I. Name of the disease
Chinese medical name: seeking heir
Western medicine disease name: male infertility (including various causes of semen abnormalities)
II. Overview
(A) Chinese medicine view.
Chinese medicine believes that the kidney stores essence and is responsible for development and reproduction. The kidney essence directly determines the growth, development and aging of the human body, and also directly affects sexual and reproductive functions. The abundance of kidney qi promotes the maturation of the heavenly sebum, which is manifested in men as the overflow of sperm, which can harmonize yin and yang and have children. In addition, although the reproductive essence from the kidney essence, but closely related to the five organs of the essence, so the coordination of the five organs, the essence is abundant, the collection of appropriate, gasification is an important factor to maintain sexual function and reproductive function, but the five organs out of order, the essence of the decline, the collection and drainage of inappropriate, gasification disorders can lead to male infertility.
The following factors are the most common causes of male infertility: insufficient endowment, weakened sperm; failure of the vital gate fire, weak and cold sperm; phlegm and stagnant blood, blocking the sperm channel; uncontrolled alcohol and food, damp-heat injection; emotional and mental disorders, liver meridian stagnation; long-standing illness and fatigue, deficiency of qi and blood; internal accumulation of filth, lewdness and poisonous invasion.
(B) Modern medical view
The infertility referred to in this article refers to the various causes of modern medicine that cause men to fail to impregnate their spouses within 12 months.
According to the etiological classification male infertility is divided into: sexual or ejaculatory dysfunctional infertility, immune infertility, unexplained infertility, simple abnormal seminal plasma infertility, medical infertility, infertility caused by systemic factors, congenital abnormal infertility, infertility due to acquired damage, varicocele infertility, male epigonadal infection infertility, endocrine infertility, oligozoospermia (OAT), etc.
III. Diagnostic criteria
Based on the classification of semen, complete medical history, and according to the WHO process on male infertility, some necessary, examinations are made to determine the diagnosis of male infertility.
(a) The following diagnoses require the presence of abnormal erectile function and ejaculatory function
Sexual and ejaculatory dysfunction: including physiologically or psychologically induced erectile deficiency and/or infrequent intercourse, ejaculatory dysfunction, retrograde ejaculation.
(b) The following diagnoses are required to have normal sexual and ejaculatory function
1. Immune infertility Diagnosis is made when >50% of the motile spermatozoa in at least one semen sample are encapsulated by antibodies. This diagnosis should be determined with other additional tests.
The diagnosis of immune infertility should have: normal sexual function and ejaculatory function; and antibody-coated sperm.
2. Unexplained infertility Sexual function and ejaculatory function are normal, and sperm and seminal plasma examination are normal.
The diagnosis of unexplained infertility should have: normal sexual function and ejaculatory function; and normal semen.
3. Abnormal seminal plasma alone Infertility It includes normal semen, but abnormal physical, biochemical or bacteriological examination of seminal plasma, or increased blood cell count, or sperm agglutination but negative immunobeads or MAR test. These patients have not met the diagnostic criteria for an infection of the male accessory gonads or other pathological conditions. Its clinical significance as a cause of infertility with only abnormal seminal plasma is unclear.
The diagnosis of infertility with abnormal seminal plasma alone should have: normal sexual function and ejaculatory function; and normal sperm; and abnormal seminal plasma or sperm agglutination or leukocytosis.
(iii) Classification according to semen without sperm or abnormal sperm
and with certain etiology, classified according to the following diagnosis.
When abnormal spermatozoa are thought to be due to drug or surgical causes, the diagnosis can be made.
The diagnosis of medical infertility should include: normal sexual function and ejaculatory function; abnormal sperm; and a history of drug treatment that may affect fertility; and or a history of surgical treatment that may affect fertility.
Infertility due to systemic factors can be diagnosed if the abnormal spermatozoa are thought to be due to systemic disease and or alcohol and or drug abuse and or environmental causes and or recent hyperthermia, or if the patient has ciliary dyskinesia syndrome.
The diagnosis of infertility due to systemic factors should have: normal sexual function and ejaculatory function; and abnormal sperm; and history of systemic disease; and or hyperthermia within the past 6 months; and or environmental causes and or occupational causes; and or alcohol abuse; and or drug abuse.
3. congenital anomalous infertility includes history or clinical evidence of abnormal testicular descent, abnormal cell karyotype, and azoospermia due to congenital dysplasia of the seminal vesicles and or vas deferens.
The diagnosis of congenital anomalous infertility should have: normal sexual function and ejaculatory function; and abnormal sperm; and history of abnormal testicular descent; and or abnormal testicular position but bilateral testes are palpable; and or no testicular injury and both testes are not palpable; and no history of orchiectomy; or azoospermia with normal volume; and ejaculate volume <2ml and PH <6 or vas deferens are not palpable (bilateral); or abnormal leukocyte karyotype.
4. Acquired testicular damage is diagnosed when abnormal spermatozoa are thought to be due to mumps accompanied by orchitis or a pathological condition that can lead to testicular damage, causing a testicular volume of <15 ml, or when one or both testicles are not palpated.
The diagnosis of acquired testicular damage should have: normal sexual function and ejaculatory function; and abnormal sperm; and a history of pathology that can lead to testicular damage; and at least one testicular volume <15 ml or not palpated; and a history of pathology that can lead to testicular damage due to mumps.
5. Varicocele infertility As a cause of infertility, it should be accompanied by abnormal semen analysis. If semen analysis is normal in patients with varicocele, varicocele should not be considered as a cause of infertility and the patient should be classified as clear-cut cause of infertility.
The diagnosis of varicocele should have: normal sexual function and ejaculatory function; and abnormal sperm; and the presence of varicocele, either palpable, or subclinical type.
6. Infertility in men with epigonadal infection The diagnosis can be made if the patient has oligospermic semen or weak sperm semen or abnormal sperm semen and has the following criteria. `
(1) History and signs: history of urinary tract infection; and or history of epididymitis; and or thickening or tenderness found on examination of the epididymis; and or thickening of the vas deferens; and or abnormalities on anal examination.
(2) Prostate fluid examination revealed: abnormal prostate massage fluid; and or abnormal urine after prostate massage.
(3) Semen manifested as: white blood cells >1×106/ml; semen culture showing significant growth of pathogenic bacteria; semen examination showing abnormal appearance and or viscosity and or pH and or biochemical examination.
The presence of any combination of the above tests is diagnostic of infertility in men with gonadal infection; history or signs of prostatitis; or history or signs of abnormal semen examination; or prostatitis manifestations accompanied by abnormal ejaculate semen; or at least two abnormalities in each semen examination.
7, endocrine causes of infertility Patients with endocrine causes of infertility may show signs of low androgens, but the diagnosis can only be made if serum FSH does not rise and plasma testosterone is low or prolactin values are repeatedly checked and elevated, and further investigation is needed to clarify the precise etiology.
The diagnosis of endocrine causes of infertility should include: normal sexual function and ejaculatory function; and abnormal sperm; and low plasma testosterone and no elevated serum FSH; and or repeatedly elevated PRL.
(iv) Others
If none of the previous diagnoses apply and the semen is classified as oligospermic semen, weak sperm semen, abnormal sperm semen or azoospermic semen, the following diagnoses can be combined.
1. Idiopathic oligospermia Diagnosis can be made if the sperm density is less than 20×106/ml, but greater than 0.
The diagnosis of idiopathic weak spermatozoa should have: normal sexual function and ejaculation function; and abnormal sperm; oligospermia; and none of the other diagnoses apply.
2. Idiopathic weak spermatozoa The diagnosis requires the presence of normal sperm density but low viability (a < 25%).
The diagnosis of idiopathic weak spermatozoa should have: normal sexual function and ejaculatory function; and abnormal sperm: low sperm motility; and none of the other diagnoses apply.
3, idiopathic teratozoospermia The diagnosis requires the presence of normal sperm density and viability, but low normal form sperm (a+b <50%).
The diagnosis of idiopathic teratozoospermia should have: normal sexual function and ejaculatory function; and abnormal sperm: teratozoospermia; and none of the other diagnoses apply.
4, obstructive azoospermia If the semen is classified as azoospermic semen, testicular biopsy is performed on subjects with normal testicular signs and FSH, and testicular biopsy suggests the presence of all spermatogenic cells of the spermatogenic process in most of the varicocele, and these indicators are also the basis for the diagnosis of obstructive azoospermia.
The diagnosis of obstructive azoospermia should have: normal sexual function and ejaculatory function; and azoospermia; and the presence of spermatozoa in testicular biopsy; and total testicular volume ≥ 30 ml; and normal plasma FSH; and none of the other diagnoses apply.
5. Idiopathic azoospermia The diagnosis can be made when the cause of the patient’s azoospermia is unknown, that is, when there is no indication of testicular biopsy because of small testicular volume or rising FSH values, or when testicular biopsy shows no spermatozoa present in the varicocele.
The diagnosis of idiopathic azoospermia should have: normal sexual function and ejaculatory function; and azoospermia; and or rising serum FSH; and or testicular volume <30 ml; or testicular biopsy showing no spermatozoa present; and none of the other diagnoses apply. The diagnosis can be made by having items (a) and (b) above and referring to other items.
6. Occult azoospermia
No sperm on routine examination, and sperm found after centrifugation and sedimentation.