Andrology is the part of medicine that deals with the study, diagnosis and treatment of pathologies that affect male sexual and reproductive health.
Among those affecting sexual health are erectile dysfunction or impotence, ejaculation disorders (anejaculation, retrograde ejaculation, premature ejaculation, delayed ejaculation), disorders (anorgasmia), lack of sexual appetite or decreased libido (anaphrodisia). Other pathologies with possible repercussions on sexual health are penile malformations such as incurvation, in young people more frequently of congenital origin and in adults of acquired origin due to fibrosis of the corpora cavernosa (Peyronie’s disease), or sexually transmitted diseases.
The andrologist is responsible for the medical treatment of ejaculation disorders and erectile dysfunction, as well as the surgical treatment of some of these pathologies, through the implantation of penile prosthesis in cases of erectile dysfunction that does not respond to medical treatment, or the surgical treatment of penile incurvation.
In relation to reproductive health, the andrologist is responsible for the diagnosis and treatment of male infertility. The male is involved in approximately 50% of the cases of conjugal sterility, in 30% of the cases he is solely responsible and in 20% he is jointly responsible with the female.
In spite of this, only 20% of reproduction centers in Spain have an andrologist on their medical staff. Since couples with fertility problems usually go to the gynecologist first, most men with fertility problems are not evaluated or treated and their only role is reduced to providing semen samples for assisted reproductive techniques.
The main causes of male infertility are testicular descent (cryptorchidism), testicular varicose veins (varicocele), infections, seminal duct obstruction (vasectomy being the most frequent), hypogonadotrophic hypogonadism (caused by a deficit of gonadotrophic hormones), immune infertility (by producing antisperm antibodies) and testicular tumors.
Other areas of competence of Andrology are contraception (vasectomy) and problems affecting genital development.
The aforementioned and other causes of sterility can alter semen quality, diminish fertile potential and decrease the probability of natural gestation. The cornerstone on which the diagnosis of male sterility is based is the semen analysis or semen analysis. This analysis is essential in all cases of conjugal sterility and evaluates, among other parameters, the volume, number, mobility and morphology of the spermatozoa.
Semen analysis indicates the functional state of the male genital tract and gives us an indication of the probability of natural pregnancy and possible pathologies related to seminal alteration.
In the last decade, Institut Marqués has dedicated a large part of its R&D efforts to the study of the male factor. Thanks to this experience, we have at our disposal the best options to treat any anomaly detected in an andrological study.
On the other hand, Institut Marquès began in 2002 to study the semen quality of Spanish men. We are pleased to have contributed to convince the scientific community that the causes classically attributed to the decline in sperm quality (stress, tight pants, alcohol, etc.) are a myth and that, in reality, one of the main culprits are chemical toxins and their effects on male fertility.
We are referring to chemical substances synthesized by man in recent decades and commonly used in industry, agriculture and in the home. These are the so-called endocrine disruptors, a long list of compounds that behave like estrogens in the female body and affect the testicular development of the fetus during gestation.
When does the problem become limiting for conceiving?
Although the semen analysis is the fundamental test on which the diagnosis is based, it is not a good predictor of fertility. In fact, up to 20% of men with altered seminograms achieve natural gestation while 10% of men with normal seminograms do not achieve pregnancy. The concept of fertility or sterility is a couple concept, therefore the fertility of the woman also plays a role in the probability of gestation. In addition, there are hidden pathologies, especially genetic ones, which are not identified in the semen analysis and which require specific tests.
The major limitation to achieve biological paternity is azoospermia or absence of spermatozoa. This can have its origin in an obstruction of the seminal duct, the testicular sperm production is normal but the transport fails. In 100% of these cases it is possible to recover spermatozoa from the testicle or seminal tract for use in IVF-ICSI techniques or to perform unobstructive surgery.
The other side of the coin is non-obstructive azoospermia, in which the problem is little or no sperm production. But even in 50% of these cases it is possible to surgically retrieve sperm from the testicle.
How to help the patient and the couple?
The first objective of the andrological study is diagnosis. Diagnosis of those causes of sterility that are potentially treatable without resorting to assisted reproduction techniques; of pathologies relevant to the patient’s health, such as testicular cancer or pituitary tumors; of chromosomal or genetic anomalies transmissible to the offspring and of genetic alterations that diminish the efficacy of reproduction techniques.
The diagnosis will allow us to provide a prognosis and to advise patients on the probabilities of achieving spontaneous gestation. It will allow us to differentiate which patients will be able to benefit from an etiological treatment that attacks the causes of the problem, from those whose only therapeutic option will be assisted reproduction techniques.
A correct evaluation of the male factor of sterility allows us to indicate to the couple the best therapeutic option, saving time and economic efforts in treatments with a low probability of success. Enough arguments for men with fertility problems who come to fertility clinics to demand to be evaluated by an andrologist.