What is Male Sterility?

The incidence of male infertility is about 10%. The purely female factor is about 50%, the purely male factor is about 30%, and the total of male and female is about 20%. Clinically, male infertility is divided into two types: sexual dysfunction and normal sexual function. The latter can be further divided into azoospermia, oligozoospermia, asthenospermia, spermatozoa, and normal sperm count. .

Basic Information

English name

male infertility

Visiting department

Urology

Multiple groups

male

Common causes

Abnormal semen, spermatogenic disorders, sperm and egg binding disorders

Causes of male infertility

The classification of male infertility can be divided into absolute infertility (azoospermia) and relative infertility (small sperm count or low sperm motility) according to fertility, and can be divided into primary and secondary infertility according to clinical manifestations According to sex organ lesions, it can be divided into pre-testicular, testicular and post-testicular. The causes of male infertility are more complicated. The main reasons are as follows:

Abnormal semen

(1) When there is no sperm or too little sperm, the sperm density in the semen is less than 0.2 × 10 ⁹ / ml. The woman's chance of conception is reduced, resulting in infertility. This type of infertility can be divided into permanent and temporary. The former is found in those with congenital testicular development disorders or severe lesions in the testes and seminal vesicles; the latter is more common in sexual life when the spermatogenic function fails once, and usually the sperm is reduced rather than whole. Azoospermia.

(2) Poor sperm quality Inactive or dead sperm in sperm (over 20%), or poor sperm motility or abnormal sperm over 30%, often cause infertility.

(3) The physical and chemical properties of the semen are abnormal. The normal semen is coagulated into a jelly after being ejected, and it is completely liquefied within the next 15 to 30 minutes. If semen does not coagulate after ejection, or incomplete liquefaction often indicates a lesion in the seminal vesicle or prostate. Bacterial and viral infection of the reproductive tract can also cause changes in semen composition and cause infertility.

2. Spermatogenesis disorder

(1) Testicular diseases Testicular tumors, testicular tuberculosis, testicular syphilis, non-specific testicular inflammation, testicular atrophy after trauma or spermatic cord torsion, testicular atrophy, etc., can cause spermatogenic dysfunction and infertility.

(2) Chromosomal abnormalities Chromosomal abnormalities can cause poorly differentiated sex organs such as the testes, causing true amphoteric deformities and congenital testicular hypoplasia. Autosomal abnormalities can cause metabolic disorders of gonadal and spermatogenic cells.

(3) Sperm dysfunction The long-term consumption of cottonseed oil can affect sperm sperm autoimmunity, and can also cause sperm dysfunction.

(4) Local diseases such as recessive varicocele, giant hydrocele and other diseases affect the local external environment of the testis, or cause infertility due to temperature, compression and other reasons.

3. Sperm and egg binding disorders

(1) Sperm tract obstruction: congenital malformations such as atresia of vas deferens, surgical ligation of the vas deferens, and chronic inflammation of the vas deferens and surrounding tissues.

(2) Retrograde ejaculation The bladder neck has undergone surgery or has been damaged or scar contracture caused by the surgery has deformed the urethra, bilateral lumbar sympathectomy or rectal cancer after abdominal perineal surgery, diabetic nerve damage caused by diabetes, spermatic cord Cystic hypertrophy, and severe urethral strictures, some drugs can cause changes in the sympathetic nerves that govern the bladder.

(3) abnormalities of the external genitalia , such as congenital penile deficiency, such as small penis, male pseudohermaphroditism, upper or lower urethra, acquired penile inflammation or injury, scrotal edema, huge testicular hydrocele, etc. One of the reasons for male infertility is that sperm can't normally enter the vagina to meet the eggs.

(4) Male sexual dysfunction: impotence, premature ejaculation, non-ejaculation, etc.

4. Systemic factors

(1) Spiritual and environmental factors Sudden changes in the living environment lead to long-term mental stress, performing high-altitude, high-temperature, super-intensive labor and engaging in radiation work.

(2) Severe malnutrition due to nutritional factors , vitamin A and vitamin E deficiency, trace elements such as zinc and manganese deficiency, calcium and phosphorus metabolism disorders, mercury, arsenic, lead, ethanol, nicotine, cottonseed oil and other toxic substances chronic poisoning , Chemotherapy drug treatment, etc.

(3) endocrine diseases pituitary dwarfism, obesity, reproductive incompetence syndrome, hypohypophysis, congenital hypogonadism, congenital dysplasia, hyperprolactinosis, pituitary tumors or intracranial infection, Birth injury, etc.

Male infertility test

Semen analysis

It is an important and simple method to measure male fertility. The standard value of semen in China is: 2-6 ml / time, liquefaction time <30 minutes, pH 7.2-8.0, normal sperm density> 20 × 10 ⁹ / ml, sperm motility rate 60%, viability grade A> 25%, or viability (a + b)> 50%, sperm deformity <40%. Through masturbation or sperm retrieval, use a special glass bottle instead of plastic cups or condoms to collect. The specimen submission time should not exceed 1 hour, the temperature should be kept at 25 ~ 35 , and the abstinence time should be 3 ~ 5 days. Since the number of sperm and the quality of sperm often change, it should be checked 3 times in a row and averaged.

2. Urine and prostate fluid examination

Leukocytosis in the urine may indicate infection or prostatitis. Retrospective ejaculation can be considered if a large amount of sperm is found in the urine test after ejaculation. Prostate fluid microscopy for leukocytes> 10 cells / HP should be used for prostate fluid bacterial culture.

3. Determination of reproductive endocrine hormones

Including testosterone, testosterone (T), luteinizing hormone (LH), follicle stimulating hormone (FSH) and other reproductive endocrine hormones. Combining semen analysis and physical examination can provide identification of the cause of infertility. If T, LH, and FSH are low, secondary hypogonadism can be diagnosed; simple T decreases, and LH is normal or high, and FSH increases can be diagnosed as primary gonadal failure; normal T and LH, FSH increased The diagnosis was selective spermatogenic epithelial dysfunction; T, LH, and FSH increased, and the diagnosis was androgen tolerance syndrome.

4. Antisperm antibody test

Immune infertility accounts for 2.7% to 4% of male infertility. WHO recommends a mixed antiglobulin response test (MAR method) and immune strain test. Not only can we detect the presence of antisperm antibodies in the serum and secretions of infertile couples, we can also determine whether these antibodies can bind to sperm, and distinguish which antibodies bind to which area of sperm. In the antiglobulin mixed response test, the percentage of microemulsion droplets and active sperm binding should be less than 10%. For the immunostrain test, the microemulsion droplets coated with IgA or IgG antibodies on the surface are mixed with the sample sperm, and the antibodies will bind to the IgA or IgG on the surface of the sperm. The key to the success of this test is that the sperm should be mobile. Immune strains can be considered positive if they bind to more than 50% of active sperm. In cases with positive results, 75% of sperm often show IgA or IgG. The results of these antibody tests should be interpreted with caution, as some patients contain antibodies that do not affect their fertility.

Diagnosis of male infertility

1. Congenital testicular malformations and dysplasia

(1) cryptorchidism: The testis stays somewhere on the way, and does not fall into the scrotum or testicular ectopic. Examination showed scrotal dysplasia, no testes on one or both sides, and most of them can reach the testicles that have not fallen into the scrotum at the root of the scrotum, inguinal canal or femoral triangle, and inner ring. Unilateral cryptorchidism generally affects fertility only, and bilateral cryptorchidism can cause infertility.

(2) Patients with congenital amphoteric malformations and true amphoteric malformations develop a male and female intermediate type, with significant abnormalities in the genitalia, and both male and female gonads are present in the body. Cytogenetic examination for abnormal chromatin and karyotype. Male pseudohermaphroditism is relatively common in men. The patient is male in nature, and the internal genitals are testis, but the external genitals are like females. It is a male body, the urethral fissure is not connected like a vaginal vestibule, the penis is not developed like a clitoris, and it is accompanied by cryptorchidism. The external genitalia are similar to females, but the undescended testes can be detected. The sex chromatin is negative and the karyotype is 46 / XY, which is a pseudohermaphroditism.

(3) Testis-free: Real testis-free is extremely rare. The main manifestations are no puberty and development without secondary sexual characteristics. It has the appearance and character of a "nature", laboratory tests, and abnormal sex hormone levels.

Testicular injury

(1) There is a significant history of trauma in testicular injury and resection . Pain, swelling, and scrotal hematoma following testicular injury. Or surgically removed due to trauma. A palpation of the scrotum can show testicular atrophy, adhesions, or adhesions, or no testicles in the scrotum. Unilateral injury or resection only affects fertility.

(2) Sperm cord torsion Severe sheath fluid and varicocele both cause pathological changes in the testes and affect the ability of the testes to produce sperm, which is one of the causes of infertility.

3. Testicular inflammation

After the inflammatory changes of the testes, the germinal epithelium cannot be restored or regenerated, so the testicles have atrophy after infection. Examination revealed that testicular atrophy became smaller and softer. Patients are infected with mumps virus in early childhood, causing inflammatory changes such as testicular swelling and pain, and infertility may occur after marriage. In addition, testicular inflammation caused by systemic infection or secondary to epididymitis may cause testicular damage and infertility.

4. Vascular Obstruction

Due to congenital seminary abnormalities, such as epididymal hypoplasia, epididymal testis disconnection, blind vas deferens, absent vas deferens, or vas deferens, the patient's body shape, sexual characteristics, and sexual life are normal, palpation can touch epididymis testis disconnection and vas deferens Absent signs. Semen examination can be performed, such as a small amount of semen and no sperm. A negative determination of fructose indicates that there is an obstruction of the vas deferens, and a vasectomy can be performed to show the morphological changes of the obstruction.

5. Reproductive tract infection

Due to genital tract infection, tissue inflammatory hyperplasia, resulting in thickened vas deferens, fibrosis and narrowing of the lumen, preventing sperm output. The inflammatory response can reduce or lose sperm vitality and change the composition of seminal plasma, which affects sperm quality. Male genital tract infections mainly include epididymitis, seminal vesiculitis, and prostatitis.

(1) Epididymitis is more common in young people and can be divided into acute and chronic. Acute epididymitis is acute, the epididymis suddenly swells, and the tenderness is obvious, accompanied by chills, fever, headache, nausea, and vomiting. Chronic epididymitis is mostly the sequelae of acute epididymitis, or chronic infection at the onset.

(2) Seminal vesicle inflammation is mainly manifested by obvious lower abdominal perineal pain after sexual intercourse and ejaculation, accompanied by blood sperm or abscess, and digital rectal seminal vesicle tenderness and swelling. Most are tuberculous, often accompanied by tuberculous epididymitis and tuberculous prostatitis. Decreased fructose concentration or prostaglandin in semen and increased white blood cell count.

(3) Chronic prostatitis: Long-term chronic prostate disease changes the normal components and physical and chemical properties of semen, affects sperm vitality and survival, and reduces fertility. Main manifestations are lower abdomen, perineal discomfort or soreness, frequent urination, dysuria, burning urethra or incomplete urination. At the end of urination, the urethra often has mucous secretions. Digital rectal examination can reveal changes in size, texture, and tenderness of the prostate. Examination of the prostate fluid can help diagnose.

6. Male sexual dysfunction

Male sexual dysfunction mainly includes impotence, premature ejaculation, retrograde ejaculation or non-ejaculation. The patient cannot perform normal sexual life, which prevents sperm from entering the vagina.

7. Respiratory diseases related to infertility

Ciliary stagnation syndrome is also called male flagella abnormality syndrome. This type of infertility is characterized by chronic cough, sputum, hemoptysis, repeated fever and other symptoms in early childhood, and the most prominent chronic respiratory disease in childhood and adolescence. Clinical examination found that the sperm count was in the normal range, but the sperm motility was low, mainly due to the abnormal ciliary tail cilia. Electron microscopy showed abnormal ciliated ciliary structure and abnormal ciliary cell structure in the respiratory tract. Therefore, it was considered to be infertility caused by sperm ciliary dyskinesia. Some patients are accompanied by visceral translocation and have a high incidence among close relatives, so they may be an autosomal recessive disease.

8.Young syndrome

Young described the syndrome for the first time in 1970. It is characterized by recurrent sinusitis and lung infections in juveniles, combined with azoospermia due to bilateral epididymal obstruction. The clinical manifestations were aspermia or oligospermia, normal testis volume, enlarged epididymis head with cystic sensation, normal serum FSH and LH, and testicular biopsy showed that spermatogenesis was basically normal. Surgical exploration showed that these lesions were limited to the epididymal head 1 to 1.5 cm. If a local puncture or incision was performed, a yellow viscous liquid could be taken out, which was filled with sperm and debris. The etiology is unknown at present, and may be related to autosomal recessive inheritance.

Treatment for male infertility

Drug treatment

Commonly used chorionic gonadotropin.

2. Surgical treatment

Patients with varicocele with abnormal semen routinely need high ligation of the spermatic vein, and those with cryptorchidism or testicular insufficiency may perform testicular descending fixation to promote the spermatogenic function of the testes.

3. Keep the insemination pipeline open

Actively treat sexual dysfunction and maintain normal sexual life. Patients with congenital absence of vas deferens, vas deferens, and vas deferens should be actively treated.

4. Improve the function of sperm

Reproductive tract inflammation should be actively given antibiotics; vitamin E, vitamin C and zinc preparations can improve sperm function.

5. Artificial insemination

Including donor sperm artificial insemination and husband sperm artificial insemination. In recent years, in vitro artificial assisted reproduction technology has developed rapidly, especially intracytoplasmic sperm injection has been used to treat oligozoospermia, asthenospermia, and azoospermia, and has achieved good results.

6. Traditional Chinese Medicine and Chinese Medicine Treatment

For 1-degree varicocele, semen infection (including prostatitis, seminal vesiculitis, epididymitis), and immunogenic male infertility, use traditional Chinese medicine to treat syndromes, or activate blood circulation, remove blood stasis, or clear liver and kidney, or tonify kidney. Refined, or dredge liver.

Prevention of male infertility

The prevention of male infertility starts from the men's underwear that most closely contacts the scrotum and the penis. Currently, tight men's underwear is popular. Generally, the front design is double-layered, which wraps the scrotum and the penis together, which causes long-term high temperature and humidity in the majesty. Environment, become a breeding ground for virus bacteria. Prolonged high temperature and humidity under the crotch is a potential cause of common male diseases such as male prostatitis, varicocele, seminal vesiculitis, and scrotal eczema. Prostatitis, varicocele and seminal vesiculitis are common male infertility diseases. Experts recommend that more underwear that penetrates the air well can give independent care space to the scrotum, avoid friction between the scrotum and the inner thigh, separate the penis from the scrotum, reduce the pressure on the scrotum, and allow the scrotum to ventilate and ventilate for a long time. Environment.

1. To master certain sexual knowledge, understand the physiological characteristics and health knowledge of men, if you find that the testicles have different changes than usual, such as swelling, stiffness, unevenness, pain, etc., it must be diagnosed and treated in a timely manner.

2. Vaccination on time and good personal hygiene habits to prevent various infectious diseases that endanger male fertility, such as mumps and sexually transmitted diseases.

3. If you are frequently exposed to radioactive materials, high temperatures and poisons, you must strictly follow the operating regulations and protective regulations. Do not be negligent. If you want children in the near future, it is best to leave this kind of work for six months before giving birth.

4. The testis is a very delicate organ, and its optimal working temperature is about 2 degrees lower than a person's body temperature. If the temperature is high, it will affect the sperm production, so any factors that can increase the temperature of the testicles must be avoided, such as riding a bicycle for a long time, taking a hot bath, wearing jeans, etc.

5. To change bad habits, quit smoking and alcohol, do not eat too greasy things, otherwise it will affect your sexual desire. Also pay attention to avoid contact with toxic substances in life. For example, clothes taken from dry cleaners should be stored for a few days before being worn, because dry cleaners can affect male sexual function.

6. Pay attention to pre-marital medical examination, early detection of abnormalities can avoid post-marital pain. After marriage, you should often communicate with your wife about problems encountered in sexual life, cooperate with each other, and understand each other, so that many mental impotence or premature ejaculation can be avoided.