Male infertility: oligospermia and azoospermia

Male infertility can depend on various pathological and non-pathological conditions. Discovering them, with the help of an andrologist, is essential for embarking on a valid and effective therapeutic path.

A first distinction can be made between obstructive causes, in the case the patient is unable to release the spermatozoa during ejaculation, and non-obstructive ones, in the case of the actual inability to produce a sufficient number of spermatozoa or a suitable sperm quality. to fertilization.

Non-Obstructive Causes of Male Infertility

ALTERATIONS OF SPERM PRODUCTION: under normal conditions, a milliliter of sperm contains between 60 and 120 million spermatozoa (the average ejaculate has a volume of 3 ml). These numbers, apparently exorbitant, are essential to guarantee the fertilization of the female egg cell Suffice it to say that of the millions of spermatozoa present in the sperm and poured into the vagina, only about a hundred are able to reach the oocyte. After this encounter, in order to be able to penetrate inside, the spermatozoa must release a series of enzymes capable of destroying its external coatings (including the zona pellucida); only the first of them who manages to open a breach will have the honor of fertilizing the egg.

It therefore appears evident that a "qualitative and quantitative alteration of the spermatozoa represents a determining cause of male infertility.

OLIGOSPERMIA AND AZOOSPERMIA

A reduced number of spermatozoa in the ejaculate, less than 40 million per ml, is indicated by the medical term oligospermia. In this case the probability of fertilization is lower the lower the number of spermatozoa produced.

The causes of oligospermia include the abuse of alcohol and drugs, the intake of certain drugs, infections of the genital tract, some systemic diseases, various hormonal dysfunctions and exposure to unfavorable environmental conditions (radiation, industrial pollutants, excessive exposure of the testicles to heat.) A common cause of oligospermia is represented by varicocele, which is the development of varicose veins near the testicles.

More than sterility, oligospermia is considered a cause of reduced fertility (hypofertility). Drug therapy is therefore based on the administration of hormones capable of stimulating spermatogenesis.

In some men the number of spermatozoa in the ejaculate is even zero (azoospermia); in this case it is easy to understand how sterility is total and often irreversible. descent of the testicles into the scrotal sac at the time of development. It also recognizes causes of a traumatic nature (particularly dangerous damage suffered in the first years of life), genetic, infectious (mostly sexually transmitted diseases - such as gonorrhea, chlamydia, syphilis and mycoplasma - severe mumps contracted in adulthood or systemic diseases such as tuberculosis), endocrine (reduced synthesis of hormones involved in spermatogenesis) and iatrogenic (resulting from the use of certain drugs).

The problem of male infertility

Worthy of note is the fact that, in accordance with the results of numerous studies, the number of spermatozoa in the male ejaculate has progressively decreased in recent decades (up to over 50%), testifying to the negative incidence of pollution. , infectious sexually transmitted diseases and other factors typical of industrialized societies (improper diet, stress, physical inactivity and obesity). The diffusion of the problem is so high - more than one in ten Italians is sterile - that it is considered a true own social disease.

Since most men with fertility problems are not sterile, but "simply" hypofertile, it is very important to adopt adequate behavioral rules, alongside the therapeutic ones prescribed by the "andrologist. These rules, also useful from a preventive point of view, include abstention from smoking, moderation of alcohol, the use of breathable and not too tight clothing and underwear, compliance with a balanced diet (possibly supplemented with zinc) and the adoption of a more active lifestyle. these are the usual routine advice; just think, for example, of the "positive effect of physical activity on circulating levels of testosterone - essential for spermatogenesis -; of the high degree of correlation between erectile dysfunction and atherosclerosis or the countless harmful effects alcohol and smoking.

Although to a much lesser extent than women, male fertility is negatively affected by old age. The slow decline in testosterone levels from the age of 30 to 35 can in fact increase the problem of oligospermia or add to other causes of own or partner's low fertility.