How is male infertility diagnosed?
Diagnosis starts with a physical examination to evaluate your general state of health and identify any physical problems that may have consequences on your fertility. The doctor required the presence of the two partners and some tests:
Semen analysis is a routine lab test that helps to determine:
– Sperm volume, concentration, and count per ejaculation.
– PH of the sperm.
– Velocity: how fast your sperm travels.
– Morphology: Size and shape of your sperm.
– Viscosity: liquefaction time of the sperm.
– Motility of the sperm.
– Viability of the sperm.
If the semen test shows low sperm numbers or the total absence of the sperm, it may not mean you are permanently infertile; more testing may be needed.
Your doctor may order a transrectal ultrasound. A probe is inserted in the rectum, and sound waves are delivered to the nearby ejaculatory ducts. This imaging technique can help the doctor to see if some structures such as the ejaculatory duct or seminal vesicles are blocked or present some problems.
If semen analysis shows oligospermia or azoospermia; you may need a testicular biopsy, which can be done with general or local anesthesia. A small cut is made in the scrotum, and a small piece of tissue from each testicle is removed and evaluated under a microscope. The biopsy helps to find the cause of male infertility; and to collect sperm for use in assisted reproduction (such as in vitro fertilization; IVF).
The health care provider may check your hormones to know how well your testicles make sperm; by evaluating the FSH level (FSH is the pituitary hormone that tells the testicles to make sperm).
Can male infertility be treated?
When the diagnosis of male infertility is confirmed, the curative phase begins to increase the couple’s chance of having a child.
Depending on the cause of infertility, treatments may include:
– Hormone therapy to increase the number of sperm, when infertility is caused by high or low levels of certain hormones.
– Treatments for sexual intercourse problems; when certain sexual problems in men cause infertility (premature ejaculation or erectile dysfunction), and in some cases the couple should consult a sexologist.
– Antibiotic treatments if there is an infection.
Surgical treatment :
For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. When there is no sperm in the ejaculation, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
– Assisted reproductive technology (ART): in ART sperm can be obtained through normal ejaculation, surgical extraction, or donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract or used to perform in vitro fertilization or intracytoplasmic sperm injection (ICSI).
In IVF, the egg and sperm (of which there are many) fertilize on their own in the laboratory. In ICSI, the selected sperm is directly injected into the egg.
What about Fertility Preservation?
When you have medical and sexual issues that affect your fertility; freezing your sperm is the best method to preserve your fertility and increase the chance of having a child.
WHO IS A CANDIDATE FOR FERTILITY PRESERVATION?
Fertility preservation is an option when a man:
– Is diagnosed with cancer at a young age.
– Has sexual dysfunctions.
– Expects to have surgery especially a vasectomy.
– Has an autoimmune, hormone, or genetic disorder.
– Experienced trauma.
– Hopes to have children later in life.
– Has high-risk occupations.
– Have low sperm counts for no known reason.
Nearly 1 in 7 couples is infertile, which means there is no pregnancy even though they’ve had frequent, unprotected sexual intercourse for a year or longer.
The male factor can be the cause of infertility, and this can lead to a stressful relationship.
When to see a doctor?
If no pregnancy after a year of regular unprotected intercourse, and if there is:
– Erection or ejaculation problems, low sex drive, or other sexual problems.
– Pain or swelling in the testicle area.
– Testicular or sexual problems.
– A groin, testicle, penis, or scrotum procedure.
– A partner over age 35.
What are the causes of male infertility?
– Sperm Disorders.
– Retrograde Ejaculation.
– Immunologic Infertility.
The most common problem is with the production and maturation of sperm. Sperm may:
– Not grow enough.
– Have a strange form.
– Not move the right way.
– We can have oligospermia (low number of sperm) or azoospermia (absence of sperm completely).
Sperm problems can be congenital; but sometimes a toxic lifestyle can reduce sperm count: smoking, drinking alcohol, and taking certain medications.
Other causes of low sperm numbers include long-term sickness (such as kidney failure), childhood infections, or hormonal testosterone disorder.
Damage to the reproductive system can cause low sperm numbers or the total absence of it ; which can cause the obstruction of the tubes that the sperm travel through.
Varicoceles are overinflated veins located in the scrotum; they are more common in infertile men (40 out of 100). They stop the growth of sperm by blocking blood drainage and lead blood to flow back into your scrotum from your belly; the testicles are then too distended and hot to touch for making sperm, which can cause low sperm number.
Retrograde ejaculation is when semen goes into your bladder instead of out the penis. This happens when nerves and muscles in your bladder don’t close during orgasm; it can be caused by some procedures, medications, or health problems of the nervous system; signs are turbid urine after ejaculation and dry ejaculation.
Sometimes a man’s body makes antibodies that attack his own sperm because of a certain surgery or infection. Antibodies prevent sperm from moving and working normally in order to fertilize the egg.
Sometimes the tubes which sperm travel through can be blocked; some infections and surgeries (such as vasectomy) can cause blockage. Any part of the male reproductive tract can be blocked, which can lead to infertility because the sperm from the testicles can’t leave the body during ejaculation.
A very low pituitary hormone level causes poor sperm growth.
Hereditary disorders such as Klinefelter’s syndrome; in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) cause abnormal development of the male reproductive organs.
Certain medications have side effects on sperm production, function, and delivery. These medications help to treat:
– digestive problems
– high blood pressure
Several factors can increase the risk of male infertility:
– Abusing illegal drugs.
– Drinking alcohol.
– Don’t maintain a healthy weight.
– Being exposed to toxins.
– Overheating the testicles.
– Having a history of undescended testicles.
– Having genetic disorders.
– Having testicular injuries.
– Testicular cancer and treatment.
What are the complications of male infertility?
– Stress and relationship problems.
– Expensive and involved reproductive techniques.
– High risk of testicular and prostate cancer.
Some measures must be taken into consideration to prevent infertility:
– Don’t smoke.
– Don’t drink alcohol.
– Steer clear of illicit drugs.
– Avoid being overweight.
– Don’t get a vasectomy.
– Avoid things that overheat the testicles.
– Reduce stress.
Diagnosis and Treatment
Overactive bladder diagnosis and treatment are very necessary to continue your life without depression and stress.
Overactive Bladder Diagnosis
We can have the same symptoms of OAB in :
-Urinary tract infection.
-Interstitial cystitis, prostatitis.
When you have these symptoms you should visit your urologist who will:
-Ask about your symptoms and your medical history.
-Do a physical exam for your abdomen, your rectum, and the organs in your pelvis.
-Bladder Diary: The patient should note how many times he goes to the bathroom and when he leaks urine; the bladder diary helps you track: when and how much fluid you drink, when and how much you urinate in 24 hours, how often you have the urgency feeling to urinate, when and how much you leak urine.
-Urine test: Your doctor will require a urine analysis and urine culture to determine if there’s a urine infection.
-Bladder scan: This ultrasound imaging shows how much urine is still in the bladder after you go to the bathroom.
-If there is any doubt about the diagnosis, the urologist required a cystoscopy or urodynamic testing.
Overactive Bladder treatment
Overactive bladder can interrupt your social life, but there are ways to combat the problem.
Natural Treatment for Overactive Bladder
-Bladder training: This type of training helps the patient to control the urge of urinating; he will able to control himself.
-Pelvic floor exercises: Called Kegels exercises; you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination.
Drugs for Overactive Bladder
In the overactive bladder, we have contraction of the muscles in the bladder wall at the wrong time. A group of drugs called anticholinergics help by blocking the nerve signals related to bladder muscle contractions; these medications increase bladder capacity and decrease the urge to urinate.
Anticholinergic drugs include:
Oxybutynin (Ditropan, Ditropan XL, Gelnique, Oxytrol)
Tolterodine (Detrol, Detrol LA)
These drugs have several side effects:
To relieve dry mouth it is necessary to drink small amounts of water (because large amounts can worsen the symptoms of the overactive bladder) and suck a sugar-free candy; the doctor will recommend eye drops to relieve dry eyes and a diet rich in fiber for constipation.
OnabotulinumtoxinA, also called Botox, is a protein injected in small doses directly into the bladder to relax the muscles. The effect of this protein lasts for 6 months so repeated injections are necessary.
Side effects of Botox injection: urinary tract infections and urinary retention.
Helps to treat an overactive bladder by adjusting nerve messages from the brain to the bladder.
We have 2 types of nerve stimulation:
-Sacral nerve stimulation (SNS)
-Percutaneous tibial nerve stimulation (PTNS)
Follow the link for more information about nerve stimulation.
Surgery is required for people with severe symptoms who don’t respond to other treatments.
We have 2 types of surgeries:
-Surgery to increase bladder capacity by using pieces of your bowel to replace a portion of your bladder. This surgery is required only in cases of severe urge incontinence that doesn’t respond to any other treatment.
-Bladder removal: This procedure is the last solution of severe overactive bladder and consists of removing the bladder and surgically constructing a replacement bladder (neobladder) or an opening in the body to attach a bag on the skin to collect urine.
Some TIPS to prevent an overactive bladder
-Maintain a healthy weight.
-Do physical activities and exercises.
-Reduce your consumption of caffeine and alcohol.
-Stop smoking: smoking is irritating to the bladder muscle.
-Treat your chronic conditions, such as diabetes, that might lead to overactive bladder symptoms.
-Do Kegel exercises for the pelvic muscles.
What is an overactive bladder?
Overactive bladder, also called OAB, describes a combination of symptoms that can include:
-An uncontrolled frequent and sudden urge to urinate.
-Pass to urinate many times during the day and night.
These symptoms can disrupt your life, even if you are able to get to the toilet in time when you feel an urge to urinate.
-The difficulty of controlling the sudden urge to urinate.
-Urinate few times in 24 hours.
-Wake up few times at night to urinate.
Follow the link for more information about the symptoms of overactive bladder.
-Weak pelvic muscles: Pregnancy and childbirth can lead to the fragility of the pelvic muscles; so the bladder will sag out of its normal position. All of these factors can cause leakage.
-Nerve damage: Trauma and diseases (Parkinson’s, multiple sclerosis) can cause the damage of the nerves that sent signals to the brain and bladder to squeeze urine out of the body; so the patient will empty his bladder at the wrong time.
-Medicines that cause a rapid increase in urine production.
-Excess consumption of caffeine or alcohol.
-Infection: A urinary tract infection (UTI), can irritate the bladder nerves and cause compression to the bladder.
-Excess weight: The overweight causes extra pressure on your bladder. This can lead to urge incontinence.
-Hormonal deficiency in estrogen after menopause
Sometimes the doctor doesn’t find a cause for the overactive bladder.
-Age: You have a high risk of having an overactive bladder when you get older. Age also raises your risk of other conditions that affect bladder control: BPH, diabetes…
-Women have more risk of developing an overactive bladder than men for several causes that affect the hormones and the pelvic muscles: menstruation, pregnancy, and menopause.
-People who have certain diseases like stroke or multiple sclerosis.
Overactive bladder can affect your life and cause:
-Sleep disorders (Waking up often at night to pee).
-Negative effects on sexuality.
Diagnosis and Treatment
Diagnosis of urinary tract infections in women
First, the doctor will ask about the symptoms and the sexual activity of the patient; a urine analysis and urine culture will be required to prove the infection and determine the nature of the bacteria.
In case of recurrent UTIs, a doctor may request further diagnostic testing to determine the cause:
Diagnostic imaging: to assess the urinary tract by using ultrasound, CT and MRI scanning, radiation tracking, or X-rays.
Cystoscopy: This diagnostic exam helps the doctor to examine the lining of your bladder with a camera lens, which inserted through the urethra through a long thin tube.
Treatment of urinary tract infections in women
-Antibiotic: The patient will probably start taking the antibiotic before getting the results of his urine test.
When the results (accompanied by an antibiogram) are done, your doctor may change the prescription if the test shows that the bacteria causing your UTI is resistant to this antibiotic.
-Medications for pain relief.
-Drinking lots of water.
If the infection is not treated, it can lead to kidney damage.
In case of recurrent infections in women:
-Take a single dose of an antibiotic after sexual intercourse.
-Take a single, daily dose of an antibiotic for 6 months.
-Undergo estrogen therapy in case of menopause especially put vaginal eggs.
Some TIPS to reduce the risk of UTIs in women:
-Drink lots of water and urinate frequently.
-Reduce the quantity of alcohol and caffeine.
-Urinate directly after sexual intercourse.
-Wipe from front to back after urinating and defecating.
-Maintain good personal hygiene of the genital area.
-Sanitary pads or menstrual cups are preferred to tampons. Avoid using a diaphragm or spermicide for birth control.
-Not use any perfumed product in the genital area.
-Wear cotton underwear.
Urinary tract infections in women
Women have a high risk (over 50 percent) of developing a urinary tract infection (UTI), especially in the case of pregnancy; where a urine test is required even if there are no symptoms because a urine infection can be dangerous for both maternal and infant health.
The essential cause is the bacterium Escherichia coli (E. coli), found in the digestive system. Chlamydia and mycoplasma bacteria can cause infection in the urethra, but not in the bladder.
When the infection is located:
-In the bladder: cystitis.
-In the urethra: urethritis.
-In the kidney: pyelonephritis.
The ureters are very rarely the site of infection.
-Sexual intercourse with multiple or new partners (especially Chlamydia and gonorrhea).
-Bad personal hygiene.
-Problems emptying the bladder completely.
-A urinary catheter.
-Inability to control bowel movements.
-Blocked flow of urine.
-A procedure aimed at the urinary tract.
-A suppression of the immune system.
-Immobility for a long period.
-Using spermicides and tampons.
-Take a lot of antibiotics, which can destroy the natural flora of the bowel and urinary tract.
Common symptoms of a UTI include:
-Urinate frequently in small quantities.
-Blood in the urine.
-Bad smell of urine.
-Pain when urinating.
-Nausea and vomiting.
-Muscle aches and abdominal pains.
-In case of Cystitis: low fever, pressure, and cramping in the abdomen and lower back.
Some upper UTIs can lead to serious problems; recurrent or non-treated kidney infections can cause permanent damage.
I the case of pregnancy, kidney infections can lead to premature delivery or to low birth weight.