As the old saying goes, “If you are unfilial, you have no children”. In the traditional Chinese concept, the idea of passing on the family line is deep-rooted. Therefore, it is a very painful thing for young couples in China not to have children, especially for men who cannot hold their heads up. At present, infertility accounts for about 15% of couples in China, with an average of one in seven couples facing fertility problems, and the trend is increasing due to male factors.
If the female partner has not conceived for more than one year after cohabitation or marriage without any contraceptive measures, infertility should be considered, and both men and women should go to a reproductive medicine specialist in a regular hospital. Due to the traditional Chinese concept, male patients with infertility are often in a plight of distress and low self-esteem. However, many patients will be able to get rid of infertility as long as they seek scientific medical treatment, identify the cause and prescribe the right medicine.
Generally speaking, when you enter the reproductive male clinic, the doctor will first take a medical history and physical examination, and then arrange some tests.
Medical history questioning is the doctor’s primary assessment of male infertility
1. Sexual and reproductive history
The doctor will ask you about your sexual life, including the timing, frequency and position of intercourse, whether you have ejaculated, and whether you have had intercourse during ovulation, as well as the duration of your infertility and previous fertility, including the age of the woman and previous pregnancies and births. Usually, those who have been infertile for more than 3 years may have more serious problems, secondary infertility is less likely to be a factor for the male partner and more likely to restore fertility, the age of the female partner is also an important factor affecting the success rate of conception, and the time and frequency of sexual intercourse position is also a factor affecting conception.
2.Past medical history
The doctor will also know whether you have any previous urinary tract infections, sexually transmitted diseases, medical diseases and surgical history. It is common that a history of epididymitis often leads to epididymal obstructive azoospermia, mumps in childhood or adolescence may complicate orchitis in 10% to 30% of cases, and prostatitis or seminal vesiculitis may cause abnormal seminal plasma and reduced fertility. Patients with febrile diseases, diabetes or multiple sclerosis and other medical conditions often suffer from male sexual dysfunction and impaired spermatogenic function, while previous surgical diseases and surgical history may damage the spermatic cord vessels or genital tract leading to testicular atrophy or spermatic tract obstruction.
3. History of poor lifestyle, radiation or chemical toxicity exposure
The doctor will also ask if you have any bad lifestyle habits, long-term medication, exposure to toxic chemicals and work and living environment. It is commonly believed that smoking and drinking alcohol can have an adverse effect on sperm, some medications (such as furantoin, metformin and lutjan sulfadiazine pyridine) can also impair sperm production, exposure to pesticides or other toxic chemicals can have a damaging effect on both sperm production and function, and a history of heat exposure such as either occupational or frequent saunas and hot tubs can cause impaired semen parameters and sperm production.
Physical examination, the key to the doctor’s evaluation of male infertility
After taking a medical history, your doctor will give you a detailed physical examination to detect abnormalities and potential causes associated with infertility. Certain changes in physical appearance (e.g., hairy or less hairy, obese or thin and long) may indicate chromosomal or endocrine abnormalities that can have an impact on male fertility and other health problems. Physical examination of the reproductive organs can reveal the presence of sexually transmitted diseases, vulvar malformations, testicular size, epididymal lesions, vas deferens, and varicocele. Most importantly, testicular volume measurement, whether unilateral or bilateral, reflects impaired testicular spermatogenic function.
Laboratory and instrumental auxiliary tests to further verify clear causes of infertility
1.Semen examination
Semen examination is the most basic laboratory test for male infertility, and the important indicators are sperm count, vitality and morphology. Note that abstinence is required for 3-7 days before the examination, and it is required to be sent for examination within 30 minutes by hand to suppress the cress. The quality of male semen has certain volatility, it is generally recommended to check 2~3 times to better reflect the level of semen quality of the patient.
2.Other tests
After taking semen specimens for examination, urethral secretions are usually taken at the same time for various types of pathogens to rule out chronic infections in the reproductive tract; for patients with small testicular volume and moderate to severe oligospermia or azoospermia on semen examination, sex hormone testing is needed to assess the function of the testes, and sex chromosome and autosomal karyotype analysis and Y chromosome microdeletion testing should also be performed.
3.Ultrasound examination
Doppler ultrasonography is also one of the most important tests for male infertility. It is the most accurate in measuring testicular volume and can also effectively detect the presence of varicocele, and in recent years, it has become more valuable in diagnosing epididymal obstruction and evaluating the spermatogenic function of the testes. In some patients (e.g. semen volume less than 1.5 ml), transrectal ultrasound is required to understand the seminal vesicles, prostate, ejaculatory ducts and their openings.
The treatment of male infertility, the treatment of the disease to solve the disease disturbance
1, general treatment: combine work and rest, ensure rest and sleep, regular diet and living, avoid sedentary high temperature environment, avoid exposure to toxic and harmful chemicals or rays, avoid smoking, alcohol and drug abuse; healthy diet, balanced nutrition, appropriate supplementation of vitamins and trace elements; maintain personal life and sexual hygiene, to prevent sexually transmitted diseases or reproductive organ infections; keep a happy mood, relieve physical and mental stress and fertility pressure. To improve the relationship between husband and wife.
2, for the cause of treatment: for the cause of the identified treatment measures can usually achieve good results, such as low gonadotropic gonadal hypogonadism using androgens, HCG, HMG treatment, hyperprolactinemia can take bromocriptine treatment, sexual dysfunction can take “Viagra”, electric massage sperm extraction treatment, spermatozoa varicose veins The spermatorrhea caused by varicocele can be treated by spermatorrhea ligation, and the spermatorrhea obstruction can be treated by spermatorrhea recanalization surgery.
3, empirical treatment: in order to improve the quality of semen and increase the pregnancy rate, especially for unexplained oligozoospermia, antioxidants such as vitamin E, carnitine and zinc supplementation, as well as herbal treatment, the use of anti-estrogenic drugs such as tamoxifen alone or in combination with androgens for some patients with oligozoospermia can achieve good results.
4, the application of assisted reproductive technology: combined with the assessment of female infertility factors, male factor infertility (such as oligozoospermia, sexual dysfunction, etc.) or unknown reasons is recommended to start with intrauterine insemination, if 3 to 6 cycles of failure, then consider in vitro fertilization – embryo transfer (IVF) or such as single sperm intracytoplasmic injection (ICSI); severe oligozoospermia or obstructive azoospermia can be considered Donor insemination, IVF or ICSI can be considered.
In summary, do not easily believe in a variety of network, television and media inaccurate medical advertising, as long as there are problems in a timely manner to the regular hospital scientific medical male infertility patients will eventually be round when the father dream.