Innledende undersøkelser av mannens fertilitet

I omtrent 40% av tilfellene ligger årsaken til fertilitetsproblemene hos mannen, 40% skyldes forhold hos kvinnen, mens det i 20% av tilfellene skyldes komplikasjoner hos begge parter1.

I utredningen av mannens fertilitet, er kvaliteten på sædcellene (spermiene) helt avgjørende. Fertilitetsspesialisten vil derfor foreta en sædanalyse, som brukes til å evaluere en rekke viktige parametere. Både antall sædceller, deres motilitet (bevegelses- og svømmeferdighet) og morfologi (form og størrelse) studeres grundig. Til dette formålet er det nødvendig med en fersk sædprøve.

Sædcellene bør ikke være eldre enn en halvtime når de skal analyseres. For å få en så fersk prøve som mulig, er det vanlig at mannen masturberer i et eget tilrettelagt rom på legekontoret eller fertilitetsklinikken.

Sædanalysen vil gi fertilitetsspesialisten informasjon om mannens fertilitet på prøvetidspunktet. Det er viktig å understreke at prøven kun gir informasjon om sædkvaliteten slik den er for øyeblikket. Den indikerer ikke hvorvidt mannens sædkvalitet over tid er like god, om den er varig nedsatt, eller om ytre påvirkninger kan ha forårsaket en midlertidig redusert sædkvalitet. Grunnen til dette er at det produseres gjennomsnittlig 1500 sædceller i sekundet2, slik at resultatet av en sædanalyse kan endre seg dramatisk på bare noen få uker.

Det finnes også mannlige fertilitetslidelser der sædkvaliteten er god. Dette kan være tilfelle ved impotens, antistoffer som angriper mannens egen spermie, forskjellige genetiske sykdommer eller hormonelle avvik. I slike tilfeller vil det være behov for videre undersøkelser, for å finne årsak og mulige behandlingsmetoder.

Ved hjelp av grundige undersøkelser og flere analyser, vil fertilitetsspesialisten forsøke å finne årsaken til mannens infertilitet. Ikke alltid, men ganske ofte, kan det være vanskelig å finne en forklaring på hva den nedsatte sædkvaliteten kommer av3. Fenomenet kalles uforklarlig eller idiopatisk infertilitet4.

Hvordan analyseres sædprøven

I en typisk sædanalyse vurderes: antall spermier i en milliliter sæd, morfologi (størrelse og form), motilitet (bevegelses- og svømmeferdighet), konsentrasjon av hvite blodlegemer, fruktosenivået i sæden (sukker), totalt sædvolum, PH, og LNG (tiden det tar for sæden å gå fra tykt- til tyntflytende form).

 

Les mer om analysen…

Pasienthistorie

Som en del av undersøkelsen ønsker fertilitetsspesialisten å kartlegge:

  • generell helsetilstand,
  • kroniske lidelser,
  • tidligere stråle/kreftbehandling5,
  • om kjønnsorganene har blitt utsatt for skader, eller har blitt operert,
  • infeksjoner eller barnesykdommer etter puberteten,
  • kjente genetiske lidelser i familien,
  • barn fra før, eventuelle spontanaborter eller dødfødsler,
  • hvor ofte man har samleie,
  • alkoholvaner6 og nikotinbruk7, 8

Kliniske prøver

Fertilitetsspesialisten vil i tillegg:

  • foreta skanning av skrotum (pungen), testiklene og bitestiklene,
  • kontrollere forskjellige kjertler, en undersøkelse som foretas rektalt,
  • vurdere transrektal eller skrotal ultralydundersøkelse av kjønnsorganene.

Andre prøver

Fertilitetsspesialisten kan vurdere å gjennomføre

  • Urinprøve etter ejakulasjon, prøven foretas for å kunne konstatere retrograd ejakulasjon, en tilstand som oppstår når sæden går inn i urinblæren istedenfor ut av penis under orgasme.
  • Blodprøver, tas for å måle hormonnivåer fra hypofysen, hypotalamus og testiklene (testosteron).
  • Genetiske tester, for å diagnostisere mulige forandringer i Y-kromosomet, samt medfødte eller arvelige syndromer.

Kosthold

Sædcellene er ekstremt sårbare, både i produksjonsfasen på 74 dager, og etter ejakulasjonen da de utsettes for store miljøendringer. Det er grunnen til at menn produserer 10 millioner spermier hver eneste time9.

Forskning har vist at hovedårsaken til den historiske trenden med redusert sædkvalitet siden 1990 skyldes dårlig kosthold10. Det vestlige kostholdet mangler tilstrekkelig mengde av mange viktige vitaminer, aminosyrer og andre mikronæringsstoffer. Dette inkluderer næringsstoffer som er nødvendige for optimal sædcelleproduksjon.

Forskning har også vist at kombinert inntak av de nødvendige næringsstoffene tredobbler antall sædceller, og øker både motilitet (bevegelses- og svømmeferdighet) og ejakulert sædvolum11. Sannsynligheten for å oppnå en graviditet er dermed vesentlig forbedret.

Videre undersøkelser av mannlig infertilitet

Klamydia

En urinprøve vil fastslå om mannen har klamydia. Er prøven positiv, vil legen foreskrive en behandling med antibiotika for å bli frisk.

Kosttilskudd som forbedrer mannens fertilitet

Fertilitetsspesialister anbefaler bruk av kosttilskudd til både menn og kvinner i forbindelse med forberedelse til IVF eller annen fertilitetsbehandling. På grunn av påvist effekt og rimelig anskaffelse, blir tilskuddene i stadig større grad anbefalt til håpefulle fedre, spesielt de over 35.

 

Les mer om kosthold…

Testikkelbiopsi

Hvis det er fastslått at sæden inneholder få eller ingen sædceller, kan legen undersøke om produksjon og transport av sædcellene fungerer som det skal ved å utføre en testikkelbiopsi. Hvis for eksempel sædlederen er blokkert, kan ikke sædcellene bli ejakulert.

Click to find out more about a testicular biopsy

Under en testikkelbiopsi hentes litt testikkelvev mens pasienten er lokalbedøvet eller i narkose12. Prøven kan således undersøkes for eksisterende kjønnsceller.

Testikkelbiopsi benyttes kun dersom paret vurderer prøverørsbefruktning (Intracytoplasmatisk spermieinjeksjon direkte inn i eggcellen, ofte referert til som ICSI)13). Grunnen til det, er at inngrepet ikke forbedrer fertiliteten.

Dersom en mann bestemmer seg for testikkelbiopsi, bør det velges en klinikk med fasiliteter for kryokonservering (nedfrysning). Da unngås flere inngrep, og kjønnscellene som fryses ned kan benyttes til en senere befruktning.

Ytterligere fertilitetsundersøkelser for par

Postkoital undersøkelse (PCT)

Noen leger bruker postkoitale (etter samleie) undersøkelser for diagnostisering14, dersom tidligere undersøkelser ikke har avdekket noen årsak til redusert fertilitet. Noen leger anbefaler undersøkelsen helt i begynnelsen av fertilitetsbehandlingen fordi den er rask og enkel å foreta.

Les vår artikkel om postkoital undersøkelse.

find out more

Bibliografi

  1. «Hudson, B. (1987). The infertile couple. Churchill-Livingstone, Edinburgh»
  2. http://humrep.oxfordjournals.org/content/18/2/447.full»
  3. «http://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/causemal.htm»
  4. «http://en.wikipedia.org/wiki/Unexplained_infertility»
  5. «Paoli D, Gallo M, Rizzo F, Spano M, Leter G, Lombardo F, Lenzi A, Gandini L. Testicular cancer and sperm DNA damage: short- and long-term effects of antineoplastic treatment. Andrology. 2014»
  6. «Muthusami KR, Chinnaswamy P. Effect of chronic alcoholism on male fertility hormones and semen quality. Fertil Steril. 2005; 84(4): 919-24”
  7. “Mitra A, Chakraborty B, Mukhopadhay D, Pal M, Mukherjee S, Bannerjee S, Chaudhuri K. Effect of smoking on semen quality, FSH, testosterone level and CAG repeat length in androgen receptor gene of infertile men in an Indian city. Syst Biol Reprod Med. 2012; 58(5): 255-62”consumption or drug abuse[3. «http://en.wikipedia.org/wiki/Male_infertility#Diagnosis»
  8. «Battista N, Pasquariello N, Di Tommaso M, Maccarrone M. Interplay between endocannabinoids, steroids and cytokines in the control of human reproduction. K Neuroendocrinol. 2008; 20(1): 82-9”
  9. «Padubidri, VG; Daftary, SN, eds. (2011). Shaw\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\’s Textbook of Gynaecology (15th ed.). p. 201»
  10. «Decline in semen concentration and morphology in a sample of 26 609 men close to general population between 1989 and 2005 in France. http://humrep.oxfordjournals.org/content/early/2012/12/02/humrep.des415.abstract – See more at: http://menfertility.org/male-fertility-continues-to-fall/#fn-38-1»
  11. «http://www.altmedrev.com/publications/5/1/28.pdf»
  12. «http://www.nlm.nih.gov/medlineplus/ency/article/003908.htm»
  13. «http://en.wikipedia.org/wiki/Intracytoplasmic_sperm_injection»
  14. «Hessel M, Brandes M, Bruin JPD, Bots RS, Kremer JA, Nelen WL, Hamilton CJ. Long-term ongoing pregnancy rate and mode of conception after a positive and negative post-coital test. Acta Obstet Gynecol Scand. 2014; 93(9): 913-20″
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