Medical Classroom

Infertility is not a problem for the wife? The husband must also take responsibility!

2018-08-09 16:07:35

In my outpatient experience, I saw my wife taking the husband's hand and comforting him with his eyes. At this time, I thought: It is possible that the couple are going to see male infertility!


Reasons for male infertility

Nowadays, social pressure, work style, living environment and dietary factors may lead to male infertility, and the relative environmental fertility is gradually decreasing. According to the trend, the number of male sperm in the 21st century has been Falling in half.

The "sperm crisis" is worsening. The quality of semen in the world is actually less than one year. The standard for sperm density set by the World Health Organization has been declining year by year. In 1990, the standard value was 66 million, but it has dropped to 15 million in 2015.

Moreover, in recent years, the age group of infertility in men and women has gradually declined. From the analysis of semen quality, it is found that up to 80% of young men under the age of 25 have symptoms of sperm motility and insufficient semen, and it is necessary to tell everyone that semen does not equal Sperm, and in sexual behavior, there is no way to detect it with the naked eye.

From the statistics of male customers who have been looking for me over the years, the main reason for the infertility of the patients is that the problem of sperm motility and the lack of semen is as high as 80%. The second is that the ligation or vas deferens account for 1 and the last one is other factors.

  1. Diet: Eating foods containing plasticizers, tainted milk powder and other items will affect sperm quality and activity. Usually, you should take foods containing zinc and selenium; such as milk, corn, purple rice and black beans.
  2. Chemical substances: chemical substances or heavy metals in life are invisible. For example, in the case of living materials, the use of wood containing formaldehyde or lead, mercury, etc., will reduce the amount of male sperm.
  3. High temperature: Generally speaking, male students' testicles are hung in vitro, mainly to help dissipate heat. The core body temperature in the body is about 36 to 37 degrees, while the test pills should be 33 degrees normally. If the temperature is too high, it may cause azoospermia. Therefore, bathing for a long time, high temperature may affect the quantity and activity of sperm.
  4. Cigarette Alcohol: The New York Medical Association research report pointed out that "nicotine affects five major parts of sperm: quantity, activity, type, implantation ability, quality", not only causes damage to sperm, but also indirectly affects the genetic problems caused by chromosomes, except for the difficulty of implantation. It also increases the chance of miscarriage and deformed children; while excessive alcohol not only hurts the liver, but also affects the testicles. Patients with chronic alcoholism may suffer from shrinking of the testicles, leading to a decline in semen quality.

"If you can't improve from your daily life, what other check items can you know if you are a high-risk group of male infertility?"

Doctor Chung: "Semen analysis using ultra-high power microscope to check the sperm type; plus blood test FSH, LH, E2, Testosterone, PRL can know whether you are a high-risk group."


Other inspection items

  1. Hypogonadotropic Hypogonadism (Hypo-hypo)
  2. Hyperprolactinemia (hyperglycemia)
  3. Low T / High E2 (low male high estrogen)
  4. Ejaculation disorder / erectile dysfunction
  5. Retrograde ejaculation / unable to ejaculate
  6. Obstructive infertility
  7. unknown reason

1.Hypogonadotropic Hypogonadism(Hypo-hypo)

  • How to diagnose: blood FSH, LH, Testosterone low
  • Possible causes: Kallmann’s syndrom, pituitary tumor, systemic disease, external injection of males (such as gymnasts, bodybuilders)
  • Cause: Due to disease (or negative feedback inhibition), the hypothalamus and pituitary gland do not normally secrete gonadal hormones (GnRH or gonadotropin), and lose the function of spermatogenesis.
  • Treatment: Hormone therapy, supplemented with hCG and rFSH, three times a week for 3 to 6 months, it is expected that 1 to 2 years of sperm can achieve the best therapeutic effect, but the treatment effect is greatly correlated with the size of the testicle.
  • According to the study, patients with a testicular size >8 ml and hormonal loss after puberty have achieved better results with this therapy.

2.Hyperprolactinemia

  • How to diagnose: blood pumping Prolactin too high, TSH too high
  • Possible causes: hypothyroidism, hypothalamic abnormalities, pituitary gland adenoma, pituitary gland adenoma
  • Cause: Excessive prolactin negative feedback inhibition causes the pituitary gland to not secrete gonadotropin, and loses its spermatogenic function.
  • Treatment: thyroxine supplementation, surgery, use of dopamine receptor antagonist drugs (Cabergoline or Bromocriptine) to shrink tumors
  • According to research, 53% of patients can restore fertility


3.Low T / High E2 

  • How to diagnose: Blood testosterone is too low, E2 is too high
  • Possible causes: Klein's disease, disease obesity, unknown cause
  • Cause: Testosterone can be converted into estrogen E2 via the enzyme aromatase in fat cells in the body. Excessive estrogen will negatively feedback to inhibit the hypothalamus and pituitary gland from normal secretion of gonadal hormones (GnRH or gonadotropin). Loss of spermatogenesis.
  • Treatment: Take aromatase inhibitors such as Letrozole, Testolactone, Anastrozole
  • According to research, T/E2 ratio<10 is more effective after taking the drug, and the drug can also be used with hCG injection.


4.Ejaculation disorder / erectile dysfunction

  • Ejaculation disorders are associated with too low a steroid, and can also be treated with aromatase
  • In the case of erectile dysfunction, it is necessary to take PDE-5 inhibitory drugs to inhibit the decomposition of cGMP, so that the smooth muscle of the sponge is continuously relaxed, and the blood inflow causes the penis to erect. Such as Viagra.

5.Retrograde ejaculation / unable to ejaculate

  • During normal ejaculation, the bladder neck muscles contract by the action of the sympathetic nerves, causing the semen to shoot forward. When surgery (such as prostatectomy), disease (such as peripheral neuropathy diabetes), drugs (such as relaxing sympathetic blood pressure lowering drugs), affecting the sympathetic effect, it may cause bladder neck muscles can not shrink, so that semen Reverse injection into the bladder.
  • Treatment: Suspension of blood pressure lowering drugs, treatment with sympathetic nerve stimulants, Imipramine, or antihistamine

6.Obstructive infertility

  • Obstruction of the vas deferens or congenital absence of the vas deferens, sperm can be obtained by deputy extraction (MESA) or sputum extraction (TESE)


7.Antioxidants

  • It has been confirmed that many infertile men have high concentrations of peroxidase (ROS) in their semen and have also been shown to be associated with sperm DNA damage.
  • Currently considered more effective antioxidants are Cartines, vitamins C and E.


in conclusion

Pre-marital health check is very important. You can know your fertility in advance, and you can also create a couple's health baby and plan ahead for your future. When the alarm sounds of fertility are found, precautions should be taken to freeze the eggs or sperm, to prevent the situation from getting worse and worse, and finally to go to the only option of "borrowing eggs."