According to the “Standard Examination and Diagnosis Manual for Infertile Couples” developed by WHO and our national conditions, there are about 16 etiologies and/or diagnoses of male infertility, and the same case may have more than one etiological diagnosis, which are common and are described as follows
1. Congenital anomalies.
(1) There are chromosomal number abnormalities, structural aberrations, and partially phenotypically normal chromosomal balanced translocation carriers;
(2) With or without abnormalities of the testes, epididymis, seminal vesicles, vas deferens, urethra and external genitalia, with or without abnormalities of sexual function and/or ejaculatory function;
(3) or normal testicular volume without spermatozoa;
(4) or ejaculate volume <1.5m1 with PH <6.8 or vas deferens;
(5) No history of testicular trauma or surgical resection.
2, acquired testicular injury.
(1) history of mumps orchitis or other testicular injury, such as consumption of cottonseed oil, continuous high temperature, radiation, trauma, hypoxia and other medical history;
(2) Testicular volume <12ml or cannot be retrieved. (Note that there are racial differences in testicular size, normal Chinese adult testes should be 12 (left) to 14 (right) ml, Shanghai has reported that 10 ml still have fertility);
(3) abnormal sperm quantity or quality;
(4) with or without abnormal sexual and ejaculatory function.
3. Intercourse and/or ejaculatory dysfunction.
(1) Low erectile function and/or insufficient frequency of intercourse and/or inability to have normal intercourse due to organic or psychological causes;
(2) Those who can have intercourse but have retrograde ejaculation or cannot ejaculate, or those who can ejaculate but cannot ejaculate in the vagina (e.g. urethral opening at the root of the penis);
4. Systemic diseases.
(1) Normal ability to have sexual intercourse and ejaculation;
(2) abnormal semen and/or sperm; such semen and/or sperm abnormalities are due to the presence of the following systemic diseases.
(i) History of high fever exceeding 38°C within the last 6 months;
②Sperm abnormalities due to diabetes mellitus or neurological disorders;
(iii) Cilia lagging syndrome: chronic obstructive disease of the whistle, infection and abnormal sperm cilia filaments (manifested by poor motility);
(iv) Karnagener’s syndrome; ciliary lag syndrome with visceral translocation;
⑤ Young’s syndrome: recurrent sinusitis, pulmonary infection with bilateral progressive obstructive azoospermia;
(6) Cystic fibrosis: loss of epididymal body tail, vas deferens and/or seminal vesicle hypoplasia, atresia or agenesis, with bile duct obstruction, pancreatic fibrocystic degeneration, etc;
(7) Tuberculosis (especially when accompanied by tuberculous epididymitis);
(viii) Heart, liver and kidney disease;
(⑨) Environmental and/or occupational chronic injurious diseases, such as radiation, high temperature, oxygen deprivation, long-term engagement in lead, cadmium, mercury, pesticides, herbicides, dithiophosphates and other toxic and harmful work;
⑩Smoking, alcoholism, drug overdose, drug addicts, etc. resulting in systemic debilitation.
5.Medical causes.
(1) There is normal sexual function and ejaculation function;
(2) Those who have semen and sperm abnormalities, such semen and/or sperm abnormalities are due to the history of medical medication, radiotherapy and/or surgical procedures. Medications to anti-cancer chemotherapeutic drugs, hormonal drugs, anti-androgenic drugs such as cimetidine, ambrisentin, nilidazole, etc. History of surgical procedures, such as urethral discernment surgery, prostate surgery, cystotomy, urethral stricture repair, post-operative repair of hypospadias or epispadias and bladder exstrophy, hernia repair, testicular syringomy, lumbar sympathectomy, post-torsional repositioning of testicles, etc. Radiotherapy, mainly perineal and/or pituitary area radiation exposure.
6, Infectious infertility: common are orchitis, epididymitis, vesiculitis, spermatorrhea, prostatitis, etc. The most common infections such as syphilis, gonorrhea, mycoplasma, chlamydia, non-gonococcal urethritis, etc. Inflammation can lead to oligospermia, weak spermia, obstructive azoospermia, induce antibodies and cause ejaculation disorders.
7, Immunological infertility: At least 1 category of anti-sperm antibodies positive in AsAb-IgG, AsAb-IgA, AsAb-IgM.
8, endocrine infertility: including abnormalities in E2, T, LH, FSH, PRL, T3, T4, TSH, F, LRH, TRH, etc.
9. Simple abnormalities of seminal plasma.
(1) There is normal sexual function, ejaculatory function and normal sperm;
(2) Low immunosuppressive substances in seminal plasma and abnormalities in the science, biochemistry (fructose, α-glucosidase (α-GLU), acid phosphatase), and biology (leukocytes) of seminal plasma.
10.Seminomatous varicocele:
(1)There is normal sexual function and ejaculation function;
(2) Abnormal semen and/or sperm;
(3) Clinical manifestations of varicocele of subclinical type until visible to the naked eye.
11, obstructive azoospermia.
(1) There is normal sexual function and ejaculatory function;
(2) No spermatozoa and spermatogenic cells at all levels in the semen;
(3) normal testicular volume and FSH;
(4) Seminal plasma fructose was 0 and α-GLU <20u/ml;
(5) Semen cytology did not show any spermatogenic cell components at all levels.
12, Idiopathic oligospermia: sperm density in semen <20×06/m1.
13, idiopathic weak spermatozoa: normal sperm density and normal morphology in semen, but low motility (less than 25% of sperm with fast linear forward motion).
14, idiopathic teratozoospermia: normal sperm density in semen: normal motility and viability, but normal head morphology sperm <30%.
15, idiopathic azoospermia, i.e. testicular spermatogenic dysfunction.
(1) No spermatozoa and spermatogenic cells with or without all levels in the semen;
(2) Small or normal testicular volume, high or normal FSH, no testicular biopsy or testicular biopsy, no spermatogonia or spermatozoa at all levels seen in the varicocele or only supporting cells syndrome;
(3) No chromosomal abnormalities.
16, unexplained infertility.
(1) there is normal sexual function and ejaculatory function ;
(2) normal semen and sperm;
(3) No cause of infertility was found.