infertility
Introduction
Introduction to infertility Infertility (sterility infertility) is divided into infertility and infertility. The couples of childbearing age live together for more than one year and have a normal sex life. If no contraceptive measures are used, those who fail to achieve pregnancy are called infertility. Infertility, which can be conceived but causes miscarriage and stillbirth due to various reasons and cannot obtain a surviving baby. Male infertility due to male reasons, called male infertility or male infertility, used to call male infertility. basic knowledge The proportion of illness: 0.03% Susceptible people: adult men and women Mode of infection: non-infectious Complications: endocrine disorders, ovulation disorders, uterine fibroids, endometritis, endometrial tuberculosis, congenital absence of vagina, vaginal septum, acute mumps orchitis, vas deferens, premature ejaculation
Cause
Infertility cause
The cause of infertility may be on the woman, the man or both. The female factor is about 60%, and the male factor is about 30%, which is about 10% of the factors.
1. Female infertility factors
(1) vulvovaginal factors:
1 vulvar, vaginal abnormalities: hermaphroditism includes true hermaphroditism and pseudohermaphroditism, the latter such as testicular feminization, congenital adrenal hyperplasia, ovarian masculinization.
Hymen dysplasia: hymen atresia, hard hymen and so on.
Vaginal dysplasia: congenital vaginal complete or partial atresia, double vagina or vaginal septum.
2 scar stenosis: the formation of adhesion scars after vaginal injury, affecting sperm into the cervix, affecting insemination.
3 vaginal inflammation: mainly trichomonas vaginitis and fungal vaginitis, light does not affect pregnancy, severe white blood cells consume the energy substances in the semen, reduce sperm activity, shorten survival time, and even engulf sperm and affect insemination.
(2) Cervical factors: The cervix is the way sperm enters the uterine cavity. The amount and nature of cervical mucus can affect whether sperm can enter the uterine cavity.
1 Cervical dysplasia: Congenital cervical stenosis or atresia, poor menstrual bleeding, reduced menstrual flow, dysmenorrhea, may be complicated by endometriosis. Cervical dysplasia, slender, affecting the passage of sperm; cervical gland dysplasia is insufficient glandular secretion.
2 Cervical inflammation: In severe cases, the purulent leucorrhea in the cervical canal is increased and thick, which affects sperm penetration.
3 Cervical neoplasms: Cervical polyps, cervical fibroids and other obstructed cervical canal affect fertilization.
(3) Uterine factors:
1 Congenital malformation of the uterus: uterine dysplasia such as congenital uterus deficiency, residual uterus, double-horned uterus, mediastinal uterus, etc. all affect pregnancy.
2 endometrial abnormalities: endometritis, endometrial tuberculosis, endometrial polyps, endometrial adhesions or poor endometrial secretion response affect fertilized eggs implantation.
3 uterine tumors: endometrial cancer causes infertility, most of the infertility of patients with endometrial atypical hyperplasia, uterine fibroids can affect pregnancy, submucosal fibroids can cause infertility or miscarriage after pregnancy.
(4) Fallopian tube factors: The fallopian tube has the function of transporting sperm, picking up eggs and transporting fertilized eggs to the uterine cavity. Fallopian tube lesions are the most common cause of infertility, and any factors affecting the function of the fallopian tube affect fertilization.
1 fallopian tube dysplasia: tubal dysplasia affects peristalsis, is not conducive to transport sperm, eggs and fertilized eggs, prone to tubal pregnancy; congenital tubal excessive slender distortion affects the operation of sperm or egg.
2 fallopian tube inflammation: salpingitis can cause adhesion at the end of the umbrella or obstruction of the lumen, adhesion of the fallopian tube to the surrounding tissue affects peristalsis and infertility. Tubal tuberculosis causes tubal stiffness, fistula and so on.
3 lesions around the fallopian tube: endometriosis is more, ectopic endometrium in the fallopian tube to form nodules or pelvic ectopic endometrium caused tubal adhesions.
(5) Ovarian factors:
1 ovarian dysplasia: polycystic ovary, ovarian undeveloped and ovarian hypoplasia.
2 Endometriosis: The traditional view is that endometriosis is the external growth of the endometrium beyond the uterine cavity (excluding the myometrium). Endometriosis is called when endometrial tissue with growth function appears in other parts of the body outside the uterine cavity. Endometriosis and infertility, according to Tianjin and Shanghai, the original infertility of patients with endometriosis accounted for 41.5% ~ 43.3%, secondary infertility was 46.6% ~ 47.3%, and normal The population infertility rate is 15%. Severe endometriosis causes adhesions, affects ovarian function, and prevents the maturation and release of egg cells.
3 luteinized unruptured follicle syndrome (LUFS): Brosen speculated that LUFS is one of the pathogenic factors of endometriosis, based on the fact that LUFS is due to unruptured follicles, 17- estradiol in ascites and pregnancy The ketone is less than normal, and the inhibition of ectopic endometrial cells is lost. The patient's ovary has no ovulation.
4 Insufficient function of the corpus luteum: Insufficient secretion of luteal phase in patients with ectopic disease affects pregnancy.
5 ovarian tumors.
(6) Ovulation disorders: factors that cause ovarian dysfunction and cause ovulation can cause infertility.
1 central effect: hypothalamic-pituitary-ovarian function axis disorder, causing menstrual disorders, such as anovulatory menstruation, amenorrhea, etc.; pituitary tumors cause ovarian dysfunction and cause infertility; mental factors such as excessive tension, anxiety on the hypothalamus - The pituitary-ovarian axis can have an effect that inhibits ovulation.
2 systemic diseases: severe malnutrition, obesity or lack of certain vitamins in the diet, especially E, A and B, can affect ovarian function; endocrine and metabolic diseases such as hyperthyroidism or hypothyroidism, adrenal hyperfunction or depression, Severe diabetes can also affect ovarian function leading to infertility.
3 ovarian local factors: congenital ovarian hypoplasia.
The cause of male infertility
The classification of male infertility can be divided into absolute infertility (no sperm disease) and relative infertility (small sperm count or low sperm motility) according to fertility, and can be divided into primary infertility and secondary according to clinical manifestations. Infertility, according to the site of sexual organ lesions can be divided into pre-testicular, testicular and post-testicular. The reasons for male infertility are more complicated. The main reasons are as follows:
(1) abnormal semen
1. No sperm or too little sperm
When the sperm density in semen is less than 0.2 billion/ml, the chance of conception is reduced, and when it is less than 0.2 billion/ml, it causes infertility. This infertility can be divided into permanent and temporary, the former is found in congenital testicular developmental disorders or testicular, severe lesions of the seminal vesicle; the latter is more common in sexual life than frequency leads to primary failure of spermatogenesis, generally sperm reduction rather than total No sperm.
2. Poor sperm quality
Insufficient or dead sperm in semen (more than 20%), or poor sperm motility or more than 30% of abnormal sperm, often cause infertility.
3. Semen physical and chemical trait abnormalities
Normal semen quickly condenses into a jelly-like form after injection, and is completely liquefied in the next 15 to 30 minutes. If the semen does not coagulate after injection, or liquefaction is not always suggestive that the seminal vesicle or prostate has lesions. Bacterial and viral infections of the reproductive tract can also cause changes in semen composition to cause infertility. Infectious bacteria in semen greater than 103 / ml, non-pathogenic bacteria greater than 104 / ml can cause infertility.
(two) spermatogenic disorders
Testicular disease
Such as testicular tumor, testicular tuberculosis, testicular syphilis, testicular non-specific inflammation, trauma or testicular atrophy after testicular torsion, testicular abscess, etc., can cause spermatogenic dysfunction, infertility.
Chromosomal abnormalities
Sexual chromosome abnormalities can cause poor differentiation of testicular and other sexual organs, resulting in true hermaphroditism and congenital testicular hypoplasia. Autosomal abnormalities can lead to metabolic disorders in the gonads and spermatogenic cells.
3. Sperm dysfunction
Long-term consumption of cottonseed oil can affect sperm autoimmunity in sperm, and can also cause sperm dysfunction.
4. Local lesions
Diseases such as recessive varicocele and giant hydrocele affect the external environment of the testicle, or cause infertility due to temperature, pressure and other reasons.
(3) Sperm and egg binding disorders
Sperm obstruction
Such as congenital insemination of the lack of obstruction such as atresia, surgical ligation of the vas deferens, chronic inflammation of the spermatic tract and its surrounding tissues.
2. Retrograde ejaculation
Such as the bladder neck has been operated or damaged or scar contracture after surgery to deform the urethra, bilateral lumbar sympathectomy or rectal cancer after abdominal perineal surgery, genital nerve damage caused by diabetes, spermatic cyst hypertrophy, and Severe urethral stricture, certain drugs, such as adrenergic blockers, can cause sympathetic changes in the bladder.
3. External genital abnormalities
Such as congenital penile deficiency, such as penile too small, male pseudohermaphroditism, urethral fissure or hypospadia, acquired penile inflammation or injury, scrotal edema, giant testicular hydrocele.
4. Male sexual dysfunction
Impotence, premature ejaculation, no ejaculation, etc.
(four) systemic factors
1. Mental and environmental factors
Sudden changes in the living environment lead to long-term mental stress, high altitude, high temperature, super-strength work and radiation work.
2. Nutritional factors
Severe malnutrition, vitamin A, vitamin E deficiency, trace elements such as zinc, manganese deficiency, calcium and phosphorus metabolism disorders, mercury arsenic, lead, ethanol, nicotine, cottonseed oil and other toxic substances chronic poisoning, chemotherapy drugs and so on.
3. Endocrine diseases
Such as pituitary dwarfism, obesity, reproductive incompetence syndrome, hypopituitarism, congenital gonadal non-development, congenital spermatogenic syndrome, hyperprolactin, pituitary tumor or intracranial infection, birth injury.
Prevention
Infertility prevention
female
(1) Good living habits: Keep your mood comfortable, balance your diet, pay attention to work and rest, and choose appropriate exercise programs according to your physical condition, such as walking, jogging, dancing and so on. Get rid of alcohol abuse and excessive smoking habits, pay attention to menstrual hygiene.
(2) Pay attention to premarital examinations in order to detect congenital malformations or physiological abnormalities of the reproductive system in advance.
(3) Avoid premature sexual life, moderate sex, and avoid conspiracy. Pay attention to postpartum or post-abortion infections.
(4) Grasp the ovulation period, sexual intercourse during ovulation (including ovulation and one or two days before and after ovulation), can increase the chance of conception. Ovulation is about the 14th day before the next menstrual period. If the menstrual cycle is 28 days, the ovulation is exactly the middle of two menstrual periods. Women with irregular menstruation, it is best to detect basal body temperature for more than 3 months, looking for their own ovulation period. (Women in the early stage of ovulation, the basal body temperature is low, between 36.4-36.6 ° C, the body temperature after ovulation increased by 0.3-0.5 ° C, until the menstrual cramps before the decline.) Can also use LH test paper to detect ovulation time.
male
1. To vaccinate on time, good personal hygiene habits, to prevent various infectious diseases that endanger male fertility, such as mumps and sexually transmitted diseases.
2. To master certain sexual knowledge, to understand male physiological characteristics and health knowledge, if the testicles are found to have different changes than usual, such as swelling, hardening, unevenness, pain, etc., must be diagnosed and treated promptly.
3. If you are in constant contact with radioactive materials, high temperature and poisons, you must strictly follow the operating regulations and protective regulations. Don't neglect the idea. If you want children in the near future, it is best to be able to give birth after half a year of such work.
4. The testicle is a very delicate organ. Its optimal working temperature is about 1 degree lower than the human body temperature. If the temperature is high, it will affect the production of sperm, so any factor that can raise the temperature of the testicle should be avoided. Such as: cycling for a long time, taking a hot bath, wearing jeans, etc.
5. Change bad habits, quit smoking and alcohol; don't eat too greasy things, otherwise it will affect your sexual desire; also pay attention to avoid contact with toxic substances in life, such as: clothes taken from the dry cleaners should be placed for a few days Wear it again, because dry cleaning agents can affect male sexual function.
6. Pay attention to the physical examination before marriage, and find abnormalities in the early stage to avoid the pain after marriage. After marriage, you should always communicate with your wife about the problems encountered in your sexual life, and cooperate with each other and understand each other so that many mental impotence or early diarrhea can be avoided.
7. Change bad habits, strengthen physical fitness patients should quit smoking, abstain from alcohol, avoid spicy products, develop good rules of life, strengthen nutrition, and exercise moderately.
Complication
Infertility complications Complications Endocrine disorders Ovulation disorders Uterine fibroids Endometritis Endometrial tuberculosis Congenital absence of vaginal vaginal septum Acute mumps orchitis vas deferens clogging premature ejaculation
1. Female complications: endocrine disorders, tubal obstruction, ovulation disorders, uterine dysplasia and malformations, uterine fibroids, endometritis, endometrial tuberculosis, cervix stenosis adhesions, cervix both fluid and trait abnormalities, Congenital without vagina, vaginal septum.
2. Male complications: congenital testicular dysplasia, testicular tuberculosis, post-mastitis orchitis, vas deferens, genital dysplasia, impotence, premature ejaculation.
Symptom
Infertility symptoms common symptoms amenorrhea endocrine function decreased varicocele menstrual cycle changes semen less menstrual period edema blood dysmenorrhea
Female infertility:
1, dysmenorrhea: there may be endometriosis, uterine dysplasia, pelvic inflammatory disease, uterine muscle retention, abnormal uterine position and other diseases, can directly affect the birth.
2, vaginal discharge abnormalities: vaginitis, pelvic inflammatory disease, endometritis, cervicitis, cervical erosion and other inflammation, can lead to increased vaginal discharge, odor, is not conducive to sperm implantation, affecting pregnancy rate.
3, abdominal pain: bilateral abdominal pain, chronic abdominal pain and lumbosacral pain, these symptoms may be a precursor to the symptoms of pelvic inflammatory disease, uterine fibroids and ovarian inflammation.
4, irregular menstruation: irregular menstruation generally refers to the menstrual cycle changes, early or delayed, menstrual volume has changed, the amount of either too much, or very little. There is also a long menstrual period, which is mainly caused by dysfunction of the corpus luteum and endometritis.
5, amenorrhea: age over 18 years old, but never had menstrual cramps, or have had menstruation, but the phenomenon of menopause more than 6 months later, we call it amenorrhea. There are also many female infertility patients due to amenorrhea.
6. galactorrhea: galactorrhea is a phenomenon in which women have milk overflow after breast-feeding or non-lacking, which is mainly caused by hypothalamic dysfunction or pituitary tumors. Lead to female infertility.
7, endocrine disorders: women before and after menstruation, chest swelling, diarrhea, edema, fever, facial acne, emotional depression and other symptoms, considered endocrine disorders, long-term endocrine disorders, can lead to infertility.
Male infertility:
1, the amount of semen is small: normal males contain about 20 million sperm per ml of semen. If the amount of semen is too small, the number of sperm can not be guaranteed, which will lead to male infertility.
2, impotence and premature ejaculation: impotence refers to male erectile dysfunction, and men's normal reproductive process includes: libido - erection - sexual intercourse - orgasm - ejaculation. Any one of these links will lead to male infertility. Premature ejaculation is only for men to complete these processes. However, in the ejaculation session, men have not put the penis into the female vagina, and they ejaculate; This phenomenon will cause male infertility.
3, cryptorchidism: cryptorchidism refers to the male in the fetus period, the testicles fall into the scrotum, not falling into the scrotum, but in other parts. This can seriously affect the spermatogenic function of the testes, resulting in poor quality of sperm, unable to combine with egg cells into fertilized eggs, leading to male infertility.
4, blood syndrome: worthy of men's semen contains bloodshot phenomenon, under the microscope can be seen that men's semen contains a small amount of red blood cells, blood sperm is mainly caused by some inflammation.
5, varicocele: varicocele is more common in young men and young men, in addition to causing inconvenience to men's normal life, but also the main cause of oligozoospermia and weak sperm.
6, genital abnormalities: mainly refers to the male penis has a painful condition, especially when the woman is doing sexual intercourse, there will be pain, which will cause men to fear sexual intercourse, and thus reluctant to go to the house.
7, azoospermia: mainly refers to the phenomenon of men's semen without sperm.
Examine
Infertility check
Female check
1. Hysterosalpingography: Women with no inflammatory tract in the genital tract are injected into the uterus under the B-ultrasound for 3-7 days. The contrast agent is filled with the uterus and fallopian tubes.
2, hysteroscopy: the application of hysteroscopy, to understand the intrauterine conditions, can be found in intrauterine adhesions, submucosal fibroids, polyps, uterine malformations and other diseases that may lead to infertility. Treatment can also be performed intuitively under hysteroscopy.
3, laparoscopy: need to know more about the pelvic conditions, laparoscopy can be used. Laparoscopy can directly observe the presence of lesions or adhesions in the uterus, fallopian tubes, and ovaries, and determine whether the fallopian tubes are unobstructed. About 20% of patients can be diagnosed by laparoscopic surgery.
4, immunological examination: This method can be used to understand the presence of anti-sperm antibodies, in addition to anti-sperm antibody detection, but also after sexual intercourse test, in vitro sperm penetration test.
5, endocrine function determination: for example, the determination of serum estrogen and progesterone levels at different times of the menstrual cycle to understand the ovarian function; determine the basal metabolic rate to understand thyroid function; perform adrenal function tests and serum prolactin determination Wait.
Male check
There are many inspection items for male infertility, because there are many diseases that cause male infertility.
1, medical history check: mainly to check whether the patient has changed the reproductive system disease before. In addition, the patient's family history of genetic disease needs to be examined to check whether the family has a history of genetic disease.
2, sexual function check: mainly to check whether men have normal sexual function, whether there is normal libido, erection, sexual intercourse, orgasm and ejaculation. Whether there will be problems in these processes.
3, testicular examination: mainly to check whether the function of the testis is normal, whether it can normally secrete hormones and produce sperm. If there is an abnormality in the testicles, then everyone who has male fertility is also huge.
4, spermatic examination: check whether the male spermatic road is smooth, with or without obstruction or impaired symptoms. If the spermatic tract is obstructed, a dredge treatment is needed.
5, sperm examination: sperm examination is a more important part of the male infertility examination. Sperm is the most important germ cell in men. It contains all the reproductive information of men. If the sperm is abnormal, it will not be affected by the reproductive information contained in it. This leads to infertility. In general, in addition to being healthy, sperm needs to have the ability to move forward in a straight line. Common sperm abnormalities are mainly weak sperm, oligozoospermia, blood azoospermia, azoospermia and so on.
6, physical examination: mainly to check the health of men themselves, with or without other diseases. A holistic assessment of male fertility can also provide some advice for men to better nurse before giving birth.
Diagnosis
Infertility diagnosis and identification
Differential diagnosis
1. Sexual dysfunction Infertility refers to infertility caused by sexual dysfunction and inability to complete sexual intercourse or sperm can not enter the vagina. Patients often have erectile dysfunction, no ejaculation or retrograde ejaculation and other sexual dysfunction, and Identification by sexual function detection.
(1) non-ejaculation: refers to penile erection normal, but can not ejaculate during sexual intercourse, there are two types of functional non-ejaculation and organic non-ejaculation, the former is more common in lack of sexual knowledge, psychological factors such as tension or indulgence during marriage Excessively, the latter is common in the lesions and injuries of the nervous system, such as pelvic surgery; penile diseases, such as foreskin is too long and phimosis; endocrine diseases, such as pituitary, gonads, hypothyroidism caused by neuropathy; drug factors, Such as sedatives, adrenergic receptor blockers can inhibit ejaculation.
(2) Retrograde ejaculation: refers to the feeling of ejaculation during sexual intercourse, but no semen is injected from the urethra, urinating immediately after ejaculation, urine can be found in the urine with a large number of sperm, common causes are, bladder neck insufficiency , pelvic surgery and transurethral resection of the prostate, urethral stricture makes it difficult to discharge semen.
2. Infertility caused by obstructive lesions of the stalks. The spermatogenic function of the testes is normal. Due to the obstruction of the spermatic tract, the sperm cannot enter the semen. The differential diagnosis is as follows:
(1) Congenital stenosis obstruction: mainly due to congenital vas deferens dysplasia or absence, seminal vesicle hypoplasia, infertility caused by vas deferens and epididymis not connected or epididymis hypoplasia, characterized by less semen, often <1ml Semen does not coagulate, seminal plasma has no fructose, and azoospermia.
(2) Infectious tract obstruction: common infections are bilateral epididymal tuberculosis, gonococcal epididymitis and filariasis, which are characterized by azoospermia but normal testicular size.
(3) iatrogenic stenosis obstruction: patients often have a history of vas deferens angiography or vasectomy; bilateral sacral hernia repair mistaken vas deferens lead to vas deferens; testicular, epididymal surgery caused epididymis or spermatic cord injury.
(4) Traumatic tract obstruction: azoospermia caused by testicular, epididymis, and spermatic cord trauma combined with spermatic tract obstruction.
3. Infertility caused by testicular spermatogenesis dysfunction It is due to various reasons that the testicle can not produce sperm, although the spermatorrhea is normal, but there is no sperm in the semen, the differential diagnosis is as follows:
(1) Genetic abnormalities: such as hermaphroditism, Klinefelter syndrome is caused by the absence of segregation of chromosomes in the meiotic phase. The clinical features include breast enlargement, beard, sparse pubic hair, shoulder and narrow hip width and other female postures; The testes are small and soft, with low sexual function, semen without sperm, elevated FSH in plasma and urine, and plasma testosterone concentrations below normal.
(2) congenital anomalies: such as congenital absence of testis, bilateral cryptorchidism, germ cell hypoplasia, etc., germ cell hypoplasia patients masculine normal, but no sperm in sperm, normal testicular size, breast enlargement, plasma testosterone And serum LH levels are normal, plasma FSH is elevated, bilateral cryptorchidism patients also have no sperm in the semen, but their testes can not be combined, plasma testosterone and serum LH levels are low, but in a single injection of chorionic gonadotropin 5000 U, The level of plasma testosterone can be significantly increased, while the congenital testis without testis, except for the testis, the plasma testosterone and serum LH levels are very low, and the plasma testosterone level is not significantly increased after a single injection of chorionic gonadotropin.
(3) endocrine abnormalities: such as hypogonadism, hypopituitarism, hypothyroidism, adrenal hyperplasia, etc., patients with primary hypogonadism often increase blood FSH and LH levels, but testosterone levels are reduced, pituitary function is low Caused by secondary hypogonadism, the patient's blood FSH and LH levels are often low, testicular interstitial cell function and sexual function decreased, semen volume decreased.
(4) Spermatogenic cell maturation disorders: such as radiation damage, drug effects, varicocele, etc., the testicular size is normal, sperm is reduced sperm or no sperm, testicular biopsy shows that the spermatogenesis process is mostly stopped in spermatocytes At the time, there are few spermatogenic cells that are further developed in the seminiferous tubules.
4. Immune infertility: Immune sterility is divided into two categories: one is male-derived anti-sperm autoimmunity, the other is female-derived anti-sperm alloimmunization, and such patients are characterized by their sexual function. Semen routine and hormone levels are normal.
