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Male Infertility

Dr Xydas has a special interest in fertility and is able to deal with the more complicated cases of infertility. Helping towards normalising or improving sperm feels like helping to create a new life. A new person who will grow up and be part of our world! 

In Dr Xydas's clinic a stepwise approach is taken into dealing with infertility issues. A careful history is taken concentrating in childhood development, previous viral infections as well as identification of testicular stress insults (such as previous anabolic steroid use, testicular trauma, testicular hernia or genetic causes of infertility).

 

Based on the history an approach to the most appropriate investigation is decided. Usually a biochemical and hormonal work up is required (based on a morning blood sampling which can be usually ordered by the General Practictioner upon Dr Xydas's guidance). A sperm check through a spermogram will also be required which can be done as a screening test through GESY (again it can be ordered by the General Practicioner) and if an issue is identified in the sperm, a more detailed sperm check might be required which can be done through Fertility Centres (like AKESO and ISIS clinic). Testicular size can be measure with the help of orchidometer and in certain cases a testicular Ultrasound might be requested.

 

Based on the results of the above tests, further specialized tests might be requesting such as sperm DNA fragmentation or genetic testing to identify certain genetic conditions that are linked with poor sperm or infertility.,

In order to understand the scope and limits of therapy, one should first understand how the testicle is producig sperm and this is explained below.

Sperm Cell Production

The testicle has two main type of cells: the Sertoly and Leydig cells.

Leydig Cells

Testosterone is secreted by cells called Leydig cells that are situated between seminiferous tubules in the testicles. They make male sex hormones, mostly testosterone.  Testosterone helps the reproductive organs develop and function. It gives men:

  • sex drive (libido)

  • fully developed genitals

  • a deep voice

  • body and facial hair

  • bigger muscles and body size

  • Testosterone helps sertoli cells make sperm.

In the absence of testosterone, sperm cells cannot mature as they should, resulting in infertility. 

Sertoli cells

Sertoli cells are responsible for sperm production which is the second main function of the testicles. Unlike females, who can only produce a limited number of eggs over a lifetime, males are able to produce millions and millions of sperm each day. It then takes several weeks for the sperm cells to mature enough to be functional. The maturation starts in the testes but mostly takes place inside the epididymis.

Causes of infertility

  • Acquired Causes

    • Varicocele

    • Testicular Torsion

    • Testicular Cancer

  • Congenital Disorders

    • ​Cryptorchidism

    • Polyorchidism

    • Transverse Testicular Ectopia

    • Absense Vans Deference

  • Genetic Causes​

    • Cystic Fibrosis Gene​

    • Kallman's Syndrome

    • Klinefelter's Syndrome

Therapy for infertility

In order for any medical doctor to be able to offer fertility therapy and expect it to work even at least partially, there is one absolute requirement: to have FUNCTIONAL SERTOLI CELLS. If a male has infertility due to complete or almost complete destruction of sertoli cells, then there is little or no possibility to help this man produce sperm. I will use a metaphor to better explain this: imagine having a shiny car which is newly painted and looks like new. If the engine of the car is missing, none will be able to make this car run! If the engine is present and is has a fault, the car will be able to run if the engine is fixed. If the engine is present but the fuel is missing, the car will be able to run once we use the correct fuel for this car. It is the same with the testicles, no matter how normal they look! If the sertoli cells are missing (either they are not present or they are completely destroyed) then this testicle will never produce sperm. If sertoli cells are traumatised or partially destroyed, then they might work if they are stimulated correctly. If the sertoli cells are functional but the correct nutrients (like the fuel of the car) is missing, then by providing the correct vitamins and micronutrient they might start producing sperm.

So one has to have the following in mind: for a therapy to succeed, we need to have AN ADEQUATE NUMBER OF FUNCTIONAL SPERM PRODUCING CELLS (i.e. SERTOLY CELLS).

Having the above on mind lets see what therapy is available.

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Vitamins

Use of micronutrients and Vitamins through an evidence based approach to target the identified issue

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Medical therapy

Use of medical oral therapy for advanced cases

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Injectable therapy

Use of a dedicated and specially formulated regime of injectable hormonal therapy for testicular stimulation  for the most advanced cases

​Collaboration with urology/andrology services for possible sperm extraction through testicular biopsy

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