Many couples face problems conceiving a child. Often the only thing possible way To give birth to a child and save the family is in vitro fertilization (IVF). But because of its high cost, most spouses lose last hope, while the state offers free help in carrying out the procedure under the compulsory medical insurance policy. Back in 2013, IVF became one of the medical services, which are provided free of charge as part of the compulsory health insurance program. But then the only indication for the procedure was the impossibility of conception due to female pathologies. Recently, male factor infertility has also entered the category of reasons according to which a couple can receive government assistance for artificial insemination.

What is male factor infertility? What could be the causes of infertility in men? What are the features of IVF for male factor infertility and is IVF free of charge under compulsory medical insurance for male infertility? We will answer these questions in this article.

What is male factor infertility?

The male factor of infertility is discussed in the case of partial or complete absence of male fertility, as a result of which pregnancy does not occur in healthy women. The pathological condition of the body may not have any external signs, and a man will begin to guess about him only after unsuccessful attempts conception with regular sexual activity without contraception. If you suspect infertility, you should immediately contact an andrologist for examination. In men, the following types of infertility are distinguished:

• Secondary - if he already has children with previous wives, and in a subsequent marriage a healthy woman does not become pregnant;
• Primary - there were never children.

To restore reproductive function, men can use various options therapy - medication, surgery, or lifestyle changes. The choice of treatment method directly depends on the cause of the pathology as determined by the andrologist.

What is the cause of infertility in men?

The list of factors that cause reproductive dysfunction in representatives of the stronger half of humanity is quite wide. About 25-45% of cases occur with varicocele. An accurate diagnosis, as well as the causes of the pathology, can only be established based on the results of a spermogram and a number of related tests. In 55-75% of men, infertility is associated with:

• Obstruction/absence from birth of the vas deferens;
• Testicular cancer/inflammation;
• Prostatitis and other inflammatory processes in the genitourinary system;
• Cryptorchidism;
• Poor quality sperm;
• Erectile dysfunction;
• Hormonal imbalances;
• Congenital pathologies;
• Sexually transmitted diseases;
• Infectious diseases;
• Injuries in the genital area;
• A course of chemotherapy;
• Poor nutrition, low content proteins in food.

The reproductive function of men is negatively affected by the current ecological situation, hazardous conditions labor, availability bad habits(smoking, drug addiction, alcohol abuse), constant physical and psychological stress.

Is IVF free under compulsory medical insurance for male infertility?

IVF under compulsory medical insurance is a fairly expensive procedure. In order to provide an opportunity more childless couples to conceive a baby, from January 1, 2015, male factor infertility is included in the list of indications for this type of fertilization, carried out under compulsory health insurance. In Russia, a federal quota for IVF has been established, which amounts to 106 thousand rubles. This amount under the compulsory medical insurance policy includes several procedures:

• Stimulation of ovulatory function of the ovaries;
• puncture;
• Growing an embryo;
• Direct procedure in vitro fertilization.

Add to list free services The compulsory medical insurance policy does not include preliminary treatment that partners or one of them must undergo before IVF, if such a need is detected. You will also have to pay for donor materials that may be needed for fertilization. If a man's infertility is associated with low sperm quality, this will be an indication for ICSI (introduction of sperm into female egg artificially), which is not included in the list of procedures under health insurance.

Features of IVF for male factor infertility

The federal program provides for the possibility of in vitro fertilization not only for those couples who are in an officially registered marriage. For common-law spouses who wish to conceive a child, this procedure is also available. The procedure for a couple planning to undergo IVF under a compulsory medical insurance policy consists of the following steps:

1. Consultation with specialists.
2. Submission of necessary tests.
3. Compliance with the doctor's instructions for preliminary treatment.

If after full course If the prescribed therapy does not achieve the desired result, the andrologist will be able to diagnose the patient with infertility and issue a referral for an IVF procedure. Only after this can you begin to collect the package of official papers that will be needed for queuing. To carry out the IVF procedure, spouses will need to collect the following documents:

• Compulsory medical insurance policy;
• SNILS;
• Passport;
• An extract from the clinic indicating the diagnosis and ICD-10 code, certified by the signatures and seals of the treating andrologist and the chief physician;
• Forms with the results of laboratory tests confirming the patient’s diagnosis;
• Consent to the processing of personal information.

The specified package of documents will be sent to the regional qualified commission, which selects couples for IVF. Typically, information is considered for no more than ten working (not calendar) days, then specialists will make an official decision, reflected in the minutes of the meeting. Once approved, spouses will be placed on a waiting list for the procedure.

Refusal may occur if a woman is under 22 or over 39 years of age, or she has contraindications to bearing a baby established by a gynecologist. Couples should not apply for permission if both spouses or one of them have drug or alcohol addiction or mental disorders. The commission may also refuse if a man and woman already have a child together.

Patients should be provided with a list of medical centers and hospitals participating in the compulsory medical insurance program where IVF can be done. The couple has the right to independently choose a specialized medical institution from the list, regardless of registration and actual place of residence. If IVF does not bring the desired result several times in a row, the procedure can be repeated - currently there are no legally established restrictions on the number of attempts. This will depend entirely on physical condition couples, as well as psychological mood.

Conclusion

Recently, male infertility, along with female factor infertility, has been included in the list of indications for IVF under compulsory medical insurance. Modern assisted reproductive technologies help overcome infertility caused by these two factors. The likelihood of achieving a positive result in the treatment of male infertility largely depends on the causes of infertility in the couple. Undoubtedly, the more sperm of satisfactory quality can be obtained during the procedures, the higher the chance of success.

Worldwide method IVF (in vitro fertilization) is considered as the main method of treating infertility. It is effective in any of its forms. In addition, IVF is often the only way out for families in which a man is sick.

In vitro fertilization is a relatively new method of treating infertility. It was first used in England in 1978. However, similar attempts were made 200 years ago.

The essence of IVF: sperm meet eggs in a test tube, and then they are implanted in the uterus of an infertile woman or a surrogate mother. If the outcome of the procedure is favorable (pregnancy occurs), there are often cases when twins or triplets are conceived, because multiple eggs are involved in the attempt. At the request of the woman, reduction can be carried out (removal of excess embryos), but it happens that this leads to the death of the remaining ones and subsequent miscarriage.

The success rate of the IVF procedure is approximately 30-35%.

When is it used?

IVF is effective for those forms of infertility when it is not possible to eliminate the cause that prevents conception. For example, after an ectopic pregnancy, when one or both fallopian tubes are removed; after inflammatory diseases when patency fallopian tubes broken and it is not possible to restore it.

In cases where there is not enough sperm or when there are few sperm in it, andrologists have developed methods for obtaining sperm artificially using a puncture or surgery. In case of male factor infertility, it is not necessary to perform IVF; you can simply introduce artificially obtained sperm into the uterine cavity. However, given that this method of obtaining sperm is complex, in this case Using IVF gives you a better chance of success.

How often is it used?

Unfortunately, the IVF method is used infrequently. There are many reasons for this:

firstly, this method of treatment is expensive and is not included in compulsory medical insurance programs, which means it is not available to all patients;
secondly, IVF centers are poorly subsidized by the state and can only be found in large cities.

Survey

If an infertile couple contacts one of the infertility treatment centers, the first stage will be an examination of both partners. A woman usually undergoes an ultrasound, blood tests for hormones, tests for AIDS, hepatitis, and syphilis. A man has a spermogram. If necessary, genetic tests are performed. The examination takes on average 2 weeks. After the examination, a decision is made which method of infertility treatment is indicated for each specific couple.

Hormonal drugs

Before IVF, a woman is prescribed special hormonal drugs that stimulate the growth and maturation of not one or two (as in a normal cycle), but several follicles. This is necessary, since to carry out the procedure you need to have a certain supply of embryos. A woman injects herself daily hormonal drugs. Duration hormonal treatment averages 2 weeks.

Then the woman undergoes follicle puncture. The procedure is performed on an outpatient basis. Using a needle through the vagina under ultrasound guidance, mature follicles are removed from the ovaries. In this way, several eggs are obtained. This procedure is low-traumatic and complications after it are unlikely.

Receiving sperm

If a man is healthy, there will be difficulties in obtaining required quantity there is usually no sperm. In cases where spermatogenesis is impaired, a man needs special treatment.

There are situations when sperm is produced, but it is not possible to obtain it naturally. Then the doctor performs a puncture. This manipulation is performed under anesthesia. It is possible for an egg to be fertilized by a single sperm.

In Vitro Fertilization
Direct IVF is carried out by embryologists in an embryological laboratory. Using modern equipment in special solutions The union of sperm and egg is carried out. After 2-4 days the embryos are ready for the next stage.

Preimplantation diagnosis

Preimplantation diagnosis is a method of examining an embryo obtained as a result of IVF before it is transferred to the uterus. With the help of modern genetic technologies, it is possible to examine an embryo consisting of only 4-8 cells. Using this diagnostic method, gross malformations of the embryo and hereditary chromosomal diseases, such as Down's disease, hemophilia, etc. In addition, with the help of preimplantation diagnostics, you can determine the sex of the unborn child.

Transfer of embryos to the uterus

Transferring embryos to the uterus is the simplest procedure of the entire method. Using a special elastic catheter, 2-3 fertilized eggs are transferred into the uterine cavity. This does not require pain relief.

After the egg transfer, the woman can go home to work. No special mode is required. However, some IVF centers provide sick leave. Naturally, after the procedure, women are not recommended to undergo heavy physical and emotional stress.

Pregnancy

Pregnancy with IVF occurs in 30-35% of cases. Out of 20 pregnancies that occur, an average of 18 end in childbirth. After the introduction of embryos, the level of hormones in the blood must be monitored once every three days. After 12 days, a pregnancy test is performed. In case of multiple pregnancy, at the request of the woman, reduction is performed - removal of “extra” embryos.

Childbirth during pregnancy after IVF is no different from normal. In cases where the cause of infertility is a woman’s illness, childbirth is carried out taking into account specific disease. This has nothing to do with the method of fertilization.

According to doctors, those conceived in vitro are no different from others. However, there is an opinion that such children study better, but get sick more often. Doctors believe that this may be due to excessive guardianship of the desired child.

Number of IVF attempts

As is known, pregnancy occurs only in 30-35% of artificial insemination attempts. The question arises: what about those 70 out of 100 women who do not become pregnant? How many times can IVF attempts be made?

In every special case this issue is resolved individually. The IVF procedure itself is quite safe and can be repeated many times. For some couples, pregnancy occurs after 8-10 attempts. There is a reasonable limit on the number of procedures; it is determined by the doctor depending on the specific situation. In repeated attempts, it is possible to use embryos that were not used the previous time. Unfortunately, no one can guarantee pregnancy with IVF.

Egg donation

By puncturing the follicles, more eggs than necessary may be obtained. In these cases, healthy women are offered to become donors. Their eggs will be used in cases where the patient does not have her own eggs - after removal of the ovaries, during menopause, with altered ovaries, etc.

To encourage donation, women who agree to donate their eggs pay less to attempt IVF. Naturally, egg donation is anonymous; the donor has no rights to the child born from her egg.

Donor eggs are fertilized with the sperm of the husband of the woman into whom they are implanted. In this case, hormonal preparation for IVF is not required. In most IVF centers, excess fertilized and unfertilized embryos are kept frozen, regardless of whether they will be used in other women or not. The shelf life is determined to be 55 years.

IVF in menopause and in women with ovaries removed
Pregnancy and its successful gestation are possible in almost all cases when a woman has a uterus.

Patients aged 40-50 years can also have children. Typically, women of this age are forced to turn to IVF - if a child dies, in late marriages, and so on. If pregnancy is not contraindicated for a woman for health reasons, then the IVF method can be used.

The first trimester of pregnancy is usually accompanied by hormone replacement therapy, then it is canceled and the pregnancy proceeds independently.

Complications during IVF

The main complication faced by doctors is multiple pregnancy. In addition, sometimes a miscarriage may occur after embryo reduction. A complication of hormonal therapy carried out before IVF can be ovarian hyperstimulation syndrome. It manifests itself as abdominal pain and bloating. If diagnosed early, it can be corrected. It is important if any discomfort During hormonal therapy, consult a doctor immediately. Ectopic pregnancy It is rare with IVF.

Male infertility is almost as common as female infertility. Often this pathology develops asymptomatically, and the man is unaware of his illness.

If pregnancy does not occur, and the woman is healthy, you should think about the possibility of infertility in the man. Currently, treatment of male infertility is quite effective; A timely examination will help prescribe adequate treatment. Therefore, knowledge of the questions, which doctor treats male infertility, how and where to get a man checked for infertility, will help in this situation. All you need is your desire and patience.

Lack of pregnancy in a woman with male infertility occurs in approximately 40% of cases. In 20% of cases, there is a problem with childbirth with disorders of the reproductive system in both spouses. Such statistics should entail questions: what is the male factor of infertility associated with, how to most accurately determine infertility in men? Diagnosis of infertility should be accessible and testing for infertility in men should be carried out in any clinic. But not all patients know that there is a specialist andrologist - a doctor for male infertility. Educational work in terms of elucidating the causes of male infertility and its prevention should be carried out starting from adolescence.

When talking with a patient, a male infertility doctor must find out whether the man has children. If there were previously children, but in currently a man complains of the inability to conceive a child, then in this case they talk about 2nd degree infertility in men, that is, secondary. If there is 1st degree infertility in men (primary), then it is assumed that the man has never had children from any of his partners. There are many more reasons for grade 1 infertility in men.

Causes of infertility in men

What is the cause of infertility in men? Let's look at the main factors.

• infectious and inflammatory diseases of the genitourinary organs. Chronic urethritis, prostatitis, carriage of ureaplasma, chlamydia, mycoplasma cause infertility (for example, chlamydia in men and infertility are often combined);
• congenital anomalies of the male genital organs;
• obstruction of the vas deferens and the inability of sperm to enter the urethra. In this case, male infertility occurs due to inflammatory processes epididymis and vas deferens. There may be a unilateral obstruction or a bilateral one with a complete absence of sperm in the tests;
• dilatation of the veins of the testicle and spermatic cord (varicocele). In this case, male infertility develops with varicocele;
• autoimmune spermatogenesis. In this case, there is a masculine immunological infertility associated with the presence of antisperm antibodies;
• systemic diseases - tuberculosis, chronic renal failure, bronchial asthma, diabetes, mumps (mumps). In the event of a complication during mumps in the form of orchitis, infertility in men after mumps is diagnosed;
• infertility of unknown origin, which occurs in 5% of cases. In this case, there is male infertility, the causes of which have not been clarified by all available diagnostic methods. It should be noted that there are common causes of female and male infertility - these are chronic infections genitourinary system: trichomoniasis, ureaplasmosis, gonorrhea.

Types of male infertility

Depending on the reasons, there are following forms infertility:

• obstructive form;
• genetic infertility in men;
• immune infertility in men;
• hormonal infertility in men;
• secondary infertility in men.

Male infertility: azoospermia

Azoospermia is the absence or severe deficiency of sperm in the ejaculate. Diagnosing male infertility (azoospermia) is only possible when laboratory research: spermogram, biopsy, genitography.

Obstructive azoospermia occurs when the patency of the vas deferens is obstructed. This condition may be congenital or acquired (inflammation, trauma). With non-obstructive azoospermia ( secretory form infertility in men), sperm are not produced in the testicles. This condition can also be congenital (anomalies in the development of the testicles) and acquired (the effects of chemotherapy, the consequences of orchitis, varicocele, epididymitis).

The optimal method of treating the obstructive form of male infertility (azoospermia) is the restoration of the vas deferens. It is possible to perform IVF for male factor infertility using ICSI. Sperm for this procedure is obtained from a biopsy of the testicles or epididymis.

Genetic infertility in men

Genetic diseases in men are the cause of infertility in 30-50% of cases. Various gene mutations reduce sperm motility and disrupt their structure. Klinefelter syndrome (extra X chromosome) is a common genetic disorder. Mutations lead to impaired spermatogenesis, and among the external signs a man has a small size of testicles. It has been established that mutation of the Y chromosome leads to azoospermia and oligozoospermia.

Male immunological infertility

Immune infertility in men is currently a poorly understood form of infertility. Treatment of immune infertility in men is a complex and ineffective process. Male immunological infertility is treated with the use of cytostatics, enzymes, glucocorticoid hormones and plasmapheresis. Most effective way overcoming autoimmune infertility in men it is IVF using ICSI.

Male infertility after mumps (mumps)

A connection has been noticed: past illness mumps (mumps) and infertility in men. Male infertility after mumps occurs because the virus affects the testicles in boys, which is accompanied by severe inflammation (orchitis). However, this does not mean that in all cases mumps and infertility in men are associated with each other. Not all boys who have had mumps become infertile. Male infertility after mumps develops only with severe orchitis.

The same can be said about a viral disease such as rubella. Infertility in men is diagnosed if the disease occurs during puberty, and orchitis was noted during the illness. As a rule, if the disease was suffered in childhood (up to 5 years), then no changes in reproductive function are noted.

Diagnosis of infertility in men (how to determine infertility in men)

Diagnosis and treatment of male infertility are interconnected, since the subsequent treatment method chosen depends on the accuracy of the diagnosis. How to test a man for infertility? It is necessary to consult a doctor for male infertility. Moreover, you should first do a test for infertility in men, and then examine the woman. A spermogram is the main test for infertility in men. At different forms male infertility there will always be changes in the spermogram. Therefore, testing for infertility in men begins with sperm donation.

Sperm analysis for infertility in men determines the total number and activity of sperm. If abnormalities are detected in the spermogram, a microbiological examination of the sperm is prescribed. Next, to clarify the diagnosis of “male infertility,” tests are carried out: hormonal and genetic studies. Big role When diagnosing male infertility, ultrasound and x-ray diagnostics of the pelvic organs are used.

Ultrasound diagnostics makes it possible to determine infertility in men if it is associated with abnormalities in the structure of the testicles, prostate gland or with developmental abnormalities. How to determine infertility in men if it is associated with the patency of the vas deferens? In this case, they resort to x-ray diagnostics using contrast.

Clinical stages of varicocele, like possible reason male infertility are immediately detected when examining a man in normal condition or after physical activity. At the subclinical stage there are no visual manifestations. How to determine infertility in men, which is associated with varicocele in the subclinical stage? Dopplerography is used for this. If the diagnostic techniques used do not establish the cause of infertility, then there is a suspicion of male immunological infertility. How to test a man for immune infertility? For this purpose, a MAP test of sperm and blood, a postcoital test and a latex agglutination test are performed.

Signs of male infertility

It must be said that the male infertility clinic and obvious signs male infertility is often absent. This is the whole problem. How to recognize infertility in men if nothing bothers them? Boys and men feel completely healthy, and only after several years family life Questions arise as to why there are no children and which spouse is to blame.

The first signs of infertility in men in the future can be suspected in the presence of cryptorchidism in a newborn. To preserve spermatogenesis, surgical treatment is recommended childhood. Timely treatment has a beneficial effect on the growth of the testicles, and their functions are restored.

Congenital hypogonadism, which manifests itself in adolescence delayed sexual development can also be considered a sign of infertility in men in the future. Identification of primary hypogonadism and replacement therapy most often restores reproductive function. In male infertility, symptoms can be considered small, underdeveloped testicles and external signs of eunuchoidism: obesity, short stature, hair growth female type. You should pay attention to these signs and consult a urologist or endocrinologist.

Since in male infertility there are often no symptoms, when planning a marriage, young people need to go to family planning centers, undergo an examination, and exclude the male factor of infertility. And if tests indicate male infertility, it is necessary to take all possible measures to eliminate it.

How to get rid of male infertility - treatment

Treatment for male infertility depends on the cause that caused it and includes:

• conservative;
• surgical;
• sanatorium-resort;
• assisted reproductive technologies.

Conservative treatment

This method treats immune infertility in men, hormonal infertility and secretory form of infertility in men.

Treatment is carried out mainly with hormonal, immunocorrective drugs and spermatogenesis stimulants. Antiestrogens are also used, which increase the level of gonadotropic hormones and testosterone. For oligospermia, the prescription of non-steroidal anti-inflammatory drugs, pentoxifylline and alpha-blockers, which cause an increase in sperm count, is justified.

Also appointed vitamin complexes with microelements. Vitamins for male infertility have antioxidant activity and are specially designed to restore the male reproductive system. The following vitamins are recommended for male infertility: “Lozenges with zinc”, “Pro formula”, “Men’s formula More than a multivitamin”, L-carnitine (the drug Spermactin), vitamin E, which maintains optimal testosterone levels.

From unconventional methods conservative treatment male infertility can be called hirudotherapy. Hirudotherapy for male infertility can only be recommended in complex treatment, since there are conflicting opinions about its effectiveness. Good effect observed in prostatitis and impaired spermatogenesis. The use of hirudotherapy for male infertility is based on the fact that under the influence of leeches blood circulation and spermatogenesis improve. Sanatorium-resort treatment also refers to conservative methods of treatment.

Surgery

If male infertility is caused by varicocele, then surgery is recommended. Infertility in men is eliminated after removal of varicose veins of the spermatic cord and restoration of normal blood circulation to the testicles. Male infertility with varicocele is successfully treated if the operation is performed on time (before testicular atrophy).

The development of obstruction in the obstructive form of infertility appears after injury to the testicles or as a result of inflammation of the testicle and its epididymis. For example, everyone knows male infertility after mumps. Infertility surgery in men in this case consists of restoring the patency of the vas deferens.

An area that has become impassable is excised or a new way for sperm. The success of reconstructive plastic surgery for infertility in men depends on the extent of the area of ​​obstruction.

IVF for male infertility

If infertility in men cannot be treated, it is recommended to use assisted reproductive technologies. Indications for IVF for male factor infertility are azoospermia (lack of sperm in the ejaculate). Insemination and IVF are also indicated for immunological male infertility.

As you can see, treating male infertility often causes difficulties, so in this situation, a conspiracy against male infertility is unlikely to help. Do not hope for a miracle - pills and medications for male infertility, for help from people far from medicine, contact specialists!

Where can a man be checked for infertility?

The best option is to contact specialized medical clinics or centers where you can not only be examined, but also treat male infertility.

Often people who are interested in male infertility issues visit a forum on this topic. On the forum you can find out where it is best to examine a man for infertility and how to test a man for infertility. In some cases it may be useful information on the topic “male infertility”, reviews of clinics and treatment in them. And perhaps, based on these reviews, you will decide on a doctor, and the diagnosis of “male infertility” will not be a death sentence for your family. Because, scrolling through the pages of the “male factor infertility” forum, you often come across joyful notes from happy spouses who have become parents and grateful reviews addressed to this or that clinic.

Two real questions from the advisory forum page:

“We were going to do IVF, but it turned out that my husband had poor sperm morphology. The gynecologist said that it was necessary to take donor sperm, because even if pregnancy occurs, there will be a miscarriage or abnormalities in the child. What should we do?

"Hello. My husband is diagnosed with cryptozoospermia. Sperm cells of all species except A were found in single specimens. What are the chances of a successful Eco? The reproductive specialist says that SD is necessary, because there may not be enough of your own cells, and your own cells may not develop, then you can use SD. Is this the only way, there’s no way without SD?”

Is this a rare situation? Not at all, I receive questions like this almost every day, which means that the problem is relevant. Let's try to be clear.

So, male factor infertility. With this, everything is more or less clear: if the spermogram is below the standards, then the man is involved in the lack of pregnancy, but if it is higher, then, most likely, you need to look for the reasons from the wife.

However, is sperm quality so important if artificial insemination (IVF) is planned? At first glance, the answer is obvious - YES, it is important. After all, how the embryo will develop depends on what the embryo is obtained from. A “bad” sperm cannot produce a healthy embryo... This statement seems quite logical. But what does a “bad” sperm mean? Unsightly in appearance, unable to fertilize on your own, or poorly moving? None of these external signs allows us to say that this particular sperm has abnormalities in its most important part - chromosomes necessary for the formation of a healthy embryo. If you look at the results scientific research, then it turns out that normal chromosome set have

• U healthy men– 92% sperm
• In patients with severely impaired sperm quality - 88% of sperm
• In men after chemotherapy - 75% of sperm

Is it worth refusing to use your spouse’s sperm because of such a small difference? In my opinion, no, it’s not worth it! Someone will object - the number of chromosomes is normal, but the chromosomes themselves can be damaged, this phenomenon is called DNA fragmentation. Yes, this happens, moreover, it happens all the time and not only in sperm. Our cells are able to “repair” such breakdowns, and, in most cases, The egg can itself repair damaged sperm DNA. Moreover, the younger the woman, the better than an egg cope with this task.

I would compare the sperm to a messenger carrying an envelope with a letter. The messenger may be a handsome grenadier or a one-legged invalid, but we understand that his task is to deliver the letter, sooner or later. In our case, during IVF, when the sperm is injected into the egg, the courier doesn’t really need legs.

If you carefully study the scientific literature on the results of IVF for male factor infertility, it turns out that the chances of success are practically independent of the quality of the sperm. Today's technologies, ICSI (intracytoplasmic sperm injection into the egg), make it possible to achieve fertilization of the egg even in the complete absence of sperm with normal appearance(normal morphology). If only there were sperm! It sounds presumptuous, but it's true!

It would be possible to end this post on this positive note, but I simply have to add a fly in the ointment...

There are several situations in which the role of men in the causes unsuccessful IVF very high. One of them is a violation of the chromosome structure in a man, which is detected by conventional karyotyping (blood test), the other is gross defects in the structure of the heads of ALL sperm without exception, the so-called total globozoospermia. In the first case, PGD helps out, in the second you just have to hope for luck. Of course, without help qualified specialist there's no way around it.

Case from practice.

A married couple came to the clinic with two attempts at IVF + ICSI, in which not a single egg was fertilized. In the previous clinic, patients were advised to use donor sperm because there were some abnormalities in the husband’s sperm, and it was concluded that the reason for the failure was in sperm quality. We proposed to fertilize only part of the obtained eggs with donor sperm, and part with the husband’s sperm; there were serious doubts about the “guilty” of the man. The next day, as in the two previous programs, we did not find any signs of fertilization; immediately, together with the patients, it was decided to unfreeze three donor eggs and fertilize them with the husband’s sperm. This decision turned out to be successful. All three oocytes were fertilized, after another five days we transferred two embryos, and after about 9 months, as is customary with people, two wonderful babies were born.

Male factor infertility: causes, diagnosis and treatment of male infertility using IVF, ICSI, AI methods

It is generally accepted in the world that only from 7 to 17% married couples- barren.

has a steady upward trend. If we consider infertile couples, then in 50% of cases of absence of pregnancy, men are responsible (of which 25% is isolated male infertility and 25% is combined: male and female). Conclusions from the analysis of spermogenic function in men are real proof

• deterioration of spermogram parameters. The method of treatment - drug therapy, elimination of the causes of decreased fertility, IVF - is selected based on the medical history, diagnosis of the severity of the condition and examination results.
• Diagnosis of male factor infertility
• Who treats male infertility
• Treatment of male infertility Artificial
• intrauterine insemination
• IVF for male factor infertility
• IVF ICSI
• IVF PIXIE

Severe male factor infertility

Factors influencing decreased male fertility It has been scientifically proven that to identify factors of male infertility

• Temperature: 2 hours of sitting causes an increase in scrotal temperature of 2 °C - “taxi driver syndrome”. This is a very harmful phenomenon that adversely affects the quality of spermatogenesis. The temperature in the scrotum is always lower than in the rest of the body - this is necessary condition for the maturation of full-fledged sperm. Under the influence of external or internal temperature factors (for example, hyperthermia during ARVI), a change in the morphological structure or mobility of germ cells occurs.

• Alcohol: high risk is fact . This is 4-5 drinks once or 15 or more drinks per week (1 drink = 14 grams ethyl alcohol). The effect of alcohol leads to a decrease in the quality and quantity of germ cells in a man.
• Smoking: an extremely unfavorable factor influencing the DNA of male germ cells and, as a consequence, the DNA of the developing embryo if conception occurs. Nicotine promotes the gluing of gametes.
• Chemo- and radiotherapy: germ cells develop from stem cells, under the influence of these physical factors sperm precursors die or lose the ability to develop into more mature forms.

Prognosis for male infertility

The outcome of treatment for male factor infertility is influenced by prognostic factors:

• Duration of infertility.
• Primary or secondary episode of infertility (was there any earlier pregnancy from this man).

Main causes of male infertility

1. Testicular insufficiency: caused by hormonal disorders, previous illnesses, injuries, congenital diseases.
2. Endocrine factor of male infertility. These include diseases accompanied by impaired production of not only sex hormones and pituitary hormones, but also diabetes mellitus, diseases thyroid gland, pituitary adenoma, obesity. Endocrine disorders account for 25-35% of all male infertility.
3. Obstruction of the male reproductive tract. There is an obstacle to ejaculation caused by genetic (eg cystic fibrosis), infectious and inflammatory diseases.
4. . Their appearance can be characterized as the appearance of an allergic reaction of the body to its own sperm. These antibodies disrupt, first of all, the motility of gametes.
5. Drug therapy (especially antibiotics), stress, chemical substances(even household chemicals), environment. The spermatogenesis cycle (the appearance of a mature sperm with the ability to fertilize) lasts 72-75 days. If during this time the influence of drugs or chemicals occurs, the morphological structure of the cell is disrupted - a sperm with an abnormal structure develops.
6. Stress leads to disruption of the production of male sex hormones, which affect the maturation of germ cells in men.
7. Varicocele is an enlargement of the veins in the scrotum.
8. Sexual disorders – ejaculation disorders due to neurological disorders (spinal hernia) and hormonal disorders. Retrograde ejaculation is when ejaculate enters the bladder.
9. Genetic diseases with chromosomal abnormalities.
10. Idiopathic infertility is infertility for which obvious reasons were not found. Vitamin deficiency falls into this category.

Examination for male factor infertility

Diagnosis of male factor infertility

If pregnancy does not occur within 6 months while maintaining an active and regular sex life or changes are detected in sperm tests, it makes sense to contact an andrologist for an initial consultation. The doctor will prescribe additional examination methods and treatment. An andrologist is the first clinical specialist who has the ability to treat certain pathologies of the male reproductive system. In some cases, these recommendations for lifestyle correction and therapeutic treatment solve the problem of male factor infertility.

If the problem is not resolved at the clinical stage or treatment is not possible, it makes sense to resort to artificial insemination using IVF or other assisted reproductive technologies (ART).

Who treats male infertility

Depending on the potential of a man’s reproductive cells, reproductive medicine clinics can offer the following types of treatment using ART:

1. - V Lately Doctors began to be skeptical about the method.

Artificial intrauterine insemination for male factor infertility

Effectiveness largely depends on the patient's medical history. It is enough to have motile sperm with the correct structure in the ejaculate. A prerequisite is:

• negative MAR test (absence of immunological infertility);

Like every method of assisted reproductive technology, it has its own disadvantages and advantages.

The ejaculate itself consists of 2 fractions - sperm and seminal plasma. To carry out IVF, seminal plasma is separated and only living cells that have an intact membrane are taken further for work. Depending on the characteristics and volume of gametes obtained, anamnesis data and additional research methods, the fertilization method is selected.

Adding sperm to an egg in a culture medium is standard IVF. The choice of sperm occurs by the egg itself on the basis of evolutionarily formed, not fully known markers.

ICSI

At sharp decline sperm parameters, they resort to micromanipulation techniques - ICSI - intracytoplasmic sperm injection. The choice of sperm is made by the embryologist based on morphological criteria and personal experience.