Treatment of male infertility in Germany begins with diagnosis.
Spermograms and tests
Spermatogenesis — is a long process that lasts approximately 74 days and is controlled by complex interactions between the hypothalamus, pituitary gland and testes. Many different factors can influence male infertility.
Haрyшения в выработки спермы могyт быть вызвaны:
- pathological disorders in some endocrine glands such as thyroid, pituitary, pancreas or adrenal glands;
- chronic diseases and medication intake (some antibiotics, steroids, etc.);
- infections;
- exposure to toxins from the environment (heavy metals or other industrial agents);
- diseases that negatively affect spermatogenesis and the progression of sperm from the testicle to the penis, i.e.
- normal ejaculation;
- anatomical (obstruction or anomaly of the external genitalia);
- neurologic,
- neglected form of diabetes,
- alcohol, drugs, smoking;
- the presence of antibodies or abnormal sperm morphology can prevent fertilization of the egg.
Tests
Spermogram (semen analysis) is a basic test to determine the fertility of sperm. The test is easy, quick, painless and extremely informative. Semen charts include many indicators and deviation from the parameter is not always a sign of disease. Only a comprehensive evaluation of the data obtained for all parameters and their dynamics over time allows a qualitative assessment of the ability of fertility y men. The main parameters studied were volume, viscosity, pH of the semen sample, concentration, motility and morphology of sperm.
Basic requirements for performing a spermogram:
- sexual abstinence for 2 to 5 days;
- no antibiotic treatment for at least the last two weeks;
- no alcohol consumption during abstinence days;
- inform before the test about all medications and supplements you are taking;
- the ejaculation receptacle must be sterile and disposable;
- you must inform the examiner if the entire amount of ejaculate is not in a sterile container. Loss of quantity will affect the validity of the results;
Sperm DNA fragmentation — an assay that provides information on the structural integrity of sperm DNA. Sperm DNA integrity is an important indicator of sperm quality and a marker of sperm fertility. The degree of abnormality in sperm genetic material is numerically expressed as DNA fragmentation index (DFl). Sperm DNA damage may be a cause of male infertility. The results of the DFl test are independent of the sperm count.
This test is recommended in the following cases:
- idiopathic (unexplained) infertility;
- after several unsuccessful attempts at artificial insemination;
- poor embryo quality;
- y couples with multiple recurrent miscarriages;
- presence of varicocele (enlarged testicular veins);
- men over 45 years of age;
- freezing of ejaculate (to ensure that the sample is frozen at an acceptable DNA fragmentation level);
- changes in body temperature in the last 3 months.
IAR test for the detection of antisperm antibodies (ASA)-IgA and ІgG forms are reported, with elevated values indicating an immunologic problem in infertility. The antisperm antibodies formed bind antigens to the sperm surface. ASA are found in sperm and human serum. They interfere with the movement of spermatozoa. Numerous ASA lead to immobilization and agglutination of spermatozoa. ASA can be directed against antigens on the plasma membrane.
Sperm passage through the cervical mucus is impeded by the presence of ACA in the sperm fluid or in the cervical mucus. The interaction between the egg and sperm is blocked. Implantation in the uterus does not occur or embryonic development ceases, which is characteristic of recurrent miscarriages. Men who undergo reproductive surgery are more likely to develop ASA. Women are much less likely to produce antibodies against spermatozoa. ASA testing is recommended for men and women with unexplained causes of infertility, chlamydia and other infections, as well as men with sperm agglutination and surgical procedures of the reproductive tract.
NBA test (sperm-hyaluronan binding assay) — this test determines the functional maturity of the sperm. Hyaluronan is a high molecular weight sugar — glucosaminoglycan. Hyaluronan is found in many parts of the body and is a key component of the group of cells that surround the ovum (cumulus ovale). Ha the final stages of sperm maturation, they develop the ability to attach to hyaluronan, which serves as a natural selection mechanism for mature sperm suitable for fertilizing the egg.
Viability test — required when there is a high percentage of fixed sperm in the sample. The test determines how viable the sperm are.
Biological Sperm Survival Test — examines the percentage of motile sperm after treatment and incubation for 24 hours. The purpose of the test is to monitor the probability of sperm survival in the uterus or genital tract of a woman during normal sexual intercourse or after fertilization.
Sperm Cryotolerance is a test that evaluates the survival of sperm after freezing and subsequent thawing. A mandatory test that accompanies sperm freezing. It provides information on the choice of an appropriate APT for the couple.
Male infertility treatment in Germany includes:
Treatment of major endocrine diseases, antibiotic therapy for infections, elimination of harmful environmental factors;
Ha insufficient sperm count and motility can sometimes be affected by hormonal or surgical treatment;
The use of assisted reproduction techniques offers spouses the opportunity to solve infertility problems.
In recent years, intracytoplasmic sperm injection (ICSI) has been the main treatment for infertility caused by the so-called male factor. It is used when previous IVF attempts have failed.
If there are no spermatozoa or you do not want to use the ICSI procedure, there is the possibility of intrauterine insemination with donor sperm (IUI).
Sperm aneuploidy test
SAT (Sperm Aneuploidy Test) is a diagnostic method to study the genetic origin (etiology) of male infertility. In particular, this test analyzes the percentage of spermatozoa with chromosomal abnormalities in the semen sample. This assessment makes it possible to evaluate the risk of chromosomal abnormalities being passed on to the next generation. The study analyzes the chromosomes most commonly associated with spontaneous abortions and leading to chromosomal abnormalities in the generation (chromosomes 13, 18, 21, X and Y).
Purpose and benefits of the test
An increased percentage of sperm with chromosomal abnormalities has been associated with lower pregnancy rates and a higher risk of miscarriage in couples who use ICSI for infertility treatment
At the embryonic level, different defects are observed depending on the type of chromosomal abnormality in the sperm. For example, an increase in the percentage of spermatozoa with sexual dysomy leads to an increase in embryos with syndromes (Πatay syndrome, Down syndrome, Edwards syndrome, Klinefelter syndrome and Turner and Trier syndrome). An increase in diploid sperm leads to an increased likelihood of triploid embryos and miscarriage.
In multi-generational studies conducted among parents with Down, Klinefelter or Turner syndrome, the results have shown an increase in chromosomal abnormalities in sperm.
For these reasons, the SAT test is indicated for genetic disorders in men suffering from infertility and in the search for suitable assisted reproduction methods.
Indications:
It is a diagnostic test for male infertility and is recommended for patients at high risk of sperm aneuploidy. These are mainly men with genetic disorders — mainly oligozoospermia, non-obstructive azoospermia and severe teratozoospermia.
Other indications for the use of the test are not necessarily related to parameter abnormalities:
- For recurrent miscarriages of unknown etiology;
- For couples with multiple failed IVF cycles;
- For couples with previous pregnancies with chromosomal abnormalities.
Meiosis — is a special mode of cell division that results in the transition of cells from one state to another,
Compared to classical tests, this test has the advantage of evaluating the final result, identifying the sperm that is able to fertilize the egg.
To obtain clinically meaningful results, we analyzed an average of 2000 spermatozoa, for each chromosome in two separate and independent laboratories. To evaluate statistical differences, the percentage of chromosomally abnormal spermatozoa was compared with a control group with normozoospermia.
Methodology
Male infertility treatment in Germany (the most important steps of the protocol):
- Fixation of spermatozoa on laboratory beakers
- Decondensation of spermatozoa
- Hybridization with fluorescent DNA samples directly targeting the chromosomes to be analyzed
- Detection with a special filter, epifluorescence microscope.
Limitations
This method detects aneuplody on specific chromosomes included in the test.
Lack of spermatozoa in the semen sample to properly assess the risk of aneuploidy.
Treatment of male infertility takes place in specialized clinics of reproductive medicine.