I. Definition and Etiology
According to the World Health Organization (WHO), a couple who has had normal regular sexual intercourse for more than 1 year without using any contraceptive measures and whose female partner is infertile due to male factors is called male infertility. Male infertility is not an independent disease, but is the result of one or many diseases and factors. The causes of male infertility are complex, mainly due to abnormal semen causes. Most of these patients have no relevant medical history, physical examination and endocrine examination are normal, and semen analysis shows oligospermia, weak semen, deformed spermatozoa and semen non-liquefaction. These patients usually cannot find the cause of semen abnormalities (called idiopathic male infertility), and these abnormalities can occur together and are called idiopathic semen abnormalities (OAT syndrome), accounting for about 75.1%; secondly, elevated scrotal temperature (including varicocele) is also a major cause of infertility, accounting for 12.3%; in addition, congenital and acquired genitourinary tract malformations (2.3%), genital tract infections (6.6%), endocrine disorders (0.6%), sexual dysfunction (1.7%), genetic defects and immune factors (3.1%) are also closely related to male fertility. Du Baojun, infertility center of Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine
The understanding of male infertility in Chinese medicine
It belongs to the category of “childlessness”, “sterilization” and “difficult heirship for men” in Chinese medicine. The disease is located in the kidney and is closely related to the liver, spleen and heart. The main pathogenesis is the disorder of the five internal organs, or the external exposure to evil spirits, or the internal production of phlegm and fire, which eventually leads to the loss of kidney essence and male infertility.
Third, the basis for diagnosis
1. The female partner is normal and has lived without any contraceptive measures for more than 1 year, and there is no history of conception due to the male partner.
2. When the testes are examined physically or by ultrasound, the testes are mostly normal or smaller, with moderate or slightly soft texture and normal or smaller volume, or even retracted testes, cryptorchid testes and ectopic testes or testicular agenesis can be found.
3. Semen analysis is below the normal standard of WHO Laboratory Test Manual for Human Semen and Sperm-Cervical Mucus Interaction (4th or 5th edition).
4. Abnormal results of endocrine, anti-sperm antibodies, chromosomal and testicular aspiration biopsy tests affecting fertility function.
IV. Identification and treatment of diseases and evidence
(1) Kidney yin and yang deficiency, infertility, sperm scarcity, or low vitality, or erectile dysfunction, or high sperm malformation rate; lack of color, fatigue, soreness of the waist and knees, hot flashes in the five hearts, night sweats and dry mouth, mental impotence, and reduced libido; red tongue, little coating, and thin pulse.
Treatment: Nourishing the kidneys to produce essence and tonifying yin and yang.
Remedy: Nourishing the kidney and generating essence with addition and subtraction (empirical formula)
(2) Kidney-Yang deficiency, prolonged infertility, clear and cold semen, indifferent libido, impotence and premature ejaculation, scant sperm or
excessive dead sperm, weak ejaculation; soreness and weakness of the waist and knees, mental impotence, pale complexion, clear and long urine, excessive nocturnal urination, fear of cold and preference for warmth; pale and fat tongue, white fur, sunken and weak pulse.
Treatment: Tonifying the kidney and strengthening Yang, producing sperm seeds
Prescription: Right Qian Sheng Jing Tang with reduction (empirical formula)
(3) Kidney yin deficiency evidence Infertility after marriage, strong sexual desire, too frequent intercourse, semen not liquefied or too many dead sperm
Excessive sperm, or too little sperm, excessive deformed sperm; hot flashes in the five hearts, night sweating and dry mouth, soreness and weakness of the waist and knees, dizziness and tinnitus; red tongue with little fur and fine pulse.
Treatment: Nourishing Yin, tonifying the kidney and producing sperm seeds
Remedy: Zuo Kun Sheng Jing Tang plus reduction (empirical formula)
(4) Evidence of phlegm-damp stagnation Infertility after marriage, low sperm count or even absence of sperm; obesity, drowsy limbs, indifferent sexual desire or non-ejaculation; pale face, fatigue, shortness of breath, dizziness and palpitations; pale red tongue, white and greasy coating, sunken and thin pulse.
Treatment: Enlivening the spleen, resolving phlegm, and promoting the flow of sperm.
Remedy: Reduce the amount of sperm by removing phlegm and promoting sperm production (empirical formula)
(5) Evidence of stasis of sperm and blood. Infertility for many years after marriage, positive anti-sperm antibody, low sperm density and motility; accompanied by distension and pain in the lower abdomen, distension and pain in the chest, bitterness and distress in the mouth, or low libido, hidden pain in the testicles or varicose veins in the spermatic cord; red tongue with stasis points and astringent pulse.
Treatment: Regulating Qi and invigorating Blood, resolving blood stasis and promoting spermatorrhea.
Remedy: Tongluo Shengjing Tang plus reduction (empirical formula)
(6) Liver depression and qi stagnation evidence Infertility after marriage, scarcity of sperm, or low vitality, or high sperm malformation rate, or impotence, or non-ejaculation; chest tightness and discomfort, good at tai-hui; distension and pain in the chest and hypochondrium, testicular swelling and pain, irritability and irritability, nodules in the testicles or epididymis; dark tongue and sunken string pulse.
Treatment: De-stressing the liver and unblocking the sperm ducts.
Remedy: Decongesting depression and generating semen with addition and subtraction (empirical formula)
(7) Damp-heat internalized evidence of infertility after marriage, high malformation rate, non-ejaculation during intercourse or impotence and inactivity or positive anti-sperm antibodies; accompanied by stuffiness in the abdomen, heavy body, bitter or thirsty mouth, wet and itchy scrotum, hot and red urine, or astringent and unpleasant, and disturbed heart with little sleep; red tongue with yellowish greasy coating, and stringy or slippery pulse.
Treatment: Clearing heat and dampness, clearing the sperm organs
Prescription: Orthodontic Tang or Prosthodontic Tang plus or minus (empirical formula)
V. Summarization
Male infertility is a multi-infrequent and difficult to treat disease. In general, due to the complex etiology of male infertility, some of the causes are not yet clear, there is no specific drug targeted treatment in Western medicine, mostly with Chinese medicine or vitamin class intervention treatment, lack of evidence, clinical treatment efficacy is not very satisfactory, Chinese medicine for different causes of evidence-based treatment, making clinical fertility rate greatly improved.