Reproductive (fertile) is the age at which a person is able to become a parent. For a woman and a man, the period of life during which they can (by joint efforts) produce offspring is different. Physiologically, childbearing for women is considered the age from 15 to 49 years. But in reality, for most of them, the opportunity to become a mother is limited to a shorter period, which is 10-15 years.
A man, from a medical point of view, is capable of continuing offspring from 14 to 60 years. But he should not become a father before the age of 20 for social reasons and for a different level of development. After 35-40 years in men, sperm activity decreases and, as a result, reproductive ability. Therefore, even with a normal state of health, the period of guaranteed fertility for a man can be about 20 years.
Puberty in men
A teenager reaches puberty at the age of 14-15 years. But in the future, in the male body, there is an alternation of certain periods, which affect sexual life and reproductive abilities in particular.
From about 10-12 years of age, boys begin to undergo physiological changes leading to puberty. Sexual feelings and thoughts become more tangible. The process can be conditionally divided into three stages:
- Show interest in the opposite sex.
- The desire for body contact in the form of touching, holding hands, kissing.
- The onset of sexual desire.
In the early stages of growing up, boys just make friends with girls, then there is an attraction to touch and mutual affection, which leads to erotic fantasies and a strong desire for sexual intimacy. After feeling his sexuality, the young man begins to be more interested in the physiology of relationships, for most girls in this regard, feelings are more important.
On the way to puberty, testosterone levels increase in the body. This main male sex hormone contributes to the development of basic sexual characteristics in adolescents, making them both fertile and attractive to the opposite sex. 
The adolescent's decision to have first sexual intercourse depends on his upbringing and his circle of contacts. The first sexual contact sometimes occurs under the influence of social stereotypes about male sexuality. This can lead to promiscuous sex in the established target-sex pattern. Emotional matching with a partner is not given special importance.
Subsequent growing up in most guys causes the need for more sensual and lasting relationships, there is a desire to start a family. Other young people choose to remain free in both life and sexual relationships.
Many men claim that only having reached adulthood, they experienced the true pleasure of having sex with their beloved wife. Moreover, the partners are already aware of each other's sensual intricacies. Physical satisfaction takes on a more emotional color.
How a man's sex life changes with age
When a man reaches the age of 30-35 years, his needs of a sexual nature become less pronounced, since the production of testosterone by the body becomes less intense. Sex drive is influenced by the stresses and emotional stresses that arise at work and in family life. By this age, the activity of sperm also decreases during fertilization of the egg. The impact on the body of external conditions and changes in health conditions impair the genetic qualities of sperm.
The age of the parents-to-be is very important when planning a woman's pregnancy.
In women, early and late motherhood may be contraindicated for medical reasons; in men, the favorable period for conception is slightly longer.
The male body generates spermatozoa throughout the reproductive period of life, but conception of a child is not recommended at any age. Planning for a baby is determined not only by the father's reproductive health, but also by his ability to support the family. In social and psychological terms, a young person is able to become a father after twenty years, but the most suitable in terms of reproductive functions is considered to be the age of 35 years.
Sperm production in the male body, which begins at age 15, slows down after 35, but does not stop until 60. However, most medical professionals believe that the optimal age for conceiving a child is the same for both women and men - 20-35 years. In men during this period, the level of the hormone testosterone provides the necessary sperm activity.
Influence of a man's age on his fertility
Medical specialists have long known that fertility is significantly reduced in women 35-40 years old, but the effect of age on the normal reproductive capabilities of men is less studied. French researchers studied the medical records of more than 10 thousand couples undergoing fertility treatment, and found out the degree of influence on the possibility of conceiving the age of the sexual partner.
According to statistics, if men have passed the 35-year mark, their companions are more likely to experience miscarriages than women who have younger partners, regardless of their own age. The number of successful conceptions is significantly reduced in couples where the partner is over 40 years old.
In connection with the research findings, there is concern about the tendency of young men to delay procreation. In the UK in 2013, the average age of men becoming fathers increased to 34.2, up from 29.2 in 1972. Embryoologists explain the influence of age on male reproductiveness by an increase in genetic errors in sperm.
In young sexual partners of future women in labor, some changes in sperm quality do not have a significant effect on the fertilization of the egg. Potential fathers of more mature age have critical DNA damage that can lead to miscarriage. Recent studies show that not only the female body is subject to reproductive aging, but also the male.
Measures to increase reproductive performance
If a decrease in male fertility is not associated with various pathologies, then the implementation of some recommendations will change the situation for the better: 
- Vitamin E, ascorbic acid, selenium have a positive effect on spermatogenesis. It is necessary to periodically take food supplements containing these elements. It is also recommended to consume nutritional supplements containing zinc and folic acid for six months.
- The reproductive process of spermatogenesis is negatively affected by overheating of the testicles. Loose underwear and loose trousers should be worn in hot weather. Do not take too hot baths and steam in a bath at high temperatures.
- Favorable conditions for conception also depend on the season. Sperm cells have the greatest mobility when the winter period begins.
- The restoration of sexual desire is facilitated by a balanced emotional state, the ability to resist a depressive state and stressful situations.
- Common bad habits - smoking, drinking alcohol, and also coffee in large quantities - harm normal fertility.
- The unfavorable environment, work in conditions of high temperature significantly affects reproductive functions.
If measures taken on your own do not help to solve the fertility problem, do not hesitate to seek medical help.
Reproductive opportunities in adulthood
With age, hormonal changes in a man's body reduce libido, emerging health problems reduce energy and potency. Decreased testosterone levels weaken sex drive, the period of sexual arousal becomes longer.
Men who have crossed the forty-year mark by this time usually have already taken place as husbands and fathers. For most of them, career growth reaches its peak, and there is a feeling that their role in family life is not so significant, and health problems appear. Competition at work on the part of young employees aggravates the psycho-emotional state. In addition, the spouse may experience irritability and fatigue due to symptoms of menopause.
Taken together, all these factors can lead to thoughts of approaching old age and depression. Against its background, low self-esteem, lack of sexual desire and impotence may occur. The midlife crisis forces a man to look for partners on the side much younger than himself in order to prove his worth. Such a relationship allows only for a short time to return the sensations of previous years and bring freshness and energy to sexual relations.
But, despite the frequent similar problems in middle-aged men, psychologists consider the age from 30 to 40 years old to be a more difficult period in sexual terms. In their opinion, it is during this period that the head of the family experiences the maximum emotional and physical stress - problems at work, small children, financial difficulties, etc.
At the same time, adolescence and age over 50 are considered a favorable period of life in this regard, provided that a mature man was able to maintain health in his younger years. A healthy maturity, a measured life and a constant loving woman are the best circumstances for a fulfilling sex life.
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Drug-free treatment
Treatment always begins with general organizational arrangements.It is necessary to eliminate occupational hazards that can have a negative effect on the male reproductive system, establish a normal rhythm of work and rest, good nutrition, streamline the treatment of concomitant diseases, and normalize the rhythm of sexual activity.
Rare sexual intercourse increases sperm count and sperm concentration, but leads to an increase in the proportion of pathological forms and a decrease in mobility.
With short abstinence, the sperm count may be insufficient. It is desirable that a woman after intercourse remain in bed with a raised pelvis for 30-40 minutes: this contributes to the formation of a seminal "puddle" at the cervix. The optimal period of abstinence is 3-5 days. With low sperm quality, the use of a condom is justified, excluding the ovulation period, since low quality sperm produces specific antisperm antibodies (ASAT)and provokes the development of immune infertility. In this case, sexual intercourse without contraception will occur only on the days of the maximum probability of conception.
Nutrition for infertility should be regular and complete. Food should contain a sufficient amount of proteins, fats, carbohydrates, trace elements and vitamins. These products include sea fish, caviar, honey, nuts, cottage cheese. Fat-soluble vitamins A and E are particularly useful for steroidogenesis, as well as vitamin C, which plays a key role in mitochondrial metabolism. The use of spicy foods, seasonings and smoked meats is prohibited.
To improve the antitoxic and metabolic functions of the liver, it is recommended to take medications such as milk thistle extract (Carsil®), phospholipids (Essentiale forte N®), some amino acids (methionine, glutamic and lipoic acids). To activate various physiological processes in organs and tissues, various biostimulants are used: aloe tree leaves, royal jelly (apilak®), plasmol®, etc.
For the treatment of male infertility against the background of chronic prostatitis and accessory gonads, physiotherapeutic methods are widely used:
Electrical stimulation;
magnetotherapy;
low-intensity laser radiation;
pneumomassage of the prostate gland.
Physiotherapy treatment has the following effects:
Improving microcirculation and increasing the tone of smooth muscles of the prostate gland;
restoration of the evacuation and secretory function of the prostate;
improving sexual function;
anti-inflammatory, analgesic effect;
changes in redox and enzymatic processes in the prostate gland;
bacteriostatic effect;
increasing the effectiveness of antibiotic therapy.
The main advantages of existing physiotherapeutic devices are combined in the domestic hardware and software complex "Andro-Gin". The principle of operation of the hardware-software complex is based on the complex effect of a local magnetic field, electrical stimulation of the pelvic organs, neurostimulation of reflexogenic zones of the skin, low-intensity laser and LED radiation, as well as color-pulse biorhythmotherapy.
In addition to the electrical stimulation previously used in medical practice, the apparatus allows the formation of impulses of various shapes, alternating with relaxation phases, which creates the possibility of contraction of the muscle fibers of the prostate gland to the entire depth; at the same time, lymphatic outflow and blood microcirculation are greatly stimulated.
The operating modes incorporated in the controlled parameters of the device create conditions for the selection of the most physiologically effective effect on the prostate tissue depending on the disease (non-bacterial, bacterial, chronic prostatitis with prostatic hyperplasia, sexual dysfunction, etc.). In the acute phase, the complex is used in combination with antibacterial and anti-inflammatory therapy according to the developed method.
The course of treatment consists of 10-12 sessions. After the full course of treatment, encouraging results were obtained. In 85% of cases, resolution of symptoms is observed (pain relief, normalization of prostate secretion, positive dynamics in terms of sexual deviations, the absence of infectious pathogens in the test material, etc.), in 15% - significant improvement. Almost all patients notice an improvement in erection, they have an increase in the duration of sexual intercourse.
Thanks to the use of the Andro-Gip apparatus, the efficiency of standard therapy for chronic urinary infections is increased.
The hardware and software complex "Andro-Gin" is used in urology for chronic inflammatory diseases of the prostate, seminal vesicles, urethra, complicated by pain and dysuria, sexual dysfunction and infertility, prostatic hyperplasia, urinary incontinence, chronic prostatitis against the background of prostatic hyperplasia , neurogenic bladder syndrome.
Against the background of the use of the hardware-software complex "Andro-Gin" in the treatment of ejaculation disorders, complaints disappear in 40% of patients, the severity of symptoms significantly decreases in 50%, and there is no improvement in 10% of patients.
Drug treatment
Currently, drug therapy for male infertility is experiencing certain difficulties associated with that. that a significant part of the drugs on which high hopes were pinned did not justify themselves.Before considering the possibilities of drug therapy, it is necessary to determine the list of nosologies in which the use of conservative therapy is possible to one degree or another. Currently, the list of such diseases is very limited.
Let's try to systematize these pathological conditions and diseases:
Infertility due to endocrinological factors (hypogonadotropic hypogonadism, prolactinoma).
Infertility due to organic factors (cryptorchidism, retrograde ejaculation).
Infertility due to infections and inflammatory factors (chronic prostatitis, epididymitis, orchitis, vesiculitis, prostatitis).
Infertility due to immunological factors.
Infertility due to the course of concomitant diseases (chronic renal failure, hepatitis, liver cirrhosis, bronchial asthma, pulmonary emphysema, hypertension).
Infertility due to the intake of pharmacological agents used in the treatment of other diseases.
In all other cases, the use of pharmacological drugs is currently not indicated, and sometimes it causes additional harm to patients who lose time, money and hope to get at least the possibility of a long-awaited pregnancy.
Endocrinological infertility
Currently, the share of endocrinological infertility accounts for 8.9% of all forms (Brugh Victor M., Lipshultz Larry I., 2004). Of all groups of patients with an endocrinological factor, conservative therapy is possible only in patients diagnosed with hypogonadotropic hypogonadism.Treatment of total hypogonadotropic hypogonadism is carried out with chorionic gonadotropin 1500-2000 IU intramuscularly 2 times a week for a month, with monthly breaks, during the entire reproductive period. In this case, the use of androgens is useful.
It was the treatment with chorionic gonadotronin (1500 IU intramuscularly every other day) as a pathogenetic method after 12-24 months of treatment that gave a positive effect on the formation of spermatogonia in patients with azoospermia, while the use of testosterone (testosterone propionate®) as monotherapy and in combination with mepopausal gonadotropin did not give a therapeutic effect. For recombinant therapy luteinizing hormone (LH) or follicle-stimulating hormone (FSH) a combination of chorionic and menopausal gonadotropins is useful (Efimov A.E., 2010).
Kalmann syndrome (olfactogenital syndrome)
In children and adults, hypoplastic testicles, by adolescence, a eunuchoid appearance is formed (high growth, prepubertal testicles, infantile penis, complete absence of secondary sexual characteristics). The clinical picture of hypogonadism is combined with hyposmia, low levels of LH, FSH in biological media. Karyotype 46XY. The hereditary nature of the disease is established from the anamnesis.
Positive test with chorionic gonadotropin and chorionic gonadotropin + menopausal gonadotropin. Treatment of pathology consists in long-term (over many years) use of chorionic gonadotropin (1500-2000 IU 2 times a week for 1 month, 6 courses a year with 1 month breaks). In case of severe hypoplasia of the testicles, it is recommended, in addition to chorionic gonadotropin, to use androgens of prolonged action for a year.
There is a slightly different tactic of drug therapy: at the first stage of treatment, testosterone preparations are used for several months to achieve virilization, stimulate libido and general well-being, and then drugs are prescribed gonadotropin-releasing hormone (GnRG)for pulse injection. They are administered by means of an infusion pump subcutaneously at a dose of 5-20 μg / pulse every 120 minutes.
GnRH pulses increase the pituitary secretion of gonadotropins, which in turn stimulate the synthesis of steroids and the maturation of sperm in the testes. Treatment continues until sperm appears in the semen or pregnancy occurs. The probability of restoring fertility in Kalmann's syndrome is very high and approaches 100%. Treatment can be lengthy. Cryptorchidism and small testicular volume are not considered contraindications to this therapy - in almost all patients, the size of the organ increases significantly during treatment. As a result, the appearance of secondary sexual characteristics and even the ability to fertilize is possible.
Pituitary dwarfism (pituitary dwarfism, microsomia) is characterized by dwarf growth (in men - up to 130 cm, in women - up to 120 cm). It develops as a result of a genetic defect in the synthesis of somatotropin, as well as an outcome of pathological processes in the hypothalamic-pituitary region (vascular, tumor diseases, intoxication) or birth trauma with damage to this area. The neighboring areas of the adenohypophysis are also involved in the pathological process. As a result, there is a sharp decrease in the amount of growth hormone, LH, FSH, thyroid-stimulating and adrenocorticotropic hormones, which determines the corresponding clinical symptoms.
Treatment of pituitary dwarfism is carried out with human somatropin, anabolic drugs, thyroidin (0.1 g / day). In order to stimulate sexual development, chorionic gonadotropin is used at 1000-1500 IU intramuscularly 2 times a week in monthly courses with monthly breaks for many years.
The complex of therapeutic measures for hypogonadism in men includes a subcaloric diet (1200-1500 kcal with fasting days), injections of amfepramone 0.025 g 30 minutes before meals 2 times a day, a course of 20 days, diuretics, hormonal drugs: chorionic gonadotropin 1500- 3000 IU intramuscularly 2 times a week in courses of 1 month for a long time.
Prolactinoma
The criteria on the basis of which the question of prescribing treatment is decided can be divided into two categories:
Absolute, due to tumor mass effects - chiasmatic syndrome, dysfunction of cranial nerves, headaches, hypopituitarism;
relative, due to the effects of hyperprolactinemia - hypogonadism, amenorrhea or oligomenorrhea, infertility, erictile dysfunction (ED), decreased libido, osteoporosis or osteopenia, persistent hirsutism, persistent galactorrhea.
Currently, the main method of treatment with prolactin, including in patients with endocrinological factor of infertility on the background of prolactinoma, is the drug; if it is ineffective, surgical treatment is used, radiation therapy (RT)or a combination of several methods. Drug treatment allows to normalize the prolactin content and control the size of the adenoma, which in most cases makes it possible to avoid neurosurgical intervention and / or RT.
In the 70s of the last century, the use of ergot derivatives, which have a dopaminergic effect, began as hypoprolactinemic agents. Stimulation of type 2 dopamine receptors (D2 receptors) by dopaminergic drugs using a calcium-dependent mechanism inhibits the activity of adenylate cyclase, resulting in a decrease in intracellular content cyclic adenosine monophosphate (cAMP)and secretion of prolactin.
In addition, D2 receptor stimulators inhibit prolactin synthesis by inhibiting transcription of the corresponding gene. Against the background of therapy with dopamine agonists, proteolytic cleavage of prolactin by lysosomal enzymes occurs, which, with prolonged use, causes perivascular fibrosis and partial necrosis of adenoma cells. Dopamine agonists suppress transcription deoxyribonucleic acid (DNA) in lactotrophs of the pituitary gland, cause dystrophic changes and necrosis in tumor cells with a decrease in the size of prolactin. Over the years, as a result of the improvement of dopamine agonists, their selectivity and ease of use have increased, and their tolerance has improved.
Clinicians currently have three generations of dopamine agonists in their arsenal:
1st generation: bromocriptine (bromergon®, parlodel®) and bromocrmptine [alpha, beta] (abergin®).
Generation II: quinagolide (norprolac®), according to its chemical structure, belongs to the group of octabenzoquinolines.
III generation; cabergoline (dostinex®) is similar in chemical structure to bromocriptine and belongs to synthetic ergoline derivatives.
Taking bromocriptine allows you to restore the normal content of prolactin and the functioning of the gonads in patients with idiopathic hyperprolactinemia and microprolactinomas in 80-85% of cases. With macroprolactinomas, the amount of prolactin is normalized in more than 60% of cases, and the functions of the gonads are restored in more than 50% of patients. Bromocriptine is a short-acting drug, its single ingestion causes a decrease in the amount of prolactin on average for 9 hours. For this reason, to achieve a therapeutic effect, its daily dose of 2.5-7.5 mg is divided into 2-3 doses.
Selective stimulants of B2 receptors include cabergoline and quinagolide. The mechanism of action of cabergoline is based on high affinity and direct interaction with D1 receptors of lactotrophs. Cabergoline has no statistically significant effect on the amount of growth hormone, LH, thyrotropin and cortisol in either healthy people or patients with hyperprolactinemia. Against the background of cabergoline therapy, a slight decrease in the release of LH and FSH in response to GnRH stimulation is possible.After the normalization of the prolactin content during therapy with cabergoline, an increase in the previously reduced concentration of estrogen in women and testosterone in men is noted.
It is recommended to start therapy with cabergoline with a dose of 0.25 mg, which is taken 2 times a week. After 1 week, the dose is increased to 0.5 mg 2 times a week. In the absence of an effect, the dose can be increased to 1.0 mg 2 times per week and even more - up to 4.5 mg per week. Stable normalization of the concentration of prolactin in blood serum was observed in 83% of patients receiving cabergoline at a dose of 0.5-1 mg 2 times a week. Many studies have shown a decrease in the size of macro- and microprolactin with an improvement in visual functions while taking cabergoline.
A decrease in size with microprolactin was noted in 74% of cases, with macroprolactin - in 91% of cases. Complete disappearance of the tumor was registered in 18% of patients with microprolactinoma and in 2% of patients with macroprolactinoma. The effect of the therapy was noticeable within a month from the start of treatment. The mechanisms of tumor regression during therapy with cabergoline are similar to those caused by other stimulators of D2 receptors. However, cabergoline is also effective in patients with prolactinomas resistant to bromocriptine, which is associated with a higher affinity for D2 receptors.
Increased estrogen content
Another direction of attraction of hypogonadotropic hypogonadism is the use of so-called antiestrogenic drugs. Representatives of this group are clomiphene and tamoxifep. By the principle of similarity, they block the cytoplasmic estrogen receptors in the hypothalamus, thus creating the illusion of estrogen deficiency. In response to this, the frequency and amplitude of the pulsating release of GnRH and, as a consequence, the secretion of pituitary LH and FSH increase.
Clomiphene is one of the most readily available, popular and cheap drugs used in the treatment of hypo- and normogonadotropic hypogonadism. The recommended doses are still I.S. Elag and N. Alexander in 1979 on the basis of treatment of 677 patients: 25-50 mg / day or 100 mg every other day. Against the background of such treatment, there is usually an increase in sperm motility and an increase in their concentration, and the mobility increases faster than the concentration.
Tamoxifep has a less pronounced antiestrogenic effect than clomiphene, but is also able to increase the amount of its own gonadotropins. Against this background, the concentration of spermatozoa may increase, but an improvement in motility and a decrease in the proportion of morphologically pathological forms of tic occurs.
But against the background of treatment with this drug, gynecomastia almost never occurs, which is a frequent companion of treatment with clomiphene. Aromatase inhibitors suppress the activity of an enzyme that normally converts androgens to estrogens, and increase the synthesis of LH and FSH. In men with moderate hypogonadism, if estradiol is elevated and testosterone is low, an aromatase inhibitor, such as testolacgon 50-100 mg 2 times a day or anastrozole 1 mg daily, can be used.
Conservative therapy of infertility due to organic factors
Currently, organic causes leading to infertility account for 7.8% of all forms. Most diseases are due to the presence of various anomalies in the structure of the genitourinary apparatus. Many of these anomalies are eliminated surgically, however, in case of cryptorchidism or insufficiency of the internal sphincter caused by its dysfunction, when there is a loss of biomaterial into the bladder, conservative therapy may be prescribed.Cryptorchidism is a systemic polyetiological disease, one of the manifestations of which is the undescended testicles into the scrotum.
Supporters of the endocrine theory of cryptorchidism believe that in the first place is hormone therapy (HT)... However, more than 20 years of experience with hormones has shown that drug treatment of cryptorchidism is not effective enough.
For the purpose of hormone therapy, chorionic gonadotropin is currently used. It is usually prescribed 500-1000 IU for children under the age of 10, children over 10 years old - 1500 IU 2-3 times a week. If the result is positive, the course of treatment is repeated after 3 months. It has been established that in boys with cryptorchidism, chorionic gonadotropin therapy is of great importance in the prevention of hypogonadism and infertility.
HT as a method of conservative descent of the testicles is prescribed to patients with cryptorchidism in the form of retention. A number of authors note that it is possible to achieve independent descent of the testicles into the scrotum (up to 15% of cases). Hormone therapy is contraindicated in ectopic forms, as well as in patients with acquired cryptorchidism.
Retrograde ejaculation is the absence of semen during orgasm, which occurs due to the lack of contraction of the sphincter: the bladder valve does not close, ejaculate is thrown into the bladder. During orgasm, there is no discharge of semen, and when urinating, its traces are noticeable in the urine. This ejaculation disorder does not affect sexual satisfaction.
Possible causes of retrograde ejaculation:
Operations in the bladder neck area - transurethral resection of the prostate gland;
a-blockers (Omnik®, Cardura®);
neurological pathology in the lumbosacral region;
venous pelvic hypostasis;
hemorrhoids;
diabetes;
open adenomectomy;
malformations;
changes after menopause.
In addition, a side effect of some drugs for the treatment of hypertension and heart disease is relaxation of the bladder neck, due to which the bulbocavernous muscles do not contract, and retrograde ejaculation occurs.
For men who have a prostate adenoma, in order to maintain normal, antegrade ejaculation, it is preferable to choose treatment methods that are alternative to transurethral resection of the prostate gland.
Treatment for retrograde ejaculation is a complex and lengthy process that begins with eliminating the cause of the disease with the help of reflexology, physiotherapy, and electrical stimulation of the prostate.
With retrograde ejaculation, medication is recommended with knowledge of therapy, the purpose of which is to restore antegrade ejaculation. Complex drug therapy may include ephedrine (10-15 mg 4 times a day) and imipramine (25-75 mg 3 times a day),
Achieving antegrade ejaculation is possible with intercourse with an overflowing bladder (in this case, the bladder neck is closed as much as possible). If this method does not lead to conception, drug therapy does not work, and the patient has spinal pathology, then apply in vitro fertilization (ECO).
Infertility due to infections and inflammatory factors (chronic prostatitis, epididymitis, orchitis, vesiculitis, prostatitis)
Among the huge number of currently known microorganisms that cause specific and nonspecific inflammatory processes, a direct effect, from the point of view of evidence-based medicine, has been identified for chlamydia. They induce the processes of apoptosis of spermatozoa, reducing their vitality, lifespan and synthesis. For other viruses, bacteria, mycoplasmas, fungi and other agents, the effect on spermatogenesis has not been proven. Nevertheless, there is an indirect effect on spermatozoa by hypokinesia due to a decrease in the content of fructose and citrates in the secretion of the prostate gland.Therapy is aimed at treating the underlying infection. There are a huge number of treatment regimens for various infections, but we will not dwell on this, as they are set out in the relevant sections of this publication.
A chronic inflammatory process in the gonads leads to the following consequences:
Damage to the hemato-testicular barrier and the development of antisperm immunity;
the occurrence of pathospermia, which occurs in 75% of patients; 35% of patients with oligozoospermia and teratozoospermia suffered from bacterial prostatitis;
various forms of impairment of the fertilizing ability of spermatozoa, in particular, impaired capacitation and acrosomal reaction. For this reason, even with normozoospermia, but in the presence of signs of inflammation in the genitals, a man cannot be considered completely fertile; violation of the physicochemical properties of semen: pH changes, the activity of enzymes responsible for liquefaction of sperm decreases, the concentration of fructose and citric acid decreases;
the presence of microorganisms and toxins in the secretions of the accessory gonads with their subsequent entry into the sperm leads to the agglutination of sperm.
Since a portion of ejaculate, in addition to the shaped elements, consists of the secretion of the prostate gland and seminal vesicles (95%), the secretion of the bulbourethral glands (1-2%) and sperm plasma with sperm, the therapy of the underlying disease in the treatment of infertility becomes pathogenetic therapy.
It includes antibacterial, anti-inflammatory therapy, drugs with a prostatotropic effect [based on prostate extract (samprost®)], antibodies (afala®, impaza®), bioactive additives, etc. Sanitation of prostate secretion reduces the severity of leucospermia and sperm agglutination , which increases fertility.
Infertility due to immunological factors
Immunological infertility of married couples is today one of the most dynamically developing areas within the framework of the problem of infertility. It is based on the antisperm conflict. Of the total number of married couples with problems in achieving the desired pregnancy, 5% reveal ASAT in the secretion of the cervical canal, ejaculate and blood serum. Detection of ACAT by any of the laboratory methods (MAR-test, enzyme-linked immunosorbent assay and zip) allows to establish the existence of autoimmune reactions against spermatozoa. If ACAT covers more than 50% of motile spermatozoa, a diagnosis of male immune infertility is made.ACAT is able to influence the following points:
Spermatogenesis in the testes;
sperm motility in the ejaculate;
penetration of cervical mucus;
acrosomal reaction;
attachment, binding and penetration of the zonapellucida sperm. The formation of antibodies directed to sperm antigens, like antisperm immunity, is one of the causes of infertility in the family.
Autoimmunity to sperm antigens causes male infertility in two ways: the direct cytotoxic effect of antibodies on sperm; gradual disruption of normal spermatogenesis with the development of oligo- and asthenozoospermia, while immune responses act as secondary, increasing damage to the testes, appendages and accessory gonads. Autoimmunization can occur due to traumatic injury or inflammation of the genital organs. Failure of protection mechanisms at any level leads to the emergence of ACAT.
The treatment of married couples with a detected increase in the amount of ASAT is carried out in different ways, depending on the survey data. They usually start with the use of the barrier method (condom) in a continuous mode for a period of 3-6 months or in an intermittent mode (sex without a condom only on days favorable for pregnancy). Reducing the supply of sperm to a woman's body reduces antibody synthesis and increases the chances of pregnancy. In parallel, therapy can be prescribed that reduces the viscosity of the cervical mucus and suppresses the synthesis of ASAT in the spouses. If conservative therapy fails, courses of intrauterine insemination with the husband's sperm or in vitro fertilization (IVF) are performed.
To reduce the level of ASAT, prednisolone is prescribed at a dose of 40 mg / day in courses of up to 3-5 days. Prescription of prednisolone in short courses at the indicated dose suppresses the formation of ASAT.
There is a drawback of this method: the circulation of ACAT and immune complexes in the patient's blood continues for a long period of time, which degrades the quality of sperm. A modification of the method is the appointment of prednisolone for 5 days daily at a daily dose of 1.2 mg / kg of the patient's body weight (30 mg per os 3 times a day, which is 90 mg with an average patient's body weight of 75 kg).
Prednisolone inhibits the synthesis of antibodies, which leads to a decrease in their amount in the blood. Due to the fact that the use of prednisolone for a long time leads to inhibition of the functions of the adrenal glands, gonads, electrolyte imbalance, the proposed therapy should not exceed 6 days.
After the end of treatment with prednisolone, the patient undergoes a course of plasmapheresis every other day, for example, on a PMF-800 plasma filter using a roller pump with a capacity of 50-70 ml / min in a plasma volume of 15 ml per kilogram of the patient's body weight, to remove ACAT and immune complexes from the patient's blood until normalization indicators. In 89% of patients, the main indicators of spermogram improve, and the effectiveness of treatment is confirmed by the onset of pregnancy in most cases.
Hyperbaric oxygenation is used to treat antisperm immunity (patent No. 2152210 dated July 10, 2000). The course of hyperbaric oxygenation includes 6-10 sessions daily for 45-60 minutes in a gentle mode at an oxygen pressure of 1.5-2 agm in the Oka-MT pressure chamber. Studies have shown the high efficiency of hyperbaric oxygenation in patients with oligozoospermia.
However, this method of treatment seems questionable, since reactive oxygen species have a toxic effect on sperm. So, according to V.A. Bozhedomova and M.A. Toroptseva, in patients with normospermia and excessive formation of reactive oxygen species in 52.9%), there are violations of the acrosomal reaction. In 52.2%, against the background of a high content of reactive oxygen species, an increased content of ASAT was revealed. In patients with chronic kidney disease, a high level of such oxygen forms was detected in 64.1% of cases, and in patients with varicocele, their content in spermoplasm was 1.9 times higher.
Recently, there have been reports of the experimental appointment of the antioxidant methylethylpyridinol (emoxipin®) with a high content of ASAT. The drug has an antitoxic and membrane stabilizing effect. Appointment of emoxipin® solution at a dose of 0.3-0.5 ml intramuscularly to a man in the first 14 days of the ovulatory cycle in a partner leads with a high degree of probability to a pronounced decrease in the amount of ASAT. To effectively reduce ACAT, two such courses are needed. The results obtained are ambiguous and, due to the lack of effective methods for reducing the content of ASAT, deserve close attention.
Enzymes make some contributions. Information on their effectiveness is set out below.
Infertility due to the course of concomitant diseases and the use of pharmacological agents
There is infertility due to the course of concomitant diseases (such as chronic renal failure, hepatitis, liver cirrhosis, bronchial asthma, pulmonary emphysema, hypertension), as well as the result of taking pharmacological agents used in the treatment of other diseases.Such diseases lead to severe sperm intoxication against the background of pronounced oxidative stress, therefore, compensation for ejaculate asthenization consists in the effective treatment of these diseases, taking into account the means that negatively affect spermatogenesis.
Such drugs include pharmacological drugs of the following groups:
Androgens in doses significantly higher than physiological.
Antiepileptic drugs.
Anabolic steroid.
Sleeping pills.
Estrogens.
H2-receptor antagonists.
GnRH agonists and antagonists.
Antipsychotics.
Glucocorticoids in doses significantly higher than physiological.
Antidepressants.
Thyroid hormone preparations in doses significantly higher than physiological.
Dopamine antagonists.
Antiandrogenic drugs.
Antineoplastic drugs.
5-a-reductase inhibitors.
A- and b-blockers.
Steroidogenesis blockers.
Anti-tuberculosis drugs.
Lipid-lowering drugs.
Narcotic drugs.
Particular attention should be paid to the selection of antibacterial drugs if anti-inflammatory therapy is planned for pathospermia. Some antibiotics have a toxic effect on spermatogenesis - tetracycline, gentamicin, erythromycin, nitrofurans (furadonin®, furagin®) inhibit spermatogenesis, reduce sperm motility. When prescribing antibacterial drugs, preference should be given to fluoroquinolones.
Prednisolone, ketoconazole, hydrocortisone, dexamethasone, hexestrol sharply inhibit the androgenic function of the testicles and negatively affect spermatogenesis at the level of spermatogonia and spermatids.
In this regard, some regulatory documents of the RF Ministry of Health are of interest. For example, according to the information letter of the Ministry of Health of the Russian Federation No. 2510 / 3797-03-32 dated 04/11/2003, the following groups of drugs are proposed for conservative treatment of male infertility:
Androgens.
For oral administration: mesterolone, testosterone (andriol TK®).
Parenteral: testosterone (testosterone propionate®, testosterone enanthate®, sustanon-250®).
Transdermal: Androgel®.
Transcrotal: testoderm.
Subcutaneous testosterone implants.
Antiestrogens: clomiphene (closgalbegid®), tamoxifen.
Gonadotropins: chorionic gonadotropin (pregnyl®, horagon®),
Releasing hormones: cyproterone (andorcur®).
Prolactin secretion inhibitors: bromocriptine (parlodel®), quinagolide (norprolac®), cabergoline (dostinex®).
Antibacterial drugs.
Immunostimulants: pyrogenal®, normal human immunoglobulin, immunal®, octagam®, viferon®, neovir®.
Angioprotectors: pentoxifylline (trental®, agapurin®).
Enzymes: Wobenzym®, Phlogenzyme®.
Means for correcting sexual function: Andriol TK®, Proviron®, Sildenafil, Chemcolin®, Carbegoline, Alprostadil (Edex®, Caverject®), Imipramine, Neostigmine methyl sulfate, atropine.
Of the above drugs, the appointment of androgens in idiopathic infertility is not justified! Testosterone derivatives suppress the pituitary secretion of gonadotropins, inhibiting spermatogenesis. They can be used for male contraception. In this case, tubule hyalinization does not occur, and spermatogenesis disorders are reversible.
The effect of antiestrogens is based on their incorporation into the negative feedback of sex steroids at the level of the hypothalamus and pituitary gland, while they increase the synthesis of GnRH, FSH and LH, antiestrogens enhance the functioning of Leydig cells and stimulate sperm motility due to increased production of testosterone.
A large multicenter study also did not reveal the effect of clomiphene: the frequency of pregnancies with treatment and in the placebo group did not differ significantly (WHO, 1992). According to a review of the literature on this topic, only 8 of the 29 relevant studies had the necessary controls. None of them was able to confirm the positive effect of tamoxifen on fertility.
A meta-analysis of the results of six studies concluded that at least 29 patients need to be treated for one additional pregnancy. The inexpediency of the use of antiestrogens in idiopathic infertility is due, in addition, to their potential carcinogenic effect. For this reason, the use of antiestrogens in male infertility is a matter of debate.
Enzymes can be used for violations of the crystal-forming function of sperm plasma, for example, with cystic fibrosis or chronic prostatitis, when sperm agglutination processes appear. Pathogenetically, therapy is justified, but the effectiveness does not exceed 60%. In this case, Wobenzym® in the first 2 weeks is prescribed 5 pills 3 times a day, the remaining 6 weeks - 2 pills 3 times a day, Phlogenzym® - 3 pills 3 times a day for 2 weeks, then 2 pills 3 times a day ...
Inosine (Riboxin®) can also be prescribed for asthenozoospermia. The drug belongs to the means that improve the metabolism and energy supply of tissues, reducing their hypoxia. One tablet contains 200 mg of inosine, which is a purine derivative. Inosine can be considered as a precursor adenosine triphosphatase (ATP)... It has an anabolic effect, activates myocardial metabolism.
Inosine increases the activity of a number of enzymes of the Krebs cycle, stimulates the synthesis of nucleotides, inhibits the destruction of the sarcolemma of ischemic cardiomyolitis and provides intracellular energy transport. By improving microcirculation, the drug reduces the size of the zone of necrosis and myocardial ischemia. Inosine has antihypoxic, metabolic and antiarrhythmic effects.
Increases the energy balance of the myocardium, improves coronary circulation, prevents the consequences of intraoperative renal ischemia. It is directly involved in the metabolism of glucose and promotes the activation of metabolism in conditions of hypoxia and in the absence of ATP. It activates the metabolism of pyruvic acid to ensure the normal process of tissue respiration, and also promotes the activation of xanthine dehydrogenase.
Penetrating into cells, it increases the energy level, has a positive effect on metabolic processes in the myocardium, increases the strength of heart contractions and contributes to a more complete relaxation of the myocardium in diastole. Reduces platelet aggregation, activates tissue regeneration (especially myocardium and mucous membrane of the gastrointestinal tract, as well as sperm).
In experiment and clinical trials, it was shown that this drug promotes an increase in the diameter of the convoluted seminiferous tubules by increasing the number of spermatogenic cells in them, reducing their desquamation into the lumen, increasing the amount of serum testosterone and the testosterone / estradiol ratio, resulting in an increase in the concentration and motility of spermatozoa in patients with moderate idiopathic asthenoteratozoospermia.
Specific schemes of use and optimal combinations of inosine with other drugs are issued as patents of the Russian Federation: "Method for stimulating the spermatogenic and androgen-producing function of the male gonads" (No. 2040258) and "Method for the treatment of male secretory infertility" (No. 2089188). Inosine is prescribed in courses of at least 1 month at a dose of 1-2 tablets 3 times a day.
The appointment of such drugs as Essentiale forte N®, Actovegin®, troxerutin (troxevasin®), in order to improve blood circulation in the reproductive organs, as well as with a protective effect, is also possible with infertility in men. However, the data obtained are contradictory and require additional confirmation.
The last group that we are considering is vitamin preparations. Of the existing vitamins and microelements, some positive effect has been recorded for folic acid, zinc, selenium, vitamin E, ascorbic acid, levocarnitine, arginine. The multivitamin and enzyme complexes on the market, specially designed to improve the quality of sperm, do not exceed the effectiveness of similar multivitamin complexes containing the same set of trace elements, but at the same time they are much more expensive.
There are reports of the use of experimental therapy with enriched cell cultures, which increases the number of spermatogonia, significantly reduces the content of ACAT. However, due to the impossibility of official clinical approbation due to deficiencies in the legislative framework, this issue remains a subject of discussion.
The appointment of conservative therapy is limited in time. On average, if a married couple has not become pregnant within 1 year after courses of therapy for infertility, they should be consulted at an assisted reproductive technology center. The duration of the courses and tactics are shown in Fig. 9-2 (Efremov E.A., Okhobotov D.A., 2008).
Fig. 9-2. Tactics of conservative therapy for male infertility.
The course of therapy is prescribed for 3 months - taking into account the cycle of sperm development (72 days). If there is no improvement, the treatment regimen is changed. If a change in therapy does not lead to improvement, further prescription of funds will only lead to financial and temporary losses. All cases of deterioration in ejaculate parameters are considered a direct indication for consultation at the IVF center.
P.V. Glybochko, Yu.G. Alyaev
It is known that the sperm is a male reproductive cell, which serves to fertilize the female egg. Translated from Greek, the word "sperm" means "seed" and "life". The term did not appear until the beginning of the 19th century, although sperm were discovered and described in the late 17th century.
Sperm structure
The sperm cell consists of a head, middle part and tail. It is the smallest cell in the body (without a tail), but it is quite complex: the sperm head consists of:
- nuclei (with a set of chromosomes);
- acrosome (contains substances that dissolve the shell of the egg);
- centrosome (provides movement of the tail of the sperm).
How fast are they moving?
The speed of movement of a healthy sperm is 30 cm per hour, therefore, about an hour or two after ejaculation, the first sperm reach the fallopian tube, where fertilization takes place. But before that, they have to go through a difficult path, since the acidic environment of the vagina is destructive for them, although the seminal fluid neutralizes it somewhat.
Spermatozoa move, determining the direction according to the level of acidity - to the lower side. For fertilization to be successful, at least 10 million sperm must enter the uterus, but only a few thousand reach the final goal. The period of maturation of the sperm lasts about two months, and for another month they can be stored in a man's body. This is just a short description of sperm and their function, but it can be understood from it that a failure in the process of maturation and formation negatively affects the reproductive functions of a man.
What are the most common reproductive disorders in men?
Not so long ago, a woman was unambiguously blamed for infertility in a married couple. However, it has been established that a woman is “guilty” only in 1/3 of all cases, in 1/3 of cases the man is “guilty”, and in the rest, both of them. Therefore, if the couple is infertile, the cause is established by examining both.
Sexual infections
Inflammatory processes in the testicles and their appendages greatly worsen the quality of sperm due to acute genital infections. After appropriate treatment, the spermogram improves. The situation is different if the acute form of the disease becomes chronic - the treatment of such infertility will be long-term.
Hormonal disorders
Sperm production and motility are affected by hormonal disorders, such as congenital deficiency of pituitary hormones.
Varicocele
Often the cause of male infertility is varicocele - varicose veins of the spermatic cord, which results in increased blood flow to the testicle. Due to stagnation of blood and overheating of the testicle, sperm formation is impaired.
Blockage of the vas deferens
Sperm matured in the testicle through the vas deferens of the epididymis should enter the seminal vesicle and, bypassing the prostate, into the urethra. But sometimes, due to some kind of inflammation, a blockage of the vas deferens can occur, due to which the sperm after ejaculation become stuck in it. The culprit may be, for example, an inguinal hernia.
What kind of examination does a man need to undergo?
In order to begin treatment that restores the function of sperm for conception and fertilization of an egg, a man is offered to undergo an examination.
Spermogram
First of all, a laboratory analysis of sperm is carried out - a spermogram is done. It allows you to establish the number, shape and motility of sperm.
Blood test for hormones
A hormone blood test is then ordered to determine the testicles' ability to produce healthy sperm.
Analysis for genital infections
Sexually transmitted infections that negatively affect sperm quality can be detected by immunological blood tests and a semen sample.
Sperm genetic analysis
Infertility can also be caused by genetic changes, so a genetic analysis of the semen is performed. Since spermatozoa mature for two months and remain in the male body for another month, external factors also affect their genetic makeup and functions for fertilizing the egg: radiation, chemicals, lifestyle, etc. After 50 years, there is a significant decrease in male reproductive functions (see "").
A man's reproductive function depends on his underwear and living and working conditions!
Male ability to leave offspring in science has a term - fertility or reproduction. As it turns out, a man's fertility is closely related to the underwear he wears. Male fertility depends directly on the man's underwear and living conditions. How does underwear affect male fertility? Everything is very simple. Scientists have conducted studies that have shown that for normal spermatogenesis (sperm formation, male reproductive cells), the temperature of the testicles and scrotum should be 3-4 degrees lower than the normal body temperature of a man. That is why the male reproductive organs are located at some distance from the body so that they are cool and active.
Male reproductive function
There is another important feature - if a man freezes, so as not to freeze the testicles and lose their reproductive function, the testicles are pressed closer to the body. If it is very hot, on the contrary, the testicles descend further from the body. Nature has taken care of our men.
Remember! Overheating of the genitals negatively affects the male reproductive function.
Living and working conditions are important! Certain living and working conditions of a man can, in which the testicles overheat, can lead to some diseases of the reproductive system. For example, living and working conditions associated with constant exposure to high temperatures or forced sitting for more than three hours in a row (drivers, office workers, etc.). A heated car seat is detrimental to men on long journeys.
Men's underwear must maintain a normal genital temperature. Housewives and loving wives need to pay more attention to their man's wardrobe, especially underwear. Give up tight-fitting briefs, swimming trunks, especially harmful thongs, which tightly tighten the genitals, preventing them from freely regulating their temperature for the normal functioning of reproductive function.
Underwear for men
What should be underwear for men?
The optimal underwear for a man is loose, spacious boxing-type panties. They should be made of cotton or silk, without any unnecessary artificial impurities. Also, scientists recommend sleeping naked, it is useful. With these simple tips, you can preserve male reproductive function and produce healthy offspring. After all, children are the true meaning of life. Let's preserve and multiply the family - the unit of society! :)
ATTENTION! IMPORTANT! The information is provided for informational purposes only and should not be used as a guide to self-medication. Self-medication can be hazardous to your health! Please consult your doctor before use! The need for prescription, methods and doses of the agent (or method) are determined exclusively by the attending physician!
Reproductive (or fertile) age is the period within which a person is able to conceive a child. This figure is different for men and women. The fertile age of a woman is less than that of a man and averages from 15 to 49 years. In theory, a man's reproductive age ranges from 14-60 years. But practically men up to 20-25 years old do not plan to have children for economic reasons (since keeping children for a man at such a young age is problematic), and for those over 40 years old, the quality of spermatozoa decreases and, consequently, reproductive ability.
A man begins puberty as early as adolescence - from 10-12 years. A man is ready to conceive a child at the age of 15. During this time, the male body goes through several stages on the way to full puberty.
- Interest in the opposite sex appears.
- There is a desire for bodily contact (touching, kissing).
- Sex drive is exacerbated.
During this period, boys want to communicate more with the opposite sex: spend time together, walk by the hand and kiss. Then the boys' libido increases due to the fact that the amount of the hormone testosterone in the blood increases.
This hormone in sufficient quantity for men makes them attractive to women and promotes sex drive. After a young man has realized his sexuality, he may decide to have the first sexual intercourse.
In adolescents, the age for first sex often depends on society and family: in this matter, they are guided either by the opinion of their parents, their recommendations or prohibitions, or by the experience of their older friends. In any case, for a teenage man, having sex is only a physiological need, not an emotional one. For sexual attraction, they choose an outwardly suitable, in their opinion, partner, without thinking about emotional compliance. But in the future, a man may change his opinion on this matter: he will either still not be so picky in sexual intercourse, or he will decide to link his life with his beloved.
In the process of a man's life and development, his reproductive function undergoes changes: of course, at a younger age there are more opportunities to fertilize an egg than in an older one.
For men, the most suitable age for conceiving a child is from 18 to 35 years old. Within this period, men produce the highest amount of testosterone, and therefore sperm, with good motility.
In men after 35 years of age, sexual needs are not as pronounced as, for example, at 20, which is associated with less intense testosterone production. In addition, at this age, a man is negatively affected by stress and emotional stress, alcohol and smoking.
After 35 years, the following changes occur in the male body:
- the concentration of androgens in the blood decreases (a group of male sex hormones);
- the production of sperm and their mobility decreases (for successful fertilization, 3-5 ml of sperm are needed, and in each milliliter there should be 2-3 million mobile, healthy cells; deviations from the norm are called necrosispermia);
- there are diseases of the male genital organs, decreased potency.
This leads to the fact that with the age of 35 years, the possibility of fertilization "at the first attempt" becomes less and less for a man.
Statistics have also proven that women who have a partner over 35 years of age, pregnancy more often ends in miscarriage than those who have a younger partner. The number of successful conceptions is significantly reduced in couples where a man is over 40 years old.
However, this does not mean that at 35 a man cannot have children. It's just that after reaching this age, negative factors (stress at work, bad habits, lack of sleep) also begin to influence men, which negatively affect fertility. But if you lead a healthy lifestyle from the beginning of puberty, then hypogonadism will come much later.
Age 60-70 years (on average) in men is characterized by hypogonadism - the end of the reproductive period, which is characterized by a change in hormonal levels.
In nature, the end of the reproductive period is necessary in order not to include the outdated generation in the reproduction process. It has been proven that the number of mutations in offspring, which was produced by an outdated generation, is many times more common than in those whose parents were younger.
Thus, hypogonadism prevents the wide spread among the new generation of such genetic diseases as:
- down syndrome;
- "Wolf lip";
- cerebral palsy;
- psychical deviations.
The reason for this negative dynamics is believed to be the production of low-quality spermatozoa with damaged DNA in men after 60 years.
Nature has specially provided for the childbearing age for men and women so that it is possible not only to give birth, but also then to fully care for the offspring. After all, it is much more difficult for people of a more mature age to physically deal with children than for young parents, which is why the reproductive function disappears over time.
Statistics show that by the age of 40 a man's testosterone level begins to decrease by several percent. But this does not mean that for everyone it will happen at this particular age. Each man has an individual process of development and extinction of the reproductive function, which means that the time for a favorable fertilization is different.
But numerous studies of male fertility have shown that the average age for peak fertility is between 25 and 30. It is believed that it is within this age range that a man is ready to bear children both physically and psychologically. Further statistics show that:
- in 17% of men, hypogonadism occurs at 43-50 years;
- at the age of 65-80 years already 40% of males suffer from hypogonadism;
- representatives of the stronger sex, who are over 80 years old, experience hypogonamism in 65% of cases.
Hypogonadism can occur both earlier than 40 years of age, and later: someone is sexually active at the age of 65, and someone cannot have children already at 30. It all depends on the quality of life of a man, the characteristics of his body, lifestyle and other factors.
A significant decrease in reproductive functions at the age of 50-60 is a normal physiological process that is laid down in a man's body by nature. But the appearance of problems with potency at the age of 35-45 years is considered early hypogonamism.
This could be due to a man's lifestyle or genetics that directly affect masculine strength. But the factors can be different.
- Groin injuries.
- Unsuccessful undergone operations on the genitals.
- Acquired sexually transmitted diseases (gonorrhea, syphilis, etc.) and congenital abnormalities of the genital organs (which were not eliminated at a young age).
- Severely transferred viral and infectious diseases, which entailed complications of reproductive function (for example, mumps or, as they say, "mumps").
- An immobile lifestyle.
- Constant presence of stress.
- Improper diet (excessive consumption of carbohydrates and fats).
- The presence of bad habits (alcoholism, smoking, drug addiction).
- Poor sex life: promiscuous sex, frequent partner changes, or irregular sex.
- The presence of endocrine disorders and diseases (diabetes mellitus, hypothyroidism, deterioration of the pituitary gland).
- Diseases of the cardiovascular system (arterial hypertension, ischemic heart disease.
The presence of the above factors does not mean that someone will not be able to have children. However, in order not to have problems with the reproductive system, it is better to treat all diseases on time, adhere to a healthy lifestyle and be selective in sexual intercourse.
In order to determine the time of the onset of hypogonadism, you need to pay attention to the signals that the man's body gives. Symptoms that characterize the completion of fertility include:
- decreased sex drive, difficulty getting an erection;
- erectile dysfunction, which manifests itself in premature or interrupted ejaculation;
- osteoporosis - a disease in which bones become brittle and brittle (which increases the risk of fractures);
- frequent and / or painful urination;
- diseases of the vascular system, which manifest themselves in redness of the face, hypertension, dizziness, shortness of breath, a sudden increase in temperature, etc.;
- hormonal disorders, the consequence of which is the appearance of excessive sensitivity, irritability, depression, apathy;
- memory impairment, sleep disturbances, general fatigue, regardless of the time of day;
- an increase in body weight due to adipose tissue;
- hair loss, the appearance of bald spots.
If any of the above problems were found, you should immediately contact an andrologist or urologist in order to either refute a possible disappointing diagnosis, or find out in time that you have a violation in the work of the reproductive organs and start treatment.
Preparation for conception for men over 50
Difficulties in psychological or economic plans often lead to the fact that for a long time a man cannot plan to conceive a child and postpones it to a later time. However, as mentioned above, this threatens that the reproductive capabilities of men of more mature age are reduced. Therefore, if a man wants to have children, then difficulties may arise with this. So how can you help yourself in such a situation? To do this, you need to follow certain rules.
- Eat right. Eat foods containing vitamins E and C, folic acid, zinc and selenium in your diet. These include oranges, lemons, tangerines, seafood, nuts, and grains. Eliminate coffee from your drinks and increase the amount of pure water.
- Observe the correct thermal regime: try not to overcool, but also not to overheat (you should avoid visiting baths, saunas, hot baths).
- Avoid a constant source of stress as much as possible (if the work is very stressful, consider moving to a quieter place).
- Exercise, but don't overload your body.
- Lead a healthy lifestyle without bad habits.
- Get enough sleep.
- Wear non-tight underwear made from quality, natural material (cotton).
- Spend time outdoors more often.
- Watch your health, treat diseases in time at their initial stage, so that you do not have to overstrain your body with antibiotics later.
- Have an active sex life (2-5 times a week).
Also, in order to exclude the appearance of genetic diseases in a child, before conception, you need to consult a doctor and undergo the necessary examination.
Modern methods of treatment, even in the presence of a damaged gene, are able to correct sperm DNA before conception and prevent many genetic diseases in offspring.
Despite such a large number of rules that mature men need to follow before conception, remember that the joys of fatherhood are much greater. In addition, in adulthood, a man has more financial and psychological opportunities to properly raise future children.