Male infertility

Introduction to male infertility Male infertility refers to infertility caused by male factors. Generally, after cohabitation for more than 2 years, no contraceptive measures are taken and the woman is not pregnant, which is called infertility. The incidence rate is about 10%, of which the female factor alone is about 60%, the simple male factor is about 40%, and the male and female are about 10%. The male infertility can be divided into absolute infertility and relative infertility according to clinical manifestations. Kind. basic knowledge The proportion of the disease: the male incidence rate is about 0.01%-0.05% Susceptible people: male Mode of infection: non-infectious Complications: Infertility

Causes of male infertility

Endocrine disease (20%):

Hypothalamic dysfunction, such as Kallmann syndrome, is mainly gonadotropin-releasing hormone deficiency; pituitary dysfunction, such as selective luteinizing hormone (LH) deficiency and urinary tropokin (FSH) deficiency, hyperprolactinemia Etc. Adrenal hyperplasia can inhibit the secretion of FSH, LH from the pituitary gland, leading to infertility.

Drug factors (30%):

Common cimetidine, sulfasalazine, tripterygium, spironolactone, nitrofurantoin, nitridazole, colchicine, various hormonal drugs and cancer chemotherapy drugs such as certain alkyl compounds, often lead to temporary Or permanent damage to sperm production.

Surgical factors (30%):

For example, urethral valve surgery, bladder neck incision performed by urethral obstruction, retroperitoneal lymph node dissection or larger retroperitoneal surgery may cause retrograde ejaculation or ejaculation disorders, leading to infertility.

Male infertility prevention

A large proportion of male infertility can be solved through crowd or individual prevention, which requires all people, especially the easy-to-follow people, to have sex education and reproductive knowledge education.

It is necessary to vaccinate on time, good personal hygiene habits, to prevent various infectious diseases that endanger male fertility, such as mumps and sexually transmitted diseases.

To master certain sexual knowledge, to understand male physiological characteristics and health knowledge, if the testicles are found to have different changes than usual, such as swelling, hardening, unevenness, pain, etc., it is necessary to promptly diagnose and treat.

If you are constantly exposed to radioactive materials, high temperatures and poisons, you must strictly follow the operating regulations and protective regulations. Don't neglect the care. If you want children in the near future, it is best to be able to give birth after half a year of such work.

The testicle is a very delicate organ. Its optimal working temperature is about 1 degree lower than the human body temperature. If the temperature is high, it will affect the sperm production. Therefore, any factors that can raise the testicular temperature should be avoided. Cycling for a long time, taking a hot bath, wearing jeans, etc.

Change bad habits, quit smoking and alcohol, don't eat too greasy things, otherwise it will affect your sexual desire; also pay attention to avoid contact with toxic substances in your life.

Pay attention to the pre-marital medical examination, and find abnormalities in the early stage to avoid the pain of marriage. After marriage, you should often communicate with your wife about the problems encountered in your sexual life, cooperate with each other, understand each other, so that many mental impotence or early diarrhea Can be avoided.

1. Eliminate close relatives, especially those who have one or both of them congenital or hereditary defects should be resolutely eliminated, which can not only reduce infertility, but also improve the quality of the birth population.

2. Eliminate the influence of physical and chemical factors, avoid contact with ionizing radiation and non-ionizing radiation, eliminate the warm state of testicular parts, avoid causing changes in testicular morphology, metabolism and biochemistry, maintain normal microenvironment, reduce reproductive immune response, etc.; Such as cadmium, lead, zinc, silver, cobalt and other metal elements and chemicals such as gossypol, dinol, etc., for chemotherapy, antihypertensive drugs, hormones, sedatives and anesthetics are as little or no Long-term excessive drinking and smoking can cause impotence, abnormal ejaculation, and even abnormal sperm quality leading to infertility or pregnancy teratogenesis, should make every patient clearly aware that malnutrition can cause protein and vitamins, trace elements Insufficient, so that sperm production, energy gain is affected, resulting in abnormal sperm number and quality, it also causes male infertility.

3. Pay attention to personal hygiene and prevent male reproductive system infection. This is an important aspect of preventing male infertility, especially sexually transmitted diseases. Once infected, not only the obstruction of the tract, but also the loss of gonadal function in severe cases, another On the one hand, because of this factor, family entanglement, emotional disharmony will psychologically affect sexual function.

4. Treatment of varicose veins varicose veins is another treatable aspect of male infertility. When men feel that the left or left and right scrotum has a sense of falling or a sputum-like bulge, they should see a doctor promptly and timely surgical treatment to avoid Long-term varicocele leads to testicular dysfunction. Others such as urinary tract abnormalities such as blood sperm, testicular swelling, etc., need to be treated as early as possible to avoid inadvertent illness, resulting in infertility, and even more serious consequences.

5. Therapeutic psychological abnormalities of sexual psychological abnormalities can lead to sexual dysfunction, and sexual dysfunction can cause male infertility, so the necessary examination and appropriate treatment should be performed as soon as possible.

Male infertility complications Complications, infertility

The disease generally has no complications.

Male infertility symptoms Common symptoms Male infertility vas deferens blocked dead sperm excessive blood deficiency sperm survival rate low sperm abundance sperm agglutination sperm abnormal varicocele nail width and short (wide...

History

Past disease history, injury and surgery history, sexual life history, birth control history, birth history and marriage history, drug and physical and chemical factors exposure history, urinary tract symptoms and female gynecological examination.

2. Physical examination

Systemic conditions to pay attention to whether there are special body types, with or without systemic diseases, external genital examination attention to penis development, urethral orifice, testicular size, epididymis and testicular relationship, spermatic cord with or without lesions (such as varicocele, vas deferens lesions Etc.), rectal examination of the prostate and seminal vesicles, prostate massage, parallel smear examination.

3. Semen examination

Abstinence for 3-7 days, semen collection by hand masturbation or in vitro excretion, check within 1 hour.

Normal reference value: precision 2-6ml, gray or light yellow, fully liquefied in 5-20 minutes, pH 7.2-7.8 sperm density is 50,000-100 million/ml, sperm motility >60%, sperm motility>75 % (>6), sperm deformity rate <30%, total sperm count >130 million / each ejaculation, sperm count <20 million / ml, fertility is very poor.

Male infertility check

I. Semen analysis

It is an important and simple method to measure male fertility. The normal normal value of semen in China is: semen volume 26ml/time, liquefaction time<30min, pH value 7.28.0, normal sperm density value>20×106/ml , sperm activity rate 60%, vitality a level > 25%, or vitality (a + b) > 50%, sperm deformity < 40%, through masturbation or sperm, use special glass bottles, no plastic cups or condoms Collection, specimen inspection time should not exceed 1h, the temperature is maintained at 25 ~ 35 ° C, abstinence time is 3 to 5 days is appropriate, because the number of sperm and sperm quality often change, it should be checked three times to take the average.

2. Urine and prostatic fluid examination

Urine leukocytosis may indicate infection or prostatitis. After ejaculation, a large number of sperm may be considered for retrograde ejaculation, and prostatic fluid microscopic examination of white blood cells >10/HP.

3. Determination of reproductive endocrine hormones

Including testosterone testosterone T, LH, FSH and other reproductive endocrine hormones, combined with semen analysis and physical examination, can provide the reasons for identifying infertility, such as T, LH, FSH are low, can diagnose secondary hypogonadism; simple T decline LH is normal or high, FSH can be diagnosed as primary gonadal failure; T, LH is normal, FSH elevation is diagnosed as selective spermatogenic epithelial insufficiency; T, LH, FSH are increased, diagnosed as androgen Tolerance syndrome.

Anti-sperm antibody examination

Immune infertility accounts for 2.7% to 4% of male infertility. WHO recommends a mixed anti-globulin reaction test (MAR method) and an immune strain test to detect the presence of antisperm antibodies in serum and secretions of infertile couples. It can also be measured whether these antibodies can bind to sperm and distinguish which antibody binds to which region of sperm. In the antiglobulin mixed reaction test, the percentage of microemulsion and active sperm binding should be less than 10%. The microemulsion coated with IgA or IgG antibody is mixed with the sample sperm, and the antibody will bind to IgA or IgG on the surface of the sperm. The key to the success of this test is that the sperm should be able to move, and if the immune strain exceeds 50. % of active sperm combinations can be considered positive, and in cases with positive results, 75% of sperm often show IgA or IgG. The results of these antibody tests should be interpreted with caution because some patients contain antibodies but do not affect their fertility. .

Five. Special inspection

Such as chromosome analysis, immunological examination, vasectomy and testicular biopsy to help identify the cause of infertility.

1. Testicular biopsy: For patients with azoospermia, it can be identified as testicular spermatogenic disorder or obstructive azoospermia. For patients with severe oligozoospermia, sperm quality can not be improved after a period of treatment, can pass sperm biopsy, spermatogenesis Obstacles make qualitative and quantitative diagnosis.

2. Vas deferens and seminal vesicle angiography: For patients with obstructive azoospermia, it can be judged whether the obstruction site and the vas deferens and seminal vesicles have abnormal development.

3. Sperm function test

(1) Semen cervical mucus cross test: This test is to collect semen and cervical mucus from infertile couples, and perform in vitro sperm penetration test with cervical mucus and semen of normal men and women, respectively, to understand that the reason for obstructing sperm from crossing cervical mucus is semen. It is also cervical mucus, which can be used to understand whether the cause of infertility is in the man or in the woman. This test is usually performed in vitro sperm penetration test, which is a routine examination method before artificial insemination or test tube baby.

(2) Post-intercourse test: The post-intercourse test is a test to determine the number of active spermatozoa in cervical mucus, in order to evaluate sperm survival and penetrating function within a few hours after sexual intercourse. This test is usually performed during female ovulation, requiring both parties to abstain from sex before the test. 3 days, 2 to 10 hours after sexual intercourse, respectively, take the vagina after the vagina, the cervix, the mucus specimens in the cervical canal examination, under normal circumstances, in the cervical mucus, more than 25 sperm with good activity can be seen in each field, if The number of sperm in each field is less than 5, especially the vitality is not good, the number of sperm is insufficient, suggesting that the cervical mucus is abnormal or the sperm motility is low. If more white blood cells are found, it indicates that there is inflammation in the female reproductive tract, which can affect fertilization. , causing infertility.

(3) Human sperm-to-transparent hamster egg penetration test: SPA, which is an important method for detecting sperm function in recent years, it uses hamster eggs instead of human eggs to detect the penetration of human sperm into the hamster eggs. Percentage to predict fertilization ability of human sperm, normal fertilization rate (penetration rate) 10%, SPA positive.

(4) Human egg cell zona pellucida reaction test: using a salt-free or salt-containing zona pellucida combined with sperm that has been labeled with different fluorescein, the degree of binding of sperm and zona pellucida can be compared with the degree of binding of normal human sperm, combined Sperm can eliminate the need to measure the acrosome state and the ability of sperm to penetrate the zona pellucida. The most successful and most powerful predictor of in vitro fertilization (IVF) is the sperm-transparent band binding rate and the proportion of sperm penetrating the zona pellucida. At present, the main limitation of these tests is that they are widely used in clinical practice. There are not many zona pellucida substances for testing. Recently, a substance called ZP3, which is a protein present on the surface of sperm, is also called transparent. With the receptor kinase ZRK (zanareceptor kinasa), it is the first determining substance for sperm/transparent band binding, which allows people to use ZP3 instead of the zona pellucida itself for sperm-transparent band reaction tests.

(5) Human sperm hypotonic swelling test (HOS): It can be used to measure the integrity of sperm serosal structure. It is carried out by placing sperm into a hypotonic medium. Normally, excessive extracellular water is transferred into the sperm. The head is swollen and the tail is distorted. These changes do not exist in abnormal sperm. The current diagnostic criteria are: hypotonic swelling rate of sperm tail 60% is normal, and hypotonic swelling rate of sperm tail <50% is abnormal.

4. Genetic examination: Chromosome examination should be used as one of the routine examinations. Some azoospermia and severe oligozoospermia have been reported to have multiple gene fragments in the Yqll23 region of the sex chromosome, collectively referred to as "azoosperm factor" (AZF). ), YRRM1, DAZ, DYS240 have been detected by DNA probe or PCR method. The former is related to severe oligozoospermia, and the latter two are related to azoospermia. It should be determined before intracytoplasmic sperm injection (ICSI). In order to avoid inheritance to the offspring.

Once the clinical examination reveals a lack of vas deferens, such as low serum pH (6.8 ~ 7.O) or less meringue berry sugar, you should consider the detection of cystic fibrosis transmembrane transport regulator (CFTR) mutations, If ICSI is to be used for spermatozoa in patients with vas deferens, it should be considered for this test. Once the possibility of a large number of potential mutations is screened, a more effective examination should be performed to determine the three most common mutations in the female CFTR gene, if the woman The test results were negative, so the risk of cystic fibrosis or congenital vas deferens in children born by ICSI was less than 1 in 1500.

Diagnosis of male infertility

diagnosis

To diagnose male infertility, at least the following points must be clarified: 1 is the male infertility or the female infertility, or both sides have infertility factors; 2 if the male is infertile, is it absolute infertility or relatively infertile; Is it primary infertility or secondary infertility; 4 If it is male infertility, the exact cause of male infertility should be ascertained as possible so that effective treatment measures can be taken for the cause.

Male infertility examination and diagnosis methods generally include detailed medical history inquiry, physical examination, semen examination, endocrine examination, immunological examination, chromosome examination, X-ray examination, testicular biopsy, biochemical examination of semen and other examinations, etc. Through the above clinical and laboratory evaluation of male infertility, and then according to the 1999 World Health Organization diagnostic criteria for male infertility.

Differential diagnosis

1. Sexual dysfunction infertility: refers to infertility caused by sexual dysfunction and inability to complete sexual intercourse or sperm can not enter the vagina, patients often have erectile dysfunction, no ejaculation or retrograde ejaculation and other sexual dysfunction, and It can be identified by sexual function detection.

(1) non-ejaculation: refers to penile erection normal, but can not ejaculate during sexual intercourse, there are two types of functional non-ejaculation and organic non-ejaculation, the former is more common in lack of sexual knowledge, psychological factors such as tension or indulgence during marriage Excessively, the latter is common in the lesions and injuries of the nervous system, such as pelvic surgery; penile diseases, such as foreskin is too long and phimosis; endocrine diseases, such as pituitary, gonads, hypothyroidism caused by neuropathy; drug factors, Such as sedatives, adrenergic receptor blockers can inhibit ejaculation.

(2) Retrograde ejaculation: refers to the feeling of ejaculation during sexual intercourse, but no semen is injected from the urethra, urinating immediately after ejaculation, urine can be found in the urine with a large number of sperm, common causes are, bladder neck insufficiency , pelvic surgery and transurethral resection of the prostate, urethral stricture makes it difficult to discharge semen.

2. Infertility caused by obstructive lesions of the tract, the spermatogenic function of the testes is normal, and the sperm cannot enter the semen due to obstruction of the spermatic tract. The differential diagnosis is as follows:

(1) Congenital stenosis obstruction: mainly due to congenital vas deferens dysplasia or absence, seminal vesicle hypoplasia, infertility caused by vas deferens and epididymis not connected or epididymis hypoplasia, characterized by less semen, often <1ml Semen does not coagulate, seminal plasma has no fructose, and azoospermia.

(2) Infectious tract obstruction: common infections are bilateral epididymal tuberculosis, gonococcal epididymitis and filariasis, which are characterized by azoospermia but normal testicular size.

(3) iatrogenic stenosis obstruction: patients often have a history of vas deferens angiography or vasectomy; bilateral sacral hernia repair mistaken vas deferens lead to vas deferens; testicular, epididymal surgery caused epididymis or spermatic cord injury.

(4) Traumatic tract obstruction: azoospermia caused by testicular, epididymis, and spermatic cord trauma combined with spermatic tract obstruction.

3. Infertility caused by testicular spermatogenesis dysfunction, it is due to various reasons that the testicles can not produce sperm, although the genital tract is normal, but there is no sperm in the semen, the differential diagnosis is as follows:

(1) Genetic abnormalities: such as hermaphroditism, Klinefelter syndrome is caused by the absence of segregation of chromosomes in the meiotic phase. The clinical features include breast enlargement, beard, sparse pubic hair, shoulder and narrow hip width and other female postures; The testes are small and soft, with low sexual function, semen without sperm, elevated FSH in plasma and urine, and plasma testosterone concentrations below normal.

(2) congenital anomalies: such as congenital absence of testis, bilateral cryptorchidism, germ cell hypoplasia, etc., germ cell hypoplasia patients masculine normal, but no sperm in sperm, normal testicular size, breast enlargement, plasma testosterone And serum LH levels are normal, plasma FSH is elevated, bilateral cryptorchidism patients also have no sperm in the semen, but their testes can not be combined, plasma testosterone and serum LH levels are low, but in a single injection of chorionic gonadotropin 5000 U, The level of plasma testosterone can be significantly increased, while the congenital testis without testis, except for the testis, the plasma testosterone and serum LH levels are very low, and the plasma testosterone level is not significantly increased after a single injection of chorionic gonadotropin.

(3) endocrine abnormalities: such as hypogonadism, hypopituitarism, hypothyroidism, adrenal hyperplasia, etc., patients with primary hypogonadism often increase blood FSH and LH levels, but testosterone levels are reduced, pituitary function is low Caused by secondary hypogonadism, the patient's blood FSH and LH levels are often low, testicular interstitial cell function and sexual function decreased, semen volume decreased.

(4) Spermatogenic cell maturation disorders: such as radiation damage, drug effects, varicocele, etc., the testicular size is normal, sperm is reduced sperm or no sperm, testicular biopsy shows that the spermatogenesis process is mostly stopped in spermatocytes At the time, there are few spermatogenic cells that are further developed in the seminiferous tubules.

4. Immunological infertility Immunological infertility is divided into two categories: one is male-derived anti-sperm autoimmunity, the other is female-derived anti-sperm alloimmunization, and such patients are characterized by their sexual function, semen Routine and hormone levels are normal.

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