Infertility is defined as the inability to conceive after 12 months of frequent (2-3 per week) sexual intercourse. When a woman is 36 to 38 years of age, the “waiting" period is limited to six months.
Infertility can be classified as primary (67-71% of cases), when it has never before been reported in pregnant couple and secondary (29-33%) when there has been a pregnancy in the past regardless of its final outcome.
About 20% of young couples face childbearing problems. The diagnosis and treatment always concerns both partners, since the infertile couple should be approached and treated as one entity. The main reason for this is the finding that in 20%-30% of all cases, the cause of infertility is found only in men, in 30% of cases in women, while in an approximately 30%-40% of cases are of mixed origin. In a fairly significant proportion (approximately 15% of couples with infertility) it is not possible to find the cause (idiopathic infertility).
Rationale
The causes of male infertility can be divided into three broad categories: the first one includes the disorders of the hypothalamic and pituitary function (pre-testicular causes), the second one includes impairments in the function of the testicles (testicular causes) as cryptorchidism, inflammation, varicocele, traumatic injuries, medicines, etc. and the third category includes abnormalties in the ejaculatory tract (post-testicular cause).
Diagnostic approach
Very important procedures in the diagnostic approach of an infertile man are the creation of detailed medical and sexual history records and the physical examination.
The examination of sperm (semen analysis) is a cornerstone in the diagnosis of an infertile husband. The sample should be taken after sexual abstinence of at least 48 hours and in no case of more than 5 days and it is collected in a special sterile container with a wide mouth. Sperm examination should be done within the first hour of collection and the sample during transport should be kept at body temperature. For these reasons, masturbation is considered to be the ideal procedure for drawing sample in the laboratory. Optional tests include sperm culture, biochemical sperm tests, anti-sperm antibodies, testicular biopsy, hormonal control (testosterone, LH, FSH and prolactin) etc.
Treatment
Conservative treatment (qualified and empirical).
Defining the time and frequency of intercourse. Many infertile couples do not know precisely the menstrual cycle of women. The ideal time of sexual contact is believed to be 48 hours before and 48 hours after ovulation because sperm can survive for at least 48 hours.
Hormone therapy
Treatment of infections. Infections (prostatitis, epididymitis) of the genitourinary system should be treated with appropriate antibiotics.
Surgical treatment.
Surgical treatment is indicated when the cause of infertility is varicocele, cryptorchidism, occlusion of ejaculatory resources, obstruction or congenital absence of a part of the ejaculatory tract.
Finally, through assisted reproductive techniques clinicians may successfully treat a variety of causes of female, male, as well as unexplained infertility, especially when they have unsuccessfully exhausted other treatments. The probability of conception per cycle does not exceed 25% in women younger than 35 years. This possibility decreases progressively with age and at 45 years the ratio becomes less than 2%. Thus the 25% success rate of achieving pregnancy through assisted reproductive techniques is similar to the success rate of the normal menstrual cycle.