In modern society, approximately 10-25% of families are sterile. Contrary to traditional opinion, a woman is not always “guilty” of the absence of children in the family. According to statistics, from 30 to 50% of married couples cannot have a child due to male infertility. Such areas of medicine as andrology and urology are solving this problem.
- How the reproductive system works in men
- Sperm characteristics
- Classification of infertility in men
- What are the reasons leading to male infertility?
- Epidemiology of male infertility
- Clinical picture
- Male infertility treatment
- Assisted reproductive technologies
- General recommendations
How the reproductive system works in men
Male genitals are located not only inside the small pelvis, but also outside it. The main male hormone testosterone is responsible for the formation of secondary genital organs. It is produced by the testicles located in the scrotum. They also produce sperm that travels from the testicles to the epididymis for nutrition and maturation. After maturation, the sperm moves along the vas deferens into the seminal vesicles for storage. The full sperm production cycle takes about 72 hours. When ejaculating, it mixes with the secretion of the prostate gland, as a result of which ejaculate is formed - seminal fluid containing sperm.
The ability to produce offspring (fertility) in men depends on the quality of the sperm, its full development and maturation.
This process takes place with the participation of hormones:
- Luteinizing hormone (LH) - stimulates spermatogenesis in Leydig cells;
- Follicle-stimulating hormone (FSH) - stimulates spermatogenesis in Sertoli cells.
In Sertoli cells, immature sperm form sperm and mature. Sperm motility occurs in the epididymis. The sperm ready for fertilization is stored in the vas deferens before ejaculation.
The amount of sperm depends on the age of the man, his sexual activity and individual characteristics. Frequent intercourse reduces sperm volume, but it is restored after 2-3 days of abstinence.
Normally, the volume of ejaculate is 1-6 ml, semen is alkaline with a pH of 7-7.6. These indicators prevent sperm from losing their mobility in the acidic environment of the vagina. They, without losing their properties, reach the cervical canal of the cervix, the pH of which is 7.5, and from there they penetrate into the uterus and fallopian tubes to fertilize a mature egg.
The sperm cell consists of a head and a tail with an intermediate part (neck) between them. He makes straight and forward movements to increase the possibility of meeting the egg. One milliliter of ejaculate contains 40 to 120 million sperm. Of these, about 60% are mobile, and 15-20% are immobile. In the same ratio, mature and atypical forms of spermatozoa are represented in semen (60% - mature, 15-20% - atypical).
With frequent sexual intercourse (more often than once every 2-3 days), the semen contains a large number of immature spermatozoa, with abstinence or with rare intercourse, a large number of deformed sperm are in the semen.
The study of the composition and quality of sperm (spermogram) is an analysis carried out primarily in the diagnosis of male infertility.
Classification of infertility in men
The variety of reasons for male sterility makes it difficult to choose the basis for classification. Forms of infertility identified in andrology:
Secretory infertility. Pathology consists in the production of inactive or defective sperm by the testes, as well as in the insufficient number of motile sperm for fertilization. Infertility can be caused by congenital and acquired negative factors.
Obstructive or excretory infertility. In this form of infertility, sperm mature in sufficient quantities, but cannot enter the urethra through the vas deferens. The reason is an obstacle in the way of their transportation.
Concomitant infertility. Combination of several types of infertility (immunological, secretory, obstructive) with the addition of an inflammatory process.
Immunological infertility. In the body of a man, the secretion of antibodies with anti-testicular functions is carried out, for which the testicular tissue is a foreign element. Antibodies penetrate the cells of the testicles, disrupting the blood-testicular barrier, provoke the formation of antibodies to sperm. This form of infertility is caused by trauma to the testicles.
Relative infertility. It arises against the background of the absolute health of both spouses, the problem of this form of infertility has been little studied.
What are the reasons leading to male infertility?
The factors of the appearance of male infertility are conventionally divided into the main, which are more common than others, and additional, acting in combination with them. Secretory infertility (hypogonadism) is characterized by impaired spermatogenesis and testicular function. Hypogonadism is primary and secondary. In the primary form of secretory infertility, there is an increased excretion of gonadotropins in the urine, leading to a decrease in the effect of the testicles on the functions of the pituitary gland. In the secondary form of hypogonadism, the affected pituitary gland negatively affects the release of gonadotoropins, reducing their amount. There are forms of secretory infertility that are not accompanied by hormonal disorders.
Secretory infertility reasons:
Varicocele. The most common cause of male infertility. Its appearance provokes varicose veins of the testicle and spermatic cord. These parts of the male reproductive system are responsible for sperm excretion. The result of varicocele is blood stagnation, insufficient blood supply to the testicular tissue, and a violation of its functioning. Factors provoking the development of pathology - an increase in the temperature of the external genital organs for a long time (visiting a bath and a sauna, wearing too warm trousers, synthetic underwear), vibration, as a professional hazard (driver's profession).
Dropsy of the testicle. Excessive fluid accumulates in the scrotum due to a number of reasons (eg, inguinal hernia). This circumstance provokes squeezing of the testicle, violation of its blood circulation, which reduces or completely stops the production of sperm.
Cryptorchidism. With this developmental disorder of the reproductive organs, the testicles do not descend into the scrotum, but remain in the abdominal cavity. It is diagnosed at an early age and must be cured by surgery before the boy reaches the age of 7 years. If this is not done, the testes will not be able to produce sperm due to the higher temperature inside the body than in the external environment. Even if the testicles produce a small amount of sperm, they will die immediately.
Mumps. Mumps, or mumps, is an infectious disease that affects the salivary glands. It is transmitted by airborne droplets, while the body is highly intoxicated. A complication of mumps is orchitis, or inflammation of the testicles, in which the spermatogenic tissue of this organ (epithelium) is affected.
Other infectious diseases. Complications of sexually transmitted infections (syphilis, gonorrhea, chlamydia, etc.), lead to the destruction of testicular tissue, the inability to produce sperm. Other infectious diseases (typhus, brucellosis, tuberculosis) have a similar effect, causing toxic effects on the body and significant hyperthermia.
Hormonal disorders In this type of infertility, spermatogenesis is disrupted due to an imbalance of testosterone and other sex hormones. The reason for this may be an excess of prolactin (hyperprolactinemia, tumor or inflammation of the pituitary gland, secondary hypogonadism. A similar effect is exerted by pathologies of the endocrine system: thyroid, pancreas, adrenal glands, obesity.
Genetic and hereditary diseases. There are a number of chromosomal abnormalities (Shershnevsky-Turner syndrome, Klinefelter syndrome, Noyane syndrome, Kartagener syndrome), accompanied by gonadal dysgenesis, which makes a man infertile. Hereditary pathologies (polycystic kidney disease, cystic fibrosis) have a similar effect.
Injuries and tumors, testicular torsion. These reasons include trauma, absence, torsion of the testicles, tumors of the prostate gland and other parts of the reproductive system.
The action of external adverse factors. This category contains:
- Side effects of drugs of certain pharmacological groups (nitrofurans, cytostatics, acetylsalicylic acid, narcotic analgesics, antibiotics, sulfonamides, hormonal drugs containing estrogens, androgens, cortisone);
- Ionizing radiation;
- Drinking alcohol, smoking;
- Occupational hazards (exposure to lead, phosphorus, mercury, manganese compounds, ammonia, pesticides).
- Hypovitaminosis adversely affects spermatogenesis, which can lead to unbalanced nutrition, fasting. Deficiency of vitamins of groups A, C, D, E disrupts potency and full spermatogenesis.
High temperatures. Visiting a sauna or bath, cycling, wearing tight clothing or synthetic underwear, professions associated with being in high ambient temperatures (foundry, bakery, boiler room).
Chronic stress and age. The impact of these factors reduces the quality and motility of sperm.
In case of unilateral or bilateral impairment of sperm transport along the vas deferens, we are talking about obstructive infertility.
Reasons for obstructive (obstructive) infertility:
Epididymitis. The process is similar to the occurrence of obstruction of the fallopian tubes in women. Epididymitis is a complication of inflammation of the epididymis when adhesion and further obliteration of the vas deferens occurs.
Injury and damage. Infertility results from accidental injury during surgery on the ureters, prostate, bladder, rectum, and trauma to the scrotum.
Tumors of the epididymis. Hypertrophy of tissues as a result of the appearance of cysts and tumors leads to compression of the vas deferens.
Congenital anomalies. These include hypospadias (removal of the urethral inflow in the lower third of the penis), the absence of the epididymis or the semen of the excretory canal.
Aspermatism. The essence of true aspermatism is the atypical effect of the cerebral cortex on the functioning of the reproductive centers. As a result, there is no sperm discharge during sexual intercourse of any duration. False aspermatism is characterized by the excretion of semen not into the urethra, but into the bladder (retrograde ejaculation). The reason for this phenomenon is the consequences of diabetes mellitus, multiple sclerosis, inflammation of the reproductive organs, spinal cord injuries, operations on the bladder and prostate gland, side effects of antidepressants and tranquilizers.
Other reasons. Other causes of male infertility include:
- Impotence (erectile dysfunction) - it is impossible to have a full sexual intercourse.
- Premature ejaculation is the removal of semen even before the penis is inserted into the vagina.
- Irregular or infrequent sexual contact.
- Excessively active sex life - with frequent sexual contacts with different partners, the risk of contracting STDs increases, immunity and body tone decrease, there is not enough time for the full maturation of active sperm cells.
- Sexual illiteracy.
Psychological causes of male infertility:
- Boys who grew up in a family where, as a result of authoritarian upbringing, they developed a complex of physical and mental inferiority, in adulthood develops a subconscious “culling” complex.
- A man who grew up in overprotective conditions, or in a family where the mother had indisputable authority, often remains an infantile child who does not want to have competitors for the attention of his wife.
- A man who has replaced his father in an incomplete family may have a "paternal complex" associated with unwillingness to endure difficulties associated with caring for children, subconsciously he does not want to have children.
- Among the life values of a man who raised the bar of priorities too high, there is no place for children.
Epidemiology of male infertility
- Endocrine system pathologies - 19.8% of cases of male infertility;
- Varicocele - 16%;
- Extragenital pathologies, chronic diseases of the reproductive organs - 10%;
- Infections - 9.7%;
- Immunological factors - 4.5%;
- Testicular tumors - 3%;
- Idiopathic infertility (of unknown etiology) - 5%;
- Other reasons - 5%.
There are no specific symptoms of male infertility, they depend on the cause that led to this condition. The main symptom is the absence of pregnancy in a sexual partner, which does not have any prerequisites for a woman. To clarify the possible factor of infertility, the woman is also examined.
If the cause of sterility is inflammation, swelling, trauma to the male reproductive organs, manifestations of infertility can be urination disorder, pain in the scrotum and lower abdomen, unilateral and bilateral enlargement of the scrotum, enlargement of the veins on its skin (with varicocele).
Hormonal disorders are manifested by gynecomastia (enlargement of the mammary glands), a decrease in sex drive, and a decrease in the size of the testicles.
Before diagnosing "male infertility", both spouses are offered to undergo a diagnostic examination. The examination of a couple is usually started with a man. It includes the following items:
Taking anamnesis. The doctor analyzes the patient's complaints, the number of illnesses and operations on the pelvic organs suffered by him, possible industrial hazards and negative habits (smoking, alcohol). He will certainly be interested in the male sex partners and the number of their pregnancies.
General inspection. The andrologist will visually assess the developmental features of secondary sexual characteristics. If the hair growth is insignificant, the physique belongs to the eunuchoid type, there is gynecomastia, there is a lack of androgens. The presence of testicles and their size (normally they are approximately 4.6x2.6 cm, volume about 18 ml), the consistency of the gonads (normally tightly elastic), the state of the veins of the spermatic cord and scrotum (varicocele is excluded) are studied. A rectal examination of the rectum is performed to exclude inflammation of the seminal vesicles and prostate.
Assessment of sexual and reproductive function. According to the patient, the doctor records in the history of the disease the number of sexual contacts (normally at least 2-3 per week), the quality of erection, the nature of ejaculation (normal, delayed, premature).
After the examination, the patient is sent for laboratory diagnostics. After 3 days of abstinence, he donates sperm for research.
Sperm counts are normal:
- Ejaculate volume - 2 ml or more;
- The number of sperm in 1 ml - 20 million and more;
- Ph-reaction - alkaline with an indicator of 7.2 or more;
- Morphology - more than 30% of the sperm must have the correct shape;
- Mobility - within an hour after ejaculation, more than 50% of spermatozoa move forward or 25% move forward quickly;
- Viability - more than 50% of live spermatozoa;
- Mar-test for exclusion of immunological infertility - less than 50% of spermatozoa with adhered particles;
- The presence of flora and agglutination - no;
- Viscosity is normal;
- Liquefaction - within 60 minutes;
- The number of leukocytes in 1 ml is less than 1 million;
- The amount of zinc - 2.4 μmol;
- Amount of fructose - 13 μmol in the total volume;
- The amount of citric acid is 52 μmol in the entire ejaculate.
- Oligospermia - the number of live spermatozoa is less than 20 million per ml;
- Leukospermia - an increased content of leukocytes (recorded in infections and inflammatory diseases);
- Asthenozoospermia - the number of motile sperm is below normal;
- Hypospermia - ejaculate volume below normal;
- Azoospermia - there are no sperm in the ejaculate;
- Polyspermia - the volume of sperm is above normal (more than 10 ml), it is recorded in the pathology of the organs of the reproductive system, in rare sexual intercourse;
- Aspermia - no ejaculate, as no ejaculation has occurred;
- Teratozoospermia - more than half of the sperm have structural defects (double head, abnormalities in the structure of the neck and tail).
If there is a suspicion of inflammatory processes in the reproductive organs or the presence of infections, the patient undergoes infection screening:
- PCR to exclude genital infections;
- Urethral swab to determine std;
- Sowing ejaculate to determine the causative agent of infection (carried out with an increase in the number of leukocytes);
- Biochemical study of prostate secretion for glucose, alkaline phosphatase, β-glycosidase, citric acid, zinc.
Hormone testing determines the level of the following hormones:
- FSH and LH.
The level of free radicals in sperm cells is investigated, since in the case of excessive production of reactive oxygen species, the fertilizing function of sperm decreases, they become inactive, and the cell membrane of male germ cells is damaged. In the study of the acrosomal reaction that occurs during the contact of the sperm with the egg, it is determined whether the sperm are able to dissolve the membrane of the egg and penetrate. Only healthy sperm with normal morphology are capable of performing specific chemical transformations on their head for such a reaction.
Microscopic examination of sperm
Microscopic examination of spermatozoa using an electron microscope and cytogenetic analysis give an idea of:
- About the number of chromosomes and their quality,
- About the structure of ejaculate plasma,
- Possible violation of the internal structure of the sperm.
If this test detects chromosome abnormalities, the patient is consulted with a geneticist. The test for the detection of class G, A, M antisperm antibodies is carried out when diagnosing immunological sterility. The Shuvarsky and Kutsrok-Miller tests will help to identify the immune conflict at the level of the cervical canal.
Instrumental diagnosis of male infertility:
- Ultrasound of the thyroid gland;
- X-ray of the skull and Turkish saddle to exclude pituitary tumors;
- Doppler ultrasound, transperitoneal ultrasound of the scrotum - for the diagnosis of varicocele, dropsy of the testicle, varicose veins of the small pelvis;
- Transrectal and transabdominal ultrasound for examining the appendages, prostate, testicular size and structure, detecting changes in the seminal vesicles in case of obstruction or pathologies of the vas deferens;
- Scrotal thermography for the diagnosis of varicocele;
- Testicular biopsy - with a refined diagnosis of idiopathic azoospermia with normal testicular size and FSH in the blood. The result of the study may be normospermatogenesis - for the formation of sperm there is a complete set of cells, hypospermatogenesis - an incomplete set of cells, aspermatogenesis - a complete absence of cells in the seminiferous tubules.
- Vasography - X-ray of the seminal canals and vesicles to determine the focus of obstruction.
One of the methods of express diagnostics of infertility is a sperm chip for determining the number of sperm cells, created by Californian scientists. It can be used at home with just a few drops of semen. The cost of the chip is about 40 €.
Fertility test in men at home
Today there is a unique opportunity to carry out a full-fledged procedure to identify infertility at home. The total cost will be about $ 25. It is much cheaper when compared to a full semen examination performed by a laboratory technician.
The test is called SpermCheck fertility. Its developers are specialists from the University of Virginia (USA). The trial was completed by a team of more than 200 male patients. Scientists claimed: the accuracy will be at least 96%. First, they released a version suitable for clinical trials. It allowed to determine the effectiveness of vasectomies. The invention has been successfully applied for a long time, since 2008.
Now anyone can carry out a procedure similar to a pregnancy test. As a result, using literally a few drops of semen to draw conclusions about infertility. After that, you have to make a choice - whether to contact the appropriate specialists.
Normal values are 200-500 million sperm per milliliter of semen. To draw the right conclusions, you need to know about the criteria of the World Health Organization. According to them, infertility is obvious when this number decreases to 2 million. When the number of spermatozoa decreases to 2 - 20 million, the possibility of conception decreases at the same time. The new method is built on a simple basis - the test is based on indicators - antibodies to sperm proteins. Their volume is determined biochemically. Everything is done at home, close to comfortable.
Male infertility treatment
The first stage of male infertility treatment is therapy or surgical treatment of the underlying disease, then spermatogenesis is stimulated. For the treatment of infertility, both traditional and alternative methods of treatment are used.
General strengthening treatment
Vitamin and mineral intake. To increase the production of steroids and improve spermatogenesis, vitamins of groups A, D, K, D, E (tocopherol) are used. The multivitamin complexes Aevit (vitamins A and E), Undevit, Gendevit, vitamin and mineral preparations Unicap, Centrum are used.
Sedatives and nootropics. Men with reduced fertility often show irritability and decreased activity, they suffer from depression and neuroses. To prevent overwork and exhaustion of the nervous system, to improve brain activity, drugs containing phosphorus (Lipocerebrin, Calcium glycerophosphate) are used. Bromine preparations, extracts of valerian, motherwort, tincture of Eleutherococcus are recommended as sedatives. More severe disorders of the central nervous system (psychological infertility) require an individual treatment plan with the involvement of a neurologist and psychotherapist.
Hepatoprotectors. These are agents that improve liver function: Karsil, Hofitol, Methionine, Essentiale-forte, Heptral, Ovesol. At the same time, it is advisable to follow diet number 5 (according to Pevzner), which provides for a restriction in the diet of marinades, pickles, fatty foods, the use of seasonings.
Biostimulants. To improve metabolism, enhance the activity of the reproductive organs, normalize their blood supply, accelerate the regeneration of tissues and organs, biostimulants are used: aloe extract, Apilak, vitreous humor, FiBS, Splenin, Methyluracil, Pentoxil.
Treatment of secretory infertility in men
Primary hypogonadism. For the treatment of primary (hypergonadotropic gonadism), androgens are used. Their function is to stimulate spermatogenesis and inhibit the production of gonadotropins FSH and LH. These are testosterone, methyltestosterone, etc. If the reserve androgenic functions of the testicles are preserved, the drugs are taken for 2-3 months. This is followed by a break for the same time during which the luteinizing hormone choriogonin is taken.
To increase the number of sperm and increase their motility, androgens (andriol, proviron) are taken in minimal doses. Anabolic hormones (retabolil, nerobol) are recommended for men with underweight.
To improve spermogram indices, activate the pituitary gland, and improve spermatogenesis, substitution therapy with drugs containing long-acting testosterone (testenate) is used. Cancellation of the drug after a two-month course has the opposite effect with a predictable reaction of the body.
With hyperlactinemia, inhibitors of prolactin production (bromocriptine) are used to increase libido, stimulate potency, improve spermogram parameters, and also to treat gynecomastia.
Secondary hypogonadism. With a lack of luteinizing hormone, testosterone synthesis decreases, spermatogenesis slows down. For the treatment of this condition, LH preparations (pregnal, choriogonin) are used for 1.5-2 months, combining them with testosterone intake. If there is not enough FSH, folistamine or anthrogon is prescribed to activate spermatogenesis for 1.5-2 months.
To stimulate the activity of the pituitary gland and hypothalamus, progestins (clomiphene) or antiestrogens (tamoxifen, zitosonium) are prescribed, the course intake (a month with 10 days off) can be repeated up to 6 times.
Treatment of excretory infertility in men
Treatment for this type of male sterility begins with correcting the cause of this condition. If infertility is caused by complications of prostatitis, vesiculitis, orchitis, urethritis, antibiotics and anti-inflammatory drugs are prescribed. Additionally, massage, physiotherapy, acupuncture and other methods are used. To normalize metabolism and stimulate spermatogenesis, hepatoprotectors, adaptogens, biostimulants, vitamins are prescribed.
Surgical treatment of male infertility
Surgical intervention is indicated for obstructive aspermia.
The tactics of the operation to restore the patency of the vas deferens depends on the structure of the pathology:
- Vasovasostomy (the site of obstruction of the vas deferens is removed);
- Vasoepididymostomy (the vas deferens are connected to the tubules of the appendages);
- Resection of the prostate through the urethra.
The age category for such operations is young men (up to 30 years old).
If aspermia is diagnosed in older men, other methods of sperm retrieval are used to carry out assisted fertilization technologies:
- Percutaneous testicular puncture;
- Percutaneous puncture of the epididymis;
- Open puncture biopsy of the gonads;
- Microsurgical intervention to obtain the contents of the epididymis.
With secretory infertility, the following surgical intervention is performed:
- Embolization or sclerotherapy of the affected ovarian vein (with varicocele);
- Puncture or hardening (with dropsy of the testicle);
- Laparoscopy or the use of the classical method (for cryptorchidism, performed in childhood).
Autoimmune infertility treatment methods:
- Glucocorticoid therapy (Hydrocortisone, Desametozone) with anti-inflammatory, immunosuppressive and antihistamine action, forms of application - tablets, ointments, physiotherapy.
- Sperm capacitation (processing and washing) for preparation for IVF or ICSI.
Assisted reproductive technologies
Alternative methods of compensation for male infertility:
Artificial insemination. The essence of the method is as follows - pre-processed sperm is injected into the woman's cervical canal or directly into the uterine cavity. In cases of low concentration of active sperm in the sperm of the spouse or their complete absence, donor sperm is used. The method is used for the cervical factor (the production of antibodies to the spouse's sperm by the mucus of the cervical canal), with autoimmune infertility and sterility of unexplained etiology.
In Vitro Fertilization. With IVF, the fertilization of the egg takes place outside the female body. Several specimens are removed after artificial stimulation of ovulation from the ovaries, fertilized in a Petri dish with the sperm of the spouse. A few days later, the most viable zygotes (fertilized eggs) are selected and transferred to the uterus.
ICSI. The ICSI (intracytoplasmic sperm injection) method consists in the introduction of a sperm into an egg cell using microsurgical manipulations. One viable sperm is sufficient for the success of the procedure. Male cells are obtained by masturbation or surgical aspiration.
Surrogacy or adoption. In the case of donor motherhood, a surrogate mother, within the framework of a previously concluded contract, bears a child developing from a zygote obtained from the germ cells of infertile spouses.
There are simple rules that can be followed to significantly improve sperm quality. These recommendations are especially relevant for men planning to have a child in their family.
Following the principles of healthy eating. It is advisable to limit the use of marinades, pickles, smoked meats, sweets, hot spices, fatty foods. Recommended products: red meat, legumes, walnuts, parsley, dill, basil, celery, large quantities of fresh fruits and vegetables, broth or rosehip infusion. It is very useful to eat tomatoes in any form due to their high content of such an antioxidant as lycopene.
Normalization of body weight and prevention of hypodynamia. A sedentary lifestyle provokes blood stagnation in the pelvic organs. The consequence of this is a deterioration in the quality of sperm, a decrease in potency, the development of diseases such as varicose veins, hemorrhoids, testicular dropsy. The increase in body weight contributes to the increased production of estrogen, a female hormone, by the adipose tissue. Physical education, walking, and gymnastics will help reduce this risk.
Wearing physiologically beneficial underwear and clothing. In order not to disrupt blood circulation in the pelvic organs, in the scrotum, it is advisable to refuse to wear tight underwear (especially if it is made of synthetics), tight jeans.
Normalization of the sex life. Normally, sexual intercourse should be at least and no more often than once every 2-3 days. Too frequent contacts can result in the production of sperm with a large number of immature spermatozoa, too rare - aging of male germ cells. In addition, regular sexual intercourse protects a man from the appearance of prostatitis and prostate adenoma.
Prevention of overheating of reproductive organs. Temporarily it is worth refusing to visit the sauna and bath.
The use of folk remedies. An excellent effect in the treatment of infertility is given by the use of beekeeping products: these are bee bread (pollen from bee honeycombs), pollen, honey, royal jelly. The consumption rate of pollen and bee bread is 1/2 tsp. in a day. Medicinal plants are used to normalize blood circulation in the pelvic organs, increase testosterone secretion and sperm quality. Plantain, ivan tea, sage, knotweed are brewed and taken in 3-4 tbsp. l. in a day.
Treatment of male infertility, its duration and effectiveness depends on the cause of the pathology, the thoroughness of adherence to the recommendations of specialists, the chosen methods of therapy. About 45-50% of couples whose infertility is "guilty" of a man, as a result of treatment, find the happiness of being parents.
Author of the article: Lebedev Andrey Sergeevich | Urologist
Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.