Patient: normal testicular epididymal development, slight tenderness in left epididymis, vas deferens palpable.
Auxiliary examination: high FSH, no sperm, ultrasound and other examinations normal
Testosterone undecanoate capsule and Tribo capsule are not effective.
Patient: What other tests should be done? Should puncture be performed?
Pan Lianjun, Department of Urology, Nanjing Maternal and Child Health Hospital: Hello, this friend. According to your description, there is still a possibility that the testicles have spermatogenic function. You need to do another microdeletion test for Y chromosome; for now, if FSH is only mildly increased, testicular puncture biopsy is necessary. I have an outpatient clinic on Friday morning.
Patient: FSH was more than twice higher than normal in March 08, reaching 26, taking testosterone undecanoate capsules and Sambucol capsules for a month, and then taking herbal medicine was also ineffective! Last week, I saw a specialist at the General Hospital of the Military Region, who said that there was almost no hope for a cure, and that there was no need for puncture, and that there was only one solution: to continue taking testosterone undecanoate capsules, and three months of Sambo capsules for rebound. I’ve been frustrated physically and mentally on the long road of seeking medical help, and I have no confidence in myself, so I came across Dr. Pan on the internet and put a ray of hope in my heart. I would like to ask Dr. Pan to give some advice. Is there really no way out? I can’t have no offspring, please Dr. Pan give me some ideas. I’d like to thank you for your help.
FSH reaches 26, which indicates that the testicular spermatogenic damage is relatively severe, but the accuracy of determining spermatogenic damage by FSH is only about 70%. There are two types of azoospermia: obstructive and non-obstructive. Looking at your profile, you should belong to non-obstructive azoospermia. There are so many types of pathologies of this non-obstructive azoospermia: support cell only syndrome (no spermatogenic cells in the testes at all, incurable), spermatogenic block, and hypospermatogenic. If the spermatozoa are blocked, as long as the spermatozoa are blocked at the secondary spermatocyte or sperm cell stage, there is still hope that sperm can be cured through treatment, and there is also hope that sperm can be cured through treatment for low spermatozoa. I have not examined you, I do not know if you have varicose veins? If you have, it is recommended that you actively surgical treatment, preferably microsurgery; research shows that varicocele with azoospermia after microsurgical treatment, about 55% of the semen can appear sperm; if there is no varicocele, if you do not want to do further examination, it is recommended that you inject HcG and HMG treatment for 3 months, after 3 months, if the semen is still no sperm, it can only be admitted, no No way! No matter what the result is, don’t be hit by the disease! I wish you a speedy recovery!
Patient: What are HcG and HMG drugs? Is there any similarity between their effects and those of testosterone undecanoate capsules and Tribo capsules? Recently checked no varicocele!
Pan Lianjun, Department of Urology and Male Medicine, Nanjing Maternal and Child Health Hospital: HCG (chorionic gonadotropin) and HMG (menopausal gonadotropin) are two pituitary hormone drugs that are currently used internationally for the treatment of idiopathic non-retrogressive azoospermia. The effect is different from that of testosterone undecanoate. Sanbao capsule is a proprietary Chinese medicine that acts as an adjunctive treatment.
Patient: What is the exact cost? It can be different from testosterone undecanoate. Do you use San Bao capsule together?
Pan Lianjun, Department of Urology and Male Medicine, Nanjing Maternal and Child Health Hospital: The cost for one month is about 300-400 yuan, and can be used together with testosterone undecanoate and Sanbao capsule.
Patient: Can I receive treatment at the local hospital?
Pan Lianjun, Department of Urology and Male Medicine, Nanjing Women’s and Children’s Health Hospital: You need to use the medicine under the guidance of a professional male doctor, if you have such a professional doctor there, you can treat it locally.
But Yao Bing of the General Hospital of the Military Region said that my condition belongs to the only supportive cell syndrome and that I can only use testosterone undecanoate and Sanbao capsules for three months to see if there is a rebound effect. What should I do? Please reply as soon as possible, for the sense!
The only way to confirm the diagnosis of only support cell syndrome is to do a testicular biopsy. The possibility of your situation being treated with sperm is not great, but it does not mean that 100% of it is hopeless. We suggest you try HCG and HMG injections for 3 months.
Patient: Do I have to inject every day? What are the side effects on one’s body? Will it be too much when used together with testosterone undecanoate and Tribo capsule. Rejection?
Pan Lianjun, Department of Urology, Nanjing Women’s and Children’s Health Hospital: It is injected twice a week, and there are basically no side effects. The dose of testosterone can be reduced by half when used together, and there will be no rejection.
Patient: What exactly do you mean by basically no side effects? Can I receive treatment at Yangzhou Women’s and Children’s Hospital? Pan Lianjun, Department of Urology and Male Medicine, Nanjing Women’s and Children’s Hospital: Adverse reactions include: headache, easy agitation, mental depression, easy fatigue; occasional injection local pain, allergic rash, these adverse reactions rarely occur and can disappear after 3-4 weeks. You can go to the Yangzhou Women’s Health Insurance Institute and ask if these drugs are available.
Patient: No need for biopsy?
Pan Lianjun, Department of Urology and Male Medicine, Nanjing Women’s and Children’s Health Hospital: Testicular biopsy is best done. It can clarify the pathological type of testicular lesion.
Patient: Where is it recommended to do it? Are there any side effects for the future? Can the specialist see all my previous messages?
The Urology Department of Nanjing Women’s and Children’s Hospital, Pan Lianjun: All previous messages can be seen, come to my side if convenient, a very small procedure, there will be no after-effects.
Patient: I have a testosterone value of 14.02, prolactin of 321.3, estradiol of 135, luteinizing hormone of 6.1, all within the normal range, but the FSH value of 26 is more than three times the normal value, Dr. Yao Bing of the General Hospital of the Military Region said that it has been basically determined that the only supportive cell syndrome, if you take three months of testosterone undecanoate and three treasure capsules to check the absence of sperm, there is no way at all. Is this really the only way to go? Save me, expert! I’m really close to collapse! I have a great body, why would I have this defect, and also in 2002, I had a semen examination in the army, the doctor did not say I was not normal, said everything is normal, just do not know if that examination is accurate?
The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. You need to meet a good doctor to see a doctor. Testicular biopsy can be done now, no need to wait until you finish your medication.
Patient: Thanks for the answer, but I’m worried that the doctor who examined me in 2002 was a horse’s ass, or that the results were wrong. What additional tests do I need to have to confirm the diagnosis? If it is really supportive cell syndrome then there is nothing that can be done, right?
The actual fact is that you can find out if there is any sperm. As already mentioned, testicular biopsy is the only way to confirm the diagnosis of only support cell syndrome. If it’s really a supportive cell syndrome, there is no way out.
The patient: expert: I am now taking testosterone undecanoate and three capsules, after three months of taking them, if there is still no effect, is the diagnosis of only supporting cell syndrome confirmed?
The fact that testosterone undecanoate can be used for the treatment of azoospermia is only one of the means, but it cannot be said that the diagnosis of only support cell syndrome is supported by taking it for 3 months with no effect, and as for the San Bao capsule, it only plays a supplementary therapeutic role. The diagnosis of support-only cell syndrome can only be determined by testicular biopsy.
Patient: Dr. Pan, I am going to give up treatment because I want to have a child as soon as possible and there is too much pressure from the public opinion around me. Is it possible to find sperm for artificial insemination by myself? What is the approximate cost? What tests does the wife need to undergo? What are the requirements for a sperm provider?
Patient: Dr. Pan, it would be better if we can cure our problem and have a child of our own in the future, but I think my wife is almost 30 years old, so it is not a good idea to delay, so we are planning to have someone willing to provide us with sperm! What do you think we need to do now to prepare?
Pan Lianjun, Department of Urology, Nanjing Maternal and Child Health Hospital: You only need to provide your previous azoospermia and sex hormone test results. Please consult the hospital where you are going for artificial insemination for the tests and preparations your wife needs. You need to prepare your marriage certificate, fertility certificate, ID card and a copy of it.