According to the World Health Organization (WHO), a couple who has lived together without any contraceptive measures for more than one year and whose female partner is infertile due to male factors is called male infertility. In the world, about 15% of couples of childbearing age have infertility problems. Patients with male infertility generally need the following examinations.
1, physical examination: examination of the male reproductive system (testes, epididymis, vas deferens, spermatic veins, penis, prepuce and urethra, etc.), examination of secondary sexual characteristics (beard, throat knot, breast, pubic hair, etc.). It is applicable to every infertility patient who visits the clinic.
2, semen examination: semen examination is the most important basis for assessing male fertility. There are many kinds of semen examination items, including routine semen analysis, sperm morphological staining analysis, sperm acrosome reaction analysis, sperm nuclear DNA fragmentation analysis, anti-sperm antibody (AsAb) detection, seminal plasma biochemical analysis, semen infectious index analysis, etc.
(1) Routine semen analysis: It mainly includes semen volume, semen liquefaction time, semen PH value, sperm concentration, sperm motility (percentage of forward-moving sperm or a+b class sperm). As the most basic indicator of male fertility, it is applicable to every male infertility patient.
(2) Sperm morphological staining analysis: It is the observation of sperm morphology after special staining of sperm, and the results are often described as the proportion of normal morphological sperm and the proportion of abnormal sperm, reflecting to a certain extent the ability of sperm to fertilize egg cells and form fertilized eggs by sperm-egg union. As the most basic indicator of male fertility, it is applicable to every male infertility patient.
(3) Sperm acrosome reaction analysis: It mainly includes sperm acrosome integrity rate and sperm acrosome enzyme activity analysis, which to a certain extent reflects the ability of sperm to fertilize egg cells. It is suitable for patients with unexplained infertility and infertile patients who are ready for IUI or IVF.
(4) DNA fragmentation analysis of sperm nuclei: analysis of the percentage of sperm with DNA fragmentation in the nucleus. A high rate of sperm nuclear DNA fragmentation indicates that the proportion of sperm with DNA fragmentation in the nucleus is too high, which may affect sperm-egg union and embryo quality. It is suitable for infertile patients whose female partner has unexplained miscarriage and embryonic abortion, and infertile patients who are ready for IVF treatment.
(5) Anti-sperm antibody (AsAb) test: The main test method is the semen mixed antiglobulin test (MAR test). It is suitable for patients with poor sperm viability, more sperm agglutination or unexplained infertility.
(6) Seminal plasma biochemical analysis: It mainly includes neutral alpha-glucosidase and fructose, reflecting the secretory function of epididymis and seminal vesicles and their patency, respectively. It is suitable for patients with azoospermia or severe oligospermia who are suspected of having vas deferens obstruction.
(7) Analysis of semen infectivity index: It mainly includes semen leukocyte peroxidase staining analysis and seminal plasma elastase test, which reflects the presence of infection and inflammation in semen. It is suitable for infertile patients whose routine semen analysis shows a high percentage of round cells and suspected gonadal infection.
3.Serum sex hormone test: It mainly includes testosterone (T), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), etc. It is suitable for patients with azoospermia, severe oligospermia and sexual dysfunction.
4.B ultrasound examination
(1) Ultrasound of the scrotum and contents, for patients suspected of having varicocele, testicular or epididymal disease.
(2) Transrectal ultrasound to examine the prostate gland, seminal vesicle gland and ejaculatory ducts, for patients with no sperm, severe oligospermia, low semen volume or hematospermia.
5.Genetic examination such as peripheral blood karyotype analysis and Y chromosome microdeletion detection: peripheral blood karyotype analysis is suitable for patients with azoospermia, severe oligospermia, primary testicular dysplasia and unexplained miscarriage and embryonic abortion in the female partner; Y chromosome microdeletion detection is suitable for patients with azoospermia, severe oligo- and hypomorphic spermatozoa.
6.Sperm vesicle and vas deferens imaging: invasive and risky, suitable for patients with suspected ejaculatory duct or vas deferens obstruction and ready for surgical treatment of infertility.
7, Testicular biopsy: The main surgical methods include sharp forceps puncture, biopsy gun puncture and incisional biopsy, etc. The aim is to understand the spermatogenic function of the testes. It is mainly used for patients with azoospermia, especially those who are preparing for IVF or vasectomy.
Precautions for semen examination
Men should pay attention to the following matters when performing semen examination to ensure that the semen examination results can correctly reflect male fertility.
1. Abstinence time. Abstinence (no sexual intercourse, masturbation or seminal emission such as semen loss) is required for 2-7 days before coming to the hospital for semen examination. Because, if the abstinence time before semen examination is too short, the number of sperm and the volume of semen will decrease; if the abstinence time is too long, dead sperm and abnormal sperm will increase, which will cause the semen examination results to be inaccurate and not correctly reflect male fertility.
2. Collection method. The best way to collect semen is by masturbation method, which ensures that the semen collected is complete and free of contamination. It is best not to use intercourse with ordinary condoms, direct vaginal intercourse, oral sex, anal sex and other ways to collect semen, because ordinary condoms contain ingredients that can kill sperm and affect sperm motility, female vaginal secretions, saliva, feces, etc. can affect sperm motility, and semen collected by these methods can affect the analysis of sperm motility. Before masturbating to take semen, you need to wash your hands and penis, especially for men with long foreskin, it is best to turn up the foreskin and clean it to avoid contaminating the semen and causing inaccurate test results. When taking semen, use a non-toxic and disinfected container with a large opening (hospitals usually provide them). When ejaculating, pay attention to ejaculate all the semen into the container and do not spill the semen outside; if the semen taken is incomplete, the results of semen analysis will be inaccurate.