INTRODUCTION
“Infertility is the inability of a sexual active, non-contracepting couple to achieve pregnancy in one year” (WHO). About 25% of couples do not achieve pregnancy within 1 year, of whom 15% seek medical treatment for infertility and less 5% remain unwillingly childless. Infertility affects both men and women : Male causes for infertility are found in 50% of involuntarily childless couples. Below you can see the main aetiological causes of male subfertility:
* Varicocele
* Sexual factors
* Prostatitis and genito urinary infections
* Congenital Anomalies
* Testicular Trauma
* Cryptorchidism
* Testicular Torsion
* Endocrine Disturbances
* Immunological Factors
* Radiation or chemical exposure
*Idiopathic causes
DIAGNOSIS
Semen analysis is fundamental in male infertility diagnosis. Semen analysis reveals a decreased number of spermatozoa (oligozoospermia), decreased motility (asthenozoospermia) and many abnormal forms on morphological examination (teratozoospermia). Usually, these abnormalities come together and are described as the oligo-astheno-teratozoospermia (OAT) syndrome.
THERAPY
There are medical and surgical therapies for many male infertility causes, but in cases of absence of spermatozoa in semen analysis (azoospermia), this situation cannot be resolved with neither surgery or medical treatment, and in these cases in the past we spoke of male sterility (failure of male to procreate). Today, however, in these cases we can attempt to retrieve the spermatozoa directly from the testicle by non-invasive percutaneous techniques (TEFNA) or by means of sophisticated microsurgical techniques of epididymal and testicular sperm retrieval (MESA, TESE), and if spermatozoa are detected in the testicle, programs of Assisted Fertilization (IVF/ICSI) with cryopreserved spermatozoa can be proposed to the couple.
GLOSSARY
TEFNA : TEsticular Fine Needle Aspiration
MESA: Microsurgical Epididymal Sperm Aspiration
TESE: TEsticular Sperm Extraction.
IVFET: In Vitro Fertilization and Embryo Transfer.
ICSI: Intra Cytoplasmic Sperm Injection
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