Monday, June 5, 2017

Acute myeloid leukaemia (AML) symptoms

All the symptoms described also occur in the context of other, comparatively harmless diseases and in most cases are not associated with leukemia. If symptoms persist, however, it is advisable to have the cause clarified by a physician. If there is indeed acute myelogenous leukemia, a therapy must be started as soon as possible.

Diagnosis of AML

In the case of suspected leukemia extensive examinations of the blood and bone marrow are necessary in order to first confirm the diagnosis and subsequently determine the type of leukemia. By means of so-called imaging methods , the extent of the disease is also determined.

If the physician / internist finds evidence of an acute leukemia due to illness and physical examinations, he will first examine the blood . If the suspicion of leukemia is confirmed, for example, because immature cells are found in the blood, anemia or thrombopenia is present, the diagnosis must also be assured by the analysis of the bone marrow. Such an examination is carried out at a specialized hospital by a specialist for blood and cancer (hematologists / oncologists). He removes bone marrow from the hip bone or bone (bone marrow) with a syringe under local anesthesia. This short outpatient procedure can be a bit unpleasant for the patient as it takes a few minutes for the bone marrow to enter the syringe.

The subsequent laboratory studies of bone marrow include the biological properties, external cell features and genetic changes of the infected cells. With the help of the analysis, the exact subform of the disease can be determined in addition to the type of leukemia. Because the subforms of acute myelogenous leukemia differ significantly in their course of disease, prognosis, and response to different therapy, the in-depth study of bone marrow is crucial to develop a suitable plan for the treatment.

When an AML is detected, additional examinations are necessary depending on the individual case in order to rule out the involvement of other organs of the body with blasts. These include chest radiographs, computer tomography and ultrasound examination of the abdomen and heart. In exceptional cases a sample is taken from the spinal fluid ( lumbar puncture ) to determine if there is leukemia in the brain.

In the further course after the start of therapy, bone marrow punctures and other control examinations are always necessary. For example, MRD diagnostics can be used to check whether the leukemia has completely re-formed (remission).

Classification of AML

Acute myelogenous leukemia is not a uniform disease, but rather a group of different subforms, which can be distinguished from each other by their biological properties, external cell features and genetic changes. The assignment to a certain subform plays an important role for the therapy decision since the different subforms differ from one another in terms of the course of the disease and the chances of healing (prognosis) and are differently sensitive to chemotherapy. Basically, one distinguishes between primary and secondary AML: If the AML occurs independently and without previous bone marrow or cancer diseases, one speaks of a primary or de novo AML. A secondary AML develops from another bone marrow disease (eg a myelodysplastic syndrome ) or arises as a result of an earlier chemotherapy or radiation therapy. Since the secondary AML is usually associated with several genetic changes, it has a poorer prognosis than the primary AML.
The classification of AML nowadays is mostly based on the WHO classification . This combines the older FAB classification, in which the blasts are subdivided into eight subgroups (M0-M7) according to their external, microscopically visible traits, with genetic features of the leukemic cells. The external characteristics as well as the underlying genetic changes can be determined by means of comparative laboratory tests such as microscopy, cytochemistry, immunophenotyping, molecular genetics, cytogenetics or in situ hybridization.

Acute promyelocytic leukemia (APL)

Acute promyelocytic leukemia (APL) is a rare subform of AML diagnosed in approximately 5% of AML patients. In this disease, a special genetic change can be detected, which is called translocation t (15; 17). It leads to the formation of the defective protein PML-RARA, which is causally involved in the development of the disease. The APL has a special role with regard to the course of the disease, the prognosis and the treatment. The disease occurs mainly in younger patients and is associated with a good prognosis. By combining chemotherapy with all-trans-retinoic acid (ATRA), which stimulates leukemia cells, more than 75% of patients can now be cured. A prerequisite is, however, the treatment in a specialized leukemia center, because the APL often causes a disturbance of the blood coagulation and is therefore associated with a high rate of bleeding complications.

Treatment of acute myelogenous leukemia

AML is a serious condition that leads to death untreated within a few weeks. It is therefore extremely important that a therapy be initiated immediately after the diagnosis. The most important component of the treatment is the chemotherapy with an accompanying therapy for the treatment of the side effects. For this purpose, a bone marrow transplant may occur in a particular case. Radiation therapy plays a subordinate role at AML. All components of the therapy serve to kill the leukemia cells as completely as possible in the body, so that the bone marrow can resume its original function - the formation of blood.

The treatment of an AML should be carried out at a clinic with experience in the treatment of leukemia, especially the AML. The clinic should have access to the latest state of research and carry out the necessary special examinations. You can find out more about the right clinic here . Because the treatment is lengthy and burdensome, patients and their relatives should inform themselves thoroughly about the planned procedure. The treating physician will speak with the patient in detail and inform him about all treatment options.


In chemotherapy , a patient receives drugs called cytotoxic drugs that specifically inhibit the growth of leukemia cells. Since a single drug is usually not sufficient to destroy all blasts, several drugs are combined with different actions. They are given as an infusion, syringe or in the form of tablets. Chemotherapy is divided into several cycles separated by breaks (intervals) in which healthy cells can regenerate. To assess the success of the therapy, the bone marrow and other infected regions are checked at regular intervals.

stem cell

Another possibility of treatment is stem cell transplantation . The aim of this therapy is to replace the diseased bone marrow with healthy ones. In the case of stem cell transplantation, purified blood stem cells of a suitable donor (allogene) or more infrequently of the patient themselves (autolog) are administered to the patient by infusion. For successful therapy, all leukemia cells must first be killed. This is achieved by a strong chemotherapy and an irradiation which, in addition to the blasts, also destroys the healthy cells in the bone marrow. Since this is a stressful and risky treatment, the patient has to be considered for stem cell transplantation with regard to general condition and age. Stem cell transplantation is usually carried out only if, due to the characteristics of the leukemia cells, it must be assumed that a high risk of a relapse (recurrence) exists or if the chemotherapy has not brought sufficient treatment success.

treatment studies

Treatment of AML patients should be performed as far as possible in the context of therapies . The patient is given access to the latest scientific knowledge and is treated with innovative medicines and according to current treatment strategies. Participation in a study does not mean that the use of the drugs used is experimental. Rather, the goal is to improve the treatment strategies of AML in the future. The decision about which study is appropriate for a patient must be discussed intensively with the treating physician. Various criteria such as disease characteristics, disease phase, pretreatment, age and risk factors play a role. However, the final decision is always made by the patient himself. In Germany, numerous clinics participate in the studies of the German study groups for adult AML . The current studies can be found in the German Leukemia Study Registry .

Treatment options for a relapse

In the event of a relapse of the AML, chemotherapy is again carried out again. In late relapses, the induction therapy can be repeated in order to achieve a complete destruction of the leukemia cells (remission). In early relapses or when the disease does not respond to the therapy (therapy failure), different possibilities are explored eg with new medicines within the framework of therapy studies. Here, it is important that the treating physicians are informed about all currently available therapeutic options. The goal is to achieve a complete remission. Frequently, when age and general condition permit and when a donor can be found, stem cell transplantation is performed.


The number of cures has been growing steadily at AML over the past decades. However, regular follow-up examinations are necessary. They include a general physical examination as well as controls of blood and bone marrow. The aim is to detect signs of a relapse or late-onset of the therapy at an early stage. With the distance from the diagnosis and the therapy end, the intervals between the examinations are then extended. The treating physician also advises on the possibility of rehabilitation (rehabilitation). It is usually funded by the health insurance companies and offers a good transitional opportunity to return to a "normal" life.

Acute myeloid leukaemia(AML)

Acute myeloid leukaemia (AML)

Acute myeloid leukaemia is a form of blood cancer. This form of cancer develops in the bone marrow. Another word for blood cancer is leukaemia. The acute myeloid leukaemia abbreviation is AML.
AML is the most common form of acute adult leukaemia. The disease also occurs in children.

Bone marrow and blood cells

How does acute leukaemia develop?

Under a microscope, healthy bone marrow looks varied. It is a combination of mature blood cells of all 3 types and cells that are still in development.

No outburst

Acute myeloid leukaemia has resulted in a number of changes in hereditary material (DNA). These changes are called mutations. This does not excite certain white blood cells in the bone marrow. And is the bone marrow going to produce deviating blood cells: malignant blasts.

Uncontrolled cell division

The unruly cells continue to share. Healthy cells respond to signals from the environment. For example, the signal to stop sharing if there are enough cells. The immature cells no longer respond to these signals: they share unchecked. This causes a lot of abnormal blood cells.

Abnormal cells displace all other cells 

First, there is only a surplus of white blood cells in the bone marrow. The large amounts of abnormal white blood cells displace red blood cells, platelets and normal white blood cells. This can happen in a short period of time: days to weeks.
Later the abnormal white blood cells enter the bloodstream and sometimes into the organs. They can then overfill with abnormal cells. For example, this can be seen by: 
  • Swollen lymph nodes
  • An enlarged spleen
  • An enlarged liver

Primary or secondary AML

If the AML originates, it is called de novo leukaemia or primary AML. 

Have you previously been treated with chemotherapy for another type of cancer? Or have you previously had myelodysplastic syndrome (MDS)? Then there is therapy-related AML or secondary AML. 

People with primary AML have a better chance of cure than people with secondary AML.
Acute myeloid leukaemia(AML)

Acute myelogenous leukemia (AML)

Acute myelogenous leukemia (AML) is a malignant disease that takes its origin from immature precursors of red blood cells, blood platelets, and a portion of white blood cells. AML is the most common form of acute leukemia in adults. Thanks to the intensive research carried out over the last decades, treatment options and healing options have improved significantly. The diagnosis of an AML should therefore not lead to hopelessness. An earlier incurable illness has in many cases become curable!
Acute myelogenous leukemia (AML) is a malignant disease of the blood-forming system (blood cancer), in which an early precursor of a myeloid cell degenerates and increases uncontrolled. Myeloid cells include the red blood cells, blood platelets, and some white blood cells. In healthy people, the proliferation and renewal of the blood cells is strictly regulated. At the AML, this process has got out of control:
Through the changes of the genetic material, the affected cell begins to divide and multiply unbraked without developing into normal, functional blood cells. The resulting cells are called myelotic blasts . They spread rapidly in the bone marrow and hinder the formation of healthy blood corpuscles there. The blasts can finally be distributed in the body via the blood and other organs can be attacked and damaged.

Causes and frequency

Acute myelogenous leukemia is not a hereditary disease and, like other cancers, is neither contagious nor can it be transmitted to other people. The cause of the AML are malignant genetic changes in the bone marrow acquired in the course of life. Ionizing radiation and certain chemical substances are considered as risk factors. Even some medicines, which are used for the treatment of cancer diseases, can occasionally trigger a so-called secondary AML in rare cases even years later. Patients with various diseases of the blood or bone marrow (eg with a myelodysplastic syndrome) or genetic diseases such as Down syndrome also have an increased risk of developing AML. In the vast majority of cases, however, it remains unclear what the cause of the disease has been.

Acute myelogenous leukemia is a rare disease with 3.5 new diagnoses per 100,000 inhabitants every year, but the most frequent form of acute leukemia in Germany. Men are slightly more affected than women. In contrast to ALL, which predominantly occurs in children, AML is a disease of the elderly - about half of the patients is over 70 years.


The symptoms of the AML usually develop within a few weeks. They arise on the one hand due to the lack of normal blood cells and on the other hand by the attack of organs with myeloid blasts.
Very common symptoms
  • Blood loss (anemia, reduction of red blood cells ) leads to pallor, fatigue, fatigue, diminished efficiency, shortness of breath, general weakness and malaise
  • Fever and / or increased susceptibility to infections caused by white blood cells (leukopenia)
  • Abdominal pain and loss of appetite by enlargement (organ attack) of spleen and / or liver
  • Increasing leukocytes (leukocytosis) by the overproduction of lymphatic blasts
Common symptoms
  • Reduction of platelets (thrombopenia) causes bleeding (small punctiform skin bleeding (petechia), bruises, nasal bleeding, prolonged bleeding, eg after a visit to the dentist or after injuries, prolonged bleeding in women, rarely also hemorrhage)
  • Lymph node swelling on the neck, armpits or groin
  • Joint and bone pain caused by the spread of the blasts into the bone
Rare symptoms
  • Involvement of the brain, spinal cord or brain with neurological changes such as headache, visual disturbances, vomiting or nervous paralysis
  • Changes in the skin and chlorome (storage of blasts eg in the skin or in the bone marrow)
  • difficulty in breathing

Some patients have little discomfort and the leukemia is discovered by chance during a routine blood test.

Sunday, June 4, 2017

Breast cancer

Breast cancer

Breast cancer is a cancers type that develops in the breast tissue of women and sometimes men. This case is about breast cancer in women. Separate information is available for men with breast cancer .

Breast cancer can develop in all areas of the chest. Another word for breast cancer is mammary carcinoma. 
Breast cancer can be subdivided into the place where it develops: 
  • Ductal: The cancer has developed in a milking parlor
  • Lobular: the cancer has developed in the mammary gland

In addition, there are also rare forms of breast cancer .

If your doctor is only a prerequisite for breast cancer, it is called in situ carcinoma. There are 2 forms of in situ carcinoma: ductal and lobular. Not all breast cancer has to be of the same kind. There may be several types of cancer in one breast at a time, for example a ductal and lobular carcinoma. 
Breast cancer is further subdivided into: 
  • Hormone-sensitive or hormone-sensitive breast cancer
  • HER2 positive breast cancer and HER2 negative breast cancer
  • Triple negative breast cancer

Ductal carcinoma in situ

Are there turbulent abnormal cells in the milk tubes, which have not yet grown through the walls of the milk tubes? Then this is a precursor of breast cancer. This is a "non-invasive" tumor. Usually this is a ductal carcinoma in situ (DCIS). For example, DCIS can be detected early in the population survey. 

Each year 1,800 patients have DCIS. 
Normally, milking passages feel smooth, sometimes the dairy gangs may feel hard and dizzy at a DCIS. However, in 80-85% of all DCIS cases is nothing to feel. Mammal patches are often visible on mammography. Another word for this is microcalcifications. These occur when the cancer cells in the tubes choke each other, die and then calcify. Kalkspats do not always indicate a DCIS. They may also have a benign cause. To investigate whether these lime pats are good or malignant, you get a biopsy. 

In DCIS, you usually get an operation. That's no different from invasive breast cancer. You will have a chest-lung operation with irradiation or chest irradiation without irradiation. 

DCIS does not grow through the wall of the milk tubes and, for that reason, does not cause any sowing. Sometimes there is also an invasive tumor between the DCIS. That's why you sometimes get a shield gland procedure . This applies especially to high grade DCIS (grade 3) and if the area with a DCIS is large.

Treating a DCIS reduces the risk of developing an invasive form of breast cancer. After treatment of a DCIS, the risk of cure is almost 100%. 
A DCIS that is not treated can develop into an invasive tumor. It is impossible to tell which women this happens and which women do not.

Lobular Carcinoma In situ (LCIS)

This form of breast cancer develops in a mammary gland and has not yet grown outside the wall of the mammary gland. LCIS is a precursor of breast cancer. LCIS increases the risk of developing lobular carcinoma. This stage of breast cancer is hard to find. Usually it is found by chance. 

Invasive ductal carcinoma

This cancer develops in the milking passages and can grow beyond. The invasive ductal carcinoma is the most common form of breast cancer and can feel like a hard bump. 

Invasive lobular carcinoma

This cancer occurs in the milk glands. The tumor is often only felt like a swelling of the breast. On a mammography or at an MRI, the lobular tumor is not always good to see. Under a microscope, small tumor cells can be seen, which are in strands. Lobular tumors occur less often than ductal tumors: in 5 to 15% of breast cancer. The prognosis of hormone-sensitive ductal carcinoma is the same as of a lobular carcinoma. These forms are therefore often treated in the same way. 

Another additional classification of breast cancer is based on the presence of receptors or the HER2 protein.

Hormone-sensitive or hormone-sensitive

Breast cancer can be hormone-sensitive or hormone-sensitive. That's important to know before treatment because hormonal therapy only works with hormone-sensitive breast cancer. 

Hormone-sensitive means that hormones can stimulate the tumor to grow and share. The hormones, for example estrogens, bind to receptors in the tumor cell. This is also called hormone receptor-positive breast cancer. 

If there are no receptors, you have hormone receptor-negative or hormone-sensitive breast cancer. This is also called an ER negative and / or PR negative tumor. The tumor does not grow under the influence of hormones. 

If more than 10% of the cancer cells have estrogen receptors, the cancer is called ER-positive in the Netherlands. Estrogen then stimulates tumor growth. A tumor less than 10% ER-positive is called ER negative. In progesterone sensitivity, the tumor is called PR-positive. 80% of breast cancer is ER-positive. About 65% of this ER positive breast tumor is also PR positive. 
Aromatase inhibitors reduce estrogen production, which causes the tumor to grow less or no longer. The tumor cells then die over time.

HER2-positive or HER2-negative

Breast cancer is also subdivided into HER2-positive or HER2-negative. That's important to know for treatment. HER2 positive breast cancer can be treated with targeted therapy. HER2 is a protein and stands for: Human Epidermal Growth Factor Receptor 2. 

A HER2-positive tumor means that excess HER2 protein is present on the tumor. HER2 protein stimulates tumor growth. To know if you are eligible for targeted therapy, the doctor must first investigate whether the tumor has too much HER2 protein.

Triple negative breast cancer 

In triple negative breast cancer, the protein HER2 is missing. In addition, the receptors for estrogen and progesterone (ER and PR) are also absent. Because it lacks all three, one speaks of triple negative breast cancer. Either: 3 times negative. 

Hormonal therapy correctly uses these receptors. The drug trastuzumab needs the HER2 protein. Therefore, hormonal therapy or treatment with trastuzumab in triple negative breast cancer is not useful.

Tumorin filtering lymphocytes 

The presence of tumor-infiltrating lymphocytes (TIL's) says something about their own defense against the tumor cells. If the defects in the cells are no longer cleared by the own immune system, cancer can develop. It is known that tumor-infiltrating lymphocytes have a predictive value in triple-negative breast cancer. When there are many tumor-infiltrating lymphocytes, patients have a better prognosis.

Benign diseases

A change in or chest does not necessarily indicate cancer. Usually it is a benign condition, such as a cyst. A cyst is a cavity filled with moisture. 

Benign cells cause swelling but do not grow through other tissues and do not spread through the rest of the body. There are more benign breast complaints. They are known as mastopathy.

Does the physician not know enough about the type of abnormality? Then he always advises further research.

Symptoms of breast cancer

It's important that you know your breasts well so that you can notice a change that will help you discover an early-stage anomaly. It is also good to know if there is an increased risk. Periodic self-examination (every month on a fixed day) is not necessarily required.

In order to recognize what suspicious changes are, it is important that you know how your breasts feel normal. For example, your one breast may always be slightly bigger than the other. Whether you have been withdrawn from one or both nipples from birth to you. It is common for most women to feel bumpy beneath your skin. That is caused by the glandular tissue in the breast. 

Symptoms of breast cancer

Feeling your breasts different from what you are used to and seeing or feeling one of the following symptoms, it is wise to consult your doctor immediately: 
  • An unusual nod in the chest
  • Peeling and redness of the nipple or pelvis in the chest
  • Recently retracted nipple
  • Strict (tje) to the nipple
  • Moisture from the nipple (bloody, aqueous, greenish or milky)
  • Warm feeling chest with red discoloration of the skin
  • A bad healing place
  • Painful, different feeling spot in the chest
  • Swelling in the armpit


A nodule is a thickening in the chest that feels different from the bumps that you can feel normal.
  • A nodule means put up glandular tissue or a cavity filled with fluid (cyst).
  • Lumps can feel very different. Often it is a spot in the chest that is somewhat stiffer or harder than the rest of the tissue. Sometimes it's bullet and slides away under the fingers like knives. Sometimes it feels like a thickened disk or a string behind the nipple. Usually, nodules do not hurt and are benign. But you should not take a risk and let you examine your doctor as soon as possible if you feel a nod.

Take these changes seriously and go to the GP as soon as possible. Even though most breast disorders are innocent and benign, they can also be caused by cancer. Thus, pain in itself is not a sign that you have a distraction in the chest. However, if your chest continues to be painful, talk to your doctor. 

Your GP looks and feels your breasts carefully. He also investigates whether there are raised lymph nodes in your armpits or in your throat. If necessary, he advises you to further investigate. Or he will immediately refer you to a doctor or a momapoli. A maternity clinic is an outpatient clinic specifically for patients with suspected breast cancer. A large number of hospitals has a mammapoli. 

Scientific research in large groups of women shows that monthly self-study does not increase the risk of survival of breast cancer.


Saturday, June 3, 2017

Male Fertility Surgery

Male Fertility Surgery

If you have a vasectomy or struggle with other fertility problems, you may want to know that many surgical options are available to restore your fertility. In the past, male fertility was difficult to solve and sometimes not even treated. Fortunately, however, times have changed. In fact, today's microsurgical techniques have made it possible to correct many male fertility problems. If you are faced with male fertility problems, surgery may be the right step for you.

Reasons for surgery

If you can not produce sperm in your ejaculate, you might want to consider a form of male infertility surgery. New surgical methods developed over the last ten years have made it much easier to restore your sperm, allowing you to feed a child. There are a number of reasons why your sperm flow can be compensated:

Surgical trauma
Epididymal blockage (caused by infection or inflammation)
Fix deference blocking
Ejaculatory channel blockage

Whatever the reason for your compromised sperm production, you can consult your healthcare provider for more information about your options.

There are a number of different types of procedures that are effective in the recovery of sperm flow. Depending on the type of block you have, you may be more suitable for a particular procedure.

A varicocelectomy is a treatment for varicocci that occur in your testes. It is a common procedure and can be done at your local clinic or hospital in a relatively short period of time.

Varicocele occur when blood flow in one or both testes begins to back up. This causes an enlarged vein, which is very similar to a spatader. A varicocele is generally painless, although varicocular symptoms can sometimes contain dull pain or swelling if you have a longer period of time. Varicocci can endanger sperm production because abnormal blood flow increases the temperature in the testes. Weak cases of varicocele can be treated by non-surgical methods.

The procedure

A varicocelectomy can be performed with relatively little trauma to the body. A small incision is made in the abdomen, allowing your surgeon to bind certain blood vessels to reduce blood flow. A second incision is then made and a microscope is inserted. This enables your surgeon to accurately identify problem patients. These veins are then repaired, removing the varicocele and returning the bloodstream to normal. This should help in the recovery of sperm production.

Successful rates

Varicocelectomy success rates are very high, with approximately 97% of men experiencing normal bloodstream and sperm production. Some men will develop even more varicocci in the future, but this is unusual.


A hydrocellectomy is a surgical procedure that is performed to remove the hydrocells found in your scrotum. It is not a common procedure, although it can be performed if your hydrocele causes pain or disrupts ejaculation.

Hydrocells are actually a collection of fluid around the testicles in your scrotum. Hydrocells are very common in newborns, and are often associated with hernia. In elderly men, hydrocells may be caused by infection or trauma to the testes or epididymis, or by clogging of lymph nodes in the testicle. Hydrocells usually go away by themselves, but if they interfere with fertility, they must be removed.

The procedure

The hydrocelectomy is a fairly simple procedure. Under general, local or regional anesthesia, your surgeon will make a small incision in your scrotum. The hydrocele is then dried from all its liquid. Your testicle and hydrocele are then removed from your scrotum, allowing your surgeon to remove the hydrocellular bag. Sometimes the hydrocellular bag is left behind and folded behind the testicle. The testicle is then replaced and the scrotum is reconstituted.

Successful rates

The hydrocelectomy procedure is usually very successful. Almost 100% of the hydrocells do not grow back, so the sperm can easily flow into the ejaculation canal.
Vasectomy Reversal

There are two different types of recurrent operations of vasectomy: vasovasostomy and epididymostomy. What kind of vasectomy reversal has been done depends on how your vasectomy reversal has been done and the health of your reproductive system. A vasovasostomy is the most common procedure, accounting for two thirds of all reversibility of vasectomy.

The procedure

In a vasovasostomy procedure, the surgeon will reconnect the ends of your vasedferences to allow the sperm to flow through. The epididymostomy procedure is a bit more complex and may take up to five hours to complete but is needed for men who have a blockage. In this procedure, your surgeon will directly match your vascular endoscopy with the epididymis, thus blocking the sperm and restoring the sperm.

Successful rates

Vasovasostomy success rates are quite high. Nearly 99% of men undergoing the procedure will produce semen in their ejaculate. 64% will be a child father. However, success rates for an epididymostomy tend to vary, with 52% to 92% of men producing sperm in their ejaculation after this procedure. On average, 41% of men who have an epididymostomy will be able to father a child.

 Epididymal Blockage and Vas Deferent Blockage

Sometimes key channels in your reproductive system can be blocked for reasons other than vasectomy. Through sexually transmitted infections, such as chlamydia and gonorrhea, the epididymis can be inflamed and blocked, so that sperm flows from your testes.

The vasedferences may also be blocked by these infections, or due to trauma during other surgical procedures. This can prevent sperm from entering your ejaculate, which makes pregnancy impossible.

The procedure

To fix a clogging of the fasteners or epididymis, the tubes must be reconnected. As with the reversal of vasectomy, vasovasostomy and epididymostomy procedures are also used.

Successful rates

Success rates are similar to those found in vasectomy reversal. About 60% of men undergoing vasovasostomy can father a child while about 40% of men undergoing epididymostomy will transport a child.

Ejaculatory Duct Obstruction

About 10% of men who do not have sperm in their semen suffer from ejaculation canal bleeding. Surgery is available to eliminate such obstructions and restore your ability to repair a child.

Ejaculatory duct obstruction may be the result of surgical scars during vasectomy procedures, cancer tumors, or cysts that grow in the prostate. These scars, tumors or cysts can press on the ejaculation canal, which causes the sperm to not be excreted. This makes it impossible to fertilize an egg.

The procedure

Surgery for obstruction of ejaculation can help restore ejaculation of sperm. The procedure is simple and is usually performed on an outpatient basis. In general or local anesthetic your surgeon will make a small cut in your testes. Using a special operating microscope, your surgeon will isolate your ejaculation duct and locate the blockage. This block will then be deleted.

Successful rates

Success rates to restore the sperm are generally high in this operation, with more than 70% of men undergoing the procedure can produce sperm in their sperm. However, the pregnancy rate after this type of surgery is not so optimistic. Between 20% and 30% of these men go to church children.

Things to consider

Surgery is often a big step to take, so it's important to first weigh all your options. Before you book your operation, there are many things you may want to consider. These include:

The cost of the procedure
Recovery times involved
Alternatives such as IVF and IUI

Semen analysis | Male Infertility Tests: Semen

Male Infertility Tests: Semen

In research into the possibility of male infertility there are a number of tests and factors that your fertility specialist wants to investigate and evaluate. To help you prepare for your fertility test, here is a list of some of the most common male factors infertility tests, as well as information about what your fertility doctor will seek.
Semen analysis
 Semen analysis | Male Infertility Tests: Semen

Semen analysis is the most common male infertility test and should always be a part of male infertility. A semen analysis evaluates how well sperm is produced and ripe, as well as how it interacts with the seminal fluid.

Your fertility specialist reports on the following criteria, using values ​​determined by the World Health Organization.
Sperm count

Also referred to as the concentration, the sperm count is a measure of how much million sperm a man has per milliliter semen. On average, the sperm should be higher than 60 million / ml. Men who have less than 20 million / ml are infertile.
Seed motility

Seed motility, or mobility, is an assessment of how well the sperm of a person moves. Ideally, at least 50%, preferably more of a sperm of a man, must be active.
Sperm Morphology

The shape of a sperm cell is also quite important when it comes to fertility. When investigating your sperm morphology, your sperm cells are examined under a microscope for certain properties. At least 30% of your semen must meet these criteria.
Ejaculate Volume

How much a man ejaculates is also assessed. 2 ml or more is the normal volume for ejaculation. However, a variety of factors may affect how much ejaculation is provided for semen analysis. If not all ejaculates are collected in the delivered container or if a man gets "performance anxiety", the amount of semen collected may be less than what the man actually produces.
Semen Fluid

Different factors regarding the seminal fluid will also be evaluated. This includes the color, viscosity of the fluid and how long it is necessary for the sperm to flow after ejaculation, since all of these aspects have a negative effect on the sperm.
Total Motile Count

This final review calculates the total number of motile sperm in a man's ejaculate. To figure this out, your fertility specialist will multiply the volume of your sample with the sperm by the percentage of sperm. An acceptable ejaculate should have more than 40 million motile semen.

Additional tests

A semen analysis is not the only type of test your fertility specialist is likely to perform. Other tests will investigate these factors:

Some cases of male infertility can be attributed to anti-sperm antibodies. This is an immunological reaction that attacks the man's body's sperm, which impedes fertility in various ways. The antibodies can prevent sperm from travel through a woman's cervical mucus, can sperm the sperm of melting the egg and / or prevent sperm ability to penetrate the egg. Some men run more risk of developing antibodies than others.
Kruger Morpology
If there is a morphology of sperm, a Kruger morphology test can be done. This male infertility test can investigate physicians more closely on the form of semen. Stringent criteria must be met in order to pass the sperm as "normal". This evaluation includes examining a sperm's head, center and tail. This test is beneficial because it gives your specialist a better idea of ​​which ART methods are most useful to you.
White blood cells
If a semen sample contains a higher than usual number of white blood cells, this may indicate a past infection or possible inflammation. Although some white blood cells are expected to be found, a sample containing more than one million white blood cells per milliliter is considered to be problematic. If elevated levels of white blood cells are found, further samples must be provided as white blood cell testing must be the first evaluation on a sample.
This test is designed to evaluate how much progress the mobile sperm can make. Because the motility does not promote progress, it is necessary to get a clear picture of how active sperm is. By combining the percentage of mobile sperm with the distance they can swim, your fertility specialist will get a better picture of how well your sperm performs.

Specialized Testing

If necessary, your fertility specialist can perform one, single or all of these specialized tests.

This staining technique enables fertility physicians to see which sperm is actually alive and sharply literally. Men whose semen analysis revealed a motility of less than 30% will probably have conducted this test on their semen sample.
Post-Ejaculatory Urinalysis (PEU)
This test was done to see whether some or the sperm is backbagged into the bladder, a condition known as retrograde ejaculation. To perform this test, a man is required to deliver a semen sample and immediately a urine sample. This post-ejaculatory urine is then examined for the presence of semen.
Men whose sperm count is low or have azoospermia will have done this test to determine whether sperm is blocked or just not produced. This test is intended to distinguish between the two problems.
Spun Specimen
In some cases, a man may have such a low sperm that no sperm is noticed on the initial test slide. However, sperm can still be present in the ejaculate. This test helps to determine if there is sperm or not by rotating the ejaculate sample, so that all sperm that may be present can be separated and collected at the bottom of the tube. If semen is identified, a few still certain ART methods can be used, such as ICSI with IVF.

Semen analysis | full notes

Semen analysis

Also found in: Dictionary, Thesaurus, Medical.
Related to Semen analysis: semen morphology

A semen analysis (plural: semen analysis), also called "seminogram" evaluates certain characteristics of a sperm of a man and the semen contained therein. It has been done to evaluate male fertility, whether it is pregnancy or to verify the success of vasectomy. Depending on the method of measurement, only a few characteristics can be evaluated (such as in a home kit) or many characteristics can be evaluated (usually by a diagnostic laboratory). Collection techniques and accurate measurement methods can affect the results.

Reasons for testing

The most common reasons for laboratory analysis in humans are as part of the infertility study of a few and after a vasectomy to check that the procedure was successful. It is also often used for testing human donors for semen donation, and for animal sensing is often used in farm culture and farm animals.

Occasionally, a man will perform semen analysis as part of the routine pre-pregnancy test. At laboratory level, this is rare because most healthcare providers will not test the sperm and sperm unless specifically asked whether there is a strong suspicion of pathology in one of these areas during medical history or during physical examination Have been discovered. Such testing is very expensive and time-consuming, and in the US it is unlikely that they will be covered by insurance. In other countries, such as Germany, testing is covered by all insurance.

Relationship to fertility

The characteristics measured by semen analysis are just some of the factors in sperm quality. One source says that 30% of men with normal semen analysis actually have an abnormal nerve function. [2] Conversely, men with poor semen analysis can go to parental children.  NICE guidelines define heavy male factor infertility as if 2 or more sperm analyses have 1 or more variables below 5th percentile and the risk of pregnancy prevents vaginal circulation within 2 years, comparable to humans With mild endometriosis. ]

Collection methods

Various methods used for sperm collection include masturbation, coitus interruptus, condom collection, epididymal extraction, etc.


Examples of parameters measured in a semen analysis are sperm count, motility, morphology, volume, fructose level and pH.

Sperm count

The estimated pregnancy rate varies from the amount of semen used in an artificial insemination cycle. Values are for intrauterine insemination, with sperm number in total sperm count, which may be about twice the total motile sperm.

Sperm count, or sperm concentration to prevent confusion with total sperm count, measure the sperm concentration in a man's ejaculate, distinguished from total sperm count, which sperm count is multiplied by volume.According to the WHO, more than 15 million sperm per millilitre is considered normal in 2010.  Older definitions are 20 million.  A lower sperm is considered oligozoospermia. A vasectomy is considered successful if the sample is azoospermia (zero sperm of any kind found). Some define success as when rare/incidental non-motile sperm is observed (less than 100,000 per millilitre). Other attorneys who obtain a second semen analysis to verify the counts are not increased (as can be done with re-channeling) and others may perform a repeat vectomy for this situation.

Home chips are emerging that can give an accurate estimate of sperm count after three samples on different days. Such a chip can measure the concentration of semen in a semen sample against a control fluid filled with polystyrene beads. 


The World Health Organization has a value of 50% and this must be measured within 60 minutes of the collection. The WHO also has a vitality parameter, with a lower reference limit of 60% live spermatozoa.  A man can have a total number of semen, far above the limit of 20 million sperm cells per milliliter, but still, has poor quality because few of them are mobile. However, if the sperm count is very high, low motility (e.g., less than 60%) can not be considered as the fraction may still be over 8 million per milliliter. On the other hand, a man can have a sperm that has much less than 20 million sperm cells per milliliter and still has good mobility if more than 60% of the observed sperm cells show a good forward movement.

A more specified measure is the degree of motility, where the sperm mobility is divided into four different classes:

Grade a: Progressive motility sperm. These are the strongest and swim quickly in a straight line. Sometimes also referred to as motility IV.
Rank b: (nonlinear motility): They also move forward, but tend to travel in a curved or curved motion. Sometimes also referred to as motility III.
Grade c: These have a non-progressive motility because they do not move forward, despite the fact that they move their tail. Sometimes also referred to as motility II.
Grade d: These are immortal and do not move at all. Sometimes also referred to as motility I.


As far as sperm morphology is concerned, the WHO criteria as described in 2010 indicate that a sample is normal (samples of men whose partners have pregnancy in the last 12 months) as 4% (or 5th centiel) or more of the observed sperm normally Morphology

Morphology is a predictor of successful fertilization of oocytes during in vitro fertilization.

Up to 10% of all spermatozoa have perceptible defects and are perceived as such in terms of fertilizing an oocyte.

Also, sperm cells with tailpoints swelling patterns generally have a lower frequency of aneuploidy.
A mobile sperm organometric morphology research (MSOME) is a particular morphological study in which an inverted light microscope equipped with high power optics and enhanced by digital imaging is used to achieve magnification above x6000, which is much greater than the magnification usually used by embryologists Used in spermatozoa selection for intracytoplasmic sperm injection (x200 to x400). [13] A possible finding on MSOME is the presence of semen vacuoles, which are associated with the immature of sperm chromatin, especially in large vacuoles.

WebMD recommends that sperm volumes between 1.0 ml and 6.5 ml are normal; WHO considers 1.5 ml as the lower reference limit.  The low volume may indicate partial or complete blockage of the seminal vesicles or the man without nerve fibers.  In clinical practice, a volume of less than 2 ml in the vicinity of infertility and absence of sperm should give an evaluation for obstructive azoospermia. A caveat for this is sure it has been at least 48 hours since the last ejaculation until the time of collecting samples.

Semen usually has a witty grey colour. It tends to get a yellowish tint as a man. Sperm color is also influenced by the food we eat: foods that are high in sulphur, such as garlic, can lead to a man who produces yellow sperm. [15] Presence of blood in sperm (hematospermia) leads to brown or red-colored ejaculation. Hematospermia is a rare condition.

Semen that has a deep yellow color or green appearance may be the result of medication. According to WebMD, brown semen is mainly due to infection and inflammation of the prostate gland, urethra, epididymis and seminal vesicles. Other causes of unusual semen colour include sexually transmitted infections such as gonorrhoea and chlamydia, genital surgery and damage to the male genitals.
Fructose level

As regards the level of fructose in the sperm, WebMD normally appears to be at least 3 mg/ml. [3] Who specifies a normal level of 13 μmol per sample. The absence of fructose can indicate a problem with the seminal vesicles. 


WebMD launches a normal pH range of 7.1-8.0; [3] WHO criteria normally indicate 7.2-7.8. [2] Acute ejaculation (lower pH) may indicate that one or both of the seminal vesicles are blocked. A basic ejaculate (higher pH) can indicate an infection. [2] A pH outside the normal range is harmful to sperm. [3]

Liquidation is the process when the gel formed by proteins from the seminal vesicles is degraded and the semen becomes liquid. It usually takes less than 20 minutes for the sample to change a thick gel in a liquid. In the NICE guidelines, a flow rate is considered within the normal range within 60 minutes. [16]

MOT is a measure of how many million sperm cells per ml are very mobile [17], which is about a degree a (> 25 microns per 5 sec at room temperature) and the degree b (> 25 microns per 25 sec at room temperature). Thus, it is a combination of sperm and motility.

With a straw [18] or vial volume of 0.5 milliliters, the general directive is that in a total of 20 million motile spermatozoa in total intracervical insemination (ICI), straws or vials are recommended. This is equivalent to 8 straws or vials 0.5 ml with MOT5, or 2 straws or vials of MOT20. For intrauterine insemination (IUI) 1-2 MOT5 straws or vials are considered sufficient. [19] WHO terms are therefore recommended to use approximately 20 million a + b of sperm in ICI and 2 million a + b in IUI.
Total motile spermatozoa

Total motile spermatozoa (TMS) [20] or total motile sperm (TMSC) [21] is a combination of sperm count, motility and volume, measuring how many million sperm cells in a whole ejaculate are motile.

Use of approximately 20 million sperms of cylinder c or d in ICI and 5 million in IUI may be an approximate recommendation.


The NICE guidelines also include testing vitality, with the normal range defined as more than 75% sperm cells alive.

The sample can also be tested on white blood cells. A high level of white blood cells in sperm is called leukospermia and may indicate an infection.  Cutoffs can vary, but a secretion is more than 1 million white blood cells per millilitre of sperm.

Aspermia: absence of semen
Azoospermia: absence of semen
Hypospermia: low sperm volume
Hyperspermia: high sperm volume
Oligozoospermia: Very low sperm count
Asthenozoospermia: poor sperm motility
Teratozoospermia: sperm carry more morphological defects than normal
Necrozoospermia: all sperm in the ejaculate are dead
Leucospermia: a high level of white blood cells in sperm

Factors that influence results

Apart from the semen quality itself, there are several methodological factors that can influence the results, which may cause inter-method variation.

In comparison with samples obtained from masturbation, semen samples from collective contraceptives have higher total sperm, sperm motility and percentage of sperm with normal morphology. For this reason, they are deemed to provide more accurate results when used for semen analysis.

If the results of the first sample of a man are subfertile, they must be verified with at least two analyses. Each analysis must be allowed at least 2 to 4 weeks.  Results for a single man may have a large amount of natural variation over time, meaning that a single sample can not be representative of the average sperm of a man.  In addition, sperm physiologist Joanna Ellington believes that the stress of producing an ejaculate sample for research, often in an unknown environment and without lubrication (most lubricants are a bit harmful to sperm), explain why the first Monsters of men often show poor results, but later monsters show normal results.

A man may rather try his sample at home than in the clinic. The sperm collection site does not affect the results of a semen analysis.

Measuring methods

Volume can be determined by measuring the weight of the sample container, with the mass of the empty container being known. Sperm and morphology can be calculated by microscopy. Sperm count can also be estimated by kits that measure the amount of semen-associated protein, and are suitable for home use.

Computer Assisted Semen Analysis (CASA) is a catch-all sentence for automatic or semi-automatic semen analysis techniques. Most systems are based on image analysis, but there are alternative methods like tracking the cell movement on a digitising tablet. [27] [28] Computer-assisted techniques are commonly used for evaluation of sperm concentration and mobility characteristics, such as velocity and linear velocity. Nowadays, CASA systems, based on image analysis and using new techniques, have almost perfect results and complete analysis in seconds. With some techniques, sperm concentration and motility measurements are at least as reliable as current manual methods.
Raman spectroscopy has made progress in its ability to carry out the characterization, identification and localisation of sperm nuclear DNA damage.

The Trak Male Fertility System is able to measure sperms using a portable centrifuge. A small sample of sperm is placed in a disposable pattern and the cartridge is attached to the Trak motor. The engine turns the cartridge, and the semen separates into its parts. The isolated sperm cells fill a visible room, such as mercury in a thermometer, and mark on the pattern an optimal, moderate or low sperm. [31] These series are based on various studies, and the World Health Organization (WHO). [34] The device also connects with a smartphone app to count sperm over time.