Having children is undoubtedly a very important thing for a family. However, according to the World Health Organization (WHO) survey, about 15% of couples of reproductive age have infertility problems, and in some areas of developing countries it can be as high as 30%, with 50% of causes for both men and women. Some studies have concluded that sperm concentration in Caucasian Caucasian men has declined at an average rate of 2.6% per year over the past 20 years, and the proportion of normal sperm and motility have declined by an average of 0.7% and 0.3% per year, respectively. Some reports show that the semen quality of men in China is declining at a rate of 1% per year, especially in terms of sperm concentration.
One wonders how to improve fertility when preparing for childbirth in the near future. What drugs can I take to treat poor semen test results? What should I do if I can’t have children even though I have taken a lot of medications in many hospitals? After several failed IVF attempts, can I still have children? …… below we will talk about the misconceptions and questions about male fertility.
I. How long does it take for a woman to get pregnant after living together? When should I suspect fertility problems?
Under normal circumstances, the pregnancy rate of couples with normal fertility is generally about 25-30% in a single month, about 75% in half a year, and about 85-90% in a year. 25-35% of couples who fail to have children within a year can get pregnant naturally in some time in the future without treatment, of which about 23% are within 2 years and about 10% are more than 2 years. If the duration of infertility exceeds 4 years, the monthly pregnancy rate is only about 1.5%. Therefore, WHO recommends that when you have regular sex and have not used any contraception for more than 1 year and have failed to have children, you may have fertility problems and need to visit a hospital. One of the cases where the female partner is infertile due to male factors is called male infertility. Male infertility is not an independent disease, but the result of one or many diseases and/or factors.
Second, if you want to have a child as soon as possible, must you wait until after 1 year of cohabitation to go to the hospital?
Nearly 90% of couples can conceive naturally within 12 months. It was once thought that male infertility evaluation was only considered after 12 menstrual cycles or 1 year of unprotected sex, or after 6 menstrual cycles or 6 months of unprotected sex for women over 35 years of age who are still not pregnant. However, it is now considered that evaluation of male fertility status can be performed at any time, depending mainly on the couple’s fertility requirements, especially if there are family reasons or suspicion of abnormalities in either of the couple, without having to try to conceive naturally for more than 1 year before being evaluated in the hospital.
What is included in the assessment of male fertility?
The assessment of male fertility includes basic items and special items.
(1) Basic items: mainly for general screening, including past medical history, reproductive history, physical examination and semen analysis.
(2) Special items: mainly used for confirming the diagnosis and classifying the disease, according to the test results of the basic items and different requirements of patients, including ultrasound of the reproductive system, endocrine hormone test, seminal plasma test, chromosome test and testicular biopsy, etc.
IV. What is semen analysis? What are the things that patients need to pay attention to before the examination?
(1) What is semen analysis? What tests are included?
It is the most basic and primary test for assessing male fertility and provides an important basis for evaluating male infertility, and abnormal results often indicate reduced fertility. The test indexes include semen volume, semen appearance, liquefaction degree, total sperm count, sperm density, sperm viability, sperm survival rate, sperm morphology, etc. Among them, the most closely related to fertility are total sperm count and viability, while sperm morphology test has important reference value for predicting the success rate of in vitro fertilization-embryo transfer.
(2) What do I need to pay attention to before the semen analysis test?
① Abstinence time should be kept at 3~5 days. The length of abstinence before semen discharge can cause significant changes in semen volume and sperm density, which can affect the results of semen examination. The number of sperm increases slowly after 4 days, and the sperm density decreases when it exceeds 7 days, and the number of dead sperm and abnormal sperm may appear after long-term abstinence. The number of dead sperm and abnormal sperm may increase after prolonged abstinence. The WHO recommends abstinence for 2-7 days, but abstinence for shorter than 2 days or longer than 7 days has a greater impact on semen quality and is generally not used.
② Collect all semen intact when taking semen. When semen is ejaculated, the initial front semen discharge is clear and sticky, mainly playing the role of lubricating the urethra to facilitate ejaculation, with very little sperm content; the second discharge is the main part of the ejaculation, with the highest number and quality of sperm; the last ejaculation is the rear semen discharge, with very little sperm and low quality of fertilization. Therefore, when masturbating to take semen, you need to align the semen collection container and collect all the semen intact.
③ Is it possible to collect semen at home and send it to the hospital later? Under normal circumstances, semen liquefaction takes 15-20 minutes after semen discharge. The composition and pH of the liquefied semen will change over time, and leaving semen for a long time will inevitably lead to sperm viability being affected, so semen analysis should be performed within 1 hour after semen is obtained, and should not exceed 2 hours when semen is incompletely liquefied or not liquefied at all. In addition, both semen liquefaction and sperm viability are affected by temperature. Therefore, semen should be collected in the nearest examination room within the hospital. If the patient cannot adapt and cannot take semen in the hospital, semen can be collected at home or in a hotel near the hospital, etc. However, semen should be sent to the hospital examination room within 30 minutes after removal, and the specimen should be kept close to the body to keep warm at 25~37° if it is a cold day.
(3) How many times does semen examination need to be done? How long is the interval between each time? What should I do if the semen test result is bad or good?
Parameters such as semen volume, sperm density and sperm motility are affected by various factors such as usual health level, good or bad rest and alcohol consumption. Therefore, it is possible that the results of each semen analysis may be different, or even vary greatly. It is not possible to make an evaluation based on the results of one semen analysis, and it is necessary to perform 2 to 3 semen examinations at an interval of 2 to 3 weeks, which can provide an appropriate evaluation of the basic function of sperm production. In order to accurately compare different semen specimens from the same patient, the duration of abstinence before semen collection must be consistent. For patients with large differences in semen parameters, especially those with recent infections, fever, and exertion, abnormal semen quality due to physical condition is considered and needs to be checked again after recovery from physical condition. Those with fever of 39℃ or more have a greater impact on the spermatogenic function of the testes, and it is recommended to recheck semen after 2~3 months.
V. How to read the semen analysis report
There are often “patients” inquiring whether the semen quality meets the standard in outpatient clinics or on the Internet, and most of them feel frustrated and anxious because of a slightly abnormal index.
It should be noted that many “patients” with semen analysis reports ask, “According to this report, can we get pregnant? What is the probability of getting pregnant?” Unfortunately, it is not possible to judge whether or not we can get pregnant or the probability of pregnancy based solely on the semen analysis report, but only to speculate about the high or low probability of male fertility. Fertility involves a variety of factors such as the total number, density and viability of the male partner’s sperm, the function of sperm-egg binding, and the fertility of the female partner, so there is no direct correlation between good or bad semen quality and fertility.
For example, in some couples, both the male partner’s sperm and the female partner’s egg quality are fine, but they are still unable to have children. This may be due to some immune factor or other as yet unrecognized factors that cause problems with sperm and egg binding disorders. Similarly, abnormal semen does not necessarily mean that you cannot have children. For example, some men may have less than standard sperm density but may succeed in getting pregnant because of their high sperm motility, low malformation rate, or their wife’s exceptional fertility. The probability of natural fertility in azoospermia patients is 0. As long as there are active sperm, there is a probability of pregnancy, but for male infertility patients, the worse the semen routine parameters are, the lower the probability of pregnancy.
What should I do if the semen analysis results are abnormal?
In clinical work, we often encounter most patients with abnormal semen analysis results, and the first question they ask is “What medication can I take?” The first question that most patients ask is “What medication can I take?”, or they have already gone through many hospitals and used many kinds of medications without any effect, without further examination of what causes the problem. In fact, there are many causes of male infertility, so the treatment of male infertility must first identify the cause, and then take the cause of the cause of treatment, including drugs, surgical treatment or assisted reproduction.
Seven, what are the causes of male infertility? Is it treatable?
There are many causes of male infertility, in the common order of idiopathic infertility, varicocele, reproductive tract infection, reproductive duct obstruction, chromosomal or genetic abnormalities, cryptorchidism, immune infertility, endocrine system diseases, sexual intercourse or ejaculatory dysfunction, testicular tumors, systemic diseases, and other causes.
There are many causes of male infertility, some diseases can be treated to conceive naturally, some diseases without special treatment require assisted reproductive technology, and even some diseases are infertile and require artificial insemination by donor sperm or adoption. Therefore, the first clear cause of male infertility and whether it is fertile, is the key to take the appropriate treatment.
Is it possible to do IVF directly without treatment?
In the male clinic, we often encounter patients suffering from male infertility who directly request assisted reproduction (IVF) without detailed examination of the cause or any treatment. They simply do not understand that most (more than 80-90%) male infertility can be cured clinically and achieve natural fertility, and that only 10-20% of patients really need assisted reproductive technology. They are even less aware of the conditions that require assisted reproduction and the potential risks of assisted reproduction for the woman and the newborn.
Assisted reproductive technology (abbreviated: ART), as one of the most important means of treating infertility today, has excellent efficacy and is constantly being optimized to achieve good clinical safety, especially for some specific clinical cases where ART has an irreplaceable role. Currently, the main types of ART include intrauterine injection (IUI), artificial insemination with husband sperm (AIH), artificial insemination by donor sperm (AID), in vitro fertilization-embryo transfer (IVF-ET), intracytoplasmic sperm injection (ICSI), etc. ART not only has high cost and low success rate, but also uses non-coital means to assist pregnancy, which bypasses the selection process of sperm for natural pregnancy to a certain extent, and The gametes and embryos are easily disturbed by external factors in in vitro culture, which may cause harm to the development of embryos and fetuses. The main safety issues include.
(1) AIH: for in vitro processing of semen followed by artificial insemination, which may cause complications such as intrauterine infection, ectopic pregnancy and cramping lower abdominal pain in the female partner; if frozen semen is used, sperm DNA and other cell structures may be damaged during the freezing-recovery process, affecting fertilization and embryo development.
(2) IVF-ET: ovarian hyperstimulation syndrome occurs in female ovulation promotion; bleeding and infection and other complications occur in egg retrieval and embryo transfer; abnormal embryo development or even death during in vitro culture process due to external factors; embryo failure to settle after transfer, ectopic pregnancy, multiple pregnancy, miscarriage; artificially taking a few sperm, so that the sperm lose the superiority competition in the fertilization process The Y chromosome with genetic defects may be brought to the next generation, so that the offspring carry congenital genetic defects, etc.
(3) ICSI: Ovarian hyperstimulation syndrome, premature ovarian failure, complications such as bleeding and infection during egg retrieval and embryo transfer; mechanical or chemical damage to the cell structure of the egg caused by microinjection; abnormal embryo development or even death due to external factors (such as temperature change, toxicity of culture medium or sperm braking agent, etc.) during in vitro culture; failure of embryo to implant after transfer; and the failure of embryos to implant after transfer. embryos cannot be implanted, ectopic pregnancy, multiple pregnancy, miscarriage; the offspring may carry congenital genetic defects, especially in patients with Y chromosome AZF microdeletion, which can be passed through ICSI and cause male offspring infertility.
Since the male partner suffers less pain during ART, while the female partner suffers more pain and potential danger, some scholars believe that doing ART directly without detailed examination of the causes of male infertility and formal treatment is an inhumane act of “blaming” the male partner’s problems on his spouse. In addition, some scholars believe that in vitro fertilization babies are three times more likely to be born with serious cardiovascular disease, cerebral palsy, and other central nervous system disorders than naturally fertilized babies. Therefore, the clinical treatment of male infertility should prefer conventional treatment options such as drugs or surgery, and then ART if necessary.
All things follow the laws of nature, and this is especially true for human reproduction. It is recommended that patients suffering from male infertility should not do IVF as a last resort for the sake of the health of their spouses and the next generation, and try to have a healthy baby through natural fertility treatment.
IX. Which diseases among the causes of male infertility can be treated for natural fertility?
Although there are many diseases that cause male infertility, varicocele, reproductive tract infection, and obstruction are the most common. These diseases can generally be cured by medication or surgery, and their improvement of sperm quality and pregnancy rate is relatively high.
(1) For example, if varicocele is treated by microscopic spermatic vein ligation, the semen quality improves in 60-80% of patients after surgery, and the natural conception rate is about 43% and 69% after 1 year and 2 years, respectively, if the spouse has no infertility factors. After varicocele surgery, the pregnancy rate increases by an average of 30% and the preterm birth rate decreases by 57% even when ART is used in the absence of spontaneous pregnancy. For more information on varicocele, see “Male Genital Malformations and Diseases Treatment No. 6 – Varicocele” and “What is the best surgical option for varicocele patients? .
(2) If the vas deferens or epididymis is obstructed, vas deferens-vas deferens anastomosis or vas deferens-epidididymis anastomosis can be performed under microscope, and doctors with microsurgical skills can increase the rate of vas deferens or epididymis recanalization to more than 60~87% after surgery, and the rate of natural pregnancy after surgery can also reach 30~43%.
(3) For patients with genital tract infection, after semen pathogenic bacteria examination and the use of sensitive antibiotics, most patients can be cured of genital tract infection and improve semen quality.
(4) In the case of genital deformities or diseases such as urethral stricture, urethral fistula, hypospadias, epispadias, severe penile curvature, severe penile trauma, pelvic fracture, vascular factors (such as venous fistula) or neurological diseases causing penile erectile dysfunction, oral medication, negative pressure suction device, implantation of penile prosthesis (penile pacemaker) and external genital deformity correction are selected according to their etiology to (5) In addition, in case of severe premature ejaculation, the patient should be able to have an erectile function and sexual intercourse.
(5) In addition, severe premature ejaculation (ejaculation outside the vagina before penetration) can also be treated with medication to delay ejaculation and ejaculate inside the vagina.
(6) In addition, when male infertility is caused by endocrine system diseases such as hypogonadism, hyperprolactinemia and thyroid disease, the quality of semen and pregnancy rate can also be improved by medication to treat the original disease.