The concept of asthenoteratozoospermia means a significant decrease in normal in structure and the occurrence of abnormal spermatozoa - teratozoospermia and a simultaneous decrease in their activity - asthenozoospermia. Due to the fact that sperm motility is directly dependent on their proper structure, both of these conditions are closely related.

Diagnosis of detected disease means general pathological changes, manifested by a decrease in the state of activity of spermatozoa, including their complete immobility with abnormal forms present. The development of the speed with which the spermatozoon moves depends on the interaction of these deviations, the more anomalies in its structure, the lower the speed.
Spermatozoa with structural disorders are incapable of motor activity.

The structure of a healthy spermatozoon

The spermatozoon is one of the smallest cells in the body, and consists of a head, own body and ponytail. The head is oval and a few microns in size. In the central part of the head there is an acrosome containing enzymes that dissolve the membrane of reproductive cells. With the help of the head, the sperm enters the cell ready for fertilization.

The neck serves to connect the head with the body, its mobility allows the spermatozoon to make oscillatory movements, the body supplies energy for movement, the tail serves to impart speed to the moving spermatozoon.

As practice shows, inflammatory symptoms with this disease are absent, the man does not experience any anxiety, no complaints, except for the impossibility of conception with regular sexual activity. Most often this main reason because of which the patient turns to a specialist for treatment. Without an examination and analysis (spermogram), it is impossible to make a final diagnosis of the presence of the disease asthenoteratozoospermia.

The examination may reveal the presence of concomitant inflammatory diseases, which can also affect spermogram parameters. For example, the presence of asthenozoospermia and pyospermia in it, indicating increased amount leukocytes, can cause asthenozoospermia. In such a case, the specialist identifies the causative agent of the disease by seeding the sperm, and determines the degree of sensitivity to antibiotics for the most effective treatment.

Diagnostics

Asthenozoospermia is diagnosed based on the results of several spermograms, in which there is a decrease in activity in more than 50% of spermatozoa and having a structure corresponding to the norms of less than 30%. To clarify the diagnosis, ultrasound of the scrotum and necessary tests for determining hormonal background, the study of the level of prolactin and testosterone. Based on the final diagnosis, the specialist prescribes the final treatment.

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The reasons

Important! Asthenoteratozoospermia may be caused by genetic predisposition. The exact cause of the disease often remains undetected, since it is very difficult to establish it, but the most likely disorders causing pathological formation spermatozoa are considered to be:

• inflammatory diseases in the pelvic organs;
• sexually transmitted infections;
• various trauma to the scrotum;
• overheating or prolonged squeezing;
• endocrine disorders;
• metabolic disorders;
• varicocele;
• transferred infections (tonsillitis, mumps, erysipelas).

Sometimes, with the exclusion of harmful factors, spermogram parameters can improve significantly. But this is only possible for early stages diseases when the development of asthenoteratozoospermia has not gone deep enough. Among the reasons affecting the abnormal development of spermatozoa, there are malnutrition, Availability bad habits, long-term use some medicines.

Elimination of the cause that caused asthenoteratozoospermia is one of the options for treating the disease. But full recovery However, it depends on the individual state of the organism and on the course of the disease.

Treatment

Since asthenoteratozoospermia can be caused by a variety of causes, the treatment of the disease should be directed individually to each of them. With absence congenital pathologies, inflammatory processes, full development sperm can contribute by eliminating a factor that has a harmful effect on their maturation. Sometimes it is enough to change the way of life for this, and the exception harmful influence habitual way of life. To stimulate the process of spermatogenesis in the treatment of asthenoteratozoospermia, special vitamin complexes designed for men, as well as medical therapeutic treatment.

In cases in which the development of the disease is of an infectious nature, treatment is aimed at identifying and eliminating the inflammatory process. With varicocele, an abnormal development of the genital organs, treatment is carried out with the help of microsurgery. The adoption of these measures can, in some cases, restore proper development spermatozoa and the ability of sperm to fertilize.

According to the severity of the disease, experts divide asthenoteratozoospermia into three groups, which depend on the severity and duration of the disease:

• the first group (mild form) - sperm motility up to 50%;
• the second (moderate form) with preserved mobility up to 30%;
• the third (pronounced form) - sperm motility is less than 30%.

Sometimes the treatment for the first, mildest group of the disease, allows you to induce pregnancy in six months drug therapy. With severe advanced cases exists more often the only way- conception by IVF - in vitro fertilization, in which the selected viable sperm is injected directly into the egg.

Asthenoteratozoospermia and IVF

If the treatment of asthenoteratozoospermia does not occur for several years, then the use of IVF becomes the main method to achieve the desired result. A group of spermatozoa is isolated from the sperm, one of which is fertilized with a reproductive cell and carried out in the uterine cavity. Further development of the fertilized cell takes place in normal conditions under the supervision of a specialist.

Possibility of pregnancy

Is it possible to get pregnant in the presence of asthenoterazoospermia, it is impossible to answer unambiguously. The cause of infertility lies in the degree of spread of the disease and the cause that caused it. If the disease is not started, belongs to the first group with a mild form, and the cause that caused it can be eliminated, then long-term treatment, lasting several months, but which can end in a long-awaited pregnancy.

The quality of spermatozoa of the group related to the moderate form also allows you to get positive result after appropriate treatment, which will take much longer, will require considerable effort and patience. The presence of full-fledged spermatozoa of the group where the third pronounced form of asthenoteratozoospermia is established is very low and, most likely, it will be necessary to use fertilization with the help of assisted reproductive technologies.

Remember! Asthenoteratozoospermia is a very serious pathological abnormality. men's health at which the probability of pregnancy natural ways minimal but possible. Restoration of the fertilizing ability of sperm is possible only by applying timely and correct treatment.

Many couples face the problem of infertility these days. If earlier the woman was primarily blamed for this, then modern fertility doctors have proven that half of the cases of infertility have male factor. And one of these reasons is asthenoteratozoospermia.

And asthenoteratozoospermia are interrelated. In the seminal fluid of men suffering from this pathology, the mobility and structure of spermatozoa are impaired. The probability of conception with this diagnosis is reduced to almost zero.

The term "asthenoteratozoospermia" defines the condition of the sperm.

Experts divide it into two different concepts:

• asthenozoospermia - decreased mobility and speed of spermatozoa;
• teratozoospermia - a decrease in the total number of full-fledged spermatozoa.

In practice, these pathologies are detected in men at the same time, so they were combined under the general term asthenoteratozoospermia. It is not difficult to explain this fact: the normal structure of male germ cells provides them with mobility and activity. A decrease in the number of healthy sperm, respectively, leads to a decrease in their ability to fertilize an egg.

Asthenoteratozoospermia can be caused by the most different reasons, but it is rather difficult to determine the main one.

Classification

Like any disease, asthenoteratozoospermia can be of varying severity. This is important to consider when choosing treatment tactics.

With a mild degree of asthenoteratozoospermia, the sperm of a man contains at least 50% of spermatozoa with normal structure and mobility. Average degree The disease is characterized by the presence in the seminal fluid of 30 to 49% of normal spermatozoa. Severe pathology means that total number healthy spermatozoa does not exceed 29% in the ejaculate.

Regardless of the severity of asthenoteratozoospermia, the disease is latent, without any symptoms. Usually the diagnosis is made only if the couple went to the doctor to look for the cause of infertility.

The reasons

The normal structure and activity of spermatozoa depend on many factors directly related to the lifestyle of a man, his heredity, past diseases.

Can be distinguished the following reasons asthenoteratozoospermia:

• unfavorable genetics;
• age-related changes;
• irregular sex life;
• excess weight;
• bad habits - alcoholism, smoking and drug addiction;
• Horseback Riding;
• genital trauma;
• genital infections;
• taking steroids;
• influence high temperatures;
• radiation and electromagnetic radiation;
• chemotherapy;
• an autoimmune factor that affects the production of antisperm antibodies;
• malnutrition, avitaminosis.

If you can eliminate the cause that led to a violation of the quality of sperm, then the onset of pregnancy will not be long in coming.

Clinical picture

Asthenoteratozoospermia usually has no clinical manifestations. Discomfort, pain and other symptoms of this pathology are not typical. That's why long years a man may not be aware that he has health problems, although at this time the disease progresses and the ability to conceive begins to tend to zero.

As a rule, a man learns about his diagnosis after contacting specialists. This usually happens purposefully if the family for a long time there are no children.

Diagnostics

The diagnosis of "asthenoteratozoospermia" is made on the basis of a spermogram, if, according to its results, the number of healthy motile spermatozoa does not exceed 50%. In order to identify the root cause of the disease and conditions that have negative impact for the synthesis of male germ cells, an ultrasound of the scrotum is additionally performed, tests for sexual infections are prescribed, and the hormonal background of the man is studied.

Deciphering spermogram

Since 2010, WHO has established the following normal limits for spermogram:

• ejaculate volume not less than 1.5 ml;
• the total number of spermatozoa is at least 33 million;
• concentration of spermatozoa from 12 to 16 million in 1 ml of ejaculate;
• group A motile spermatozoa (the most mobile and most promising for fertilization) 31-34%;
• spermatozoa of group B (less mobile, progressive movement) and group A in total should be 38-42%;
• viable spermatozoa 55-63%;
• morphologically healthy cells at least 4%;
• acidity over 7.2 pH;
• leukocytes less than 1 million / ml.

The study of the ejaculate should be carried out no later than 1 hour after ejaculation. With asthenoteratozoospermia, the seminal fluid is dominated by the number of spermatozoa of groups C and D (fixed and inactive cells that have no chance of conception). The diagnosis must be confirmed by three spermograms, which should be carried out at intervals of 14 days for the greatest accuracy of the study.

Treatment

Treatment of asthenoteratozoospermia is aimed at eliminating adverse factors and treatment of existing pathologies. At the same time, the doctor may prescribe medications that improve spermatogenesis, including vitamins and amino acids necessary for the synthesis of male germ cells. Often, improving the quality of sperm and the health of a man at this stage is sufficient for the pregnancy of a partner.

But more often in men with asthenoteratozoospermia, conception can only be achieved with the help of. In severe cases, the disease is so advanced that it is impossible to isolate the required number of healthy spermatozoa from the seminal fluid of a man.

Unfortunately, many married couples in modern world faced with the impossibility of conceiving a child. There is a stereotype that the culprit of infertility first of all is a woman. However, this well-established myth is shattered by hard statistics. Doctors say that in half of cases of infertility, the responsibility lies precisely with male body. And one of the reasons for this is asthenoteratozoospermia.

In order to thoroughly understand the pathological condition, it is necessary to understand what should be normal performance sperm and how spermatozoa are formed.

Spermatogenesis is the sequential development of male germ cells, ending in the formation of healthy spermatozoa, which acquire the ability to fertilize an egg. This process in the male body lasts continuously - from the beginning of the boy's puberty and almost to old age.

There is a process with permatogenesis in the paired male sex gland - the testicles (testicles, testicles), which are located in the scrotum. The testicles are made up of many seminal tubules, and it is in them that the male sex cells are formed. Progenitor cells ( spermatogonia, and then spermatids) undergo a series of divisions, during which the set of chromosomes is halved. In addition, it also changes appearance cells - they lengthen. As a result, the cell nucleus (repository of genetic material) placed in the head of the spermatozoon. After full maturation, spermatozoa enter the epididymis, which is also located in the scrotum, and is located on top of the testicle.

On average, the maturation process lasts 74 days at a temperature that is 1–2 0 C lower than body temperature. That is why nature placed the testicles outside the body. High temperature regime detrimental to male sex cells. In this case, not only spermatogenesis stops, but already mature spermatozoa die. At low temperatures, the process of maturation of spermatozoa also freezes, but the stock of already ripe ones remains intact.

A mature spermatozoon is a microscopic cell (50-60 microns), which consists of:

• heads (contains the genetic material of a man);
• necks and bodies (contain structures that provide motor activity throughout the cell)
• tail (flagellum), which promotes the advancement of the spermatozoon by rotating around its axis;
• end thread.

The chromosome set of a sperm cell can only consist of:

• Y chromosomes, and then such spermatozoa are called androspermia, i.e. after fertilization of the egg, the fetus will develop in a male pattern;
• X chromosomes - spermatozoa are called gynospermia. Combining such a sperm cell with an egg cell (which always contains only the X chromosome) will contribute to the development of a female fetus.

It is considered normal when sperm healthy man contains up to 20% pathological forms spermatozoa. Exceeding this percentage may lead to infertility or abnormal development fetus.

Asthenoteratozoospermia: what it is?

This trudely pronounced the term describes the pathological condition of the sperm. It is based on Greek words:

• "astheno" means impotence, weakness;
• "teratos" means deformity, a monster;
• "zoo" - a living being;
• "sperm" means seed.

Thus, if translated literally, it would be that the sperm contains "weakened ugly living seed."

The reasons asthenoteratozoospermia

To date, no clear cause of this pathology has been identified. However, there are several factors that contribute to a change in the structure or mobility of a normal spermatozoon:

1. infections, especially viral nature. It is believed that the most dangerous for the gonads of men is parotitis. This is a widely known viral infection, which is colloquially called "mumps". AT childhood epidparotitis proceeds much easier, and with a lower likelihood of complications. In adult men this viral disease often causes orchitis (inflammation of the testicles). And if you do not start treatment in time, then there is a high probability of atrophy of the testes.
2. Injuries to the external genital organs can disrupt the development of germ cells.
3. Influence of high temperature. It has already been mentioned that temperatures above 35 0 C adversely affect the testes. Men who abuse saunas, like to take hot baths, and simply wear tight underwear, this factor should be taken into account if conceiving a child is planned. Particular attention to Negative influence high temperatures should be addressed to those men whose profession is associated with their constant and prolonged exposure.
4. Congenital malformations of the testicles:

• anorchism(congenital absence of both testicles is extremely rare);
• monorchism(absence of one testicle); the second testicle at the same time compensatory increases in size;
• polyorchism(the presence of 3 or more testes); additional testicles are usually underdeveloped;
• testicular hypoplasia (underdevelopment and reduction in size);
• cryptorchidism(unilateral or bilateral non-descent of the testicles into the scrotum) .

1. Hormonal disorders. This factor is multifaceted:

• decrease in the level of male sex hormones (testosterone);
• level up the hormone prolactin, which produced by the pituitary hyperprolactinemia);
• hypofunction thyroid gland(hypothyroidism);
• increased production of female sex hormones (estrogen);
• diabetes .

1. Exposure to x-rays and other types of radiation. The sex glands are extremely susceptible to the effects of any type of radiation. The danger lies not only in the fact that infertility develops, but also in the fact that if conception occurs, abnormalities in the development of the fetus are possible due to teratogenic (causing mutations) effects on chromosomes.
2. chronic intoxication. This includes, for example, alcohol abuse. When this occurs, fatty degeneration of the convoluted tubules of the testes and replacement connective tissue. It has been noticed that smokers and drug addicts also have a impaired ability to conceive (there is a "gluing" of spermatozoa).
3. chronic infections. This is especially true for sexually transmitted infections. For example, chlamydia can not only disrupt the process of permatogenesis, but also directly negatively affect spermatozoa. A similar effect is observed with gonococcal infection, trichomoniasis, genital herpes, etc.
4. Irrational nutrition. A lack of vitamins can lead to a violation in spermatogenesis. It has been established that for normal functioning testicles great importance have vitamins E and A. Both of these substances stimulate the formation of spermatozoa, and vitamin A (retinol) also affects sexual desire.

Classification asthenoteratozoospermia

Like any disease or pathological condition, asthenoteratozoospermia has several degrees of severity. They must be considered in order to select right tactics treatment. The classification is based on sperm motility. For the reliability of the result, the calculation of mobile male germ cells is carried out one hour after ejaculation.

• first degree of severity. Seminal fluid contains 50% or more spermatozoa, which have a normal structure and high mobility;
• second degree of severity. normal structure and sperm motility are maintained in the range from 30 to 49%;
• third degree of severity. Total normal spermatozoa with high motility in the ejaculate is less than 29%.

Whatever the severity asthenoteratozoospermia, there will be no clinical manifestations in a man. Symptoms can only be in another pathology or disease that causes asthenoteratozoospermia. And then, with complaints about the underlying disease, the man turns to medical care. Or pathological changes in the seminal fluid are detected during the search for the causes of infertility in a married couple.

Diagnostics asthenoteratozoospermia

AT ideal a man should get an appointment with an andrologist (specialist in diseases of the male genital area and methods of their treatment). The doctor conducts an examination, finds out information about past diseases, injuries and other points that will help in making the correct diagnosis.

In the future, with a frequency of 14 days, two spermograms are prescribed (study of the composition of sperm and its biochemical characteristics). The study itself is carried out under a microscope on glass slides. Counting chambers can also be used, in which the quantitative composition of spermatozoa is determined. To obtain biochemical indicators, special reagents are used.

Before examining a spermogram, a man needs to prepare:

• sexual abstinence for 3-5 days (if less days pass, there will be an insufficient amount sperm for analysis, more - unreliable results are possible due to a deterioration in the quality of sperm);
• on the days of preparation, it is necessary to avoid overheating of the body (exclude visiting the sauna, wearing tight underwear, taking a hot bath);
• refrain from drinking alcoholic beverages and other substances that can adversely affect the quality of spermatozoa;
• avoid heavy physical activity and overwork on the eve of analysis.

AT medical institution there is a specially equipped room for the delivery of ejaculate.

• before the study, the bladder is emptied;
• held hygiene procedure genital organs;
• ejaculate is collected in a sterile container through masturbation.

Deciphering spermogram

In 2010, WHO established the following rules for spermogram:

• ejaculate volume 1.5 ml or more;
• the total number of spermatozoa in the sample is from 33 to 46 million;
• the concentration of male germ cells in 1 ml of sperm is from 12 to 16 million;
• the presence of category A motile spermatozoa (with a fast forward movement, which are the most promising in terms of conception) from 31 to 34%;
• total spermatozoa of category B (with slow forward movement) and category A should be 38-42%;
• the number of viable germ cells 55-63%;
• acidity over 7.2 pH(at her deviation spermatozoa will not be able to move normally);
• morphologically normal cells should be at least 4%;
• the presence of leukocytes - less than 1 million / ml.

White blood cells in a sample are difficult to recognize because they resemble immature forms of spermatozoa. Therefore, special dyes are used for differentiation. If their number exceeds the specified norm, then there is a high probability of acute or chronic inflammation and sexually transmitted infections should not be ruled out. Therefore, with a diagnosis: “leukospermia of the ejaculate, asthenoteratozoospermia”, further thorough examination, because to . at inflammatory process the function of germ cells is sharply disturbed.

From non-quantitative sperm parameters are taken into account:

• Colour: Normally whitish-grayish. Color deviation allows you to draw preliminary conclusions about some pathologies;
• smell: unpleasant or Strong smell may indicate an inflammatory process or infection;
• viscosity : normal seminal fluid immediately after ejaculation, it becomes jelly-like, and after 30-40 minutes it becomes liquid. Thick semen is difficult to penetrate into the cervical canal of a woman .

For maximum reliability of the results, the study should be carried out no later than one hour after ejaculation. At diagnosis asthenoteratozoospermia in the ejaculate, sex cells of category C predominate (movement non-rectilinear- in one place or in a circle) and category D ( absolutely immobile).

With regard to changes in the structure of spermatozoa, the following violations are observed:

• altered shape of the sperm head (wrong contours, size) or its complete absence (this is the reason for the change in the trajectory of the cell);
• altered neck or body of the spermatozoon (curvature, lengthening or shortening);
• altered shape or size of the flagellum, an increase in the number (doubling), complete absence flagellum (which is the cause of absolute immobility).

When identifying asthenoteratozoospermia the spermogram is examined three times (with an interval of 10-14 days) for greater reliability of the results.

The Kruger study is considered the most accurate method in determining abnormal forms of spermatozoa. With this technique, a smear dried and stained with a certain method is studied. It is believed that the proportion of abnormally altered spermatozoa in a smear should not exceed 85%. In addition, the index With permal disorders ( 1 cell) and index teratozoospermia (the average number of pathologies per 1 abnormal sperm). Only after this study has been carried out can one confidently speak about asthenoteratozoospermia.

Additional Research

Additional research is being done to identify the cause pathological condition:

• general and biochemical analyzes blood;
• determination of the level of glucose in the blood;
• determination of hormonal levels (testosterone, prolactin, estrogen levels);
• Ultrasound of the scrotum and pelvic organs;
• computed tomography of the pelvic organs;
• digital examination of the prostate;
• study on on the presence of pathogens of sexually transmitted infections (smear from the urethra, blood test on the antibodies);
• MAR test (analysis for antisperm antibodies). It's about about the body's antibodies against its own spermatozoa. Such a violation occurs when "failures" in immune system. Antibodies, connecting with the flagellum of the germ cell, block its movement;
• genetic analyzes are carried out with a pronounced anomaly of spermatozoa (the patient's blood is examined) .

Treatment asthenoteratozoospermia

The main thing in the normalization of male sperm is the treatment of the underlying disease or pathological condition that led to asthenoteratozoospermia. According to the reviews of men suffering from this pathology, with the exclusion of a provoking disease, and sometimes just lifestyle changes, spermogram indicators improved significantly after some time. Therefore, you should not brush aside the persistent recommendations of the doctor to give up bad habits, switch to proper nutrition and lead active image life.

To stimulate full-fledged spermatogenesis with asthenoteratozoospermia the following drugs are used:

Folic acid (vitamin B 9). Daily dose tableted folic acid should be 400 mcg (at the discretion of the attending physician, it may exceed the recommended). Vitamin stimulates the formation of new cells, improves their morphology. In addition to tablet forms of folic acid, it is welcome to include foods that are rich in it in your diet. These products include: greens (spinach, cilantro, basil), cabbage, meat and fish products ( beef liver, horse mackerel, cod liver, offal), dairy products (fatty cottage cheese and cheese, sour cream), products from rye flour, eggplant, walnuts.

Vitamin E improves the absorption of folic acid in the body, and also helps maintain the testosterone hormone at the proper level. Thus, vitamin E indirectly through the hormone helps to improve spermatogenesis. Vitamin E is part of one of the drugs that is prescribed for asthenoteratozoospermia– Selzinc plus. At its core, the drug is biologically active additive, and in addition to vitamin E contains:

• zinc ions (on which the qualitative and quantitative characteristics of sperm depend);
• vitamin C (has an antioxidant effect and improves the metabolism of folic acid in the body);
• beta-carotene (turns into vitamin A in the body).

The dosage regimen and dosage is prescribed by the attending physician. The same applies to the use of the drug Spermactin, which also applies to biological additives. It is produced in the form of a packaged powder of 5 g. The powder contains natural metabolites and amino acids, which contribute to normal maturation and increase in sperm motility. In addition, the components of Spermactin improve metabolic processes, stabilize the cell membranes of male germ cells, and also improve the fertilizing properties of sperm. The drug should be used with caution when chronic diseases liver.

AT complex treatment asthenoteratozoospermia use the drug T ribestan, which contains in 1 tablet 250 mg of dry extract of the herb Tribulus terrestris. He renders positive influence not only with this pathology, but also with immunological infertility, erectile dysfunction(impotence). The course of treatment is at least 90 days. Repeated course therapy is carried out at the discretion of the doctor. The extract of Tribulus terrestris is also contained in the Verona preparation of complex action. The course of treatment with this drug is 8 weeks.

• turn to IVF (in vitro fertilization). Colloquially, this method is called "in vitro fertilization" because the most complete sperm and egg "meet" in specially created laboratory conditions. Thereafter fertilized the egg is implanted in the uterus, where it develops naturally;
• ICSI. A method in which the most viable spermatozoon is inserted into the egg using a special needle. And then, just like with IVF, the egg is implanted into the uterus.

On the male sperm many factors influence: heredity, state of health, lifestyle, habits. A man who does not care about his health will sooner or later see in medical card disappointing diagnosis. There are sperm diseases and separately sperm diseases. In this article will be discussed about serious illness spermatozoa, which combines two pathologies of these most important cells and is called asthenoteratozoospermia.

Asthenoteratozoospermia is a complex pathology of the male reproductive system. With such a disease, the chances of a natural pregnancy are minimal. This disease is complex. Asthenozoospermia characterizes a condition in which a man low activity spermatozoa. Some patients are diagnosed with complete immobility of germ cells. - the presence of abnormal cells in the semen.

These deviations are interrelated, since the activity of spermatozoa largely depends on the number of abnormal cells. The predominance of abnormal forms significantly affects the ability of germ cells to move. Spermatozoa with a broken structure simply cannot be active.

Pathology can be eliminated only with the help of modern treatment. Asthenoteratozoospermia, fortunately, is effectively treated, and in case of failure, doctors suggest artificial insemination.

Normal sperm counts

In a healthy man, spermatozoa consist of a regular head, neck, body and one tail.

Structural parameters of a healthy male germ cell:

1. The head is the oval anterior part of the cell. The size reaches 3 microns in width and 5 microns in length. The top of the cell contains the acrosome, an organoid with enzymes that must dissolve the egg cell membrane. Behind the acrosome is the nucleus haploid set 23 chromosomes. At fertilization, they are connected to the chromosomes in the female germ cell. A spermatozoon can be a carrier of the X chromosome and is called gynospermia. When fertilized by such a cell, a girl is born. Spermatozoa with Y chromosomes are called androspermia and result in boys.
2. The neck is the junction for the head and body of the spermatozoon. The mobility of the neck provides vibrations of the head in the process of movement.
3. The body is a cylindrical part of the cell, consisting of mitochondria and microtubules. It has a diameter of 1 micron, and a length of 4-5 microns. The constituent bodies transform nutrients into the energy that makes it possible for the tail to move and ensure the activity of the spermatozoon.
4. The tail is the longest part of the germ cell, which can reach up to 50 microns. It is shaped like a smooth cylinder. In the presence of irregularities and abnormal changes, the cell is considered unhealthy. Approximately 800 movements of the lower part of the tail provide 10 mm advance of the cage. The most active germ cells have an ending at the end of the tail. With this thin ending, the speed of the sperm increases by a third.

Cell Motility Assessment

Cell mobility is assessed using a microscope. In the sperm of even a healthy man, there is a certain amount of abnormal and immobile cells. Everything is decided by their concentration.

Variants of sperm activity:

• move forward (group A);
• weakly move forward (group B);
• move actively, but the trajectory is broken (cells that are directed in a circle or backwards are classified as group C);
• do not move (group D).

A healthy man has more than 25% active cells that move forward. Also, normal conception is ensured with 50% of active cells and weakly active ones.

Disease classification

This pathology is different in that it has different degrees of severity:

• 1st degree - up to 50% of healthy and active spermatozoa;
• 2nd degree - an average of 30-49% of healthy spermatozoa with normal mobility;
• 3rd degree - less than 29% of active cells with a normal structure.

You can analyze the sample one hour after the delivery of the ejaculate.

Causes of sperm pathology

It is difficult to accurately determine the cause of the disease, because asthenoteratozoospermia can develop due to many factors.

Possible causes of pathology:

• genetic predisposition;
• sharp and chronic forms diseases;
• inflammation in the genitourinary system;
• sexually transmitted infections (STIs);
• injury to the scrotum;
• failures in endocrine system;
• in various stages(expansion of the veins of the seminal canal);
• overheating of the genitals (regular visits to the bath or sauna);
• squeezing the genitals (tight underwear, riding).

Also affect the health of the genital organs and the implementation of spermatogenesis can wrong diet, bad habits and lifestyle in general. Often, problems with sperm occur in patients who are overweight, after chemotherapy or taking strong drugs.

On the initial stage improvement can be achieved if harmful effect on the reproductive system. However, this effect can be achieved when the pathology is still in its infancy.

Asthenoteratozoospermia has no visible or palpable symptoms. The only indicator may be the inability to conceive a child with regular sexual contact. If the cause of the disease is an infection or inflammation, the symptoms will be characteristic.

Diagnosis of problems with spermatogenesis

The main method for diagnosing asthenoteratozoospermia is a spermogram - a detailed study of qualitative and quantitative indicators seminal fluid. For getting reliable results it is recommended to conduct a study 2-3 times with breaks of 0.5-2 months. This need is due to the fact that sperm is very susceptible to internal and external factors. It can change even from a small amount of alcohol or passive smoking.

For the purity of the study, you need to exclude sex 5 days before the sample is taken. Since many indicators depend on the volume of ejaculate, if you lose some part, you need to report this to the laboratory.

To make a diagnosis, you need to get the following results:

• less than 25-30% of spermatozoa of the correct form;
• less than 50% of active and weakly active spermatozoa that move along the correct trajectory (groups A and B).

Confirm the diagnosis and find out the cause will help only full examination urinary area. Close attention should pay attention to the levels of hormones in the blood and ultrasound scan pelvic organs.

If more than 1 million leukocytes are found in the seminal fluid, a culture should be carried out, which will help identify the causative agents of the disease and assess the degree of their sensitivity to antibiotics. If during the diagnostic process an infectious or inflammatory disease, it can be argued that they are the main causes of pathology.

Asthenoteratozoospermia is an effective treatment

Medicine does not yet have ways to unambiguously treat asthenoteratozoospermia. The difficulty lies in the fact that in the absence of symptoms, it is almost impossible to detect the disease early. And the most favorable prognosis is for those who begin treatment of pathology of the 1st degree.

Therefore, it is difficult to predict whether it will recover reproductive system or the disease will lead to complete infertility. Often, patients turn to doctors already when long time cannot conceive a child. In this case, we can say with great confidence that the pathology has been developing for a long time.

To choose a treatment, you need to find out the cause of asthenoteratozoospermia. The examination should be comprehensive: spermogram, ultrasound procedure and CT scan pelvic organs, counting prolactin and testosterone levels, etc. These tests will help determine the extent of the disease.

With the timely elimination of the cause, you can count on success. Full recovery is observed only in some cases and depends on the characteristics of each organism, the degree of damage to the reproductive system and how asthenoteratozoospermia proceeds.

Ways to treat asthenoteratozoospermia

• if the cause of the development of the disease was a violation at the genetic level (malfunctions in the development and functioning of the reproductive system), the only opportunity to become pregnant is in vitro fertilization(ECO);
• if the cause is inflammation or a focus of infection, treatment involves taking medications that will eliminate excitation, restorative therapy (vitamins, adaptogens, antioxidants), stimulation of spermatogenesis (sperman, spermactin);
• if the varicocele provoked the pathology, it is required surgical intervention(also with anomalies in the structure of the genital organs);
• if it's all about lifestyle and nutrition, doctors ask you to exclude all harmful factors (addictions, dangerous products, uncomfortable clothes, baths and saunas), optimize food intake, give up alcohol and cigarettes.

Diagnosis of asthenoterazoospermia does not guarantee recovery. Treatment of pathology is very complex and lengthy, and often completely impossible. However, many couples with a disappointing diagnosis have achieved the appearance of the long-awaited baby.

Stages of treatment

1. All risk factors are excluded. The cause of asthenoteratozoospermia is subject to treatment. Medications are prescribed to stimulate spermatogenesis, as well as multivitamin complexes with amino acids, which also help germ cells to mature. In some cases, improvement in sperm counts is observed already at this stage of treatment. The indicators return to normal, and natural conception becomes possible.
2. If after treatment the spermogram shows poor results, doctors recommend artificial insemination. If there are still enough cells of the correct form in the sperm, they are selected for IVF or ICSI (sometimes both procedures are done at once to increase the chances of success). With a serious 3rd degree of asthenoteratozoospermia, it is impossible to select right amount spermatozoa.

It must be remembered that any infertility requires examination of both partners. This pathology is no exception, because male problems with conception are often supplemented by female ones. The principle of treatment will be different if a woman has or does not have pathologies.

reproductive medicine

Modern reproductive technologies allow conception even with complex pathologies reproductive system. Asthenoteratozoospremia interferes with natural conception, therefore methods artificial insemination save a lot of couples.

When the remnants of healthy germ cells are still preserved in the seminal fluid, doctors recommend artificial intrauterine insemination(IUI) or in vitro fertilization (IVF). implies the introduction of the processed into the uterus for conception. IVF uses multiple eggs and sperm to provide at least 25% successful conception. IVF requires more costs and time, but gives more chances.

Difficult cases are solved with ICSI (intracytoplasmic sperm injection). This procedure requires at least one healthy sperm cell. It is selected, processed and prepared in every possible way for conception. With the help of micro-instruments, the doctor places the immobilized sperm into the egg. The fertilization process is also controlled. After that, the embryo is placed in the uterine cavity and the body is artificially helped to accept it.

Modern medicine significantly increases the chances of having native children, even in the most difficult cases. Therefore, do not despair, because in the process of treating any disease, mood and confidence in success play a big role. Both a man and a woman should hope and in every possible way tune in to a good result.

However modern diagnostics this problem does not stand still, and it is not difficult to find out who is the "culprit" and the reason for the inability to get pregnant. Oddly enough, but in half the cases, the problem is found in the body of a man. One of the most common pathologies is asthenoteratozoospermia. It is characterized by a change in the structure and activity of spermatozoa in the male seed, and has many causes of development. Women whose husbands have been diagnosed with this diagnosis are very worried about whether it is possible to get pregnant with asteoteratozoospermia and how to do this?

What is asthenoteratozoospermia and how to detect it in a man

Asthenoteratozoospermia is complex pathology spermatozoa, which includes two deviations:

• changes in the structure and shape of germ cells (teratozoospermia);
• decreased activity of male germ cells (asthenozoospermia).

Most often, both seminal fluid defects occur simultaneously, since the structure of the spermatozoon directly affects its speed and activity. sex cells irregular shape cannot actively move forward, and therefore the possibility of fertilization of the egg is reduced. Sometimes an obstacle to natural pregnancy becomes oligoasthenoteratozoospermia - overall decline spermatozoa concentration against the background of irregular shape and low activity.

Causes of asthenoteratozoospermia

This sperm defect is not the cause of any specific pathological process. The etiology of asthenoteratozoospermia is very diverse and it is often quite difficult to find the origins of the disease. Among the most common factors are:

Often it is the combination of several risk factors that leads to the development of the disease.

Symptoms of asthenoteratozoospermia

Unfortunately, specific symptoms this state of sperm has no. The only one visible sign pathology - the absence of conception with a complete rejection of contraception. Judging by the feedback from patients, pregnancy with asthenozoospermia could not occur for several years. In addition, a man may be alerted by the presence of at least several risk factors - past illnesses genitourinary system, injuries, the presence of similar problems in relatives in history. If a woman is fully examined and no health problems have been identified, then naturally the problem is in a man.

Diagnosis of asthenoteratozoospermia

To make a diagnosis, it is necessary to pass an analysis of the ejaculate - a spermogram. Now this study is available in many diagnostic laboratories. Before the analysis, it is necessary to refrain from sex for 5-7 days, give up alcoholic beverages and visit steam rooms (bath, sauna, etc.). Right in the laboratory in a specially designated place, the man collects the sperm in a sterile container and sends it for analysis for further research. The main evaluation criteria are the concentration, shape, motility and viability of spermatozoa. The diagnosis of asthenoteratozoospermia can be made if less than 25-30% of the germ cells of the correct form and less than half of the spermatozoa have normal motility in the spermogram of a man. For the final diagnosis, a man should undergo a comprehensive examination:

• Ultrasound of the genitals and pelvic organs;
• CT and MRI;
• general analysis of urine and blood;
• blood chemistry;
• blood for sugar;
• screening for infection immunological studies, planting on flora).

Usually, one spermogram is not enough to make a final verdict, and a man has to take this analysis several times over a couple of months. Is it possible to get pregnant with asthenoteratozoospermia depends on the results of the spermogram, since varying degrees gives deviations from the norm different probability for conception.

How to get pregnant with a diagnosis of asthenoteratozoospermia

Asthenoteratozoospermia absolutely does not exclude the possibility of becoming pregnant. However, for this it is important to go through all the stages of diagnosis and find out the reason for the development of such a state of sperm. If the etiology of a defect in the seminal fluid is identified, the doctor prescribes the appropriate treatment. The duration of therapy is determined by the degree of violations detected. It usually lasts about six months. It can be antibacterial, antiviral, anti-inflammatory, hormonal treatment or even surgery. At the same time, a man must definitely give up bad habits, adhere to proper nutrition and play sports. He is prescribed multivitamin complexes, immunomodulators, adaptogens and drugs that improve spermogenesis.

If the treatment has yielded results, then the probability of natural fertilization of the egg is high. If the dynamics of improvements in the spermogram does not please the couple, then you have to resort to IVF (in vitro fertilization). For infertility on the male side, this procedure is called IVF-ICSI. it helper method artificial insemination, which consists in the introduction of a male germ cell into the cytoplasm. For this, the reproductive specialist selects the most normal and mobile spermatozoa. With the help of special micro-instruments, he pierces the shell of the egg and introduces the sperm there. The fertilized egg is implanted in the woman's uterus. This unique way conception "out of the body" helps many couples to become parents of wonderful children who in the future will not be any different from their "normal" peers.

Thus, it is quite difficult to answer the question of whether it is possible to become pregnant with asthenoteratozoospermia. In many ways, this depends on the desire and ability to be examined and treated by the man himself. This takes time and patience. And in the case of artificial insemination, there is also money, because this is an expensive procedure. The most important thing is to start treatment on time so as not to delay or aggravate pathological process. In any case, you should never give up and give up and then everything will work out.