La infertilidad en la pareja.

En una pareja infértil es importante estudiar a ambos miembros de la pareja y al mismo tiempo. Para evaluar al hombre, hay que efectuar una correcta historia clínica, realizar una exploración física y analizar los resultados del seminograma.
En un seminograma se deben valorar: el volumen del eyaculado, el pH seminal y la vitalidad de los espermatozoides. Además, se analizan otros parámetros como con el número total de espermatozoides, la concentración de los mismos por ml, la movilidad total y progresiva, su vitalidad y morfología.

La American Urological Association recomienda realizar el cariotipo (análisis de cromosomas para descartar enfermedades congénitas) en hombres con sospecha de azoospermia (ausencia de espermatozoides) no obstructiva. Se utilizan términos muy específicos en el diagnóstico de los varones infértiles: la oligozoospermia consiste en la reducción del número de los espermatozoides en un seminograma, la teratozoospermia es un trastorno caracterizado por menos del 4% de espermatozoides con forma normal y la astenozoospermia es un trastorno caracterizado por menos del 32% de espermatozoides móviles progresivos. En caso de un seminograma alterado, debe realizarse un segundo análisis para confirmar los resultados.
La ecografía es una prueba de rutina no invasiva que se realiza en la evaluación de hombres con infertilidad y puede ser útil, por ejemplo, en la evaluación de la patología testicular o el varicocele.

Las concentraciones de las hormonas hipofisarias, que son las que regulan la producción de testosterona y los espermatozoides, son importantes en la evaluación del varón infértil.

La duración de la infertilidad, si es primaria (de siempre) o secundaria (ya ha tenido hijos), los resultados del seminograma y la edad de la pareja, son factores pronósticos para la fertilidad. La edad de la mujer es el factor pronóstico más importante en estas parejas. En comparación con una mujer de 25 años, la posibilidad de fertilidad disminuye al 50% a los 35 años, al 25% a los 38 años y a < 5% por encima de los 40 años.

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