After a busy day, the list of outpatients finally disappears one by one from the computer screen, and before I have time to stand up, there are always a few patients at the door who are not registered, or do not want to register, rushing in and begging, “Doctor, help me to take a look at the test list, less than a minute, please!”
Usually I refuse, not because I am indifferent, not because I am heartless, not because I feel sorry for the 20 yuan registration fee (and ultimately get my hands on less than 5 yuan)! A few examples of labs, and by the way, male semen reports.
I can help you look at the labs and tell you that the results of both are abnormal, but what is causing these results? I don’t know! How to treat them later? I don’t know either! Without knowing the cause, we can’t provide an accurate treatment plan, so we have to sit down and talk slowly because I need to clarify the following conditions, i.e., take a medical history.
1. in what state his semen was collected
Whether abstinence was 3-7 days. Semen quality is diminished with too short or too long an abstinence period. Whether he missed part of the semen when collecting it and did not collect all of it, of course the semen volume will be low.
2. His occupation and living habits
Is he a high-temperature worker, steel and iron maker (referring to pre-furnace operation), steel rolling worker, large machine forger, kiln burner (including kiln out worker), locomotive driver, calcium carbide sinterer, ferry steam turbine stoker. Do you frequent sauna rooms? High temperature environment is not conducive to sperm viability.
3. whether he is in good health
Has he had mumps and a history of tuberculosis? Severe mumps combined with orchitis may lead to impaired spermatogenesis, and tuberculosis of the epididymis can lead to azoospermia. Does he have hepatitis, fatty liver combined with impairment of liver function? Impaired liver function can lead to increased estrogen levels in men, and continued high levels of estrogen can affect not only male sexual function, but also sperm quality. Patients with adrenal tumors or testicular tumors can involve the sperm production function of the testicles.
4. whether he is taking some medications
Medications can affect semen: chemotherapy drugs, such as: Adriamycin, Vincristine, Azacitidine, Cisplatin, Azelenimide, etc.; antihypertensive drugs, such as: diuretics (Antiseptic), b-blockers (Tretinoin), calcium channel blockers (Nifedipine), etc.; hormonal (anti-androgen) drugs: Finasteride, etc.
5. whether he has prostatitis, cryptorchidism and varicocele
When varicoceles are present, the local temperature of the testis increases and vasoactive substances increase, thus affecting the spermatogenic function of the testis. The degree of varicoceles is not proportional to the quality of sperm.
Cryptorchidism is one of the important reasons affecting the quality of semen. About 60% of patients with unilateral cryptorchidism are infertile, so if sperm density is low and cryptorchidism exists, early treatment is necessary. In addition, those with bilateral cryptorchidism, post-vasectomy, and congenital absence of the vas deferens gland may be azoospermia.
Chronic infection of the genital glands attached to reproductive tract infection can affect various laboratory indicators in semen.
6. whether his sex hormones and other endocrine hormones are normal
Men also have hyperprolactinemia, which affects the secretion of androgens and, of course, the quality of sperm and male sexual function. High estrogen and low androgen states can cause changes in sperm quality, as well as hyperthyroidism, hypothyroidism, pituitary disorders, and adrenal disorders can also affect sperm quality.
7. whether he has a chromosomal abnormality, enzyme deficiency or genetic abnormality
Men with Creutzfeldt-Jakob syndrome, karyotype 47,XXY. Men with Fernando 47,XYY, 46,XX, Noonan syndrome (Turner syndrome in men), 5a-reductase deficiency, congenital hypogonadotropic syndrome, selective FSH or LH deficiency, etc., are mostly azoospermic.
8. Other factors: history of exposure to alcohol, marijuana, radiation, smoking, environmental toxic substances, etc.
From a semen report, we can only detect the symptoms, but we have to take the above mentioned medical history to tell you what to do next? Not hastily prescribed medication, but to rule out all possibilities one by one, determine a certain cause, and clearly diagnose before we can advise you on which conditions can be treated medically, which require surgery, which must be in vitro, and which men can only donate sperm or hold a child.
So, fellow patients, in a hurry, doctors don’t help you read your labs because.
1. one minute can not solve your fundamental problem, the doctor needs to combine the medical history and laboratory results to give accurate diagnosis and treatment advice.
Usually, when a patient is registered with a doctor, a legal relationship is created between the doctor and the patient. The doctor’s treatment process will produce records that protect both the patient’s rights and the doctor’s rights, and the doctor will be held responsible for the treatment process. If you don’t register, the doctor is not responsible, and you can respond to questions without proof.
3. the doctor needs to be in a very relaxed state of mind to help you carefully analyze, how long does it take to analyze, look at all I wrote above, it will take you a few minutes to read it all, right? I haven’t even mentioned the treatment yet?
4. the end of the shift, it is time to let the doctor breathe, but also to go to the toilet to solve the urinary emergency! Gave you a person to see, the back did not see the unhappy. Doctors do not leave work, other staff (charge office, laboratory, pharmacy, nurses, janitorial staff, cleaning staff) all waiting there to look at the doctor. Maybe doctors have meetings, business studies, and picking up children? Doctors can’t sit still, please understand!