I. Definition.
Male infertility is not an independent disease, but a more complex clinical syndrome. Generally refers to cohabitation after marriage for more than 1 year, without contraception, due to the male partner causes female infertility. Infertility occurs in 10% of married couples in China, with the male and female partners accounting for half of the causes. The causes of this disease are complex, and many diseases or factors can lead to male infertility.
Second, the etiological classification
1, according to the results of semen examination, can be classified as azoospermia, severe oligospermia, oligospermia, infertility with normal sperm count, polyspermia and weak spermatozoa. The treatment of this disease focuses on identifying the specific causative factors and carrying out etiological treatment. For absolute infertility (such as azoospermia), artificial insemination with donor sperm is required.
2, congenital disorders due to endocrine diseases and chromosomal abnormalities, manifesting as sexual maturation disorders, insufficient masculinization, breast enlargement, testicular atrophy, small penis, low libido, premature ejaculation and impotence, etc.
3, congenital abnormalities of testes: no testes, cryptorchidism and testicular hypoplasia, etc.
4, Varicocele: painful scrotal swelling, palpable masses of varicose veins in the scrotum, VALSALVA test (+).
5.Infection of reproductive ducts.
6, sexual dysfunction.
III. Normal values of semen routine: normal values of semen (WHO 5th edition): semen volume 1.5ml (1.4-1.7ml), total sperm count 39×106 (33-46) / one ejaculation, sperm density 15×106 (12-16)/ml, total viability (fast forward motion + non-fast forward motion) 40% (38-42%), fast forward motion 32% ( 31-34%), survival rate (live sperm) 58% (55-63%), morphology (normal morphology) 4% (3-4%).
IV. Treatment principles
1.Etiological treatment.
2.Endocrine therapy.
3.Non-specific treatment.
4.Surgical treatment.
5, artificial insemination.
(1) Infertility caused by genital tract infection is treated mainly with antibiotics and anti-inflammatory therapy, supplemented by drugs to improve sperm vitality.
(2) Azoospermia, oligospermia and idiopathic infertility should be treated mainly with sex hormone drugs for endocrine therapy.
(3) For low sperm vitality, drug therapy to improve sperm vitality should be the main treatment.
(4) For varicocele, obstruction of vas deferens, cryptorchidism and urethral fissure leading to infertility, surgical treatment should be performed, supplemented by endocrine drugs and other adjuvant drugs.
(5) For absolute infertility (such as azoospermia), artificial insemination should be performed.