Infertility is also known as male infertility for the male factor? Male infertility is infertility due to male factor. Generally speaking, if a woman does not get pregnant after living together for more than 2 years after marriage without using any contraception, it is called infertility. Some men who have a history of childbearing after marriage and then fail to have children are called secondary male infertility. The incidence is about 10%. The female factor alone is about 50%, the male factor alone is about 30%, and the total number of men and women is about 20%. Clinically, male infertility is categorized into sexual dysfunction and normal sexual function, and the latter can be further categorized into azoospermia, oligospermia, hypospermia, spermatozoa incompetence and normal sperm count infertility based on the results of semen analysis. Etiology The pathogenesis of this disease is complex, and many diseases or factors can lead to male infertility. Depending on the results of semen examination, it can be categorized as azoospermia, severe oligozoospermia, oligozoospermia, normal sperm count infertility, polyzoospermia, and spermatozoa incompetence. The causes of male infertility are summarized as follows: 1, chromosomal abnormalities. The common ones are male pseudohermaphroditism, Kirschner’s syndrome and XYY syndrome. 2, endocrine diseases. The cause is gonadotropin deficiency. The common ones are selective hypogonadotropic hypogonadism, i.e. Kallmann’s syndrome; selective LH-deficiency and FSH-deficiency; adrenocortical hyperplasia; and hyperprolactinemia. 3, reproductive tract infections are more common. With the increase in the incidence of sexually transmitted diseases in recent years, the incidence and severity of inflammatory diseases of the reproductive tract, such as prostatitis, epididymitis, orchitis and urethritis, have increased, seriously affecting male fertility. 4, obstruction of the vas deferens. It affects the transportation of sperm. 5.Abnormal spermatogenic function of testis. Commonly seen in cryptorchidism, varicocele, toxins, magnetic field, high heat and trauma and other physical and chemical factors can cause spermatogenic disorders of the testes. 6. Abnormal sperm structure and abnormal seminal plasma. It affects sperm movement, energy acquisition and acrosome reaction. Immune sterility. The anti-sperm immunity produced by men themselves and the anti-sperm isoimmunity produced by women can cause male infertility. 8, male sexual dysfunction. Impotence, premature ejaculation, ejaculation and retrograde ejaculation can cause male infertility. Clinical manifestations 1, couples cohabiting after marriage for more than 3 years (some scholars believe that more than 2 years), no contraceptive measures but failed to get pregnant. 2. Congenital diseases caused by endocrine diseases and chromosomal abnormalities, manifested as impaired sexual maturation, insufficient masculinization, breast enlargement, testicular atrophy, small penis, low libido, premature ejaculation and impotence. 3.Testicular congenital anomalies: absent testes, cryptorchidism and testicular hypoplasia. 4.Varicose veins of the spermatic cord: painful swelling of the scrotum, palpable varicose veins in clusters in the scrotum, Valsalva test (+). 5.Reproductive duct infection. Examination and diagnosis 1, medical history History of past diseases, injuries and surgeries, sexual life, birth control, fertility and marital history, exposure to drugs and physical and chemical factors, urinary tract symptoms and gynecological examination of the female partner. 2, physical examination, including the general condition of the body, nervous system and reproductive system examination, focusing on checking the development of secondary sexual characteristics, the size and texture of the testicles, testicles, epididymis, spermatic cord and vas deferens and prostate, to understand the existence of urethral hypospadias, cryptorchidism, varicocele, and so on. 3, semen examination Abstinence for 3-7 days, with masturbation method or extracorporeal spermatozoa method to collect semen, check within 1 hour. Normal reference value: semen volume 2-6ml, gray or light yellow, 5-20 minutes complete liquefaction, pH7,2-7,8 sperm density of 50-100 million / ml, sperm viability >60%, sperm viability >75% (>6), sperm Abnormalities <30%, total sperm count >13,000,000/each sperm discharge. If the sperm count is less than 20 million/ml, the fertility is extremely poor. Measurement of reproductive endocrine hormones Serum testosterone (T), luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin (PRL) should be measured by immunoassay method to determine the functional status of gonadal axis. 5.Special examination such as chromosome analysis, immunological examination, vasovaginography and testicular biopsy, etc., to help clarify the cause of infertility. Therapeutic measures I. Principles of treatment: 1. etiological treatment; 2. endocrine treatment; 3. non-specific treatment; 4. surgical treatment; 5. artificial insemination. Second, the principle of medication: 1, genital tract infections caused by infertility to antibiotic anti-inflammatory treatment, supplemented by drugs to improve sperm vitality. 2, azoospermia, oligospermia and idiopathic infertility, should be sex hormone drugs for endocrine treatment. 3, low sperm vitality, to improve the sperm vitality of the drug treatment. 4, varicose veins, vas deferens obstruction, cryptorchidism, urethral fissure caused by infertility, it is advisable to perform surgical treatment, supplemented by endocrine drugs and other auxiliary drug therapy. 5, absolute infertility (such as azoospermia), should do artificial insemination. Treatment includes both causative treatment and symptomatic treatment: 1. Promote the spermatogenic function of testis. 2. 2. Keep the vas deferens open. Actively treat sexual dysfunction and maintain normal sex life. For congenital absence of vas deferens, obstruction of vas deferens tract and vasectomy should be actively treated by surgery. 3.Improve the function of sperm. Those who have inflammation of the reproductive tract should be actively given antibiotic treatment; vitamin E, vitamin C and zinc preparations such as zinc complex protein can improve sperm function. For immune infertility, the use of condoms can eliminate and reduce the stimulation of sperm antigens on women. Immunosuppressant high-dose short-term application and sperm washing artificial insemination are helpful in the treatment of immune infertility. 4, Artificial insemination (AI). It includes two categories: artificial insemination with donor sperm (AID) and artificial insemination with husband’s sperm. In recent years, in vitro artificial assisted reproduction technology has developed rapidly, especially intracytoplasmic single sperm injection (ICSI) has been used to treat oligozoospermia, weak spermatozoa and azoospermia, and better results have been achieved. Prevention Male infertility itself is not an independent disease, caused by many causes of male infertility, such as congenital developmental abnormalities, cytogenetic chromosomal abnormalities, hypothalamus – pituitary – gonadal dysfunction, endocrine dysfunction, sexual dysfunction and reproductive tract infections, and even psychological factors and so on, caused by a consequence. Ex-life experts suggest that: in addition to the diagnosis and treatment of male infertility should be emphasized, prevention is also very important, generally from the following aspects to take measures. First, the prevention of male genitourinary infection Current clinical information, reproductive tract infection is one of the most common factors. Therefore, the prevention of urogenital infections is a very important issue. Causes of urogenital infections are direct and indirect in many ways, when you have a urinary tract infection should be timely and effective treatment to prevent the infection from going up to the reproductive system, that is to say, to prevent going up to the prostate, epididymis and testicles. Sexually transmitted diseases such as gonorrhea, condyloma acuminatum, non-gonococcal urethritis, caused by mycoplasma, chlamydia infections, the spread of very fast, if found to have sexually transmitted diseases, married parties to fast, thorough and effective treatment. Second, the prevention of immunity caused by sterility Immune factors is one of the causes of sterility. Prevention is to improve self-protection awareness. Specifically, men should protect their testicles from harm, prevent urinary tract infections, and especially prevent infections from traveling upward to the prostate, epididymis and testicles, so as not to destroy the local immune barriers of the reproductive system and cause local immune reactions. Injecting anti-mumps vaccine in the boy’s age, usually once the fever occurs, prostatitis, testicular inflammation, then timely and effective treatment. Prevention of toxic effects in daily life According to research data, in the past 30 years, male sperm counts have decreased by 30% to 55%, and the decrease in sperm counts of human males is directly related to environmental pollution, including air, water and food pollution. These pollutants can act on the male urinary system and reproductive system, causing not only a decline in male sperm count but also a decline in sperm quality. Everyone should enhance the awareness of self-protection, cultivate healthy and upward living habits, maintain a normal work schedule, ensure that there is enough sleep, change bad habits, less alcohol and smoking, strong tea, keep the testicles locally clean, do not wear tight pants, self-adjustment of the individual’s state of mind, and a balanced life. Factors causing male infertility 1, mental and environmental factors Sudden changes in the living environment lead to long-term mental tension; high altitude, high temperature, over-intensity labor and radiation work. 2, nutritional factors severe malnutrition vitamin A, E deficiency, trace elements such as zinc and manganese deficiency, calcium and phosphorus metabolism disorders, mercury, arsenic, lead, ethanol, nicotine, cotton-oil and other toxic substances such as chronic poisoning, chemotherapy treatment. 3, endocrine diseases such as pituitary sister Confucianism, obesity, reproductive impotence syndrome, hypopituitarism, congenital gonadal hypoplasia, congenital spermatogenic inability syndrome, hyperprolactinism, pituitary tumors or intracranial infections, such as tumors with birth trauma. 1.Medical history History of past diseases, injuries and surgeries, sexual life, birth control, fertility and marital history, exposure to drugs and physical and chemical factors, urinary tract symptoms and gynecological examination of the female partner. Physical examination The general body condition should pay attention to whether there is any special body type and systemic diseases. External genitalia examination pay attention to the degree of penile development, urethral orifice, testicular size, the relationship between the epididymis and testicles, the spermatic cord with or without lesions (such as varicose veins of the spermatic cord, vas deferens, etc.), rectal fingerprinting pay attention to the prostate gland and seminal vesicles, prostate massage surgery, and smear examination. 3, semen examination Abstinence 3-7 days, with masturbation method or extracorporeal spermatozoa method to collect semen, check within 1 hour. Normal reference value: semen volume 2-6ml, gray or light yellow, complete liquefaction in 5-20 minutes, PH7,2-7,8 sperm density of 50-100 million/ml, sperm viability >60%, sperm vitality >75% (>6 levels), sperm abnormality <30%, total sperm count >13,000,000/each sperm discharge. Those with sperm count <20 million/ml have very poor fertility. Male infertility examination program 1, semen analysis, including semen routine and cervical mucus penetration test to understand the sperm plasma . 2. Measurement of reproductive endocrine hormones Serum testosterone (T) luteinizing hormone (LH) follicle stimulating hormone (FSH) and prolactin (PRL) are measured by immunoassay to determine the functional status of the gonadal axis. 3.Special tests such as chromosome analysis, immunological examination, vasovasography and testicular biopsy to help clarify the causes of infertility.