A. The amount of semen is too small
In general, normal men ejaculate about 2-6ml each time, and the amount of ejaculate is related to the frequency of ejaculation. Semen volume less than 1ml each time is called too little semen volume. The causes of semen reduction: ① obstruction of ejaculatory ducts or congenital lack of seminal vesicles; ② pituitary or testicular interstitial cell lesions, resulting in reduced gonadotropin or reduced estrogen causing reduced semen production; ③ infectious diseases of the reproductive tract can also cause damage to the function of the accessory gonads and reduced semen production. If the semen volume is persistently reduced, we can first look for the cause and treat it. For example, congenital lack of seminal vesicles cannot be treated; ejaculatory duct obstruction can be treated surgically; reduced gonadotropins or androgens can be treated with hormone replacement therapy; and reproductive tract infections can be treated with anti-infection therapy.
Normal semen is liquefied at the time of ejaculation, and then immediately forms a jelly or clot. After 5-20 min in a 37°C water bath, semen is transformed from a solidified state to a liquefied state, a phenomenon known as semen liquefaction. If this process is longer than 1 hour, it is called prolonged semen liquefaction. The coagulation of semen is caused by the production of coagulation proteins by the seminal vesicles. In contrast, liquefaction is the result of the action of a series of protein hydrolases, or liquefaction factors, secreted by the prostate gland. Therefore, inflammation of the prostate gland and seminal vesicles disrupts their secretory function, increasing the coagulation factor or decreasing the liquefaction factor of semen, resulting in semen non-liquefaction. The semen is not liquefied so that the sperm is networked by mucus, which hinders its ability to move in the female reproductive tract, and so causes male infertility.
The key to treating semen liquefaction is to eradicate the original disease, such as prostatitis and seminal vesiculitis, which can be treated with antibacterial therapy, plus drugs to promote semen liquefaction, such as phlegm easy to take orally and chymotrypsin 5mg twice a week intramuscular injection also have good effect. For non-infection induced semen non-liquefaction disease can be treated with western medicine.
Second, oligospermia
The number of spermatozoa in semen is lower than that of normal healthy fertile men. As the quality of human sperm has been declining in recent years with the environment, pollution from estrogen-like toxins and other factors. Nowadays, sperm count less than 20 million per ml is considered as oligospermia. However, clinically it is often accompanied by low sperm viability, poor forward motility and high sperm malformation rate, which is then called oligospermia, a more common condition of male infertility.
The spermatozoa are produced in the testes and undergo a continuous process of spermatogonia, primary spermatocytes, secondary spermatocytes, spermatocytes, and finally mature spermatozoa, which are released into the seminiferous tubules for about 64-72 d. The entire process of sperm formation is regulated by endocrine hormones, and any factors that affect the spermatogenic function will lead to a decrease in sperm Any factor affecting spermatogenesis will result in a decrease in sperm count.
The causes of oligospermia include the following 7 aspects: varicocele, cryptorchidism, reproductive tract infection, autoimmunity, endocrine abnormalities, chromosomal abnormalities, high bursal temperature, radiation damage, chemical drugs and medications can all cause oligospermia.
1. Those with a clear cause should be treated for the cause, such as varicocele, cryptorchidism can be treated surgically; reproductive tract infections should be treated with anti-infection; autoimmune anti-sperm antibodies can be treated with immunosuppressive drugs such as adrenal glucocorticoids and high dose vitamin C. For exogenous factors causing oligospermia, these exogenous factors can be removed. With the removal of the primary disease and exogenous factors, the sperm count will improve and satisfactory results will be achieved.
2. For idiopathic oligospermia of unknown etiology can be treated with testosterone or synthetic testosterone derivatives, such as testosterone propionate, fluoxymesterone, etc.; in addition, glucocorticoids, clomiphene and other drugs can be tried.
3. Chinese medicine treatment
The formula, dosage and course of treatment should be determined according to the patient’s condition to improve sperm quality and sexual function.
Third, azoospermia
Azoospermia is defined as the absence of sperm after centrifugal sedimentation of ejaculated semen, and the diagnosis of azoospermia can be confirmed when no sperm is found in three examinations. Azoospermia can be divided into two main categories. The first category is testicular spermatogenic dysfunction, where sperm cannot be produced, also known as true azoospermia. The second category is normal testicular spermatogenesis, but the vas deferens is blocked and sperm cannot be discharged from the body, also known as obstructive azoospermia.
1. Treatment of true azoospermia due to sperm production disorder The treatment effect of this type of disease is poor, especially for azoospermia and diseases with serious testicular pathological changes. For patients with bilateral cryptorchidism, if early surgery is performed, fertility is still preserved, but if the patient is older than 5 years old and still not operated, the prognosis is not good. For low spermatogenic function, FSH value is within normal range, Chinese herbal medicines such as clomiphene can be used for 3 months, and if effective, continue to take until the sperm count is restored to 20-60 million/ml.
2. Treatment of obstructive azoospermia For those with obstruction due to inflammation and edema of the vas deferens, antibiotics plus glucocorticoids can be used; for those caused by cyst compression, the cyst can be surgically removed.
Fourth, high malformation rate sperm
If the percentage of deformed sperm is higher than 50%, it is called high deformed rate sperm, which can lead to infertility.
The presence of a large number of malformed sperm in semen reflects testicular abnormalities; certain drugs such as furans can increase the rate of sperm malformation; varicocele can lead to an increase in malformed sperm, typically double-headed sperm; in addition, some acute diseases and physical and mental factors have a causative role.
If you are looking for the cause, you should stop taking medication immediately, high ligation is feasible for varicocele, anti-infection treatment is performed for those who have reproductive tract infection, testicular sperm abnormalities are more difficult to treat, artificial insemination can be considered.
V. Hemospermia
Hemospermia is defined as the presence of blood in the semen. It is usually pink, red, brownish red or with blood. Depending on the nature of the lesion and the amount of blood contained, it can be manifested as naked-eye hematosperm, blood clots and microscopic hematosperm.
Inflammation of the seminal vesicles and prostate, tuberculosis, hemosiderosis, stones and injuries can lead to hematospermia, among which seminal vesiculitis is the most common; some tumors such as seminal vesicle, prostate cancer, sperm papilloma, benign prostatic hypertrophy can also cause hematospermia, varicose veins of the seminal cord and some blood system diseases may also cause hematospermia.
In addition, prostate massage, prostate laser and drug iontophoresis treatment are also effective; seminal vesicle and prostate tuberculosis should be given anti-tuberculosis treatment; seminal vesicle and prostate malignant disease should be operated early. The cause is not very clear, but also should stop intercourse, anti-infection, hemostatic or physiotherapy treatment, if necessary, feasible cystoscopy found to have bleeding feasible electrocautery treatment.
Sixth, low sperm motility and dead sperm
Within one hour after sperm discharge, the sperm with vitality should be more than 70%, if there are sperm with vitality less than 50% is abnormal, called sperm hypo-motility, also known as weak sperm. If the sperm is completely inactive, it is called dead sperm. Low sperm motility and dead sperm is one of the important causes of male infertility.
1, long-term abstinence, long-term non-ejaculation often high sperm density, more dead sperm, poor sperm motility, this situation is normal, so 5-7d abstinence is appropriate before the examination of semen.
2, reproductive tract infection, reproductive tract infection makes the seminal plasma composition change zinc, magnesium, citric acid, fructose reduction and pH increase will affect sperm vitality.
3, varicocele, due to impaired blood circulation in testes and epididymis, local temperature increases and toxic substances accumulate, making sperm motility low.
To treat the cause, anti-infection treatment should be applied to germline infections, and varicocele should be treated by surgery as early as possible. Increase sperm energy, participate in the metabolic process of sperm or increase the activity of certain enzymes in sperm or semen to enhance sperm activity and help sperm activity. For example, nucleotides, pancreatic kinase releasing enzyme, hexoketone cocaine, zinc, and vitamin A and vitamin E.