A. How to know if you are likely to be infertile A man and a woman who are married and living together and have a normal sex life without any contraceptive measures and have not caused the woman to become pregnant after 1 year (12 months) should be considered infertile or low fertility and should be seen in a fertility clinic. Primary infertility is defined as having no past experience of conception, while secondary infertility is defined as having had a previous pregnancy that did not result in pregnancy in another woman for more than one year. A couple with normal fertility should have a probability of pregnancy of no more than 25% per month under the above conditions, so it is not advisable to undergo infertility-related tests prematurely before reaching the above time, unless there are obvious self-perceived abnormalities (e.g. severe erectile dysfunction, low continuous semen volume, non-ejaculation, no conception even after living together with girlfriends without contraception several times in the past, etc.). For men, fertility is largely determined by the quality of sperm, including sperm density and the total number of sperm in a row, sperm motility (referring to the speed of sperm movement and percentage of active sperm), sperm morphology, and the composition and state of seminal plasma, such as the presence of anti-sperm antibodies with high titers, and various important biochemical indicators in seminal plasma, etc. Next, the presence of infection in the semen, etc. Past fertility status, i.e. whether there is a history of conception and the number of years of infertility, is very important for treatment and prediction of fertility outcomes. This is because congenital male fertility loss persists, whereas reduced or lost fertility that occurs later in life usually has a more significant clinical course, such as testicular/epididymitis, exposure to radiation, certain medications, surgery, heat, drug use, severe varicocele, etc. Sexual function conditions, too infrequent conjugal life after marriage, abnormal ejaculation (non-ejaculation, retrograde ejaculation or severe premature ejaculation, inability to ejaculate semen into the vagina), severe erectile dysfunction inability to have sex, etc. can affect fertility. However, if semen can be ejaculated into the vagina, even if there is some degree of low sexual function, the effect on fertility will not have a greater impact. Similarly, masturbation or circumcision generally does not affect fertility. The age of the female partner, the age of the spouse is an important factor affecting the fertility of the couple. Statistics show that a woman’s fertility begins to decline at around 34 years of age, and both the ability to conceive naturally and the success rate of assisted reproductive technology treatment decline with age. Therefore, the younger the woman is, the longer she can be observed waiting to conceive, and conversely, the older she is, the more aggressive her treatment should be. Female factors, factors affecting female fertility are relatively more and more likely to occur than male, the common ones are tubal obstruction, pelvic adhesion, endocrine disorder, abnormal ovulation function, etc. The specific causes should be examined in gynecology. Developmental abnormalities of the reproductive system, congenital or acquired developmental abnormalities of both male and female reproductive systems can seriously affect fertility. Developmental abnormalities of the male reproductive system commonly include gonadal dysplasia (small testicles), vas deferens, urethral malformations, etc. Other diseases, including certain congenital or hereditary diseases, systemic diseases, endocrine causes, etc., and a small number of patients (about 10%), the cause of which cannot be determined due to the current level of medical technology. Third, understanding semen and semen examination Semen examination is a basic clinical test to determine male fertility, and is one of the tests that must be performed when infertile men undergo fertility evaluation or male infertility clinic visits. Male semen is composed of spermatozoa discharged from the epididymis, a small amount of epididymal fluid, about 1/3 of prostatic fluid and about 2/3 of seminal vesicle fluid, and the indicators reflecting fertility are mainly the number of spermatozoa, their activity and sperm morphology. Semen examination should be performed after a certain period of abstinence, which should be 2-7 days, too short or too long may affect the accuracy of the results. Semen indicators are affected by many factors, such as the frequency of semen discharge, the duration of abstinence after semen discharge, even the interval between two sexual intercourses before abstinence before the examination, the method of semen extraction and whether semen collection is complete. Therefore, the results of one semen test often cannot provide an objective analysis of fertility, and the results of two or more tests are required. Semen tests do not always accurately reflect male fertility, especially results near the threshold value. Low semen quality is not absolutely impossible to achieve a natural pregnancy, and conversely normal semen indicators are not always sufficient to achieve a natural pregnancy. The doctor should take into account the medical history, the condition of both partners and other tests. You should not make your own judgment against the reference value, terminate further examination or carry a psychological burden by whether the examination result is normal or not. The following abnormalities should be highlighted to the doctor because they are high-risk factors that may affect male fertility: history of pubertal development: past acute mumps, testicular descent and abnormal development history of testicular injury: scrotal swelling and pain after severe perineal trauma, open scrotal injury history of surgical procedures: hernia surgery, testicular surgery, spermatic cord varicose vein surgery and pelvic spine surgery History of drug or drug exposure: antineoplastic drugs, hormones, some traditional Chinese medicine History of genitourinary system infection: severe urethritis, gonorrheal urethritis or epididymitis, epididymitis/ orchitis Systemic diseases affecting fertility: such as liver and kidney dysfunction, endocrine disorders, malignancy Occupational environmental factors affecting fertility: ionizing radiation, microwaves, radiation, heavy metals Serious sexual dysfunction: erectile dysfunction, premature ejaculation, inability to complete intravaginal ejaculation Family genetic history: marriage of close relatives, infertility of relatives in the family, especially siblings Visceral inversion, olfactory deficiency and susceptibility to upper respiratory tract infections, etc. V. Which infertility cases should be considered with the help of assisted reproductive technology Assisted reproductive technology refers to a type of technology that intervenes artificially in the reproductive process through medical means, commonly used techniques include artificial insemination with husband sperm, artificial insemination with donor sperm, in vitro fertilization (commonly known as IVF) and single sperm intracytoplasmic injection. There are strict medical indications for receiving assisted reproductive technology treatment, which should be decided by a reproductive medicine specialist based on the specific condition. However, assisted conception techniques should be considered in the following cases: primary infertility for more than 4 years, even if no obvious cause is found in the examination of both partners; persistent and severe low quality of male semen that has not been treated (medication or surgery); both men and women have some degree of abnormality, such as decreased semen quality in the male partner and abnormal follicle development or obstruction of the fallopian tubes in the female partner, and are unable to conceive naturally for a long time; no sperm in the semen of the male partner, or severe oligospermia. The male partner has no sperm in the semen or severe oligospermia; the female partner has follicular dysplasia or severe tubal adhesion obstruction; the spouse is older, such as over 34 years old. The basic process of in vitro fertilization consultation: Consultation: both men and women should register for our male infertility clinic and fertility center respectively, bringing the records of previous examinations and reports of relevant examinations, and the special medical records of assisted reproduction technology issued by both doctors; examination: including semen analysis, anti-sperm antibodies, serological examination of infectious diseases (such as AIDS, syphilis, hepatitis B, hepatitis C, etc., the results of which are valid within six months), chromosomal G-banding of the male partner. valid), chromosomal G-band analysis, etc. The female partner has the same tests as the male partner except semen, and records of gynecological (infertility) examination and treatment (e.g. ultrasound, sex hormones, reproductive ductography, etc.), etc.; file building: The doctor of the fertility center will arrange for the treated couple to come to the fertility center to build a file according to the progress of the disease and treatment. The couple must sign an informed consent form and bring all the above-mentioned documents and three certificates (ID card of both parties, valid marriage certificate, and birth certificate issued by the family planning department of the household registration); receive fertility treatment: according to the situation, they will receive treatment such as down regulation, ovulation promotion and follicle monitoring, egg retrieval, sperm retrieval, in vitro fertilization, embryo culture, transplantation and pregnancy monitoring.