A. There are many causes of low sperm motility. The main causes of low sperm vitality are as follows: 1. Infections Acute and chronic inflammation of the reproductive tract or reproductive glands such as the epididymis, vas deferens, seminal vesicles and prostate can reduce the motility of sperm. The effect of infection on sperm motility can be multifaceted. The direct effect of microorganisms on sperm, such as mycoplasma, can attach to the head, mid-section and tail of sperm, causing increased hydrodynamic resistance and slower movement when sperm make forward motion, affecting sperm viability and the ability to penetrate egg cells. In addition, mycoplasma can cause partial sperm membrane defects or even membrane structure destruction, affecting the fertilization ability of sperm. E. coli can reduce sperm viability by binding to sperm through its own receptors; the indirect effect of microorganisms on sperm can be through the production or release of toxic substances, and mycoplasma produces NH3 during growth to have a direct toxic effect on sperm. Escherichia coli can produce sperm braking factor. Decreased sperm viability due to infection can also be achieved by changing the pH of seminal plasma, which decreases significantly when the pH is below 7 or above 9. In patients with acute adnexal inflammation or epididymitis, the pH is mostly alkaline, while chronic adnexal inflammation can cause the pH to fall below 7. In addition, inflammation-induced leukocytosis in semen can lead to a decrease in sperm motility through direct and indirect causes. The lack of sperm motility caused by prostatitis may be the result of a combination of factors, which may be related to zinc disorders in addition to microorganisms, leukocytes and pH. 2, abnormal semen liquefaction Semen non-liquefaction or high viscosity is one of the causes of male infertility, a very important factor that may cause infertility by affecting the motility of sperm. In seminal plasma with non-liquefied semen, elongated fibrin may be seen and intermeshed to reduce the space for sperm movement, and sperm are held back, while coarse fibers are seen connected by many fine fibers in a network, which may be responsible for mechanically limiting forward movement of sperm. The authors of this paper have used urokinase-type fibrinogen activator (uPA) alone on specimens of non-liquefied semen in vitro and found that when semen changed from non-liquefied to liquefied state, sperm viability and forward motility increased significantly, and the same effect was obtained with chymotrypsin. 3. Immune factors Anti-sperm antibodies (AsAb) can affect the fertilization function of sperm in several different ways. The effect on sperm viability may be that AsA b b binds to the tail of the sperm, which impedes sperm viability, reduces motility, and has poor penetration ability, as has been demonstrated by the markedly reduced ability to penetrate cervical mucus when anti-sperm antibodies are present against the tail of the sperm. Some scholars have used AsAb positive serum and human sperm contact, observed a so-called sperm “shaking phenomenon” (shaking phenomenon) is mainly the head and the entire tail of sperm combined with anti-sperm antibodies, the forward motion of sperm suppressed, but no significant changes in survival rate. 4, endocrine factors endocrine hormones, in addition to their role in spermatogenesis and maturation, also affect sperm motility. gonzales et al. found that prolactin in seminal plasma has a linear relationship with sperm activity, which improves sperm oxygen uptake or affects sperm motility through the cAMP system. when serum E2 levels are elevated, sperm motility is reduced. Excessive testosterone in seminal plasma may inhibit sperm motility. 5, Kartagener’s syndrome In the early 1930s, Kartagener’s first discovered a condition that was later confirmed by other scholars to be a congenital lack of ciliary structures, manifested by the inability of the cilia of the various ciliated cells in the body to move, mainly the absence of the ciliary dynein arms (dynein alms) of the peripheral microtubules. Patients with this syndrome may have chronic respiratory infections traced from their medical history, in addition to the inability of sperm to move. 6. Chromosomal abnormalities Autosomal and sex chromosome aberrations affect sperm viability and forward motility, in addition to sperm count. The ultrastructural apparatus known to be associated with sperm motility can have abnormal sperm tail structure due to genetic factors, for example, lack of inner or outer branching arms or absence of both arms. There can also be a lack of central junctions and central complex structures, as the interaction between the central microtubules and the radial spokes can mediate the gliding of the outer microtubules, and when this structure is abnormal, sperm motility can be impaired. Varicocele can lead to male infertility in several ways, not only by affecting the occurrence of spermatozoa, but also by causing a decrease in sperm motility. The mechanism may be due to blood stagnation in the varicose veins, impaired microcirculation, lack of nutrient supply and reduced partial pressure of oxygen, insufficient energy production and endocrine dysfunction. In addition, it may also be caused by autoimmunity such as the production of anti-sperm antibodies and mycoplasma infection indirectly caused by varicocele. 8, other factors (1) trace elements in seminal plasma zinc, copper, magnesium and semen quality, seminal plasma zinc content is more than 100 times the plasma content, low sperm vitality patients in the seminal plasma zinc, iron, magnesium content is significantly lower than the normal vitality of healthy men. Zinc delays lipid oxidation of cell membranes and maintains the stability and permeability of cell structures, thus ensuring good sperm motility. Trace elements cadmium (Cd) content is high, can lead to reduced sperm motility, cadmium can directly inhibit sperm oxidase and direct inhibition of sperm motility organs, infertile men semen cadmium content significantly higher than fertile men. (2) Lack of enzymes or reduced enzyme activity related to sperm motility, vitamin class deficiency, engaging in high temperature, radiation occupations and exposure to chemical toxins can all cause reduced sperm motility. (3) Smoking, alcohol consumption and drug factors Nicotine in tobacco affects sperm motility through direct and indirect damage to sperm, long-term alcoholics can directly and indirectly affect sperm motility, and there are more drugs that affect sperm motility. There are also some people with low sperm vitality whose cause cannot be identified, called idiopathic weak spermatozoa. The diagnosis of weak spermatozoa is made mainly based on routine semen analysis and medical history. Weak spermatozoa can be diagnosed after 3-7 days of abstinence and masturbation, and after more than 3 consecutive routine semen analyses indicating that the forward motion of spermatozoa (class a+b) is less than 50% or the fast linear forward motion of spermatozoa is less than 25%, and the sperm density is greater than 20~106/mL, while other parameters are normal or basically normal. Or 1 h after ejaculation, sperm viability less than 50%, laboratory or other auxiliary examination can find reproductive tract infection, or other diseases affecting sperm viability, can be diagnosed as weak spermatozoa. Treatment (a) Western medical treatment 1. General treatment Prohibit smoking, alcohol and less stimulating food, do not overexert yourself. (1) Shiercon contains a variety of trace elements, especially zinc and selenium. 1 tablet each time, 1 time daily. (2) ATP ATP is involved in the metabolism of sperm and provides energy directly for the movement of sperm. Oral preparation of 20 mg per tablet, 2 tablets each time, 3 times a day is available. (3) Vitamin E 0.1 g/tablet, 1 tablet each time, once a day. (4) Calcium preparations. 2, etiological treatment (1) antibacterial and anti-inflammatory drugs semen analysis, when WBC > 1 / HPF suggests the possible presence of reproductive tract infection, antibiotic treatment should be given to eliminate white blood cells in the semen. If available, antibacterial anti-inflammatory drugs can be selected according to bacterial culture and drug sensitivity test. One of the antibiotics can be used for mycoplasma or chlamydia infections, such as memantin a tetracycline, azithromycin, doxycycline and erythromycin, and pioneer antibiotics such as ceftazidime can be used for gonococcal infections. For mycoplasma and chlamydia infections, a medication schedule of 10 to 14 d is appropriate, requiring the couple to take the medication at the same time. Chronic inflammation of the reproductive tract or gonads, the use of cotrimoxazole combined with haloperidol or quinolone antibacterial drugs, semen analysis after 2 weeks of continuous medication, sperm viability and forward motility often have a significant increase. Since some antibiotics have an effect on sperm viability while sterilizing. In particular, when antibiotics are used in higher doses, in combination, and for longer periods of time, sperm viability does not increase within a short period of time after discontinuation, and is sometimes worse than before the drug was used, in addition to an increase in sperm malformations. The following anti-inflammatory drugs can be chosen: Memantin 0.2g per time 2 times daily Tetracycline 0.5 g per time 3-4 times daily Erythromycin 0.5 g per time 3-4 times daily Doxycycline 0.1g per time 2 times daily Cefradil 0.5g per time 3 times daily Compound Synthroid 0.5g per time 2 times daily Fluoroperazine O.1g per time 2 times daily Fluorizinic acid O.1g per time 3 times daily (2) with For poor semen liquefaction, high-dose vitamin C 0.6-1 g/time, 3 times a day for 2 weeks; chymotrypsin 5 mg, 1 time a day, intramuscular injection for 2 weeks; and Zhiba Dihuang Wan. (3) For those with positive anti-sperm antibodies, use immunosuppressants, such as dexamethasone or prednisone administered in decreasing doses, and may be supplemented with sperm-reducing decoction. 3, hormone therapy For normal or below normal reproductive hormones can be used respectively (1) hCG 2 000Iu / time, 3 times a week, intramuscular injection, continuous with l to 2 months. (2) Testosterone undecanoate 250 mg/time, 1-2 times a month, intramuscular injection for 1~2 months. 4. Assisted reproductive techniques (1) Sperm optimization using upstream and discontinuous Percoll gradient centrifugation to select sperm with good motility for intrauterine insemination (.intra-uterus insemination, IuI) or for other assisted conception techniques, during the female partner’s ovulation period, using ultrasound to monitor ovulation, and injecting hc when the follicle > 1.8 em. IuI is performed 36 h after injection of hcGl million Iu at 1.8 em. (2) IuI is performed by aspirating 0.2 to 0.3 mL of optimally treated sperm through the cervix with a catheter and pushing the sperm into the uterine cavity. Avoid damaging the endometrium during the operation. After the operation, the patient is asked to elevate the hips and lie flat for 1 h while using 3 d anti-inflammatory drugs. Progesterone injection for 7 d is available, and hcG 1,000-1,500 Iu is also available for intramuscular injection every other day until urinary hcG is positive. (3) In vitro artificial insemination (IVF) can be considered for infertile men with a sperm viability of 30% or more. (4) Intracytoplasmic single sperm injection (ICsI) can be used for infertile men with very poor sperm motility who have not resolved their fertility despite conventional IVF treatment. It is a better treatment to resolve weak spermatozoa in patients with very poor semen quality. See Chapter 46 for details. 5, urokinase (uPA) once l million Iu, once a day, intravenous injection, continuous use of 10 to 14d for a course of treatment, for some patients with weak spermatozoa satisfactory results. (2) Traditional Chinese medicine treatment (1) The type of life gate fire failure, the right return pill plus flavor, Chinese medicine can be used to choose the tortoise collection. (2) Kidney essence deficiency type Wu Zi Yan Zong Wan with added flavor, and Chinese herbal medicine can be used as Shen Li Tonic. (3) Qi and Blood deficiency type: Ten Perfect Tonic Soup with added flavor, and Chinese herbal medicine can be used to supplement Zhong Yi Qi Pill or Gui Lu Tonic Kidney Pill. (4) Yin deficiency and fire type Zhi Bai Di Huang Wan. (5) Damp-heat infusion type Gentian Diarrhea Liver Soup.