According to the recommendation of the World Health Organization (WHO), a couple who has lived together for more than one year after marriage without using any contraceptive measures and whose female partner is infertile due to the male partner is called male infertility. About 15% of the couples in the world are troubled by infertility, and about 50% of them are caused by male factor, and the Department of Urology of the First Affiliated Hospital of An Medical University has been devoted to the treatment of infertility caused by male, and has achieved good results.
Etiology and diagnostic classification
Male infertility may be the result of a combination of factors, rather than an independent disease, and the WHO has proposed a classification based on etiological diagnosis, which classifies male infertility into 16 categories:
1. sexual and/or ejaculatory dysfunction due to sexual problems: e.g. premature ejaculation, impotence, non-ejaculation and retrograde ejaculation.
2. Immunological etiology: more than 50% of active spermatozoa have sperm antibodies wrapped around them.
3. Unexplained infertility: Sperm and seminal plasma examination is normal, but the cause of infertility cannot be identified with the available diagnostic tools.
4. Pure seminal plasma abnormalities: These patients have normal sperm, but the physical properties, biochemical and bacterial contents of seminal plasma are abnormal, or the number of white blood cells is increased, or the semen agglutination is abnormal, which may cause male infertility.
5. Medical causes: male infertility caused by abnormalities in sperm production, storage, transport and excretion due to medical reasons such as drugs or surgery.
6, systemic causes: some systemic diseases can damage male fertility, thus causing male infertility.
7. Congenital anomalies include testicular descent abnormalities, karyotype abnormalities, and azoospermia due to congenital spermatophore and/or vas deferens dysplasia can lead to azoospermia.
8, Acquired testicular injury: This refers to infertility due to mumps orchitis or testicular injury that may cause testicular atrophy resulting in sperm abnormalities.
9. Varicose veins of the spermatic cord.
10. Infertility caused by male paraphimosis.
10, endocrine etiology: such as hyper- or hypopituitarism, hyperthyroidism or hypothyroidism can lead to abnormal spermatogenic function, resulting in low male fertility and secondary impotence.
11, idiopathic oligospermia: normal sperm count is ( 100 ~ 150) × 109 / L. If the sperm density is less than 20 × 109 / L, it can be defined as oligospermia.
12, idiopathic weak spermatozoa: weak spermatozoa refers to a condition in which the forward-moving spermatozoa (a and b levels) in the semen parameters are less than 50% or less than 25% of the spermatozoa with a level of movement.
14. Idiopathic azoospermia: normal sperm density and viability, but normal sperm morphology < 30%.
15. Obstructive azoospermia: no sperm on semen examination, but testicular biopsy proves that sperm occur in the varicocele.
16. Idiopathic azoospermia: no sperm in the semen without an identified cause, accompanied by testicular volume reduction (total volume < 30 ml), and testicular biopsy proves that no sperm occur in the varicocele.
Diagnosis
1, history detailed understanding of personal reproductive history, sexual life history, living environment and working conditions and family history, including sexual life should be asked in detail, to exclude the infertility factors caused by sexual dysfunction.
2, examination of reproductive organs: including examination of penile development, whether there are congenital malformations; testicular and epididymal size, texture, etc.; examination of prostate size, texture, smoothness, etc.; attention to the spermatic vein varicose and varicose degree.
3. Semen laboratory test: semen routine. Semen analysis is the basic method to assess the fertility. A sperm density >20×106/ml is considered to be fertile. Sperm cell testing and testicular biopsy.? Detection of leukocyte spermatozoa. Semen leukocyte count > 1×106/ml is diagnosed as leukocytic spermatozoa.
4, the detection of immune infertility sperm is antigenic and can cause an autoimmune reaction against sperm in men and can also lead to an alloimmune reaction against sperm in women.
5, seminal plasma biochemical detection of seminal plasma biochemical indicators can reflect the spermatogenic function of the accessory glands, epididymis and testes, such as zinc, magnesium, citric acid, glutamyl transpeptidase can reflect the function of the prostate.
6, reproductive tract infection detection male reproductive tract can be infected with a variety of bacteria, viruses and chlamydia, mycoplasma. These microorganisms themselves and the toxins they release can affect the quality of sperm.
7, genetic factors test Y chromosome long arm specific region of the microdeletion can lead to infertility. In azoospermia and oligospermia, microdeletions in the AZF region amount to 10-15%.
Treatment
1. Preventive treatment To prevent male infertility in the future, the following points should be noted:? Prevention of sexually transmitted diseases;? In cases of testicular hypospadias, appropriate treatment should be made in early childhood;? Avoid contact with harmful factors and chemicals to the testicles, etc.
2, drug treatment Currently, there are domestic studies pointing out that taking a combination of Chinese and Western drugs as well as improving lifestyle habits, the cure rate is more than 20% higher than relying solely on Chinese and Western drug treatment. Therefore, in the process of treating male infertility in the future, a comprehensive treatment method should be used.
3, surgical treatment including surgery to improve testicular spermatogenesis and surgery to relieve obstruction of the vas deferens, such as high spermatic cord vein ligation and testicular fixation.
4.Assisted reproductive technology The methods to make infertile couples conceive by medical means without sexual intercourse are four: ① artificial insemination of husband’s semen; ② in vitro fertilization embryo transfer technology, mainly used for infertility treatment of damaged and obstructed female fallopian tubes; ③ intra-ovarian sperm injection, mainly used for patients with severe oligospermia, dead sperm and obstructive azoospermia; ④ artificial insemination of donor semen.