The incidence of male infertility is rising, with numerous contributing factors. Many cases stem from stress in daily life and work, while poor lifestyle and dietary habits are primary triggers for various diseases. How should we identify and diagnose this condition? Let's explore the science together.
Male Infertility Identification and Diagnosis
1. Sexual Dysfunction-Related Infertility
Refers to infertility caused by sexual dysfunction preventing intercourse completion or sperm entry into the vagina. Patients often have a history of erectile dysfunction, anejaculation, or retrograde ejaculation, which can be identified through sexual function testing.
(1) Anejaculation:
Refers to normal penile erection but inability to ejaculate during intercourse. It includes functional and organic forms. The former is often caused by lack of sexual knowledge, psychological factors like nervousness during newlywed periods, or excessive sexual activity. The latter commonly results from neurological disorders or injuries (e.g., pelvic surgery), penile conditions (e.g., phimosis or paraphimosis),endocrine disorders like hypopituitarism, hypogonadism, or hypothyroidism-induced neuropathy; or drug-induced factors such as sedatives or adrenergic receptor blockers that inhibit ejaculation.
(2) Retrograde Ejaculation:
Refers to the sensation of ejaculation during intercourse without semen being expelled through the urethra. Immediate urination after ejaculation reveals a significant presence of sperm in the urine.Common causes include incomplete closure of the bladder neck, pelvic surgery, transurethral resection of the prostate, or urethral stricture causing difficulty in semen expulsion.
2. Infertility due to obstructive lesions of the spermatic ducts
Sperm production in the testes is normal, but sperm cannot enter the semen due to obstruction of the ducts.Differential diagnosis is as follows:
(1) Congenital spermatic duct obstruction:
Primarily caused by congenital underdevelopment or absence of the vas deferens, seminal vesicle hypoplasia, failure of the vas deferens to connect with the epididymis, or epididymal hypoplasia. Characterized by low semen volume (often <1ml), failure of semen to coagulate, absence of fructose in seminal plasma, and azoospermia.
(2) Infectious Obstruction of the Vas Deferens:
Common infections include bilateral epididymal tuberculosis, gonococcal epididymitis, and filariasis. Characterized by azoospermia with normal testicular size.
(3) Iatrogenic Obstruction of the Vas Deferens:
Patients often have a history of vas deferens angiography or vasectomy;Accidental vasectomy during bilateral inguinal hernia repair causing vas deferens obstruction; damage to the epididymis or spermatic cord during testicular or epididymal surgery.
(4) Traumatic Obstruction of the Vas Deferens:
Azoospermia resulting from obstruction of the vas deferens following trauma to the testicle, epididymis, or spermatic cord.
3.Infertility due to testicular spermatogenic dysfunction
This condition arises when the testes fail to produce sperm for various reasons. Although the spermatic ducts are intact, no sperm are present in the semen. Differential diagnoses include:
(1) Genetic abnormalities:
Such as intersex conditions or Klinefelter syndrome, resulting from chromosomal nondisjunction during meiosis leading to mosaicism.Clinical features include gynecomastia, sparse facial and pubic hair, narrow shoulders and wide hips (feminine physique); small, soft testes; low libido; and azoospermia. Elevated FSH levels in plasma and urine, with reduced plasma testosterone concentration.
(2) Congenital abnormalities:
Such as congenital anorchism, bilateral cryptorchidism, and gonadal dysgenesis. In gonadal dysgenesis, masculinization is normal but semen contains no spermatozoa. Testes are of normal size, breasts do not enlarge, plasma testosterone and serum LH levels are normal, and plasma FSH is elevated.Patients with bilateral cryptorchidism also exhibit azoospermia, but their testes are non-palpable. Plasma testosterone and serum LH levels are low, though plasma testosterone levels significantly increase after a single injection of 5000 U chorionic gonadotropin.In congenital anorchism, besides undetectable testes, both plasma testosterone and serum LH levels are markedly low. Following a single injection of chorionic gonadotropin, plasma testosterone levels show only a slight increase.
(3) Endocrine Abnormalities:
Such as hypogonadism, hypopituitarism, hypothyroidism, and adrenal cortical hyperplasia. Patients with primary hypogonadism often exhibit elevated serum FSH and LH levels, accompanied by reduced testosterone levels.Pituitary insufficiency can cause secondary hypogonadism, where patients exhibit low serum FSH and LH levels, impaired testicular interstitial cell function, diminished sexual function, and reduced semen volume.
(4) Spermatogenic Cell Maturation Disorders:
Such as radiation damage, drug effects, varicocele, etc. Testicular size and texture appear normal, but semen analysis reveals reduced sperm count or azoospermia.Testicular biopsy reveals that the spermatogenesis process often stops at the spermatocyte stage, with very few spermatids undergoing further development in the seminiferous tubules. 4. Immunological Infertility Immunological infertility is divided into two categories: one is male-produced anti-sperm autoimmunity, and the other is female-produced anti-sperm alloimmunity. The characteristic of these patients is that their sexual function, semen analysis, and hormone levels are all normal.
Above, we've outlined the diagnosis and differential diagnosis of male infertility. Given the numerous potential causes, we strongly advise seeking evaluation at a reputable hospital to identify the root cause before pursuing targeted treatment. Avoid responding to street advertisements, as they not only fail to cure but may inflict greater financial harm. Wishing you all good health.