Male infertility
Male infertility is a type of disease in which a couple of childbearing age has lived together for more than 2 years, has a normal sex life, does not use any contraceptive measures, and the woman has the ability to conceive, but the woman cannot conceive due to the male partner.
Infertile couples in China account for about 10% of married couples, about 60% are female factors, about 40% are male factors alone, and about 10% are common to both men and women.
In the past 40 years, environmental pollution, the spread of sexually transmitted diseases, drug abuse, alcoholism, excessive smoking and other biological, physical and chemical factors causing damage to the testes of the male reproductive organs are the most common causes of the decline in the quality of male semen. In addition, the abuse of hormonal drugs, neurological drugs and cardiovascular system drugs have toxic side effects that affect sperm production in the testes, and can damage the sperm production capacity of the testes if taken in excessive doses for a long time. Zhu Shulun, Department of Urology, Guangdong Provincial Hospital of Traditional Chinese Medicine
The Chinese medical literature has long recorded about “infertility”, such as “childlessness”, “sterilization”, “men’s difficult heir The “infertility” has been recorded in the Chinese medical literature, such as “childlessness”, “sterilization”, and “men having difficulty in making heirs.
Etiology and pathogenesis
According to Chinese medicine, the kidneys store essence and are responsible for development and reproduction. The strength or weakness of the kidney essence directly determines the growth, development and aging of the human body, and also directly affects sexual and reproductive functions. The abundance of kidney qi promotes the maturation of “Tian Kuei”, which is manifested in men as “essence overflowing and diarrhea”, which can harmonize yin and yang and have children. In addition, the reproductive essence from the kidney essence, but closely related to the five organs of the essence, so the coordination of the five organs, the essence of the abundance, storage and drainage appropriate, gasification is an important factor to maintain sexual and reproductive function, and the five organs out of order, the essence of the decline, the collection and drainage inappropriate, gasification disorders can lead to male infertility.
1. Weakness of kidney Qi Insufficient endowment, weak kidney Qi, and failure of the vital fire can lead to impotence and inactivity, and even internal deficiency of Yang Qi, and inability to ejaculate semen; long illness and injury to Yin, and dissipation of essence and blood, then less semen and weakness of semen; insufficient Yuan Yin, Yin deficiency and fire, and hyperactivity of phase fire, and sticky semen heat, can lead to infertility.
2. Liver depression and qi stagnation, emotional discomfort, depression and anger injury to the liver, liver qi stagnation, no right to drain, can lead to impotence and inactivity of the tendons, or qi depression and fire, liver fire is hyperactive, burning kidney water, liver wood loss of nourishment, the tendons are constricted, the path of sperm is blocked, can also affect fertility.
Dampness and heat can cause impotence and spermatorrhea, which can cause infertility.
4. deficiency of qi and blood overthinking, tiredness and sadness, resulting in lack of heart energy, heart and blood loss; after a long illness, the vital energy is greatly injured, qi and blood deficiency, blood deficiency can not produce semen and sperm less sperm weak, or even no sperm, can also cause infertility.
The etiology of infertility is very complex, and various diseases can cause infertility by acting on various aspects of spermatogenesis, sperm transport, and the union of sperm and egg. According to etiological analysis, the factors affecting male infertility include anatomical abnormalities of the reproductive organs, reproductive ecological disorders, exogenous, mechanical and medical injuries, and microbiological factors. With the development of urogenital science, modern medicine has divided its etiology into four categories: 1) sperm production disorders; 2) semen abnormalities; 3) factors affecting the union of sperm and egg; and 4) sexual dysfunction.
II. Diagnosis
Understanding medical history: occupation, past history, personal life history, marital history, sexual life, past semen examination results and health status of spouse, etc. History of exposure to radioactive and toxic substances, history of high temperature work, history of mumps with orchitis, other chronic diseases and long-term medication, frequent consumption of cottonseed oil, alcoholism, smoking, etc.
Physical examination: the focus is on the general condition and external genitalia. Such as body shape, development, penis development, testicular location and size, texture, swelling or pressure pain, epididymis, vas deferens, nodules, pressure pain or absence, varicose veins of the spermatic cord, etc.
The male reproductive system is the key part of the examination for male infertility, and should be performed sequentially, with the patient in an upright or lying position according to the examination site, to check whether there are any deformities in the reproductive organs. The penis, scrotum, testes, epididymis, vas deferens, spermatic cord, and anal examination of the prostate and seminal vesicles are examined one by one.
Penis Pay attention to the development of the penis, the presence of dysplasia or micropenis, the presence of penile scrotal transposition, hypospadias, supra-urethral cleft, penile sclerosis, prepuce, circumcision, trauma and scar, etc.
Scrotum Observe the scrotal skin for surgical scars, sinus tracts, rubber swelling, or eczema-like changes, abnormal increase in scrotal volume, syringomyelia, inguinal hernia, and varicocele.
Testicles The size of the testicles and the hardness and elasticity of the testicles are important for the estimation of male fertility. A soft and small testicle usually indicates atrophy and often spermatogenic disorders. A testicular volume of less than 11 ml is often indicative of poor testicular function.
The epididymis is noted for its shape, texture, tenderness and hardness. The normal epididymis is soft, with a palpable border and mild swelling to palpation. If the epididymis is inflammatory or tuberculous, hard nodules and varying degrees of tenderness can be found in the tail or head of the epididymis. In case of vas deferens obstruction, the whole epididymis may be swollen and enlarged.
Vas deferens The vas deferens can be found in the scrotum and its parts, which are tough, smooth, uniform in thickness and painless to touch. If the vas deferens is thickened, nodular with tenderness or slender, it is abnormal. Particular attention should be paid to the vas deferens to determine whether there is congenital vas deferens.
Spermatic cord Examination of varicocele should be done in a standing position. If the varicocele is visible in the scrotal wall and is easily palpable, it is a grade III varicocele. If only the tortuous veins can be palpated, the varicocele is a degree II varicocele. If the varicose veins are not normally palpable, the varicose veins of degree I can be detected only when the patient increases abdominal pressure (Valsalva test). The varicose veins may be reduced or disappear when the patient is lying in a flat position. Prolonged varicocele can lead to testicular hypoxia and toxic substances in the refluxed blood from the spermatic veins, which can cause the testicles to become smaller and less flexible.
Laboratory and other ancillary tests. The examination mainly includes routine analysis of semen, biochemical determination of semen, sperm penetration test of cervical mucus, sperm agglutination test, testicular biopsy, vasovaginal X-ray, reproductive endocrine determination, genetic examination, etc.
Reference values for semen specimens established by WHO①
Standard tests
Tests for selection
Volume
2.0ml or more
Alpha-glucosidase (neutral)
One ejaculation ≥20mU
PH
7.2 or more
Zinc (content)
One ejaculation ≥2.4umol
Sperm density
20×106 sperm/ml or more
Citric acid (total)
One ejaculation ≥ 13umol
Total sperm count
40×106 sperm/one ejaculation or more
Acid phosphatase (total amount)
One ejaculation ≥ 200U
Vigor
50% or more with forward motion (i.e., class a and b), or 25% or more with rapid forward motion (class a) within 60 minutes after ejaculation
Sugar (total)
One ejaculation ≥ 13umol
morphology
*
Survival rate
50% or more survived.
Leukocytes
Less than 1×106/ml
Immune bead reaction
Less than 50% of motile sperm attached to beads
MAR test
Less than 10% motile sperm attached to pellet
Treatment
To treat male infertility, we must first find the cause of the disease, identify the deficiency, cold and heat, qi, blood, yin and yang, and then adopt the method of identifying the evidence and the disease, and gradually figure out the rules of treatment for the disease by integrating the treatment methods of “disease” and “evidence”. In conclusion, benefiting the kidney and replenishing essence is an important treatment rule for this disease. The key to this disease is the kidney, so treatment should focus on regulating the yin and yang of the kidney, replenishing the essence of the kidney, and draining the essence of the kidney. This disease is deficient and real, so the treatment is divided into kidney and spleen, and kidney is different from yin, essence, and yang; the treatment is different from blood, stasis, heat, damp, cold, and depression.
In addition, the treatment of male infertility should not be deluded into bitter cold or warm products. Because the bitter drainage is excessive, one defeats the stomach, causing stomach and epigastric pain, nausea and vomiting; the other hurts Yang, resulting in indifference to sexual desire, impotence and inactivity, while affecting sperm quality. Warming the kidneys and strengthening the yang is too much, and every easy to cause congestion and edema in the reproductive tract, which not only aggravates inflammation, but also burns the yin essence, affecting the quantity and quality of sperm.
Identification and treatment
Internal treatment
The first identification of the deficiency and analysis of the nature of the disease: male infertility clinical symptoms vary, the causes vary, but the outline can be summarized as the two ends of the deficiency and reality. In the case of deficiency, there is a lack of essence in the kidney and a loss of yin and yang; in the case of reality, there is phlegm, blood stasis, and damp heat blocking the sperm channel, and both deficiency and reality are often seen together. If the Yang is not raised, the semen is cold, spermatorrhea and premature ejaculation, back pain, dizziness and tinnitus, etc., it is mostly a deficiency of kidney qi; if the external force is injured, serious and prolonged illness, little or no semen, inability to ejaculate or painful ejaculation, the skin is wrong, the abdomen is urgent, the face is dull, etc., it is mostly stasis of blood; if the quantity and quality of semen is abnormal, the Yang is not firm, laziness and laziness, chest and abdomen are stuffy, the body is obese, it is mostly phlegm and turbidity; if the discharge of semen is not smooth or blood semen, the chest is If sperm discharge is not smooth or blood sperm, chest fullness, dripping urine, burning pain in the stem, bitter mouth and greasy mouth, etc., it is mostly damp-heat injection.
The coldness of sperm is cold, which means that the sperm is cold, often due to the lack of fire of the vital gate; the heat of sperm is a burning sensation in the uterus of the woman when the sperm has been in the room for a long time, which is mostly due to the deficiency of kidney water, not the hyperactivity of the phase fire.
Less semen and loss of semen: less semen refers to less semen during intercourse, mostly due to deficiency of semen energy; loss of semen refers to excessive leakage of semen, which is caused by deficiency of kidney energy and inability to store semen.
Seminal blood and seminal turbidity: Seminal blood is caused by straining the kidney qi and causing both seminal blood and seminal fluid to come out. The clinical characteristics of sperm turbidity are that slop-like material often flows from the mouth of the penis, and the stem may be itchy or painful, and the turbidity is white for white turbidity, and red for red turbidity.
The examination of the infertility pulse: If the ulnar pulse is sunken, it is more likely to see kidney deficiency: fine astringent pulse can be seen in male infertility with semen deficiency and blood deficiency. Weak pulse is mostly the sign of deficiency of qi and blood; small pulse is the sign of infertility of deficiency; hard and astringent pulse is mostly the sign of stagnation of blood and obstruction of sperm channel.
Kidney Yang deficiency: decreased libido, impotence and premature ejaculation, low sperm count, low viability, weak motility, or weak ejaculation; accompanied by lumbar soreness and weakness, fatigue and weakness, and clear and long urine. The tongue is pale, the coating is white, and the pulse is sunken and thin.
Treatment: Warming kidney yang, benefiting kidney and filling essence.
Prescription: Jin Kui Kidney Qi Pill and Wu Zi Yan Zong Pill or Yang Shi Wan Tang with reduction.
Kidney-Yin deficiency: seminal emission, low semen volume, low sperm count, weak sperm motility or sticky semen, more deformed sperm; dizziness and tinnitus, heat in the hands and feet; red tongue, little moss, sunken and thin pulse.
Treatment: Nourishing kidney yin, benefiting essence and nourishing blood.
Remedies: Zuo Gui Wan and Wu Zi Yan Zong Wan plus or minus.
Liver depression and qi stagnation: low libido, impotence and inactivity or inability to ejaculate during sexual intercourse, scarcity of sperm and decreased vitality; mental depression, distension and pain in the two hypochondrium, belching and generalized acidity. Dark tongue, thin coating and thin pulse.
Treatment: De-stressing the liver and warming the kidney to benefit sperm.
Treatment: De-stress the liver, warm the kidneys and improve the essence.
Damp-heat infiltration: lack of virility or erection, low sperm count or more dead sperm; abdominal urgency and fullness, short and red urine; thin yellow fur on the tongue and slippery pulse.
Treatment: Clearing heat and relieving dampness
Remedy: Cheng’s Dioscorea Z Fenqing Drink plus or minus.
Qi and Blood deficiency: decreased sexual desire, lack of virility, or low sperm count, low viability, weak motility; fatigue, lack of color; pale tongue, thin white fur, sunken and weak pulse.
Treatment: Tonifying Qi and Blood
Remedies: Ten Perfect Tonic Soup with addition and subtraction
Other treatments
Depending on the condition, HCG, testosterone, clomiphene, arginine, vitamins, zinc sulfate syrup, etc. may be used. Or sexual technology guidance, if necessary, artificial insemination can be done. For those who are infertile due to varicocele, surgery can be considered if conservative treatment is not effective.
Assisted reproductive technologies (ART) refers to a series of simple to complex methods for conceiving infertile couples by medical means. These include artificial insemination (AI), in vitro fertilization and embryo transfer (IVF-ET), gamete tubal transfer (GIFT), microfertilization, pre-implantation genetic diagnosis and other related fertility techniques such as egg donation, embryo donation and embryo freezing.
IV. Prevention and Care