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“O sucesso do tratamento de fertilização assistida não se restringe ao teste de gravidez positivo. Muito mais que isso, é a garantia de que a mãe e o bebê permanecerão saudáveis desde o início dos procedimentos até o nascimento da criança. Afinal, de nada adianta alcançar rapidamente a gravidez única, gemelar ou até mesmo tripla, se o tratamento e a gravidez provocarem complicações que levem ao comprometimento da saúde do bebê e da mãe durante o tratamento a que estiver sendo submetida”
Dr. Arnaldo Schizzi Cambiaghi

Male’s fertility

12 de setembro de 2011
Home » IPGO Inglês » Male’s fertility

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The research of male fertility is an important chapter in Human Reproduction, both for participating in the couple’s difficulties in having children, and for the embarrassment and the manner of collecting the material (by masturbation), and the prejudices that still exist involving possible diagnoses (as absurd as it may seem).

IN CASES WHERE RELIGION CONDEMNS MASTURBATION, THE SEMEN IS COLLECTED DURING THE SEXUAL ACT USING A SPECIAL TYPE OF CONDOM. THE COLLECTED MATERIAL IS FORWARDED TO THE LABORATORY SOON AFTER INTERCOURSE.

Research of male fertility is always much simpler than the female. It is fundamental to know what is relevant in this research, so that superficial results do not lead the couple to waste time and money, in addition to psychological distress involved in this type of treatment. The male factor is responsible, alone, for 30 to 40% of infertility cases, and associated with the female factor for 20% more; an accomplice, therefore, for 50% of the couples having difficulty to conceive. Since the assessment of this factor is relatively simple and inexpensive, it should be performed in all the cases before any therapeutic recommendations. This study is based on clinical history (past history of infection, traumas, prior surgeries, impotence, habits such as alcoholism, smoking, etc.), physical exam, sperm analysis and, in special cases, genetic exams.

Causes of male infertility

  • Low sperm count.
  • Poor motility of spermatozoa.
  • Abnormal spermatozoa.
  • Lack of sperm production.
  • Vasectomy.
  • Difficulties in sexual intercourse.

Most common diseases

  • Varicocele
  • Infections
  • Chromosomal/genetic problems
  • Malformations

Most common abnormalities in a sperm analysis

Asthenospermia: It is when the motility of the spermatozoa is reduced. According to some researchers, it is the most common abnormality in a sperm analysis. The most common causes are immunological infections, varicocele, smoking, alcoholism, medicine, psychiatric problems, endocrines, stress, and professional diseases.

Oligospermia: It is the reduction in the number and motility of the spermatozoa. The causes are the same as cited in the two previous items.

Teratospermia: They are the abnormalities in the shape of the spermatozoa. The main causes for these abnormalities are: inflammations, certain drugs, congenital origin, and varicocele. Spermatozoa capable of fertilization must have perfect shape. The ideal shape is oval.

NOMENCLATURE
SCIENTIFIC NAME QUANTITY OF SPERMATOZOA
AZOOSPERMIA ABSENCE OF SPERMATOZOA
OLIGOSPERMIA LESS THAN 20 MILLION/ML
SEVERE OLIGOSPERMIA LESS THAN 05 MILLION/ML
POLYSPERMIA MORE THAN 250 MILLION/ML
NECROSPERMIA DEAD SPERMATOZOA MORE THAN 30%

 

Male treatments in difficult cases

Retrieval of spermatozoa directly from the testicles or epididymis.

In some cases, the quality of the spermatozoa is so poor that it is impossible to carry out a treatment with the collection obtained by ejaculation. Therefore, we have two alternatives in order to achieve success in the treatment: PESA and TESA. Through these procedures, the spermatozoa are retrieved directly from the testicle or epididymis (region near the testicle), and through ICSI or IMSI (Intracytoplasmic Morfologically Select Sperm Injection) – Hight Magnification Morfological Selection the eggs are fertilized. The main techniques are:

PESA (Percutaneous Epididymal Sperm Aspiration): A small amount of semen is aspirated from the epididymis and the retrieved spermatozoa are used for fertilization by ICSI.

TESA (Testicular Sperm Aspiration): It is a similar technique, in which the spermatozoa are extracted by a tiny testicular tissue biopsy. Then they are retrieved and, like the example of the previous technique, are used for fertilization by ICSI.

MICRODISSECTION: It is a microsurgery that enables the retrieval of spermatozoa directly from the seminiferous ducts, where there is higher concentration. This technique is used in men who are unable to excrete spermatozoa by ejaculation, but produce a small quantity. The advantage when compared to other techniques is that it is less aggressive and offers the possibility of retrieving several sperm samples, making it possible to freeze for future use.

The results of PESA, TESA, and MICRODISSECTION have been very encouraging. For men who, for various reasons (including vasectomy), are incapable of ejaculating or producing sperm, are now capable of supplying spermatozoa to fertilize the eggs of his wife through these techniques. The woman, evidently, must follow the routine procedures of super ovulation and egg collection.

Sperm Bank (Sperm donor)

In some special situations of severe male infertility, the only option is to use a sperm donor from a “Sperm Bank” of undeniable reputation. There are cases of total lack of sperm (azoospermia, vasectomy) due to Aids, transmissible hereditary diseases, and chemotherapy treatments. Single women who wish to have children, within ethical principles, may also benefit from this resource. Donors are selected in accordance with strict criteria: over 21 years old, but under 40 years old, proven physical and mental integrity, proven fertility acknowledged, always anonymous, and in accordance with physical and intellectual characteristics that are in agreement with the interest of the couple.
 

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