Part 1: What is the main problem of male infertility?
What is the difference between the male clinic in the reproductive center and the general male clinic?
At present, male clinics in public hospitals in China are mainly based on urology or reproductive centers, and the scope of treatment includes all male diseases, but the focus is different. Most of the male clinics in hospitals are based on urology and can be called urological male clinics, which may be what you call general male clinics. Urological male clinics mainly focus on the treatment of male diseases that require surgery, such as varicocele and circumcision, as well as some male diseases that affect urination, such as prostatitis and prostatic hyperplasia.
As the name implies, reproductive male medicine is the treatment of male reproductive system diseases, generally not those requiring hospitalization, but can do artificial insemination and IVF and other assisted reproductive technologies, reproductive male medicine mainly focuses on the treatment of male infertility, as well as some fertility-related male diseases, such as impotence, premature ejaculation, ejaculation difficulties The Department of Reproductive Gynecology focuses on the treatment of male infertility, male fertility-related diseases such as impotence, premature ejaculation, ejaculation difficulties, low libido and other sexual dysfunctions, chronic prostatitis, epididymitis, vesiculitis and other inflammatory diseases of the adnexal glands, Kaman syndrome and other hypogonadism, as well as reproductive health and eugenic counseling.
What are the main problems of male partner in the current infertility of couples? Can you roughly rank them?
Male infertility is defined by the World Health Organization as infertility of the female partner due to male factors after the couple has lived together for more than one year without using any contraception. Male infertility is not an independent disease, but the result of one or more diseases or factors.
In men with infertility, the main problems, when ordered from common to uncommon, include.
The first type of problem is sperm abnormalities, mainly oligo-weak deformed spermatozoa and azoospermia. Weak spermatozoa are the most common, that is, poor sperm motility, with the percentage of forward-moving sperm below 32%; oligospermatozoa, that is, too little sperm density or total number of sperm; teratozoa, that is, too many sperm with abnormal morphology and too low percentage of normal morphology, which reflects the deviation of the overall fertilization ability of sperm; and azoospermia, that is, no sperm can be found in the ejaculated semen. Other infertility patients have problems such as abnormal sperm acrosome reaction and high sperm DNA fragmentation rate. Abnormal sperm acrosome reaction indicates poor sperm penetration of the egg, and high sperm DNA fragmentation rate not only reduces the sperm fertilization ability, but also may cause poor quality of the embryos after fertilization, which may lead to embryo abortion and miscarriage.
The second type of problem is sexual dysfunction. Severe sexual dysfunction can cause the male partner to be unable to ejaculate semen into the female partner’s vagina, and thus unable to conceive naturally. For example, penile erectile dysfunction, commonly known as impotence, is manifested by difficulty or lack of hard erection of the penis, which makes it difficult to insert into the woman’s vagina to complete intercourse, not to mention ejaculation in the woman’s vagina; severe premature ejaculation patients will ejaculate before the penis is inserted into the woman’s vagina and cannot ejaculate semen into the woman’s vagina; patients who have difficulty ejaculating during intercourse are often accustomed to ejaculating under the stimulation of excessive masturbation, and cannot Ejaculation during vaginal intercourse, unable to ejaculate semen into the woman’s vagina; in patients with retrograde ejaculation, semen is not ejaculated forward out of the body via the urethra during ejaculation, but is ejaculated backward into the bladder or posterior urethra, manifesting as no semen is ejaculated during ejaculation, while some sperm is flushed out when urinating after ejaculation; in patients with low libido, it is also difficult to conceive naturally due to too little sexual intercourse.
In addition to the two common problems mentioned above, there are also some fertility-related diseases, such as chromosomal abnormalities and couples carrying mutations in the thalassemia gene, which may cause recurrent miscarriage or fetal abnormalities in the female partner.
Part 2: Can I take medicine to solve the problem of sperm detection?
Can I take medicine to solve the problem of sperm detection? What are the chances?
Mild to moderate sperm abnormalities, such as oligo- and malformed spermatozoa, abnormal sperm acrosome reaction, and high sperm DNA fragmentation rate, can mostly be improved or cured through treatment. Those with severe oligo- and malformed spermatozoa may take longer to improve, and some patients have difficulty returning to full normalcy and require assisted reproduction techniques such as IVF to obtain children. The majority of azoospermia cannot be treated simply by taking medication to make sperm appear in the semen and requires IVF technology to obtain fertility. The treatment of sperm abnormalities is not only medication, but also includes life care and surgery. These three treatments are sometimes used in combination, and it is best to find some of the causes of infertility and treat the causes for better results.
How do I know if the medication is working? How long do I have to observe?
A complete spermatogenesis cycle is 3 months, which, by analogy, means that it takes 3 months for the raw material to change into a complete product through the various stages of the production line, and medication is applied to the various stages of this production line to improve the production and quality of this product of sperm. Therefore, the medication for sperm abnormalities is usually a course of treatment for 3 months, with 3-6 months of continuous treatment. During the course of treatment, weak spermatozoa, can be reviewed every 1 month, and oligospermia, deformed spermatozoa, abnormal sperm acrosome reaction, and high sperm DNA fragmentation rate, can be reviewed once every 2-3 months. During the treatment, the medication will be adjusted according to the semen examination results and the patient’s response.
If the sperm abnormality does not improve significantly during the treatment process, it indicates that the condition is more serious, and it is recommended to change the drug treatment plan in time; if the woman has not gotten pregnant after 6 months or more of treatment with drugs, she can consider using assisted reproduction techniques such as artificial insemination or IVF to produce offspring. Some patients with severe oligo- and azoospermia and azoospermia may choose to directly use assisted reproductive techniques such as IVF to have offspring. Don’t delay too long because the fertility of women decreases with age. If you delay until the woman is older, it will be difficult to make the woman pregnant even if the man’s sperm is completely normal.
If the semen has improved, how should I have sex to help improve my chances of pregnancy?
In male infertility, it is possible to try to get pregnant naturally during the treatment process. Most of the medications used to treat male infertility are not harmful to fertility and there is no need to worry about causing fetal abnormalities.
In terms of sexual life, in order to improve the success rate of pregnancy, the first is to ensure that the man can ejaculate sperm into the woman’s vagina. If the man has sexual dysfunction such as impotence, premature ejaculation and ejaculation difficulties, and the woman has sexual dysfunction such as vaginal dryness, vaginal atresia and sexual frigidity, they must be treated in time; the second is to ensure enough sexual intercourse, men in their 20s and 30s can have intravaginal intercourse once every 2-3 days The third is to ensure that the woman has intercourse during ovulation, the woman simply based on the menstrual cycle projection and measurement of body temperature, it is difficult to accurately calculate the ovulation date, it is recommended that it is best to first project the ovulation date based on the menstrual cycle, near the ovulation date, using ovulation test paper or ultrasound monitoring ovulation and other methods to monitor ovulation, on the day of ovulation and the next day to have intravaginal intercourse, in these two days over Sexual intercourse is the easiest way to get pregnant. Especially for those couples who do not have a regular enough sex life due to separation, they should at least make sure to have sex during the woman’s ovulation period.
If the male partner’s semen is found to have problems, does the female partner also need to complete any tests?
Infertility is related to both partners, so it is better for both men and women to come to the hospital together for examination. The male partner should first have his semen checked and abstain from ejaculation for 3-6 days before the test. For the female partner, firstly, blood should be drawn to check ovarian function, that is, some reproductive endocrine hormones, usually on the 2nd-5th day of menstruation, and the day of menstrual bleeding should be taken as the first day for calculation; secondly, the female partner should have a gynecological physical examination and vaginal discharge examination to see if there are any vaginal atresia, vaginitis and other diseases; thirdly, the female partner should have a gynecological ultrasound to check the uterus, ovaries and other organs. These are the most basic tests for infertility. If the male partner’s semen examination is generally normal, the female partner should also undergo a tubal patency examination.
Part 3: When should I consider assisted reproductive technology?
When should assisted reproductive technology be considered? What is the difference between artificial insemination and IVF?
Assisted reproductive technologies include artificial insemination and IVF (in vitro fertilization and embryo transfer), both of which can increase the success rate of pregnancy. The combination of sperm and egg is a process of natural selection, and the more natural the method of conception, the more natural it is and the healthier the offspring. In order of naturalness and cost, natural pregnancy, artificial insemination and in vitro fertilization are the most popular methods of fertility.
Natural pregnancy is when a couple gets the woman pregnant through intravaginal intercourse and ejaculation. This type of fertility is the most natural and healthy.
In artificial insemination, the semen ejaculated by the male partner is washed and optimized in the laboratory of the fertility center on the day of ovulation of the female partner, and the most motile part of the sperm is selected and delivered to the uterine cavity of the female partner through an injection device, allowing the sperm and the egg to unite naturally inside the female partner. According to the source of the sperm, artificial insemination is divided into “husband insemination” and “sperm donor insemination”, which are artificial insemination with the sperm of one’s own husband and artificial insemination with the sperm of another person (sperm bank), respectively. The commonly referred to artificial insemination is the husband’s sperm artificial insemination.
The basic prerequisites for IUI are that the male partner has a sufficient number of motile sperm in his ejaculate, the female partner has at least one open fallopian tube and normal ovulation in that ovary, and the female partner has a normal uterus or abnormalities that do not affect the IUI operation or the conception of the fetus. IUI can be done if the following conditions exist.
1, mild to moderate male sperm or semen abnormalities, such as various kinds of oligo- and malformed sperm, long liquefaction time or non-liquefaction of semen.
2. Sexual dysfunction of the male partner, who can ejaculate semen out of the body but cannot ejaculate semen into the vagina of the female partner, such as hypospadias, retrograde ejaculation, penile erectile dysfunction, premature ejaculation, and difficulty in ejaculation during intercourse.
3. Spasm or anatomical abnormality in the vagina of the female partner, which prevents semen from entering the vagina.
4.The female party’s cervix factors hinder sperm from entering the uterus, such as cervical stenosis, thick cervical mucus, etc.
5.Ovulation disorder of the female party.
6.Mild to moderate endometriosis on the female side.
7. Immune factors, such as positive anti-sperm antibodies in male semen and positive anti-sperm antibodies in female cervical mucus.
8. Unexplained infertility.
If you have done IUI three times and failed, you generally have to do the first generation of IVF, of course, some people can continue to try IUI several more times.
IVF is the common name for in vitro fertilization and embryo transfer (IVF-ET) technology. Instead of a baby actually growing up in a test tube, “IVF” involves removing several eggs from the woman’s ovaries, having them combine with the man’s sperm in a laboratory to form an embryo, and then transferring the embryo to the woman’s uterus, where it can implant and gestate. In the past, IVF technology was divided into three generations, first, second and third generation IVF, and this three-generation classification is no longer accepted. In the past, the so-called first-generation IVF technique, or conventional IVF, involved removing the woman’s eggs through medication to promote ovulation and egg retrieval surgery, placing them in preferentially processed semen, then fertilizing and developing them into embryos in a petri dish, from which high-quality embryos were selected and transferred back to the woman’s uterus for implantation and development; this technique only provided a platform for the sperm to combine well with the eggs, and the doctor did not directly intervene in which sperm met the egg. The doctor does not directly interfere with which sperm will unite with the egg.
Conventional IVF is mainly used for women with tubal infertility, such as tubal ligation or inflammatory conditions that cause tubal incompetence. In the past, the so-called second generation IVF technology, namely intracytoplasmic sperm injection alone (ICSI), was used to fertilize a single sperm directly into the cytoplasm of the egg under a microscope, that is, this sperm had to rely on human help in order to unite with the egg; it is mainly applied to patients with severe oligo-, hypo-, and malformed spermatozoa, severe sperm acrosome abnormalities, and mature sperm can be obtained through testicular or epididymal sperm retrieval procedures Patients with azoospermia. In the past, the so-called third generation IVF technology, i.e. pre-implantation genetic diagnosis (PGD), was used to obtain embryos through the above-mentioned IVF technology, and then genetic diagnosis was performed on the embryos to select healthy embryos for transfer back to the uterus; it is mainly applied to genetic diseases such as chromosomal translocation and thalassemia.
Part 4: Male infertility consultation guide.
What is the success rate and price of assisted reproductive technology at Zhongshan First Hospital?
As one of the birthplaces of assisted reproductive technology in China, the reproduction center of Zhongshan First Hospital, where I work, can do most of the assisted reproductive technologies including artificial insemination and IVF, but of course the success rate and cost of different assisted reproductive technologies are different. Pregnancy rate, which is the percentage of getting the woman pregnant. In 2013, the pregnancy rate at our center was 12,48% for IUI, 47,32% for conventional IVF, 46,23% for intracytoplasmic sperm injection (ICSI), and 37,16% for preimplantation genetic diagnosis (PGD), which costs about $3,000 to $5,000 per IUI, including the cost of testing and treatment. The cost of IVF and intracytoplasmic sperm injection (ICSI) is about $20,000 to $30,000, and the cost of preimplantation genetic diagnosis (PGD) is about $30,000 to $50,000. Of course, the exact cost will vary due to each person’s condition.
If the decision is made to do IVF, does the male partner need to continue taking medication? Or is there anything to be aware of or prepared for?
If you have already decided to do IVF, if the male partner has sperm abnormalities, you can continue to take medication until the sperm is back to normal, or until the day before the woman’s egg retrieval date, so that you can get the best possible sperm for IVF. Of course, if the semen has not improved significantly after 3-6 months of previous treatment, you can also give up the treatment and wait for IVF. In terms of daily life care, pay attention not to stay up late, go to bed before 11 pm, and try to avoid smoking and drinking. It is important to prepare the couple’s ID card, marriage certificate and family planning service certificate (for those who have a second child, they should prepare the second child birth certificate), with these documents, they can do assisted reproduction.
When a man suffers from infertility, where should he go for medical consultation and treatment? What fertility options should be chosen to obtain offspring?
Currently, with assisted reproductive technologies such as artificial insemination and IVF, male infertility patients have the choice between natural pregnancy and assisted reproduction, and fertility no longer seems to be a problem. However, there are still many infertile couples who struggle with confusion and pain, and the main problem lies in the choice. To summarize, male infertility patients, should choose the right doctor, at the right age for the female partner, and choose the right fertility modality.
First, choose the right doctor. As the saying goes, finding the right person can make things happen, and choosing the right doctor can be good. At present, many hospitals have fertility centers, which are medical institutions specializing in infertility treatment. Reproductive centers are equipped with gynecologists to see female infertility patients, male doctors to see male infertility patients, couples can be examined together and treated together, reproductive centers can provide medication, surgery, assisted reproduction and other treatment methods to solve infertility problems. Therefore, to see infertility, it is preferred to visit a reproductive center.
Second, choose the right age for the female partner to complete the fertility. The first thing that male infertility patients should understand is that on the issue of fertility, the role of men is to provide sperm to help women get pregnant, by analogy, men provide the seeds and women provide the soil. The best seeds cannot germinate and grow even if they are placed in the desert. And a woman’s fertility is closely related to her age, a woman’s age is one of the most important factors affecting the success rate of pregnancy. A woman’s fertility at age 35 is 50% of what it was at age 25, dropping to 25% by age 38, and dropping to less than 5% over age 40. Therefore, purely from the point of view of age, it is best for a woman to get pregnant and have a child around the age of 25.
Third, choose the right fertility method. Male infertility patients should understand that assisted reproduction is after all risky and expensive, and that natural pregnancy is best. The choice of fertility method should be analyzed on a case-by-case basis, and male infertility patients should preferably visit a fertility center to choose the right treatment and fertility method with the help of a doctor’s guidance.