In my medical practice patients often ask: „Doctor, tell me the reasons of infertility?”

What is infertility of men and when it is necessary to talk about it? When during a long time period (more than a year) of a joint sexual life of husband and wife has not came pregnancy in case that none of partners uses contraceptive remedies.

How often occurs this phenomenon? Dogmatic prejudices, especially in the Latvian provinces, are widespread, that in infertility a woman is mainly guilty. Infertility of men meets almost as often as well as for women - it is in 30%- 40% from all cases.

Most commonly encountered reasons of infertility:

1. Varicocele - varix dilatation (varicose expansion, enlarged varicose veins), on appearance reminds of a bunch of grapes, it can be groped, and in neglected conditions it is possible even to see it on the left half of seminal bag. As an explanation for this can be that venous weaving of testicle carries out function of its cooling – and that sperm could develop normally, the certain range of temperature is necessary for them. In this case venous outflow and, together with it, normal temperature of testicle is disturbed.

There is a myth, that in this case it is impossible to help anyhow, that it is impossible to restore quality indicators of sperm, but, in effect, after operation these problems almost completely are solved.

2. On the second place of frequency of occurrence there are all sorts of possible infections, for example: sexually transmissible diseases - mycoplasmosis, ureaplasma, clamidiosis, etc. the Prostatitis - an inflammation of prostate gland, an inflammation of testicles and their appendages, a late epidemic parotitis (In popular speech "mumps") which has become a complicated inflammation of testicles and tuberculosis.

3. On the third place it is possible to specify genetic factors or factors of heredity, for example, the abnormal quantity or structure of chromosomes, what is especially important, that structure of Y - chromosomes should be normal. Also we can mention hereditary illnesses - such as Klinefelter's syndrome, Kalman’s syndrome, the congenital form of bladder fibrosis, Young's syndrome.

4. On the fourth place - hormonal illnesses and deviations: especially important is deficiency of a sexual hormone - testosterone which, in turn, causes every possible illnesses and conditions, therefore it is very important to supervise level of this hormone in organism. The lowered function of the thyroid gland, the increased level of hormones of a bark of adrenal glands – it’s by those patients with bronchial asthma, who use these hormones in medical purposes.

 5. On the fifth - immunological factors and illnesses: especially it is necessary to mention autoimmune illnesses by which antibodies against sperm are produced, which spoil them, stick them together and complicate their moving. In turn, occurrence of these illnesses can be promoted by injures of testicle, operations and inflammations of testicle.

6. Lock-out or overlapping of seminal channels caused by various post infectious warts. Vasectomy - the kind of contraception used in the USA and other countries at which seed channels are tied up. Congenital insufficiency of seed channels - bladder fibrosis.

7. As the following I want to mention cryptorchidism, it is when one (or both) testicle does not move into the scrotum. If testicles are in an abdominal cavity then there is no maturing of sperm.

8. Hydrocoel – into the scrotum is an excess of liquid, what is an anatomic defect, which appears as a result of disturbance of penis development.

9. Also it is possible to mention abuse or overdose of various medicines. For example, various antibiotics: Erythromycin, Furazolinum, Gentamycin, various anticancer preparations - Methotrexate, hormonal preparations - it is especially necessary to mention anabolic steroids, which are often used by sportsmen, these preparations oppress development of natural hormones, what can cause a hormonal castration. Also are not harmless a lot of the preparations used to treat diseases of digestive apparatus, for example, Cimetidine, or to treat diseases of blood vessels of heart (Verospiron, Captopril) and many other preparations.

10. It is also important to mention many other factors, physical and chemical substances or gonad toxins:

• Alcohol - influences semen, reducing quantity of sperm and causing its variable defects. Also it reduces a level of testosterone in blood.         
• Smoking - nicotine causes damages of sperm.
• Drugs, for example heroin, reduce a level of a sex hormone testosterone down to an infantile level.
• Saunas, hot baths, wearing skintight underwear, and other factors which cause rise of temperature of scrotum: generally, in this connection I would like to add, that we - andrologists, pay special attention to the type of underwear patients are wearing. When men are staying for a long time in such hot places as, for example, by stokers, workers of boiler-houses, reduction of sperm motility per 28-30% is observed.
• Too frequent use of coffee reduces motility of sperm.
• Pollution of environment by chemical substances which occurs in a big quantity, for example, in exhaust gases of motor vehicles (lead). Therefore I would like to advise to all - not to eat fruits and vegetables growing along highway. Mercury, arsenic, herbicides - atrazine, cycloate, fungicides, insecticides, pesticides - DDT (dichloro-diphenyl-trichloroethane), lindane. Every possible preservative. Still it is necessary to mention synthetic estrogen - female hormones which are used in cattle-breeding, in poultry-farming and in other places, therefore men should beware using milk and meat products which contain estrogen.
• Radiation X-rays.

Sexual disturbances: retrograde ejaculation – it is such a condition when sperm is not splashed out through the uric channel, but goes down in a urinary bladder, also I can mention premature ejaculation - sperm does not go into vagina.

System diseases: pancreatic (insular) diabetes, multiple sclerosis, chemotherapy applied in anticancer therapy or irradiation. Cirrhosis of a liver, chronic illness of kidneys, rheumatoid arthritis, Cushing's syndrome, HIV - infection, etc.

Traumas of a spinal cord: sports, industrial, which can lead to disturbances of ejaculation (splashing of sperm) and can lead to disturbances of production of sperm.

    16.12.2016                                                                       Doctor Janis Orbidans

Sēklinieka ūdenstrūce
Latīņu val.: hydrocele Skaidrojums: gr. hydor ūdens + kēlē pampums, trūce. Starp sēklinieka apvalkiem sakarā ar atteces traucējumiem limfvados uzkrājas serozs šķidrums (no dažiem ml līdz 2—3 1)

Tas ir iedzimts uretras atveres attīstības defekts. Dažādās valstīs hipospādiju sastropamība ir ļoti variabla un tas svārstās no 1/ 4000 līdz 1/ 125 jaundzimušo pēdējais skaitlis attiecās uz ASV 1990.gadu
Cēloni – genetisks pericentriska 16 hromosomas inversija.