The diagnostic algorithm for male survey consists of two stages.
In the first phase estimated history data, including a history of fertility and transferred urogenital diseases. In addition, a Physical methods of investigation, analysis of the semen, the definition of immunologic factors of infertility. The first stage of the examination should be performed for all patients to see a specialist about the infertile marriages.
Optimal timing of abstinence to obtain reliable results in the study of semen 48-72 hours. Analysis of sperm in the presence of patospermii should be doubled in 2 weeks. During this period, alcohol intake, as well as the use of potent drugs, if they were not prescribed by a doctor, is not valid. It must be remembered that even low-grade fever, been set out in the previous study of 3 months, can cause significant changes in the ejaculate until azoospermia.
Diagnosis of immunological factor infertility is based on the conduct of tests for the presence of sperm antibodies in semen and serum of patient and his partner. Standard methods are MAR-test, which characterizes the percentage of sperm coated with antisperm antibodies (a positive test - more than 50% motile sperm antibody-coated) IFA - sperm antibody titers in the serum of patient and his sexual partner (laboratory standards are set).
Positive test results indicate the presence of an immune factor infertility. In the absence of other pathology a diagnosis of isolated immune infertility, which accounts for about 10% of infertile marriages.
At this stage it is possible to diagnose clinically pronounced varicocele, obstructive azoospermia to determine and identify the group of patients with decreased fertility without clarifying the etiology of at this stage or immunological factor infertility. Information obtained during the first stage to narrow the diagnostic algorithm of the second phase.
In the second stage of the patient with unexplained infertility conducted a full range of diagnostic measures determination of hormonal status Ultrasound of the scrotum definition of agents of urogenital infections genetic studies research ejaculate and post-orgasmic urine. Hormonal studies should be conducted with the expressed patospermii and azoospermia. In these cases, determined the levels of testosterone, FSH, LH and sex hormone binding globulin, which gives an idea not only about the number of testosterone, but also about its biologically active fraction. Determination of prolactin advisable to carry out a suspected pituitary tumor.
Ultrasound examination determined the structural changes and abnormal formation of the testis, epididymis, prostate gland.
Indications for TRUS - low-volume azoospermia, this method can detect changes in the seminal vesicles in the obstruction of the distal vas ways or lack thereof in congenital agenesis of vas deferens.
Color Doppler study reveals the presence of venous reflux in the spermatic veins, and the so-called subclinical varicoceles.
Sowing of the ejaculate is produced when piospermii (concentration of leukocytes over 1mln./ml) in the case of idiopathic nature of fertility decline and deterioration of semen, as well as in the preparation of the patient in the course of assisted reproductive technologies.
Human herpes simplex virus, chlamydia can affect sperm, leading to their immobilization, the formation of ACAT (antisperm antibodies) to them and miscarriage, as well as congenital anomalies of the fetus. Indications for such a diagnosis is idiopathic nature of fertility decline and patospermii, miscarriage, as well as during the preparation of the patient in a cycle of assisted reproductive technologies.
It should be noted that the diagnosis of sexually transmitted infections should be carried out by the method of enzyme-linked immunosorbent assay (ELISA) combined with PCR.
Genetic studies should be undertaken with azoospermia and severe patospermii. Karyotyping identifies anomalies sets of chromosomes (karyotype of the patient). In recent years has become increasingly important study of AZF region of Y-chromosome microdeletions in the presence of it. About 10% of all cases of severe non-obstructive azoospermia and patospermii due to prolapse of one or several loci in the Y-chromosome is localized in the interval AZF. In addition to the diagnostic value of genetic studies can provide information about the possibility of transmission of the disease of male offspring, which is necessary to inform patients.
In non-obstructive azoospermia can be detected or isolated sperm cells of spermatogenesis in the study of centrifuged ejaculate. Therefore, this study is shown in the differential diagnosis of the causes of azoospermia, and in a series of reproductive technology (search for a single sperm ICSI).
Research conducted at postorgazmennoy urine retrograde ejaculation. The question of the appropriateness of the diagnostic biopsy for azoospermia to date, remains controversial.
In our opinion, testicular biopsy for diagnostic purposes is unacceptable and can only be used as a method of obtaining the genetic material in order to include it in a cycle of IVF-ICSI.
It should also be borne in mind that repeated surgical intervention is possible only through 6-18 months, which is associated with the need to restore the original level of spermatogenesis and holding conservative measures aimed at improving the process of spermatogenesis.
Diagnosis of male infertility, Analysis of sperm, Genetic studies
