Diagnosis
1 History
The past history of disease, injury and operation history, life history, contraceptive history, reproductive history and history of marriage, drugs and physical and chemical factors exposure history, urinary symptoms and the gynecologic examination.
2 physical examination
General attention has special shape, there is no systemic disease. Genital examination note penile development degree, the external orifice of urethra, testicular size, epididymal and testicular relationship, spermatic cord has no lesions ( such as varicocele, vas deferens lesions ), digital rectal examination, pay attention to prostate and seminal vesicle, prostate massage, parallel smears.
3 semen examination
3-7 day of abstinence, masturbation or extracorporeal ejaculation by collecting semen, 1 hours of examination.
Normal reference values: precision 2-6ml, gray or pale yellow, 5-20 minutes complete liquefaction, PH7.2-7.8 sperm density was 5 million - 100000000 / ml, sperm motility rate > 60%, sperm vitality of > 75% ( > 6 ), sperm deformity rate < 30%, total sperm number > 130000000 / per spermiation. Sperm count < 20000000 / ml, fertility is poor.
The diagnosis of male infertility, must make clear the following:
The man is sterile or female infertility sterility factors, or both; as for the man of sterile, belongs to the absolute or relative infertility, sterility;
The primary or secondary infertility sterility;
If the male sterility, should be possible to identify the exact cause of male infertility, so that for the causes of the use of effective treatment measures.
Male infertility diagnosis and check method generally includes a detailed history, physical examination, semen examination, endocrine examination, immunological tests, chromosome examination, X-ray examination, biopsy of testis, semen biochemical examination and other examination. Through the above male infertility clinical and laboratory assessment, and then in 1999 who on male infertility diagnostic criteria for diagnosis and classification.
Identify
1 sexual dysfunction infertility due to sexual dysfunction and cannot finish sexual intercourse or sperm cannot enter the vagina caused sterility. Patients often have erectile dysfunction, retrograde ejaculation ejaculatory incompetence or the sexual dysfunction such as history, and through the function test to identify.
( 1) non-ejaculation disorders: refers to the normal penile erection during sexual intercourse, but not ejaculation, a function not ejaculate and organic cum two. The former is more common in nature and lack of knowledge, psychological factors such as the wedding of tension or over-indulgence caused. The latter is common in the nervous system disease and injury, such as pelvic operation; Penile Diseases, such as redundant prepuce and phimosis; endocrine diseases, such as the pituitary, gonad, hypothyroidism induced neuropathy; drug factors, such as sedatives, adrenergic receptor blockers inhibit ejaculation.
( 2) retrograde ejaculation: refers to sexual intercourse with the sensation of ejaculation, but no semen from urethral injection. During ejaculation immediately after micturition, examination of the urine may be found in the urine of a large number of sperm. Common reasons, bladder neck closure insufficiency, pelvic operation and transurethral resection of the prostate, urethral stricture that semen discharge difficulties.
2 fine tract obstruction infertility of testicular spermatogenic function of normal, because seminal tract obstruction of sperm in semen can not enter the. The differential diagnosis as follows:
( 1) congenital seminal tract obstruction: mainly because of congenital agenesis of vas deferens or absent, seminal vesicle agenesis of vas deferens epididymis, and not connected or epididymal dysgenesis induced infertility. Its feature is semen volume is little, often < 1ml, semen coagulation, seminal plasma fructose free, as well as azoospermia.
( 2) infected seminal tract obstruction: common infection for bilateral epididymal tuberculosis, gonococcal epididymitis and filariasis. Characterized by azoospermia but testis size normal.
( 3) the iatrogenic fine tract obstruction: patients often have vesiculography or a history of vasectomy history; bilateral hernia repair, ligation vas resulted in vas deferens obstruction; testicular, epididymal operation caused by the epididymis or spermatic cord injury.
( 4): traumatic fine tract obstruction due to testicular, epididymal, testicular trauma combined with fine tract obstruction caused by azoospermia.
3 testicular spermatogenesis in rabbits induced by disturbance of infertility is due to various reasons testis cannot produce sperm, while spermatic tract normal, but no sperm in semen. The differential diagnosis as follows:
( 1): cytogenetic abnormalities such as hermaphroditism, syndrome Klinefelter, is the result of chromosome in meiosis nondisjunction caused by mosaicism. Clinical characteristics of breast enlargement, beard, pubic hair is sparse, narrow shoulder hip width and other female body; testicular small and soft, sexual dysfunction, semen sperm. Elevated FSH concentration in plasma and urine, plasma testosterone concentrations lower than normal.
( 2): congenital abnormalities such as congenital anorchia, bilateral cryptorchidism, germ cell dysgenesis. Germ cell hypoplasia in patients of normal semen in men, but no sperm, testicular size in normal breast, not accrescent, plasma testosterone and serum LH levels were normal, elevation of plasma FSH. Bilateral cryptorchidism in semen of no sperm, but its not palpable and testis, plasma testosterone and serum LH level is low, but in a single injection of chorionic gonadotropin 5000 U, plasma testosterone levels can be significantly elevated. Congenital anorchia but not palpable and testis, the plasma testosterone and serum LH level is very low, a single injection of chorionic gonadotropin after the plasma testosterone levels increased obviously.
( 3): endocrine abnormalities such as hypogonadism, hypopituitarism, hypothyroidism, adrenal hyperplasia. Primary gonadal insufficiency patient blood FSH and LH levels often increased, and testosterone levels are reduced. Hypopituitarism can cause secondary hypogonadism, patient blood FSH and LH level is on the low side, Leydig cell function and impaired sexual function, decrease in semen volume.
( 4): spermatogenic cell maturation disorders such as radiation damage, drug effects, such as varicocele. The testis size is normal, the examination of semen sperm decreased or no sperm. Testicular biopsy showed spermatogenic process more pauses in spermatocytes, seminiferous tubules in further development of spermatogenic cells rarely.
4 immune infertility immune sterility is divided into two categories: one category is males produce antisperm autoimmunity, one kind is the female anti-sperm immune. In such patients is characterized by its function, semen and hormone levels were normal.