СТЕРОИДИТЕ И МЪЖКАТА ФЕРТИЛНОСТ

ANABOLIC STEROIDS AND MALE FERTILITY

Тestosterone and its synthetic derivatives have been used to increase muscle mass for a long time. Although forbidden for professional athletes, they are sometimes used by men practicing amateur sports. Along with their effects on  physical appearance and libido, steroids also affects male fertility.

WHAT HAPPENS IN THE BODY WHEN YOU TAKE ANABOLIC STEROIDS ?

Testosterone stimulates spermatogenesis. When a man is taking extra testosterone, its internal production in the testes is inhibited and spermatogenesis is disturbed. The result is reduced amount to a complete absence of sperm in the semen, which can be detected by a regular semen analysis. This effect is very often observed when anabolic steroid administration is not prescribed or overseen by a physician.

Some couples have problems conceiving because of anabolic steroids intake by the male partner. Although their use may lead to complete suppression of spermatogenesis, this condition is in most cases reversible. The longer the drugs were taken, the longer the recovery of spermatogenesis takes. Improvement of semen analysis results can be observed after at least 3 months following discontinuation of the anabolic steroids. After that many couples get pregnant naturally. In rare cases, long-term use of steroids leads to permanent suppression  and male infertility.

ANABOLIC STEROIDS AND ASSISTED REPRODUCTION

Even if the man hasn’t used anabolic steroids for a long time, sometimes there are indications for in vitro fertilization (IVF) or intrauterine insemination (IUI). This could be caused by a female infertility factor. If this is your case, you must inform the treating fertility specialist that you have taken steroids in the past.

Anabolic steroids are strictly prohibited prior to an assisted reproductive procedure (IUI or IVF). ANABOLIC STEROID INTAKE NOT PRESCRIBED BY A PHYSICIAN ESPECIALLY PRIOR TO AN ASSISTED REPRODUCTIVE PROCEDURE HAS STRONG NEGATIVE IMPACT ON THE OUTCOME OF THE PROCEDURE.

If you use or have used steroids and you have been trying to get your partner pregnant for more than a year, consult with a reproductive medicine specialist. They will refer you for the necessary hormonal tests (e.g. for testosterone, follicle stimulating and luteinizing hormone) and semen analysis. This will give you information about your hormonal profile and sperm count. If necessary you will be prescribed medication that will improve hormonal imbalance and stimulate spermatogenesis.

IMSI

WHAT IS IMSI FERTILIZATION and HOW IS IT DIFFERENT FROM ICSI?

An in vitro fertilization (IVF) procedure normally starts with hormonal stimulation, proceeds with oocyte recovery trough an ovarian puncture, oocyte fertilization, culturing of the resulting embryos and concludes with an embryo transfer procedure. The step considered by many to be the most technically complicated is the oocyte fertilization step. This is especially true if fertilization is carried out by the IntraCytoplasmic Sperm Injection (ICSI) method. The other main method of fertilization is called Conventional In Vitro Fertilization.

What is ICSI fertilization?

ICSI fertilization is mainly used in male factor infertility cases. The nature of the procedure allows oocytes to be fertilized even in the presence of only single motile spermatozoa with good morphology. This is achieved as the embryologist catches these single spermatozoa by means of the so called micromanipulator (See Fig.). Each of the selected spermatozoa is separately immobilized, aspirated in the injection micropipette and injected into a single oocyte.

What is the difference between ICSI and IMSI?

IMSI is an improved version of ICSI (IntraCytoplasmic Sperm Injection) which allows the embryologist to look at spermatozoa at a much higher magnification (x 6000), compared to x600 or less for the standard ICSI procedure. The higher magnification allows much more detailed visualization of subcellular structures like the acrosome, the head, the midpiece, the cytoplasmic droplet or the tail of the spermatozoon. Therefore, with IMSI a much more precise selection of spermatozoa is achieved. Following the selection of particular spermatozoa, the IMSI procedure is identical to ICSI.

The IMSI method is useful for patients with a very low percentage of spermatozoa with normal morphology. Although it is more laborious and much more time-consuming, for those patients it is definitely beneficial. In some cases the IMSI procedure is also recommended for couples with a few unsuccessful ICSI cycles as well as couples with recurrent abortions. Talk to your reproductive specialist to find out which is the most suitable method in your case!

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