Impaired sperm function

Violation of sperm functions includes defects in sperm production and its emission. Diagnosis of sperm function disorder is based on sperm research and genetic tests. The most effective treatment for sperm function disorder is artificial insemination by the method of intracytoplasmic sperm injection.

[1], [2]

Causes of the impaired sperm function

Spermatogenesis occurs continuously. Each embryonic cell requires approximately 72-74 days for complete maturation. Spermatogenesis most effectively passes at a temperature of 34 ° C. Within the vas deferens, Sertoli cells regulate maturation, and Leydig cells produce the necessary testosterone. Normally fructose is produced in seminal vesicles and secreted through the vas deferens. Sperm disorders can be the result of an inadequate amount of sperm: too little (oligospermia) or lack of sperm (azoospermia) or sperm quality defects: abnormal mobility or an abnormal sperm structure.

Spermatogenesis can be disturbed at high temperature, with urinary tract disorders, endocrine disorders or genetic defects; when taking medications or toxins, resulting in inadequate quantity or defects in sperm quality. The reasons for the reduced emission of sperm (obstructive azoospermia) are retrograde ejaculation in the bladder for  diabetes mellitus, neurological dysfunction, retroperitoneal dissection (for example, with Hodgkin's lymphoma) and prostatectomy. Other causes include obstruction of the vas deferens, congenital bilateral absence of the vas deferens or epididymis. Many infertile men have gene mutations at the level of cystic fibrotic transmembrane conduction regulators (CFTR, cystic fibrosis), most men with symptomatic cystic fibrosis have congenital bilateral absence of the vas deferens.

In men with microdeletion of the Y chromosome, oligospermia may develop by different mechanisms, depending on the specificity of the deletion. Another rare mechanism of infertility is the destruction or inactivation of sperm with sperm antibodies, which are usually produced in men.

Causes of decreased spermatogenesis

Causes of a semen function disorder	Examples
Endocrine Disorders	Violations of hypothalamic-pituitary-gonadal regulation Adrenal disorders Hyperprolactinemia Hypogonadism Hypothyroidism
Genetic disorders	Gonadal Dysgenesis Klinefelter Syndrome Microdeletion of Y-chromosome sections (in 10-15% of men with impaired spermatogenesis) Mutations of genes at the level of cystic fibrosis transmembrane conductivity regulators (CFTR, cystic fibrosis)
Disorders of the urogenital tract	Cryptorchidism Infections Damage Orchitis after mumps Atrophy of testicles Varicocele
Influence of high temperatures	Exposure to excessively high temperatures during the last 3 months Fever
Substances	Anabolic steroid Diethylstilbestrol Ethanol Regional drugs, for example, opioids (hypnotics) Toxins

[3], [4], [5], [6], [7], [8], [9]

Diagnostics of the impaired sperm function

When a sterile marriage is always necessary to conduct a survey to identify violations of sperm in men. An anamnesis of the disease is studied, the patient is examined to identify potential causes (eg, disorders of the urogenital tract). The normal volume of each testicle is 20-25 ml. It is necessary to perform a  spermogram.

In oligospermia or azoospermia, genetic testing, including standard karyotyping, PCR of labeled chromosomal sites (for detecting Y-chromosome microdeletions), should be performed and the CFTR gene mutations should be evaluated. A male partner with a gene mutation CFTR should also be screened to exclude the status of a carrier of cystic fibrosis before sperm is used for reproduction.

Before the study of sperm, a man is asked to abstain from ejaculation for 2-3 days. As the amount of sperm changes, more than two samples taken with a break of more than 1 week are necessary to complete the study; Each sperm sample is masturbated into a glass container, preferably in a laboratory. If this method is difficult, a man can collect semen at home in a condom. The condom should be free of lubricants and chemicals. Examination of the ejaculate is carried out after holding the sperm at room temperature for 20-30 minutes. The following parameters are evaluated: the volume (normal 2-6 ml), the viscosity (normally the beginning of the liquefaction within 30 minutes, completely diluted within 1 h), the examination is carried out and the microscopic examination (normally opaque, creamy, contains 1- 3 white blood cells in the field of view at high magnification).

The pH is measured (normally 7-8); count the number of spermatozoa (normal> 20 million / ml); determine their mobility after 1 and 3 hours (normal mobility> 50%); the percentage of sperm with normal morphology is counted (normal> 14%, according to strict WHO criteria, used since 1999); determine the presence of fructose (indicates the correct functioning of at least one vas deferens). Additional computerized methods for determining sperm motility (for example, linear sperm velocity) are available, but their correlation with fertility is unclear.

If a man does not have hypogonadism or a congenital bilateral lack of vas deferens, and the ejaculate volume is less than 1 ml, then urine is taken for the purpose of determining the sperm after ejaculation. A disproportionate number of sperm in the urine relative to their number in the semen suggests retrograde ejaculation.

If specialized tests of sperm, available in some centers of infertility, do not explain the causes of infertility in both partners, then the question of the possibility of artificial insemination and the transfer of embryos to the uterus is solved.

A test is performed to identify sperm antibodies, as well as a hypo-osmotic swelling test to measure the structural integrity of the sperm plasma membranes. A sperm binding test is also carried out with a shiny egg shell and a sperm penetration test to determine the ability of the sperm to fertilize the in vitro egg.

If necessary, a testicular biopsy is performed to differentiate obstructive and non-obstructive azoospermia.

[10], [11], [12], [13], [14], [15], [16]

Treatment of the impaired sperm function

Treatment of impaired sperm function includes therapy of disorders of the urogenital tract. Men with sperm in the ejaculate 10-20 million / ml and lack of endocrine disorders are prescribed clomiphene citrate (25-50 mg orally once a day 25 days a month for 3-4 months). Clomiphene (antiestrogen) can stimulate sperm production and increase the number of spermatozoa. However, whether this improves sperm motility or morphology is unclear; the increase in fertility was not confirmed.

If the amount of spermatozoa is less than 10 million / ml or the use of clomiphene is ineffective with normal sperm motility, the most effective treatment is artificial insemination with a single injection of sperm into one egg (the so-called intracytoplasmic sperm injection). An alternative method is sometimes intrauterine insemination using washed semen samples in the presence of ovulation. Pregnancy usually comes on the 6th cycle of treatment, in the case of the effectiveness of the method.

The reduced number and viability of sperm does not exclude pregnancy. In such cases, fertility can be increased by ovarian hyperstimulation in women with simultaneous use of artificial insemination or other methods of reproductive technology (eg, artificial insemination, intracytoplasmic sperm injection).

If a male partner does not produce enough fertile sperm, then one can consider fertilization with the use of insemination of donor sperm. The risk of developing AIDS and other sexually transmitted diseases is minimized by freezing donor sperm for more than 6 months, after which donors are re-examined for infection before the insemination procedure.