I. Purpose
Outpatients are more, the average time for each patient to treat the disease is very limited, so the advice is prepared, only personal opinion, and only male infertility some common things, each patient there are individual differences, for reference only, I hope it will be helpful to you.
The simple interpretation of semen routine
There are three main parameters of semen routine: sperm concentration, vitality (generally only look at the a and b level sperm, these are forward motion sperm, forward motion ability is necessary for insemination) and sperm morphology.
Sperm concentration is required to be greater than 20 million/ml;
Sperm viability a ≥ 25% or grade a+b ≥ 50%, generally without looking at sperm viability (because sperm viability = grade a+b+c sperm); normal morphology sperm ≥ 4%.
About morphology: the 3rd edition of the World Health Organization manual normal morphology to account for more than 30%; the 4th edition of the World Health Organization manual normal morphology as long as it accounts for more than 15%; the 5th edition of the World Health Organization manual, normal morphology as long as it accounts for more than 4%, which is the same as the student examination, the teacher is difficult, the student examination score will become lower, the same reason, the morphology of the standards set more and more stringent, the patient morphology The morphology is mainly related to the probability of pregnancy, but not to the essence of the sperm (genetic material), just as there is no direct relationship between the appearance and the essence of a person, so you should not worry.
The parameters of azoospermia are only to assess the probability of pregnancy, not the ability or inability to conceive, nor to predict the quality of embryos, etc.
The probability of pregnancy is 0 for azoospermia patients, but there is a probability of pregnancy if there is sperm, but the worse the semen routine parameters are for male infertility patients, the lower the probability of pregnancy.
The general treatment plan for male infertility
1. The female partner should also see a reproductive gynecologist
Infertility is about 40% male factor, 40% female factor, and 20% because of the current level of medicine, no clear cause can be found, and it may be related to both men and women, so it is necessary to see the doctor at the same time.
Female fertility is more related to age: when a woman reaches 35 years old, her fertility is only 50% of that of 25 years old, when she reaches 38 years old, it is only 25%, and over 40 years old, it is less than 5%. The success rate of IVF is more related to the age of the woman: 30-40 years old for women, 30-40% for women, 5-10% for women between 40-45 years old, and almost 0 for women over 45 years old. therefore, if the woman is older, it is advisable to have an aggressive treatment plan. This is only a recommendation, and the female partner’s situation is specifically assessed by a reproductive gynecologist.
2. Precautions for the male partner
Avoid smoking, drink less alcohol (less than a medium amount of alcohol does not affect fertility), stay away from radiation and harmful chemicals, do not take a sauna, do not wear tight underwear for a long time (taking a sauna or wearing tight underwear for a long time will increase the local temperature and inhibit sperm production, some data show that if the fever exceeds 39 degrees, it is possible to inhibit sperm production for more than six months). Exercise and weight loss are also beneficial for fertility.
Precautions, although not drugs, do not cost money, but also very important, such as smoking can affect the success rate of IVF, if the patient smokes, some famous foreign fertility centers generally do not give IVF.
3. Treatment of male infertility
There are generally three treatment options, medication, artificial insemination or IVF. Medication, if it does not achieve the goal, then consider artificial insemination; if it has not achieved the goal, or can not do artificial insemination, then consider in vitro fertilization. The treatment of all diseases is the same, and is based on the principle of moving from simple to complex and from non-invasive to invasive. It is not advisable to choose too high technology, because the higher the technology, the more human interventions, the more troublesome and costly; as long as the interventions, it is not the natural state, the more interventions, the further away from the natural state, then the higher the potential genetic risk.
Preferred drug treatment: to understand the drug effect and drug treatment time of.
(1) Drug action: The role of drugs to improve each parameter of semen routine is to increase the probability of pregnancy;
(2) Drug treatment cycle: human spermatogenesis cycle is 70-74 days, about 3 months, so if you take empirical drug treatment, the course of treatment should be generally 1-2 spermatogenic cycles, that is, 3-6 months, such as the efficacy of the need to consider assisted reproductive technology, rather than the unlimited use of more expensive spermatogenic drugs;
(3) But not intermittent medication, because the spermatogenic cycle is continuous, so it is generally 1 month of medication, about 25 days to review the. In the case of hypogonadotropic patients, the medication is usually administered for 12-18 months.
Artificial insemination.
Artificial insemination, generally recommended to do 3-6 cycles in a row, the data show that the cumulative success rate of 3 cycles of artificial insemination is about 20%. However, it is determined by the reproductive gynecologist.
In vitro fertilization.
(1) can do the first generation of IVF, not the second generation of IVF, because the higher the more money spent, the higher the risk, but the specific by the laboratory according to the actual situation;
(2) if the IVF stage, the general female can only take more than 10 oocytes, ovulation, the woman is prone to over-row, dangerous; if the female ovarian function is not good, take fewer oocytes, for the number of these oocytes, the number of sperm available to the male is generally sufficient, so do not worry, do not have to use a lot of drugs.
When to consider assisted reproductive technology (artificial insemination or IVF)
It is not advisable to choose too high technology, because the higher the technology, the more human intervention, the more trouble and money; as long as the intervention, it is not the natural state, the more intervention, the further away from the natural state, then the higher the potential genetic risk.
There are two general situations in which the decision to do artificial insemination or IVF is made.
1. A protocol developed by a reproductive gynecologist based on the objective situation of the female partner. This option is not a matter of how the patient wants to be treated, but rather the objective situation of the female partner’s disease determines the next step to consider assisted reproductive technology (IUI or IVF).
2. The situation of the male partner. Generally speaking, there is no specific drug for male infertility, if the drug treatment 1-2 spermatogenic cycles, i.e. 3-6 months, the efficacy is not good, you need to advise the reproductive gynecologist to consider assisted reproductive technology, rather than the unlimited use of more expensive spermatogenic drugs