains, and fatty inclusions are distinguished. The secretion of the prostate liquefies the ejaculate; together with the secretion of the seminal vesicles, they form a favorable nutrient medium for sperm.
Sperm morphology abnormalities
In the spermogram of a healthy man, along with normal ones, there are also pathological forms of sperm, but not more than 20-25%. Exceeding this number can lead to infertility or congenital deformities of the fetus. With pathology in the ejaculate, the number of normal sperm decreases and the number of motile forms may decrease.
Absent (spermatozoa are normal or with mild pathology) - pathology of the tail - anomalies of the acrosome (reduction in size, absence) - change in the shape of the nucleus - immature forms (with a cytoplasmic drop) - pathologies of the neck and midsection - doubling or change in the head section
Pathologies of the sperm tail affect their mobility (they have impaired movement or are completely immobile). Abnormalities of the acrosome affect the ability of a sperm to fertilize an egg. An increase in cells with nuclear pathology in the ejaculate may be associated with a deterioration in the morphology of embryos and, as a result, with a decrease in the pregnancy rate. The presence of sperm with a cytoplasmic drop may indicate a violation of the sperm maturation process. Anomalies of the neck and midsection, as well as changes in size and duplication of the head, as a rule, are recorded last.
Main pathologies of sperm
AZOOSPERMIA (a...+ zoo...+ sperm), the absence of sperm in the ejaculate, but the presence of their preceding forms - spermatogenesis cells, along with secretion products of the prostate gland and seminal vesicles. Should be distinguished from aspermia. With azoospermia, spermatogenesis (division or maturation of sperm) is inhibited at various stages. This can be caused by congenital (genetic) disorders, toxic effects (radiation, alcohol, harmful chemicals, certain medications, etc.), and various diseases of the body. Various types of obstruction of the vas deferens as a result of inflammatory diseases of the genital organs can also lead to azoospermia. Azoospermia is one of the causes of infertility in men, which requires examination and treatment by a doctor.
AKINOSPERMIA (I... + Greek kineo- set in motion + sperm; synonym - akinesia), complete immobility of living sperm in sperm and their inability to fertilize.
The reasons for this phenomenon have not been sufficiently studied. Presumably, they could be diseases of the gonads (most often inflammatory), hormonal deficiency, etc.; in laboratory conditions - sudden hypothermia of sperm during storage, exposure to direct sunlight, accidental entry of chemicals into a test tube with sperm, receiving sperm in a condom, etc. When akinospermia is established, a 2-3-fold thorough examination of the ejaculate is necessary (see spermogram).
ASPERMIA (a... + sperm), the absence of spermatozoa and spermatogenesis cells in the ejaculate. During sexual intercourse, the release of fluid consisting of the secretion of the prostate gland, seminal vesicles, and the feeling of orgasm are preserved, which distinguishes aspermia from aspermatism. However, the amount of fluid released during ejaculation , very insignificant, and the feeling of orgasm is weakly expressed and erased. The cause of aspermia is the congenital absence or underdevelopment of the vas deferens or their blockage due to inflammatory processes or trauma to the genital organs (obstructive aspermia), as well as the inability of the testicles to produce sperm (testicular aspermia). Testicular aspermia is a sign of secretory infertility as a result of genetic sex abnormalities. In such cases, treatment is futile. Aspermia, caused by blockage of the vas deferens, is the cause of excretory infertility and requires plastic surgery.
ASTHENOZOOSPERMIA (Greek asthe neia - impotence, weakness + zoo... + sperm; synonym - asthenospermia), a decrease in the number of motile forms, as well as the speed of movement of sperm in the semen. The number of sedentary or immobile forms exceeds 30%. The causes of asthenozoospermia have not been fully elucidated, but the role of changes in the chemical composition of sperm plasma, a decrease in the content of carbohydrates or other energy substances in it, as well as a decrease or disappearance of the negative electrical charge of sperm, and the deposition of various microorganisms on their surface, especially mycoplasma infection, is assumed. The cause may also be various disorders of spermatogenesis, as a result of which not only a smaller number of sperm are formed (oligozoospermia), but also pathological, abnormal forms (teratozoospermia), incapable of full movement. Asthenozoospermia can lead to infertility in men, and therefore consultation with a urologist, medical examination and treatment are necessary.
HEMOSPERMIA (Greek haima, haimatos - blood + sperm), the appearance of blood (erythrocytes) in the sperm, which at the same time acquires a red or “rusty” color. Most often, blood enters the sperm from the seminal vesicles or prostate during their inflammatory or tumor diseases. Blood can also appear in the ejaculate from the urethra, vas deferens or epididymis, in the presence of stones in the prostate gland, rupture of small varicose veins, papillomas, seminal tubercle and for other reasons. Hemospermia does not reduce the viability of sperm, but indicates a disease of the genital organs, which makes it necessary to conduct a urological examination to determine the source of bleeding and prescribe appropriate treatment.
HYPOSPERMIA (hyp... + sperm), see Oligospermia.
NECROSPERMIA (necr...+ sperm), the presence of non-viable sperm in the ejaculate. Necrospermia can be reversible (false), when the sperm can be revived, and irreversible (true). The latter is extremely rare, its causes are not clear and it cannot be treated. There is also partial necrospermia, in which there are less than 20% of live sperm. Necrospermia due to sperm immobility is often mistaken for akinospermia.
The phenomenon of necrospermia is sometimes explained by the effect of the dye on sperm or the accidental ingress of chemicals into a test tube with sperm during its examination. To avoid artifacts, samples are taken repeatedly. In cases of true necrospermia, childless spouses should be recommended artificial insemination with donor sperm or adoption. False and partial necrospermia, which can be caused by asthenozoospermia, akinesia and other factors, can be treated with medication.
NORMOSPERMIA (normal... + sperm; synonym - normozoospermia), a condition of the body in which all spermogram parameters are within normal limits. The content of sperm in the ejaculate of a healthy mature man is 60-150 million/ml, of which at least 70% are mobile. Normospermia indicates a normal spermatogenesis process and high sperm viability. However, the latter does not guarantee 100% pregnancy in a gynecologically healthy woman. The reasons for possible infertility may be psychological in nature, often unconscious or inexplicable due to insufficient development of knowledge at the moment.
OLIGOZOOSPERMIA (olig... + zoo... + + sperm), a decrease in the number of sperm in the ejaculate. Should be distinguished from oligospermia.
Sperm is considered normal if 1 ml contains 60-150 million sperm (see Normospermia).
There are several degrees of oligozoospermia: I - 1 ml of ejaculate contains 60-40 million sperm; II-40-20 million; Ill-20-5 million; IV - less than 5 million. Currently, the lower limit of the norm has been revised and, according to the World Health Organization (WHO), is 20 million sperm per 1 ml of ejaculate. It is believed that this number of sperm may be sufficient for pregnancy to occur, provided there is a normal amount of sperm in 2-5 ml of ejaculate and high fertilizing ability. It is only necessary that a certain number of sperm enter the uterus to the egg, the so-called “fertile pool”, which will create the conditions for one sperm to penetrate into the egg and fertilize it. If pregnancy does not occur in a healthy examined woman, then oligozoospermia, regardless of the degree, should be considered as a pathological condition. The causes of oligozoospermia are considered to be hormonal deficiency leading to impaired spermatogenesis, fasting, vitamin deficiencies, alcohol and nicotine abuse, chronic poisoning with lead, mercury and their derivatives, carbon dioxide, exposure to X-ray and radioactive radiation, chronic inflammatory processes (chlamydia, mycoplasmosis, etc.). Oligozoospermia can be caused by physical and mental fatigue, stress, conflicts, as well as frequent ejaculation in any form (intercourse, masturbation, wet dreams). A healthy person is also characterized by fluctuations in the sperm count, but they do not exceed 10-15% in one direction or another. Deciding on whether oligozoospermia is a cause of infertility is within the competence of the physician.
OLIGOSPERMIA (olmg...+ sperm; synonyms - hypospermia, hypovolumia), a decrease in the volume of ejaculate ejected during ejaculation. Should be distinguished from oligozoospermia.
The volume of ejaculate usually does not exceed 1-1.5 ml, while the norm is 2-5 ml. Among the causes of oligospermia, the most often cited are hormonal deficiency, various congenital, genetic diseases (for example, Klinefelter syndrome), aspermia and azoospermia, chronic prostatitis of various origins, mental fatigue, conflicts, alcohol, and poor nutrition. Oligospermia can also be observed in healthy men with too frequent sexual intercourse or masturbation. Therefore, we can talk about true oligospermia only if the man, before receiving sperm for analysis, abstained from any form of ejaculation (intercourse, masturbation, emission) for 4-5 days and collected it without loss in a laboratory vessel. Those suffering from oligospermia, as well as other disorders of spermatogenesis, should consult a doctor.
PIOSPERMIA (Greek ruon - pus + sperm), the presence of pus in the sperm. The sperm has a greenish-yellow color and often has a foul odor. Leukocytes, microorganisms, decaying cells, etc. are found in it. Pyospermia is often combined with hemospermia, oligospermia, and teratozoospermia.
Sources of pus can be any part of the genital organs, but most often the urethra, seminal vesicles, epididymis, and prostate gland.
Toxins (poisonous substances) released by microorganisms have a damaging effect on sperm, increasing the number of pathological forms and disrupting sperm motility, which naturally reduces the fertilizing ability of sperm. Pyospermia is always a sign of an inflammatory process in the male genital area, which requires urological examination and treatment.
POLYSPERMY (poly... + sperm; synonyms - multisemy, multipolation), persistent release during ejaculation of an increased number of sperm in the ejaculate (over 250-300 million/ml). Sometimes the term “polyspermy” is used to refer to a large volume of ejaculate - more than 8-10 ml. At the same time, all spermogram parameters are within normal limits. It is believed that the cause of this condition is a violation of spermatogenesis.
Increased spermatogenetic activity of the seminiferous tubules of the testicles leads to the appearance of sperm with low fertilizing ability. Quite often, with polyspermy of the husband, a woman may have miscarriages or lack of pregnancy. For the purpose of conception, it is recommended to dilute sperm with special solutions and artificially introduce it into the uterus for the purpose of insemination. Medical tactics for treating male infertility with polyspermy are not clearly defined.
TERATOZOOSPERMIA (Greek teras, teratos-freak, deformity + zoo... + sperm; synonyms - teratospermia, anisozoospermia), the presence in the ejaculate of pathological, abnormal forms of sperm in an amount exceeding 50%. The causes of teratozoospermia are the same as for oligozoospermia and asthenozoospermia - pathological conditions or unfavorable environmental factors leading to impaired spermatogenesis.
According to some data, artificial insemination with sperm with a large number of degenerative sperm leads to severe developmental disorders of the fetus in 45-65% of cases and is often the cause of miscarriage and miscarriages. If there are a large number of pathological forms of sperm in the ejaculate, the spouses should temporarily refrain from conceiving, and the husband should undergo the necessary treatment from an andrologist.
Sperm can deteriorate significantly with smoking, drinking alcohol, and poor nutrition. She is sensitive to various diseases, including sexually transmitted diseases. Therefore, before conceiving a child, it is advisable to undergo appropriate examinations and exclude pathologies; this can be done using a spermogram.
Patologija_spermy._osnovnye_terminy.txt · Last changes: 2012/06/21 22:58 (external change)
The treatment process should begin with a clarification of the diagnosis. A spermogram, which is prescribed during the examination, gives the doctor a lot of information about the patient’s reproductive cells. In most cases, the pathology that causes infertility is reflected in the test results.
Interpretation of spermogram and types of sperm pathologies
Normal spermogram indicators are considered:
- acidity from 7 to 8;
- volume – minimum 2.5 ml;
- liquefaction time – up to 1 hour;
- sperm viscosity – 2 cm;
- total sperm count – 60,000,000 or more;
- the level of mobility is expressed by a letter designation (A – motile and fast sperm; B – movement is present, but slow (non-linear, linear); C – cells move only in place; D – immobile sperm).
- the presence of at least 25% type A cells and more than 50% A+B.
- from 30 to 70% of sperm without pathologies;
- leukocytes in sperm – 10 6 in 1 ml;
- absence of agglutination process of red blood cells;
- epithelial cells - in single numbers, and spermiogenic cells - no more than 4% of the total number.
The study may reveal the following forms of sperm pathology:
- Azoospermia– diagnosed in the complete absence of sperm in the sample taken. It can be obstructive (there are sperm in the testicles, but they are not ejaculated due to obstruction of the vas deferens) and secretory (there are no sperm in the testicles).
- Asthenospermia– sedentary male reproductive cells. The diagnosis is established if there are more than 60% unhealthy sperm in the analysis.
- Pyospermia– this is the presence of a large number of leukocytes and pus in the sperm, which indicates an inflammatory process in the genitourinary system.
- Teratospermia– detection in the analysis of a large number of pathological sperm from a morphological point of view.
- Anejaculation– this is the complete absence of ejaculation in a man.
- Necrospermia– non-living spermatozoa in semen.
- Oligospermia– insufficient sperm volume during ejaculation.
- Cryptospermia– detection of motile spermatozoa in single numbers in the analysis.
- Oligozoospermia– the number of sperm in the ejaculate is less than 15,000,000 per ml.
Classic methods of treating infertility in men
The type of treatment depends on the cause of infertility, which is divided accordingly into the following types:
- surgical;
- auxiliary techniques;
- hormonal;
- treatment of sexual disorders;
- medicinal;
- physiotherapy.
Surgical treatment of infertility in men
They resort to it if the cause of infertility is tumor-like swelling of the veins that provide blood flow from the testicle. Varicose veins of the spermatic cord are removed through surgery, due to which blood flow in this area is normalized.
Important: Surgery for varicocele will be effective only if it is performed on time. When the testicles atrophy due to the lack of normal local blood circulation, it is almost impossible to restore a man's ability to conceive.
Surgical treatment is also indicated for obstructive infertility, when there is obstruction of the spermatic cord due to trauma, orchitis (in childhood). During this intervention, the surgeon restores the patency of the vas deferens by removing the obstructed segment or creating a new one. The success of the operation depends entirely on the length of the pathological part of the cords that needs to be removed or replaced.
Conservative treatment of infertility in men
This method is used in cases of immune, hormonal or secretory infertility. Only a doctor is competent to prescribe certain drugs and their dosage after confirmed infertility in a man.
In particular, after identifying the causes of the disease, the following remedies can be used:
Note:For male infertility, treatment with folk remedies cannot replace the main one. In particular, in this regard, the method of hirudotherapy is quite popular among patients. Its use is allowed only in combination with other techniques, taking into account the fact that there are quite conflicting opinions among doctors about its effectiveness. Leeches are used to improve local blood circulation and the process of spermatogenesis, but in case of male infertility, treatment with folk remedies should be agreed with the attending physician.
Physiotherapy
For infertility, the following local procedures are prescribed:
- electrophoresis;
- laser;
- transurethal microwaves;
- phonophoresis.
Physiotherapeutic treatment has a positive effect on prostate trophism, blood supply to the genital organs, sperm productivity and quality, and eliminates hidden inflammatory processes.
Treatment of sexual disorders
Erectile dysfunction is treated with medication by taking a group of PDE-5 inhibitors, such as:
- Levitra;
- Viagra;
- Cialis.
Injection of Alprostadil into the urethra and intracavernosal injections are also practiced.
If the drugs do not have an effect or the patient has contraindications to taking them, then they resort to a surgical solution to the problem:
- local embolization of arteriovenous shunts;
- implantation of a penile prosthesis;
- endovenous stenting of penile arteries;
- vacuum constriction.
Premature ejaculation is treated using the “squeeze technique” and “stop-start” (delayed ejaculation). Among the medications, centrally acting drugs are used (tramadol, clomipramine, fluvoxamine, fluoxetine, paraxetine, sertroline). Vasoprostan, Emla cream, etc. are used topically. As surgical treatment, they resort to neurectomy of the dorsal nerve of the penis, selective resection of the spinal nerves.
Assisted reproductive techniques for treating male infertility
They are used when obstruction of the vas deferens cannot be corrected, in the presence of retrograde ejaculation and other similar problems that cannot be cured. Among the most popular methods, they most often resort to infertility. An egg is removed from a woman's ovary, and in a laboratory it is fertilized with sperm taken from the man's testicle or bladder.
Modern reproductive technologies
It should be understood that these techniques are used for severe or incurable male infertility. But even in this case, modern medicine can give a man a chance to become the father of a healthy child.
Treatment of infertility in men using the TESA method
This technology is used when there is a complete absence of sperm in the patient’s semen. It is carried out in the form of a needle biopsy under visual control in areas of active spermatogenesis. Testicular puncture is performed very carefully to take the required amount of materials.
ICSI
This is a procedure for the embryologist to select the correct one, taking into account the morphological parameters of the sperm. It is immobilized and placed in a thin needle, which is inserted 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 sperm for fertilization. Preliminary selection of PICSI is based on the selection of male germ cells, taking into account their behavioral characteristics in an environment that is as close as possible to the egg. The method is advisable to use in cases of male infertility, unsuccessful IVF attempts (2-3 times), low quality embryos.
IMSI
It is an innovative method of fertilizing an egg in the treatment of male infertility. Spermatozoa undergo very careful selection by selection under multiple magnification (x 6300). The embryologist selects the best sperm using a digital image that is displayed on a monitor. Afterwards, it is injected directly into the egg itself, which greatly increases the success of fertilization, and the chance of pregnancy increases to 70%.
More detailed information about sperm pathologies and modern methods of treating male infertility is presented in the video review:
Yulia Viktorova, obstetrician-gynecologist
The morphology of sperm is determined using spermogram analysis. This test is one of the first to be prescribed if a couple cannot become pregnant for a long time. Based on the results of the analysis, the doctor determines the reason why it is impossible to conceive a child. There can be quite a few reasons. For example, a man’s ejaculate may simply contain few sperm, or they may have various structural defects. Depending on the problem, the doctor gives recommendations and prescribes treatment.
What diseases do sperm pathologies lead to?
The sperm of a healthy man should contain no more than 50% of sperm with poor morphology. Some experts admit the possibility of natural fertilization even in the presence of 80% of abnormal sperm in the semen. So a bad spermogram is a very relative concept. Much depends on the properties of the ejaculate as a whole, for example, the ratio of the number of sperm with pathology to the total volume of sperm. If a man has too much or dead sperm that seriously predominates over sperm with normal morphology, natural conception may not occur. Much depends on how the various parameters are determined and the analysis is deciphered. Only a qualified specialist is able to establish the reasons due to which each existing pathology appeared, and then prescribe treatment.
If a man’s sperm contains a large number of sperm with a certain pathology, this can lead to the development of the following disorders.
Akinospermia. In men with this pathology, the semen does not contain motile sperm. If sperm is immobile, natural conception is impossible. The main reasons why immobile sperm appear in male sperm are as follows:
- work that is harmful to health, for example, in which a man is regularly exposed to various types of radiation;
- alcoholism, smoking and drug addiction;
- autoimmune and hormonal disorders.
When taking an analysis, sperm must be placed in a clean and specially designed container. If you donate sperm into a dirty container or condom, or if it gets too cold or too hot before the test, the test results will definitely be distorted. Therefore, in order to confirm pathology, the analysis must be taken according to all the rules and preferably in several places.
With asthenozoospermia, the ejaculate contains too many sperm with low speed and mobility. There may be varying degrees of sperm immobility. Most often, abnormal and immobile sperm appear due to hormonal problems, inflammatory, infectious and viral diseases, exposure to high temperatures and radiation, the production of antibodies that attack sperm, alcohol abuse, etc. Quite often, the reasons why the male body produces abnormal sperm remain unknown.
If there are a large number of non-viable sperm in the ejaculate, necrospermia is diagnosed. It can be irreversible and reversible, false and partial. In cases of irreversible necrospermia, the couple is most often recommended adoption or insemination with donor sperm. If it is reversible, treatment is prescribed.
With teratozoospermia, the semen contains many spermatozoa with a structural disorder. Many factors can lead to this. First of all, these are bad habits and various infectious and inflammatory processes. Most defective sperm are unable to reach the egg. If just such a sperm penetrates into her, the fetus will most likely begin to develop incorrectly, and the woman will have a miscarriage.
Various abnormalities in sperm morphology can develop if antibodies are present in the ejaculate. Such antibodies can block the process of spermatogenesis, interfere with the normal movement of sperm, disrupt cleavage and lead to many other problems. Antisperm antibodies bind to the surface of sperm and prevent them from performing their function. The production of antibodies can begin spontaneously, but in most cases it is provoked by trauma to the genital organs, viral and bacterial diseases.
What structural damage may occur?
If sperm morphology is disrupted, the following defects may be observed:
- irregular head shape;
- incorrect tail length;
- thickening and bending of the tail;
- absence of a chromosome;
- presence of vacuole cells in the head.
It is important to remember that a relatively small number of abnormal sperm is not a disorder. When taking the analysis, you can rely on the data provided on the form. However, only a doctor can make an accurate diagnosis.
The main causes of violations
Most often, the appearance of sperm with abnormal morphology is associated with the insufficient ability of the male testicles to produce high-quality sperm. Surgeries and injuries, radiation, inguinal hernia, and chemotherapy can lead to a decrease in their function.
The development of pathologies can be observed against the background of dilation of the veins of the spermatic cord and varicocele. Currently, the effect of varicocele on the process of spermatogenesis has not been fully studied, however, cases of decreased sperm morphology in men with this disease are observed quite often.
Disturbances can appear against the background of inflammation of the genitourinary system, which includes prostatitis. A variety of viruses and sexually transmitted diseases lead to the development of pathologies.
Endocrine system disorders are sometimes an indirect cause of such deviations. Against this background, its quality may decline and deteriorate.
Possibility of natural fertilization
In many cases, deterioration in sperm morphology is not an indicator of infertility, but any abnormalities have a negative impact on pregnancy. The more sperm with poor morphology in the ejaculate, the lower the likelihood of natural fertilization and a full pregnancy.
Problems with fertilization occur due to the fact that sperm with an abnormal structure cannot fertilize the egg normally. For example, if the structure of the tail is abnormal, the motility of the sperm is significantly reduced, which makes it difficult for it to “travel” to the egg. With pathology of the head, the consequences can be even more serious. Such sperm are not able to penetrate the egg. If the sperm succeeds, then, as a rule, the development of the fetus occurs with anomalies, and the woman has a miscarriage in the early stages.
In many cases, for natural conception it is necessary to use various assisted reproductive technologies.
Treatment Options
Before starting any actions aimed at improving sperm morphology, it is necessary to undergo a comprehensive andrological examination. It includes the following activities:
- ultrasound examination of the prostate and scrotal organs with Doppler;
- bacterioscopic analysis of sperm;
- blood test for hormone levels;
- detailed spermogram.
Having the results of all these tests in hand, the doctor will be able to determine the causes of the development of existing pathologies and draw up a treatment program.
Treatment will primarily be aimed at eliminating the causes that led to the development of pathological processes. Most often, the causes are a variety of diseases of the male genitourinary system: infections, inflammation, prostatitis, varicocele, etc.
It is very important not to neglect and treat all diseases in a timely manner, so as not to deal with their complications in the future.
In treatment aimed at, it is important to exclude congestion in the pelvis. Stagnation occurs in men who lead a sedentary lifestyle. To restore the normal formation of spermatogenesis, a man needs to be active and eliminate bad habits from his life. You need to eat right. The diet should be rich in vitamins and microelements that help improve sperm quality (zinc, selenium, etc.). It is important to exercise. Swimming, running and race walking have the most beneficial effect. It is necessary to exclude fatty foods. The diet should primarily consist of fresh fruits and vegetables, seafood, legumes, honey, and grains. The doctor may prescribe a variety of vitamin complexes and dietary supplements (speman, spemactin, folic acid, etc.). You can start taking any medications only as prescribed by your doctor, adhering to the prescribed dosages.
Quite often, treatment of male infertility, which has developed against the background of various pathologies of sperm morphology, is carried out using assisted reproductive technologies. They increase the likelihood of successful conception and normal pregnancy.
For minor deviations, the method of artificial insemination may be recommended. Before the procedure, the ejaculate undergoes special treatment, which helps to increase the quality of the seminal fluid and increases the likelihood of a successful pregnancy.
If the ejaculate contains too many pathological sperm, the use of in vitro fertilization and a number of auxiliary procedures is considered more effective and justified. Such techniques allow you to select the most mature and morphologically correct sperm from the entire ejaculate. By carefully selecting healthy sperm, the likelihood of abnormal fetal development and miscarriage is reduced.
Modern methods make it possible to effectively combat male infertility, and assisted reproductive technologies increase the likelihood of a successful pregnancy. However, even with such methods, it is highly recommended for a man to improve the quality of his sperm. Particular attention should be paid to proper, regular and balanced nutrition with a sufficient amount of essential microelements and vitamins.
Every man should undergo regular preventive medical examinations. Timely detection of the problem and treatment can prevent the development of many complications that can harm men’s health.
Boys in childhood should be shown to a surgeon. During such examinations, various abnormalities (phimosis, undescended testicle, etc.) will be excluded or promptly eliminated.
After unprotected sexual intercourse with an untested partner, if you suspect various infections, inflammations, etc., you must consult a doctor, get tested and, if necessary, undergo a full course of treatment. You should stop drinking alcohol, smoking and taking drugs.
Therefore, if your partner does not become pregnant after a year of unprotected sex, you both need to see a doctor. At the same time, you need to eliminate all bad habits and stressful situations. Maintaining a normal weight, eating a healthy diet, and getting enough (not excessive) physical activity are also very important for good sperm quality.
Follow all doctor's recommendations. Be prepared for the fact that infertility treatment is a very lengthy process. However, modern medicine has extensive experience and a rich arsenal for solving this problem, so in most cases you can count on a positive result. Be healthy!
