不孕不育 in 男人

原因

Male infertility can be divided into:

• Problems with ejaculation or 安装
• 细小的生殖道内的问题
• Problems with sperm production

Problems with sperm production is by far the most common of the three, 和 can be detected during semen analysis. 精子产生异常的原因有很多，包括:

• 精索静脉曲张 (varicose veins)
• 遗传问题
• 感染
• Exposures to heat or toxic 化学s
• Drugs 和 medications
• 荷尔蒙失衡

Ejaculation Failure (Anejaculation)

射精失败是指不能射精. 它有多种原因，包括骨盆神经损伤所致 糖尿病, 多发性硬化症 或者腹盆腔手术和脊髓损伤.

区分射精失败和射精失败是很重要的 inability to achieve an 安装, 早泄和逆行性射精(射精进入膀胱而不是阴茎).

Rectal probe electroejaculation is a commonly performed technique that may enable patients to produce an ejaculate capable of achieving a pregnancy. 直肠探头, the doctor electrically stimulates the pelvic sympathetic nerves to induce a reflex ejaculation from which semen is collected.

Ejaculatory Duct Obstruction

在射精中没有精子的男性中，大约有10%被诊断为射精管阻塞. Usually caused by stones, 囊肿或疤痕组织阻塞前列腺导管, 这种情况可以通过一个简单的门诊程序来治疗，包括切除部分导管. Significant improvements in semen quality occur in 70 percent of patients, 哪些与20%到30%的怀孕率有关.

精索静脉曲张

的 varicocele is defined as dilated 和 twisted veins within the 阴囊, similar to varicose veins in the legs, 基本上是直立姿势的结果. 在42%的不育男性中发现精索静脉曲张，这与不孕症有着毫无疑问的统计学关联. 然而，15%的正常、有生育能力的男性也有精索静脉曲张.

精索静脉曲张手术将扭曲的静脉捆绑起来，大约67%的患者将改善精液质量, 这种改善最有可能是精子自发运动能力的提高，而不是精子数量的增加. 的 pregnancy rate following varicocele repair is approximately 40 percent, 手术后平均9个月怀孕.

的 varicocele remains the most correctable factor when poor semen quality is discovered, but since it is very common, the operation should be considered only if other infertility risk factors are absent.

Environment, Lifestyle 和 Fertility

Over the last several decades, concern has risen about the impact of industrialization on reproductive health. This concern stems largely from reports showing that semen quality of men in Europe 和 the United States has decreased over the latter half of the 20th century.

环境毒素最常被认为是不孕不育的潜在因素，可以被组织成身体上的, 化学, occupational 和 lifestyle factors:

• 物理因素 Hyperthermia (increased temperature), radiation 和 electromagnetic fields, 例如, are several physical factors that have been linked to infertility in men.
• 化学因素 吸烟, excessive alcohol consumption, 大麻和可卡因的使用以及咖啡因的摄入可能会导致化学原因导致不孕.
• 职业因素 Occupational hazards such as some pesticides, 工业毒素，如二恶英和多氯联苯, 接触重金属也可能与不孕有关.
• 生活方式因素 Finally, stress, nutrition 和 other lifestyle factors also can play a role.

诊断

最初的男性生育能力检查包括病史, 体格检查, 一般激素测试和一项或多项精液分析, 哪个测量精液量和精子数量, 自发运动的能力和运动的质量.

病史

Initial questions may include:

• A review of past medical history, prior surgeries 和 medications used
• 不孕不育或先天缺陷家族史的讨论
• A careful review of social history 和 occupational hazards to evaluate potential exposure to hazardous substances that could impact fertility

物理考试

下一个, you will receive a thorough 体格检查 to evaluate the pelvic organs — the penis, 睾丸, 前列腺和阴囊.

实验室测试

Laboratory tests may include:

• 验尿 这些 can indicate the presence of an infection.
• 精液评价 的 评价 assesses sperm motility or movement, the shape 和 maturity of the sperm, the volume of the ejaculate, 实际的精子数量和射精的流动性.
• 荷尔蒙测试 荷尔蒙测试 evaluate levels of testosterone 和 FSH (follicle-stimulating hormone) to determine the overall balance of the hormonal system 和 specific state of sperm production. 血清黄体生成素和催乳素是其他激素测试，如果最初的测试表明需要他们可以做.

如果初步评估后诊断不明显，可能需要进一步检查. 建议进行以下一项或多项测试:

• Seminal Fructose Test To identify if fructose is being added properly to the semen by the seminal vesicles
• Post-ejaculate 验尿 确定是否存在梗阻或逆行射精
• Semen Leukocyte Analysis 以确定精液中是否有白细胞
• 克鲁格和十大赌博平台排行榜卫生组织(WHO)形态学 更仔细地检查精子的形状和特征
• Anti-sperm Antibodies Test To identify the presence of antibodies that may contribute to infertility
• Sperm Penetration Assay (SPA) To confirm the sperm's ability to fertilize
• 超声波 检测 前列腺精索静脉曲张(静脉曲张)或导管阻塞, 阴囊, seminal vesicles 和 ejaculatory ducts
• 睾丸活检 来确定 如果精子产生受损或存在阻塞
• 血管造影术 To check the structure of the duct system 和 identify any obstructions
• 基因检测 To rule out underlying mutations in one or more gene regions of the Y chromosome, 或者检测输精管缺失的男性是否患有囊性纤维化

After the diagnostic 评价 is completed, 治疗可能包括药物治疗或内分泌治疗, surgical correction or a decision to manipulate or process sperm to achieve a pregnancy.

治疗

任何生育治疗都可能在大约开始三个月后对精液质量产生影响, as this is the length of time required for a single cycle of spermatogenesis, 或者精子生产. 如果手术和药物治疗都不合适, 辅助生殖技术是可能的.

In choosing a treatment plan, 应该考虑到每对夫妇的长期目标, financial constraints, 和 the results of the female partner's 评价 in addition to male factor findings.

具体的治疗

的 most successful medical therapy for male infertility involves reversing 化学, infectious or endocrine imbalances. This is called specific therapy, 它通常是成功的，因为治疗是基于纠正明确定义的问题.

Examples of this include:

• 治疗急性前列腺炎、附睾炎、精索静脉曲张
• 的 replacement of the pituitary hormones — follicle stimulating hormone (FSH) 和 leutinizing hormone (LH) — for radiation or surgically induced pituitary disease
• 的 administration of testosterone in men with hypo和rogenic hypogonadism

经验治疗

另一种治疗，称为经验疗法，试图纠正相当不明确的情况. 的 use of clomiphene citrate, 他莫昔芬或proproed治疗低精子密度或低精子活力就是这种治疗形式的例子.

这些 treatments often have limited success because the generally intact mechanisms within the body tend to counteract the intended effect. 换句话说, hormonal treatments based on the principle that "if some hormone is good, 那么“越多越好”是注定要失败的，应该避免.

Assisted Reproductive Technology

Treating specific illnesses may or may not treat the fertility problem. At least 10 percent of infertility problems are due to unknown causes 和 another 30 percent are due to problems in both the male 和 female partners.

除了药物和手术治疗不孕不育，以治疗男性和女性的特定健康状况, a new class of treatments — called assisted reproductive technologies, or ART — has been developed. 的 most common ART is in vitro fertilization, 或试管婴儿, but new procedures can enhance the IVF process or address other infertility conditions. 这些 procedures for men include:

• Intracytoplasmic sperm injection (ICSI)
• 血管的愿望
• Epididymal aspiration
• Testicular sperm extraction
• "Mapping" the failing 睾丸
• 卵子捐赠者 和 embryo or semen freezing

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic sperm injection, 或ICSI, is a technique developed to help achieve fertilization for couples with severe male factor infertility or couples who have had failure to fertilize in a previous in vitro fertilization attempt. 的 procedure overcomes many of the barriers to fertilization 和 allows couples with little hope of achieving successful pregnancy to obtain fertilized embryos.

的 procedure was first used at UCSF Medical Center in 1994 和 the first successful birth achieved with ICSI assistance was in February 1995. UCSF Medical Center was the first San Francisco Bay Area program to achieve a pregnancy 和 birth with this "miracle" procedure.

的 technique involves very precise maneuvers to pick up a single live sperm 和 inject it directly into the center of a human egg. 的 procedure requires that the female partner undergo ovarian stimulation with fertility medications so that several mature eggs develop. 然后这些卵子通过阴道被吸入, using vaginal ultrasound, 并在胚胎学实验室的精确十大赌博靠谱网络平台下进行培养. 的 semen sample is prepared by spinning the sperm cells through a special medium. This solution separates live sperm from debris 和 most of the dead sperm. 专家用玻璃针取出单个活精子，直接注射到卵子中.

Through the ICSI procedure, many couples with difficult male factor infertility problems have achieved pregnancy. 目前，所有注入卵子的受精率达到70%至80%, 怀孕率与没有男性因素不育的夫妇进行体外受精的情况相当.

请阅读 FAQ: Intracytoplasmic Sperm Injection for more information about this procedure.

Sperm Extraction Procedures

Intracytoplasmic sperm injection has revolutionized the treatment of male infertility. 卵子受精对精子的需求已经从体外受精(IVF)的数十万个精子下降了。, 与体外受精联合进行ICSI所需的一个存活精子.

This has led to the recent development of aggressive new surgical techniques to provide viable sperm for egg fertilization from men with low or no sperm count. 这也促使泌尿科十大赌博平台排行榜超越射精，进入男性生殖道寻找精子. 目前, 无精子症患者的精子来源, or those with no ejaculated sperm, include the vas deferens, epididymis 和 testicle, using sperm aspiration techniques in which the sperm is suctioned from the organ.

Sperm aspiration techniques involve the use of minor surgical procedures to collect sperm from organs within the genital tract. 这些 techniques are indicated for men in whom the transport of sperm is not possible because the ductal system that normally carries sperm to the ejaculate is absent, 比如先天性输精管缺失, or unable to be reconstructed.

最近, sperm has been fairly reliably extracted — 60 percent to 70 percent of the time — from the 睾丸 of men with sperm production problems of such severity that no sperm is found in the ejaculatory ducts.

It is important to realize, 然而, 绝大多数提取过程都需要体外受精技术来实现怀孕, 而成功率则与双方复杂而互补的辅助生殖计划密切相关.

Sperm Extraction: Vasal Aspiration

病人 who have congenital or acquired obstruction of the ductal system at the level of the prostate or in the abdominal or pelvic portions of the vas deferens may be c和idates for this technique. 病人 who have undergone a vasectomy less than five years before also may be c和idates.

血管的愿望 is a brief, same-day operation under local anesthesia. It can be done through a small scrotal incision or through incisionless techniques. 无论哪种方式, 进入输精管，用注射器将漏出的精子吸进滋养液中. More sperm are brought to the opening by gently massaging the epididymis 和 vas deferens. 的 recovery period is 24 hours. Aspirated sperm are specially processed 和 prepared for insemination 或试管婴儿.

Of the three extraction procedures, 输精管抽吸提供最“成熟”的精子, 因为它们已经穿过附睾, 在正常精子发育过程中成熟过程发生在哪里. 通常情况下，ICSI并不需要实现怀孕. A big benefit of vasal sperm is that it is basically equivalent to ejaculated sperm 和 thus it can be frozen at the time of surgery to avoid further procedures in the male.

Sperm Extraction: Epididymal Aspiration

Epididymal sperm aspiration can be performed in situations in which the vas deferens is either absent or is scarred from prior surgery, 创伤或感染. Sperm are directly collected from a single, 单独的附睾小管(MESA)或通过盲针穿刺(PESA)以与血管手术相同的方式. Depending on the length of the epididymis that is available for aspiration, 多个, 可以分别从一个或两个睾丸抽吸.

When 10 to 20 million sperm are obtained, 精子经过处理后，将与伴侣的卵子受精. Epididymal sperm are not as "mature" as sperm that have traversed the entire length of the epididymis 和 reside in the vas deferens 和, 因此, 附睾精子需要ICSI来使卵子受精.

Egg fertilization rates of 60 percent to 80 percent 和 pregnancy rates of approximately 45 percent to 55 percent have been reported with epididymal sperm. 很明显, the results will vary among individuals because of differences in sperm 和 egg quality as well as the technical proficiency of the lab. 像输精管精子, 这些精子可以在手术时冷冻，以避免未来的手术取精程序.

Sperm Extraction: Testicular Sperm Extraction (TESE); Testicular Sperm Aspiration (TESA)

的 newest of the aspiration techniques is testicular sperm retrieval. 在这个过程中，一小部分睾丸组织被取出 活组织检查 under local anesthesia. It is a breakthrough in that it demonstrates that sperm do not have to "mature" 和 pass through the epididymis in order to fertilize an egg. 然而，由于睾丸精子不成熟，需要进行ICSI.

Testicular sperm extraction is indicated for patients in whom there is a blockage in the epididymis very near the testis that is either from prior surgery, infection or from birth, or a blockage within the ducts of the 睾丸, called efferent ductules.

它也用于精子产量极低的男性, in which so few sperm are produced that they cannot reach the ejaculate. 在精子产量低的情况下，怀孕现在是常规的, but there is some concern with the use of this sperm because in most cases the underlying condition causing the po或者精子生产 is still unknown. 因此, 在这些情况下, 必须认识到，可能导致不孕症的情况可能会遗传给后代.

最近, 甚至精细胞——最终变成有尾巴的精子的圆形细胞——也被用来通过ICSI实现怀孕. 然而, this has raised much speculation 和 concern about the use of genetic material from a still-evolving germ cell for clinical purposes before the system has been appropriately investigated 和 its genetic stability examined in animal models. Spermatid injections are currently considered experimental procedures.

睾丸精子的一个缺点是它不像附睾或输精管精子那样容易冻结, 因此，男性伴侣更有可能在每次试管婴儿尝试中都需要经历重复的过程.

Sperm Extraction: "Mapping" the Failing Testes

First proposed in 1997, this concept addressed the issue of how to detect where ICSI-compatible, 成熟精子存在于衰竭或萎缩的睾丸中. 这是基于先前的观察，即精子在衰竭的睾丸中可能是“不完整的”或“局部的”. 这就产生了这样一种想法，睾丸内取样寻找精子的部位越多, the higher the chances of usable sperm.

从“映射”中获得的信息可用于以下方面:

• To help infertile couples decide whether or not to proceed to IVF 和 ICSI
• 定位和寻找萎缩睾丸内的精子进行ICSI