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NEPLODNOST KOD MUŠKARACA
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Neplodnost kod muškaraca

Neplodnost kod muškaraca

 

NEPLODNOST U MUŠKARCA
Prof.dr.sc. Velimir Šimunić
Poliklinika IVF

Tradicionalno mišljenje bilo je da uzroke neplodnosti treba tražiti kod ženskog partnera. Istina je danas posve drugačija. U više od polovice sterilnih parova glavni ili udruženi uzrok neplodnosti je muški.

Čak smo i u tisku prije nekoliko dana mogli pročitati kako se u zapadnom svijetu neprestao umanjuje plodnost muškaraca. Citirani su znanstveni dokazi dugotrajnih studija. Struci su nalazi sličnih istraživanja odavno poznati. Prihvaćena je činjenica da danas plodni muškarci (imaju djecu) imaju 50% lošije pokazatelje plodnosti u spermiogramu, nego prije 50 godina. Valja podsjetiti da je stvaranje spermija vrlo osjetljiv biološki proces.

Simptomi i znakovi koji bi trebali ukazati na neplodnost kod muškaraca su rijetki, i najjednostavnije je da se stručno analizira spermiogram u slijedećim okolnostima:

* u 1 godini zajedništva ne dolazi do trudnoće
* partner, stariji od 42 godine
* poremećaji ejakulata i ejakulacije
* operacije testisa u dječijoj dobi (ili kasnije)
* neke virusne dječje bolesti (npr. mums)
* teže kronične bolesti, endokrinološki poremećaji
* proširenje vena testisa (tzv. varikokela)
* upale urogenitalnog sustava

Pretraga je jednostavna u pripremi, ali samo napredna tehnologija i iskustvo supspecijaliste daje vjerodostojan rezultat.
Za davanje ejakulata optimalna potrebna apstinencija je 2-6 dana. Ocjenjuje se broj spermija (u 1ml), brzina i kvaliteta pokretljivosti te udio morfološki normalnih spermija. Raspon normale je dosta širok, ali je pogrešno mišljenje da je za oplodnju dovoljan samo 1 kvalitetan spermij. Optimalno je za plodno sjeme kada u 1 ml utvrdimo – više od 10 milijuna napredno pokretnih normalnih spermija.

Kada je spermiogram umanjene plodnosti on se ponavlja za 3 mjeseca, i obavljaju se dodatne analize (centrifugiranje, DNA fragmentacija spermija, mikrobiološka analiza ejakulata i dr.).

Teška neplodnost muškaraca zahtijeva određivanje hormona, kromosomskog statusa, urološki i endokrinološki pregled. Krajnja pretraga može biti i biopsija testisa.

Kada u ejakulatu uopće nema spermija – tzv. Azoospermia, valja razlučiti radi li se o začepljenju izvodnih kanala testisa ili se spermiji ne proizvode.

Osim ranije navedenih uzroka muške neplodnosti nabrojiti ćemo i preostale:

* dob iznad 45 godina
* pušenje duhana, alkohol, kofein
* droge
* tekstikularna vrućina i hladnoća
* zračenje, UV zračenje
* mobitel
* nezdrava prehrana – nutritivni uzroci
* debljina
* hormoni u mesu, anabolici
* pesticidi, insekticidi
* bisfenoli, etilen oksid, toluen
* metali – olovo, živa, kadmij
* spolna disfunkcija
* drugi brojni okolinski polutanti
* rak i njegovo liječenje

U našoj okolini uz svakodnevni život moguć je kontakt s 60 000 kemikalija koje mogu štetiti spermatogenezu. One se nazivaju – endokrini disruptori. Većina ih za 30-50% umanjuje mušku plodnost. Čest je i sinergizam štetnih čimbenika.

INFERTILITY IN MEN

Prof.dr.sc. Velimir Šimunić
Poliklinika IVF

The traditional view was that the causes of infertility should be sought in a female partner. The truth is very different today. In more than half of sterile couples the main and associated cause of infertility is male.

Even in the press a few days ago, we could have read that in the western world, the continual diminishing of male fertility. Scientific evidence of long-term studies are cited. Professional findings of similar studies have been known for a long time. It is accepted that today fertile men (having children) have 50% worse fertility indicators in the spermiogram than 50 years ago. It should be recalled that sperm production is a highly sensitive biological process.

Symptoms and signs that should indicate men’s infertility are rare, and the simplest way is to semen analyze (the spermiogram) in the following circumstances:

*In 1 year of communion no pregnancy occurs
* Partner, older than 42 years
*Ejaculate and ejaculation disorders
* Testicular surgery in a childhood (or later)
* Some viral pediatric diseases (eg parotitis)
* Serious chronic diseases, endocrinological disorders
* Testicular vein enlargement (so called varicocele)
* Inflammation of the urogenital system

The search is simple in preparation, but only advanced technology and the experience of a sub-specialist gives a credible result.
To give ejaculate the optimal abstinence is 2-6 days. The number of sperm (in 1ml), the speed and quality of motility and the proportion of morphologically normal sperm are evaluated. The normal range is quite wide, but it is wrong to believe that only 1 quality sperm is sufficient for fertilization. It is optimal for normal fertile semen when found in 1 ml – more than 10 million progressive moving normal sperms.

When the spermiogram is subfertile, it is repeated in 3 months, and additional analyzes (centrifugation, DNA sperm fragmentation, microbiological analysis of ejaculates, etc.) are performed.

Severe male infertility requires hormone determination, chromosomal status, urologicall and endocrine examination. The final step may be a testicle biopsy.

When there is no sperm in the ejaculate – so called – Azoospermia, it is necessary to distinguish whether it is due to the testicular duct obstruction or the sperm are not produced and secreted.

In addition to the aforementioned causes of male infertility, we will list the remaining:

*Age over 45 years
*Smoking tobacco, alcohol, caffeine
* Drugs
* Testicular heat and cold
* Radiation, UV radiation
* Cell phone
* Unhealthy Nutrition – Nutritional Causes
* Obesity
* Hormones in the meat, anabolics
* Pesticides, insecticides
* Bisphenols, ethylene oxide, toluene
* Metals – lead, mercury, cadmium
* Sexual dysfunction
* Other numerous environmental pollutants
* Cancer and its treatment

In our environment with daily life we can contact 60,000 chemicals that can harm spermatogenesis. They are called – endocrine disruptors. Most of them reduce male fertility by 30-50%. There is also a synergism of harmful factors which is common..

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