bubble_chart Overview

Normal couples of childbearing age who have regular sexual intercourse after marriage but fail to achieve pregnancy within one year or longer, or who can conceive but cannot carry the pregnancy to childbirth, are collectively referred to as infertile. When the cause is attributed to the male, it is termed sterility. Among married men, approximately 6% suffer from sterility. Sterility has gained increasing attention, shifting away from the past notion that infertility was primarily a female issue (infertility). Sterility has now become a common clinical problem encountered in practice.

bubble_chart Etiology

1. Disorders of sperm production and maturation: Testicular dysfunction includes primary damage to the testes, such as testicular aplasia and hypoplasia, cryptorchidism, varicocele, and testicular atrophy caused by sexually transmitted diseases. Abnormalities in the hypothalamus and pituitary function, exposure to radioactive substances, and drugs that inhibit spermatogenesis can all affect sperm production and maturation.
2. Obstruction of the sperm transport pathway: The epididymis, vas deferens, and ejaculatory duct serve as channels for sperm transport. Any pathological changes, especially obstructive conditions such as congenital absence or atresia of the vas deferens, epididymitis, or subcutaneous nodules in the epididymis, can lead to infertility.
3. Failure of sperm to enter the female reproductive tract: Malformations of the external genitalia or dysfunctions in sexual intercourse and ejaculation can prevent sperm from entering the vagina, resulting in infertility.
4. Abnormal semen: Semen abnormalities are closely related to sterility.
5. Disorders of the accessory glands: Prostatitis, abnormalities in prostatic enzymes, and functional disorders of the seminal vesicles can all contribute to infertility.
6. In addition, genetic and immunological factors can also cause sterility.

bubble_chart Diagnosis

The diagnosis of sterility still faces many practical issues. First, it is essential to accurately determine whether the cause of infertility lies with the male rather than the female, or if both partners contribute to the infertility. After confirming sterility, further examinations are needed to identify the disease cause responsible for the sterility in order to implement effective treatment measures.
To achieve the above objectives, a detailed medical history and physical examination are necessary. Taking a medical history is a crucial step in diagnosing sterility, with particular attention paid to collecting infertility-related history. During the physical examination, attention should be given to systemic diseases and urogenital organ examinations that may affect fertility, as these can provide important evidence for determining sterility. Among these, measuring testicular size is the most critical. Ninety-eight percent of testicular tissue consists of seminiferous tubules, so testicular shrinkage indicates atrophy of the testicular tissue. Testicular volume can be measured using internationally standardized testicular volume models. In China, the normal adult testicular size ranges from 15 to 25 ml, with most being around 20 ml.
Semen analysis is an important method for assessing male fertility. In routine tests, reduced sperm count, decreased sperm motility (both vitality and movement), and excessive abnormal sperm may all contribute to infertility. When collecting semen, the individual should abstain from ejaculation for three days prior, and the sample should be tested within two hours after ejaculation, with care taken to keep it warm during transport. Prostatic fluid examination can also aid in diagnosing infertility.

Testicular biopsy and vasography, being invasive procedures, are not commonly used in sterility diagnosis.
When necessary, endocrine function tests, immunological studies, and cytogenetic examinations may be conducted.
Determining the cause of sterility can be highly complex in some cases, while relatively straightforward in others. Therefore, unnecessary tests should be avoided during the diagnostic process.

bubble_chart Treatment Measures

Sterility is a difficult problem to solve. The treatment principle is to target the specific disease cause based on a clear understanding of it. Treatment should not be carried out blindly.
(1) Medical treatment of sterility

1. Testosterone rebound therapy: For patients with oligospermia, use testosterone propionate 50mg, intramuscular injection, three times a week; or use testosterone enanthate 200mg, intramuscular injection once a week, for 12–20 weeks. After treatment, aspermia may occur; 6–18 months after the end of treatment, sperm count rebounds to levels higher than before treatment.
2. Combined use of human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG): Daily administration of HMG 150 IU and weekly administration of HCG 5000 IU yields better results.
3. Clomiphene can increase the secretion of gonadotropin-releasing hormone, acting at a level above the pituitary gland, thereby stimulating the pituitary to secrete gonadotropins, which is effective for treating male infertility due to pretesticular factors. Take 25–50mg orally daily for 25 days per month, continuing for 3–6 months or until pregnancy occurs.
4. Tamoxifen is similar to clomiphene. Take 30mg orally daily for 3–9 months as one course of treatment. For patients with oligospermia, it may improve semen quality and increase fertility.

In addition, the use of kallikrein, 600 IU orally daily, or 40 IU intramuscularly three times a week; adenosine triphosphate, 20mg intramuscularly once daily; arginine, 4g orally daily; and vitamin E, 10–20mg orally daily, may all have some effect.
(2) Surgical treatment of sterility Infertility caused by reproductive system surgical diseases can be treated surgically. Examples include corrective surgery for hypospadias, orchidopexy for cryptorchidism, and reanastomosis surgery for localized obstruction of the vas deferens (such as vasovasostomy or vasoepididymostomy). The use of microsurgical techniques may improve the success rate of surgery. For infertility caused by varicocele, internal spermatic vein ligation can be performed, and fertility may be restored postoperatively.
(3) Artificial insemination and embryo transfer Artificial insemination with husband's sperm (AIH) between spouses, or in vitro fertilization and embryo transfer technology for oligospermia, are both viable methods for treating sterility, with an overall success rate of about 60–85%.
Traditional Chinese medicine treatment based on pattern identification for sterility has shown some effectiveness.