Male Infertility

　　The classification of the causes of male infertility can be divided into absolute infertility (azoospermia) and relative infertility (low sperm count or low sperm motility, etc.) according to the ability to reproduce. It can be divided into primary infertility and secondary infertility according to clinical manifestations, and it can be divided into pre-testicular, testicular, and post-testicular according to the site of the lesion in the sexual organs. The causes of male infertility are complex. The following are the main causes:

　　(I) Abnormal Semen

　　1. Absence of Sperm or Sperm Deficiency

　　When the sperm concentration in the semen is below 0.2 billion/ml, the chance of conception for the female partner decreases, and below 0.2 billion/ml, it can cause infertility. This infertility can be permanent or temporary. The former is seen in congenital testicular developmental disorders or severe lesions in the testis and seminal vesicle; the latter is often seen in frequent sexual activity leading to a temporary failure of spermatogenesis, usually characterized by a decrease in sperm count rather than the complete absence of sperm.

　　2. Poor Sperm Quality

　　An excessive number of non-viable or dead sperm (over 20%), or poor sperm motility or morphologically abnormal sperm exceeding 30% can often cause infertility.

　　3. Abnormal Physical and Chemical Properties of Semen

　　Normal semen quickly coagulates into a gel-like state and then liquefies completely within 15 to 30 minutes after ejaculation. If semen does not coagulate after ejaculation or does not fully liquefy, it often indicates lesions in the seminal vesicle or prostate. Bacterial and viral infections of the reproductive tract can also cause changes in semen composition, leading to infertility. Sperm concentration greater than 103/ml of pathogenic bacteria, or non-pathogenic bacteria greater than 104/ml can cause infertility.

　　(II) Spermatogenic Disorders

　　1. Testicular Diseases

　　Diseases such as testicular tumors, tuberculosis, syphilis, nonspecific inflammation of the testis, atrophy of the testis after trauma or torsion of the spermatic cord, and absence of the testis can all cause spermatogenic dysfunction and infertility.

　　2. Chromosomal Abnormalities

　　Abnormal sex chromosomes can lead to poor differentiation of sexual organs such as the testis, causing true hermaphroditism and congenital incomplete testicular development, etc. Autosomal abnormalities can lead to metabolic disorders of the gonads and spermatogenic cells.

　　3. Spermatogenic Dysfunction

　　Long-term consumption of cottonseed oil can affect the spermatogenesis and induce autoimmunity of sperm, as well as cause spermatogenic dysfunction.

　　4. Local Lesions

　　Diseases such as hidden varicocele and large hydrocele can affect the local external environment of the testis, or cause infertility due to factors such as temperature and pressure.

　　(Three) Obstacles to sperm and egg combination

　　1. Obstruction of the seminal tract

　　Such as congenital absence or atresia of the spermatic duct, surgical ligation of the spermatic duct, chronic inflammation of the seminal tract and its surrounding tissues, etc.

　　2. Retrograde ejaculation

　　Such as surgery or injury to the bladder neck, or postoperative scar contracture causing urethral deformation, bilateral lumbar sympathetic nerve resection after surgery, or abdominal perineal surgery for rectal cancer, diabetic damage to the pudendal nerve, spermatic cord cyst hypertrophy, and severe urethral stricture, certain drugs such as adrenaline blockers can cause changes in the sympathetic nervous function that支配 the bladder.

　　3. Abnormalities of the external genitalia

　　Such as congenital absence of the penis, small penis, male pseudohermaphroditism, urethral fistula or cleft, acquired penile inflammation or injury, scrotal edema, large hydrocele of the testicle, etc.

　　4. Male sexual dysfunction

　　Impotence, premature ejaculation, anejaculation, etc.

　　(Four) General factors

　　1. Mental and environmental factors

　　Sudden change in living environment leading to long-term mental stress, working at high altitude, high temperature, and ultra-intensity labor, and engaging in radiation work.

　　2. Nutritional factors

　　Severe malnutrition, vitamin A and vitamin E deficiency, trace elements such as zinc and manganese deficiency, calcium and phosphorus metabolism disorders, chronic poisoning of toxic substances such as mercury and arsenic, lead, ethanol, nicotine, cottonseed oil, and chemotherapy drug treatment, etc.

　　3. Endocrine diseases

　　Such as pituitary dwarfism, obesity, reproductive dysfunction syndrome, hypopituitarism, congenital gonadal dysgenesis, congenital spermatogenic failure syndrome, hyperprolactinemia, pituitary adenoma or intracranial infection, birth injury, etc.

　　In addition to its clinical manifestations, male infertility can also cause other diseases. The complications of this disease are generally complications of testicular injury, anorchia, congenital hermaphroditism, and so on, so this disease generally does not have complications.

　　In today's society, male infertility, due to the increase in incidence, has received more and more attention from people. Just as each disease has its own symptoms, male infertility is no exception. The symptoms of male infertility generally appear in male sperm, such as asthenozoospermia, teratozoospermia, etc. To treat it early, it is necessary to know what symptoms of male infertility there are.

　　1. Seminal fluid increase and seminal fluid decrease

　　The normal amount of seminal fluid discharged in one ejaculation is 2-6 milliliters, less than 1.5 milliliters is seminal oligospermia, and more than 6 milliliters is seminal polyuria. An increase in seminal fluid does not mean an increase in sperm count.

　　2. Abnormal spermatogenic function of the testicle

　　Commonly used methods include intramuscular injection or oral administration of clomiphene citrate. For varicocele with abnormal seminal fluid, a high ligation of the spermatic cord is required, and orchiopexy can be performed for cryptorchidism or incomplete descent of the testicle to promote spermatogenic function of the testicle.

　　3. Hematospermia

　　The seminal fluid mixed with blood, in severe cases, the seminal fluid with blood visible to the naked eye is called 'gross hematospermia'; in mild cases, it is not visible to the naked eye, but red blood cells can be seen under a microscope, called 'microscopic hematospermia'.

　　4, Seminal fluid liquefaction disorder

　　The symptoms of male infertility are reflected in the normal seminal fluid being a uniform flowing liquid. If the seminal fluid outside the body does not liquefy or still contains liquefied clots after 60 minutes at room temperature (22-25 degrees Celsius), it is called 'seminal fluid liquefaction disorder', which affects the agglutination or immobilization of sperm, slows down or inhibits the normal movement of sperm.

　　5, Abnormal vas deferens

　　Actively treat sexual dysfunction and maintain normal sexual life. For patients with blocked vas deferens or those who have undergone infertility surgery, reconstructive surgery of the vas deferens can be performed using a surgical microscope. For those who have failed surgery or are congenitally without a vas deferens, recent microsurgical techniques can be used to extract sperm from the testicle and other tissues using fine needles, and then use it for in vitro fertilization.

　　6, Varicocele

　　The symptoms of male infertility, varicocele, refer to the dilatation of the pampiniform venous plexus, which will impede the return of blood to the testicle, increase temperature, disturb metabolism, and, coupled with the inability to expel harmful substances in time, cause spermatogenic disorders in the testicle, leading to oligospermia, sperm malformation, and decreased vitality, causing infertility.

　　7, Sexual dysfunction

　　The symptoms of male infertility include erectile dysfunction, premature ejaculation, decreased libido, and ejaculation disorders, which are important causes of infertility. Erectile dysfunction refers to the inability of the penis to be erect or firm, and cannot be inserted into the vagina to complete marital life. Without ejaculation or retrograde ejaculation, there is not enough seminal fluid entering the vagina even during marital life, which cannot realize the encounter and combination of sperm and egg.

　　This is an introduction to the symptoms of male infertility, the harm to male patients is very great, sometimes even threatening the harmony of the family, therefore, male friends should understand these symptoms of male infertility, which has a positive role in the prevention and treatment of male infertility.

　　To prevent male infertility, it is important to pay attention to pre-marital physical examinations, detect abnormalities early, and avoid post-marital suffering. After marriage, it is important to often communicate with your wife about the problems encountered in sexual life, to cooperate and understand each other, so that many psychogenic impotence or premature ejaculation can be avoided.

　　Prohibit consanguineous marriage

　　Especially those who have been clearly identified with congenital or hereditary defects on one side or both sides should be strictly prohibited, which not only can reduce infertility but also can improve the quality of the population born.

　　Eliminate the influence of physical and chemical factors

　　Avoid contact with ionizing and non-ionizing radiation, eliminate the warm state of the testicular area, prevent changes in testicular morphology, metabolism, and biochemistry, maintain a normal microenvironment, reduce reproductive immune responses, etc.; try to minimize contact with metal elements such as cadmium, lead, zinc, silver, cobalt, and chemicals such as cotton phthalate and diquat, and take as few as possible or do not take chemotherapy, antihypertensive drugs, hormone drugs, sedatives, and anesthetics; excessive drinking and smoking over a long period of time can cause impotence, abnormal ejaculation function, and even lead to infertility or malformed fetus due to abnormal sperm quality. It should be made clear to each patient that malnutrition can lead to deficiencies in protein, vitamins, and trace elements, affecting the production and maturation of sperm, causing abnormalities in sperm count and quality, and can also lead to male infertility.

　　3. Pay attention to personal hygiene

　　Preventing infection of the male reproductive system is an important aspect of preventing male infertility, especially sexually transmitted diseases. Once infected, not only can it cause obstructive azoospermia, but also, in severe cases, cause loss of gonadal function. On the other hand, domestic strife and emotional discord caused by this factor can also affect sexual function psychologically.

　　There are many tests to be done for male infertility, and it is generally to perform routine examinations of the male reproductive system.

　　1. Semen analysis

　　Semen analysis is an important and simple method to measure male fertility. The normal value standard for Chinese semen routine is: semen volume 2-6ml per time, liquefaction time 20×10^6/ml, sperm motility ≥60%, vitality grade a >25%, or vitality (a+b) >50%, sperm畸形 10/HP, and prostatic fluid bacterial culture should be performed.

　　2. Reproductive endocrine hormone measurement

　　Including testosterone (T), LH, FSH, and other reproductive endocrine hormones. Combined with semen analysis and physical examination, it can provide a differential diagnosis of the cause of infertility. If T, LH, and FSH are all low, secondary hypogonadism can be diagnosed; if T is decreased alone, LH is normal or elevated, and FSH is increased, primary hypogonadism can be diagnosed; if T and LH are normal, and FSH is increased, selective spermatogenic epithelium dysfunction can be diagnosed; if T, LH, and FSH are all increased, androgen resistance syndrome can be diagnosed.

　　3. Anti-sperm antibody test

　　Immunological infertility accounts for 2.7% to 4% of male infertility. The World Health Organization recommends the mixed antiglobulin reaction test (MAR method) and the immunocyte test. Not only can it be determined whether there are anti-sperm antibodies in the serum and secretions of infertile couples, but it can also be determined whether these antibodies can bind to sperm and distinguish which antibodies bind to which region of the sperm. The percentage of microemulsion droplets combined with motile sperm in the antiglobulin mixed reaction test should be less than 10%. Immunocyte test: Microemulsion droplets coated with IgA or IgG antibodies are mixed with 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 motile. If the immunocyte binds to more than 50% of motile sperm, it can be considered positive. In cases with positive results, 75% of the sperm often show the presence of IgA or IgG. The interpretation of these antibody test results should be very careful, as some patients have antibodies but do not affect their fertility.

　　4. Special examinations

　　Such as karyotype analysis, immunological examination, seminal duct造影, and testicular biopsy, etc., to help clarify the cause of infertility.

　　1. Testicular biopsy: It can differentiate between spermatogenic disorders and obstructive azoospermia in patients with azoospermia. For patients with severe oligospermia, whose sperm quality cannot be improved after a period of treatment, testicular biopsy can be performed to make qualitative and quantitative diagnoses of sperm dysfunction.

　　2. Vas deferens and seminal vesicle angiography: For obstructive azoospermia patients, it can determine the location of the obstruction and whether the vas deferens and seminal vesicles have developmental abnormalities.

　　3. Sperm function test:

　　(1) Semen-cervical mucus cross test: This test is to collect the semen and cervical mucus of infertile couples, and separately perform in vitro sperm penetration tests with normal male and female cervical mucus and semen, to understand whether the cause of the obstacle to sperm passing through cervical mucus lies in the semen or cervical mucus, and further understand whether the cause of infertility is in the male or female. This test is often used in vitro sperm penetration test, which is a routine examination method before artificial insemination or in vitro fertilization.

　　(2) Post-coital test: The post-coital test is to determine the number of active sperm in cervical mucus, and to evaluate the survival and penetration function of sperm within a few hours after coitus. This test is often performed during the female ovulation period, and requires both parties to abstain for 3 days before the test, and to perform the test 2-10 hours after coitus, taking specimens from the posterior fornix, cervical orifice, and cervical canal for examination. Normally, more than 25 active sperm can be seen in each field of the cervical mucus, if the number of sperm in each field is less than 5, especially if the vitality is poor and the number of sperm is insufficient, it indicates that the cervical mucus is abnormal or the sperm vitality is low. If there are many white blood cells, it indicates that there is inflammation in the female reproductive tract, all of which can affect fertilization and cause infertility.

　　(3) Human Osmotic Swelling Test (HOS): It can be used to measure the integrity of the sperm plasma membrane structure, which is carried out by placing the sperm in a low-osmotic culture medium. Normally, excessive extracellular water moves into the head of the sperm, causing it to swell and the tail to curl, and these changes are not present in abnormal sperm. The current diagnostic criteria are: sperm tail low-osmotic swelling rate ≥60% is normal;

　　Traditional Chinese medicine emphasizes the adjustment of such diseases through diet, believing that sparrow, walnut, dog meat, and shrimp have the effect of reinforcing Yang and kidney, and consolidating essence. Patients with sexual dysfunction may as well consume more of these foods. In addition, traditional Chinese medicine also believes that foods that damage essence and Yang and are not conducive to sexual function should be used with caution, such as cottonseed oil, pork brain, sheep brain, rabbit meat, black fungus, winter melon, water chestnuts, and almonds.

　　1. Consume more high-quality protein

　　High-quality protein mainly refers to various animal foods such as chicken, duck, fish, lean meat, and eggs, which can provide the various amino acids needed for human sperm production. Some animal foods naturally contain some sex hormones, which are beneficial to improving libido and the production of seminal fluid and sperm.

　　2. Consume adequate fats

　　Adjustments show that women who have been on a vegetarian diet for a long time delay their first menstrual period, reduce estrogen secretion, decrease libido, and affect reproductive ability. Men, due to reduced intake of essential fatty acids, are limited in sperm production, libido decreases, and even infertility may occur.

　　3. Supplement vitamins and trace elements

　　Research proves that vitamin A and E are vitamins related to maintaining sexual function and delaying aging. They play a decisive role in promoting testicular development, increasing sperm production, and enhancing their vitality. Vitamin C also has a positive effect on the recovery of sexual function and is rich in fruits and vegetables such as fresh jujube, hawthorn, green peppers, and tomatoes.

　　Conventional methods of Western medicine for the treatment of male infertility

　　1. The principle of medication for the treatment of male infertility is to investigate the cause and treat it specifically, and also pay attention to daily life in order to achieve better efficacy.

　　1. Infertility caused by reproductive tract infection should be primarily treated with antibiotic anti-inflammatory therapy, supplemented with drugs to improve sperm vitality.

　　2. Azoospermia, oligospermia, and idiopathic infertility should be primarily treated with sex hormone drugs for endocrine therapy.

　　3. Patients with low sperm motility should be primarily treated with drugs to improve sperm vitality.

　　4. Patients with infertility due to varicocele, obstructive sperm ducts, cryptorchidism, and urethral fistula should undergo surgical treatment, supplemented with endocrine drugs and other adjuvant medications.

　　5. Absolute infertility (such as azoospermia) should undergo artificial insemination.

　　2. Surgical Treatment

　　(1) Patients with varicocele should undergo high ligation of the spermatic vein as early as possible.

　　(2) To prevent possible azoospermia in the future, children with cryptorchidism should undergo orchidopexy before the age of 2.

　　(3) Excessive scrotal fat should be excised.

　　(4) Surgical treatment for hydrocele of the tunica vaginalis and inguinal hernia.

　　3. Maintain the Patency of the Sperm Duct

　　Actively treat sexual dysfunction and maintain normal sexual life. For men with congenital absence of the vas deferens, obstructive sperm ducts, and vas deferens ligation, active surgical treatment should be considered.

　　4. Improve Sperm Function

　　Patients with reproductive tract inflammation should be given active antibiotic treatment; vitamin E, vitamin C, and zinc preparations can improve sperm function. For immunological infertility, the use of condoms can eliminate and reduce the stimulation of sperm antigens to women. The use of high-dose short-term immunosuppressants and sperm washing artificial insemination methods can help treat immunological infertility.

　　5. Artificial Insemination

　　Including two major categories: artificial insemination with donor sperm and artificial insemination with husband's sperm. In recent years, in vitro artificial reproductive technology has developed rapidly, especially intracytoplasmic sperm injection has been used to treat oligospermia, asthenospermia, and azoospermia, achieving good results.