48 and a half million – more or less so many people around the world are unsuccessfully trying to conceive. It was once thought that infertility affects only women. Today we know that 40% is caused by a male factor. The cause is often testicular disease and associated semen quality reduction.

48 and a half million – more or less so many people around the world are unsuccessfully trying to conceive. It was once thought that infertility affects only women. Today we know that 40% is caused by a male factor. The cause is often testicular disease and associated semen quality reduction. Read this article and find out which testicular diseases can lead to male infertility.

Inflammation of the testes and epididymitis

Inflammation of the testes and / or epididymis is caused by sexually transmitted pathogens such as herpes (herpes simplex virus), chlamydia bacteria, mycoplasmas, gonococci, Proteus sp., Staphylococcus aureus, Escherichia coli or Streptococcus faecalis. Bilateral orchitis is also common in mumps (common parotitis).

Acute orchitis and / or epididymitis is mainly manifested by painful swelling and redness of the scrotal skin. It may also be accompanied by elevated body temperature. When acute orchitis becomes chronic, the man may not feel any discomfort. The only symptom suggesting the disease will be low sperm parameters – increased viscosity, low sperm count in the sperm, higher number of dead or motionless sperm, increase in the number of leukocytes in the sperm or abnormalities in sperm morphology. Some men also report sexual problems, including erectile dysfunction and decreased libido.

Orchitis / epididymitis is a disease that requires treatment because, if left untreated, it can damage the testicles and clog the ducts leading to the testis and epididymis. This condition may also promote the production of sperm antibodies. Antibiotic therapy and non-steroidal anti-inflammatory drugs are used to treat orchitis / epididymitis. Acute conditions are treated in hospital.

Varicocele

Varicocele is a disease caused by the widening of the veins of the flagellate plexus. This disease is the most common cause of male infertility (statistically, it occurs in about 40% of infertile men). Much more often, as much as 80%, they concern the left nuclear vein. This is due to the different arrangement of the nuclear veins because of both sides of the body.

Varicocele can occur for a variety of reasons, including due to lack or failure of valves in the nuclear vein. A less common reason is compression of the renal or nuclear vein through the aorta and mesenteric artery – we observe here the mechanism of so-called “Nutcracker.”

As a result of impaired venous blood circulation and its hypoxia, the temperature in the scrotum increases, which in turn leads to a decrease in sperm parameters. If a man ignores the problem, irreversible changes and infertility can occur. That is why in the case of varicocele ,rapid diagnosis and appropriate treatment are so important. Most often it involves surgical cutting or ligation of the nuclear vein.

Testicular torsion

We talk about torsion testicular torsion, when there is a sudden, mechanical tightening of the spermatic cord. As a result, blood supply to the testicles is very difficult. Testicular torsion primarily affects adolescent boys between 13 and 21 years old. This does not mean, however, that it cannot happen to an older man.

Torsion of the testicle occurs due to sudden movement, e.g. a jump. The most common causes also include insufficient attachment of the testicle in the scrotum and its excessive mobility, testicular failure (cryptorchidism), viral and bacterial infections.

Testicular torsion is a very serious condition that requires immediate medical attention. Why? Because testicular ischaemia for several hours may end in necrosis. Torsion of the testicle is manifested by severe testicular pain, sometimes radiating to the groin, as well as swelling of the scrotum and increased sensitivity to touch. In addition, nausea, vomiting, headaches and dizziness may appear. It is diagnosed by means of ultrasound and is surgically treated. Sometimes the nucleus will spontaneously unscrew. Nevertheless, any case of sudden testicular pain should be immediately consulted with a doctor.

Testicular cancer

Testicular neoplasms are divided by the type of cells they come from. Most often we are dealing with seminoma, which is a cancer derived from cells that form sperm. Other cancers that affect the testicles include germ cell, chorionic and teratocarcinoma. The first symptoms of testicular cancer are often ambiguous and may indicate, for example, inflammation. The nucleus enlarges and is painful, on its surface there are also hardening and unevenness. It happens that a man comes to the doctor with back and stomach aches, coughing or enlarged lymph nodes – this type of symptoms may already indicate metastases to other organs.

In many cases, surgical nuclear resection and chemo or radiotherapy are necessary. Unfortunately, cancer treatment is associated with a risk of loss of fertility. Therefore, before starting chemo or radiotherapy, a man should be informed about the possibility of storing sperm in a sperm bank.

How to protect yourself from testicular diseases?

Almost everyone knows about the need for breast self-control by women. Men, unfortunately, very often forget that they are also subject to monthly self-examination – not breasts, but testicles. Regularly examining his testicles, a man has a chance to detect any irregularities early – papules, bumps, swelling or pain in the testicles. It is good that every 2-3 years a man goes to see a doctor to have such an examination.

The testicles are very sensitive not only to all kinds of injuries, but also to external factorsHi. High t temperaturę  can significantly reduce the quality of sperm in an ejaculate. Therefore, a man who wants to maintain fertility should not use the sauna too often. He should also avoid hot baths, wearing underwear that is too tight and restricting movement, holding a laptop on his lap and putting a mobile phone in his pants pocket. A chance to avoid testicular diseases and thus infertility is increased by a healthy lifestyle. Therefore, a well-balanced diet – providing the right amount of calories, deprived of junk food and highly processed foods – and regular physical activity will be equally important.

On the difficult path to parenthood, finally comes the moment when the infertile couple goes to the office of an endocrinologist – a doctor specializing in hormonal disorders. How can an endocrinologist help an infertile couple in their efforts to get pregnant? You can find out by reading our article!

On the difficult path to parenthood, finally comes the moment when the infertile couple goes to the office of an endocrinologist – a doctor specializing in hormonal disorders. How can an endocrinologist help an infertile couple in their efforts to get pregnant? You can find out by reading our article!

Endocrinologist – hormone specialist

The endocrinologist is a doctor involved in the diagnosis and treatment of any irregularities within the endocrine system. In his work, he focuses primarily on hormonal disorders. The production of hormones occurs in endocrine glands, which include the pituitary gland, thyroid gland, adrenal glands, testicles and ovaries. Unfortunately, sometimes, due to illness, these glands do not function properly. The task of the endocrinologist is to determine why this is happening and to propose appropriate therapy. In the treatment of infertility, endocrinologists usually work closely with gynecologists. Often, they also decide on a double specialization, becoming gynecologists-endocrinologists.

Hormone economy and its influence on human health

Each of the endocrine glands secrete a hormone responsible for some important body function, e.g. body growth and development, metabolic changes or fertility. Statistics show that 30-40% of women who have difficulty getting pregnant are caused by a malfunctioning endocrine system.

How do hormonal disorders affect woman’s fertility?

Hormonal disorders can completely upregulate the menstrual cycle, even causing complete suppression of ovulation. Meanwhile, ovulation is a prerequisite for a couple to conceive. It is worth recalling that normal menstrual cycles should last from 21 to 35 days. And if they actually last that long, then you can probably suppose that ovulation occurs. Any abnormalities of the menstrual cycle – its lengthening, shortening, very scanty or very heavy menstrual periods, may suggest ovulation disorders, and thus fertility disorders.

One of the most common causes of menstrual disorders among women is polycystic ovary syndrome (PCOS). It also happens that menstruation is degraded due to a malfunctioning thyroid gland (e.g. due to Hashitmoto’s disease) or hyperprolactinemia, i.e. high levels of prolactin in the woman’s body.

Endokrynologist may also help in case of male fertility

Hormones have a huge impact on the ability to fertilize, not only in women, but also in men. Hormonal fluctuations and abnormal levels may affect the quality of male sperm, lower libido or cause erectile dysfunction.

A man, just like a woman, may suffer from the aforementioned hyperprolactinemia, i.e. a state of elevated levels of prolactin in the body. Too high a concentration of this hormone produced by the pituitary gland may cause secondary testicular failure. Deficiency of thyroid hormones will also lower sperm parameters, also causing other troublesome ailments, such as drowsiness and fatigue or uncontrolled weight increase.

Male sperm may also be of inferior quality due to congenital adrenal hyperplasia, i.e. small glands located directly above the kidneys that produce androgens, cortisol and aldosterone. In men with congenital adrenal hyperplasia, the level of adrenal androgens increases, which unfortunately is reflected in the condition of the spermatozoa – there are fewer and slower they move. In the ejaculate of a man with congenital adrenal hyperplasia, a higher percentage of immature sperm is also observed.

With which symptoms a couple have to go to the endocrinologist?

Irregular menstruation is not the only symptom that may suggest hormonal disorders. People with very different ailments and health problems: unexplained weight gains or decreases, excessive hair growth of various body parts, acne, oily hair, excessive sweating, palpitations or difficulties with conceiving a child are consulting with an endocrynologist.

Endocrinological fertility – which hormonal tests can the endocrinologist recommend?

Before the endocrinologist provides the patient with any treatment plan, the doctor must ensure that the woman’s cycles are ovulatory. To determine it, a blood progesterone test needs to be done. The doctor will probably want to assess the woman’s ovary reserve as well. It is determined by examining serum AMH, FSH and estradiol levels. It is worth remembering that the low ovarian reserve does not yet eliminate the chance of parenting. Nevertheless, the results of the tests carried out allow this opportunity to be determined.

When there is a suspicion that infertility may be due to an endocrine factor, the doctor recommends examining the thyroid gland. Abnormalities within this gland are in fact the most common endocrine cause of problems with conceiving a child. They can be caused by hypothyroidism, including Hashimoto’s disease, and hyperthyroidism. To assess its condition, the endocrinologist directs the patient to examine thyroid hormones: triiodothyronine (fT3) and thyroxine (fT4) and pituitary thyroid stimulating hormone (TSH).

A very similar hormonal panel is provided for an infertile man. In addition to thyroid hormones, prolactin, FSH, LH and estradiol, it also includes testing for total and free testosterone.

Endocrinologist will propose effective treatment

Hormonal infertility usually requires treatment, which includes medication. The therapy is selected individually. Most often it involves taking tablets or taking injections containing the appropriate doses of specific hormones. In this way, we can improve the function of the thyroid gland, ovaries or pituitary gland. Because the level of hormones in the body is also affected by external factors, such as the amount of sleep, stress level or body weight, infertile couple is often forced to change their current, not always hygienic lifestyle.

Most of us sooner or later start dreaming about becoming parents. However, conceiving a child does not always come as easily as we would like to, and in the end we proceed with the IVF treatment. One of the key elements of the in vitro fertilization process is the collection of an egg, i.e. ovarian puncture. What does it look like step by step? You can read about it in our article.

Most of us sooner or later start dreaming about becoming parents. However, conceiving a child does not always come as easily as we would like to, and in the end we proceed with the IVF treatment. One of the key elements of the in vitro fertilization process is the collection of an egg, i.e. ovarian puncture. What does it look like step by step? You can read about it in our article.

Hormonal stimulation first

Before the egg is retrieved, the patient undergoes a hormonal stimulation. Its goal is to obtain more Graff follicles with mature eggs than in a normal cycle. Such stimulation lasts from few to several days, depending on whether the doctor has chosen a short or long stimulation protocol for the patient. When the ovarian follicle reaches a size of more than 16 mm, the doctor stops its growth. Then, about 36 hours before ovarian puncture, a woman administers a chorionic gonadotropin (hCG) to induce ovulation.

To make it on time before ovulation

You are probably wondering why it may not take more than 36 hours from the time of administration of chorionic gonadotropin to ovarian puncture? The doctor must make it before the Graff follicle bursts. This is very important, because the eggs are located in the fluid that fills the ovarian follicles.

In order to retrieve them, the ovaries are punctured with a thin needle inserted through the vagina. Everything is done under ultrasound control. During the procedure, the woman does not feel any pain or discomfort, because it is carried out under short general anesthesia, and the patient’s safety is supervised by an anesthesiologist at all times. The egg collection takes 15 to 20 minutes. After the procedure, the patient remains in the Clinic for about 2 hours. In the meantime, the patient also meets a doctor who selects special drugs for her. They are designed to prepare the uterus for the embryo transfer.

Fertilization? Only with the best cells!

Before the magical moment occurs and the fertilization takes place, the embryologist assesses all collected eggs and selects only the best ones. It is guided by certain criteria. First of all, the embryologist assesses their maturity, i.e. what phase they are in at the moment. Before the egg cell matures, it undergoes several divisions. Generally, oocytes are classified as: immature, almost mature, mature and degenerated, i.e. dead, having irregularities in structure. Degenerate and immature cells are basically rejected immediately because they cannot be used in the IVF procedure. However, mature cells with a visible directional body can be used.

The embryologist then assesses the mitotic spindle of the egg. This structure is very important because it ensures the correct propagation of chromosomes to the opposite poles of the cell. The embryologist finally proceeds to assess its structure. A normal, mature oocyte should have, above all, a bright cytoplasm and a smooth, round shape.

Keep your fertility for longer – i.e. oocytes freezing

More and more women are choosing to protect their fertility by freezing oocytes. There are many reasons. Ladies are afraid that cancer and related cancer treatment may deprive them of the possibility of conceiving a child in the future. Cryopreservation- because that is the professional name of egg cell freezing, are also decided by single ladies, who have not yet found a suitable candidate for a father for their child, but would like to become mothers one day.

After collection, the cells are stored in liquid nitrogen vapors, at -196 ° C. In such conditions, they can last for many years. Elapsed time will not affect their quality in any way. If a woman does not decide to use frozen cells, however, she can always hand them over for adoption.

When oocyte adoption becomes the only chance for a child – IVF with the donor’s egg

When the attending physician is certain that all methods of infertility treatment, including the traditional IVF, have not been successful, he suggests the IVF with the donor’s egg. Of course, before a woman becomes an egg donor, she must undergo a series of medical tests and meet certain requirements.

The collected oocyte is fertilized under laboratory conditions with the semen of the recipient’s partner, or possibly the donor’s semen. Such formed embryo is then placed (transferred) in the recipient’s uterus. In case of IVF with the donor’s egg, the patient does not undergo ovulation stimulation and does not have to undergo ovarian puncture. (the donor undergoes these procedures). The next stages – preparation for the transfer and the embryo transfer itself, however, look the same as in traditional IVF.

In Poland, the egg donation is anonymous for both, the donors and the recipients. The donor does not find out what woman her egg will go to. The recipient also does not know from which woman she received this cell – she can not meet her or talk to her. However, when choosing a donor for a couple, the infertility treatment clinic always takes into account the phenotypic similarity, i.e. appearance. Women donating eggs very often don’t realize how much they do for others. Thanks to them, a couple who, for health reasons, cannot have biological offspring, has a chance to fulfill the dream of parenthood.