Patient's question:
I'm only 26 this year, and taking medicine for a long time hasn't been effective. I've always wanted a baby.Doctor's answer:
But according to the routine semen analysis report, you should be classified as having low sperm quality. However, when treating diseases, it is important to adopt a comprehensive approach. Medication or surgical treatment is just one aspect. Do not treat illnesses mechanistically or dogmatically—meaning, if there is a disease, then medication is necessary, and medication will be effective; if there is a problem, then undergo tests, and if the test results are abnormal, then treat the test results (blind medication or blind surgery).Remember clearly, the treatment is for the disease, not for the test report, and certainly not for the numbers on the test report! First and foremost, the key question is whether you have a history of infertility? That is, how long have you been sexually active without using contraception?
Regarding the analysis of routine semen test results: Routine semen analysis must be combined with a history of infertility to be correctly understood. It is different whether or not there is a history of infertility. The World Health Organization defines male infertility as the inability of a couple to conceive after 1 year of regular sexual activity without contraception due to male factors. Note that the definition of male infertility is based on time, not on indicators (such as sperm concentration or sperm motility). We treat diseases, not test reports or the numbers on them. Within 1 year, if active sperm are present in the semen, theoretically, it can be observed. Studies show: a 75% chance of pregnancy in 6 months, 85% in 1 year, and some sources indicate 90%. If, within 1 year, it is classified as oligospermia or asthenozoospermia, it is essentially over-treatment, followed by blind and excessive medication. Therefore, without a history, as long as it is not absolute infertility (e.g., azoospermia in males), it is still in the stage of promoting healthy reproduction, and observation is sufficient. There is no need to worry, nor is it necessary to use large amounts of medication to improve semen parameters.
A history of male infertility primarily refers to the duration of sexual activity without contraception. In clinical practice, if the woman is ≤34 years old, the limit is 1 year; if the woman is ≥35 years old, she can enter the infertility treatment process after 6 months. This is because a woman’s fertility at 35 is only 50% of that at 25, at 38 it is only 25%, and above 40, it is less than 5%.
In clinical observation, many patients with hypogonadotropic male infertility may achieve pregnancy if some sperm are present in the semen after medication, which also confirms the importance of the history. If there is a history, and the male’s semen parameters are normal, and the woman has no major issues, it may indicate unknown infertility factors that are more difficult to treat.
Some precautions may be helpful: Avoid smoking, limit alcohol consumption (light to moderate drinking has little impact on fertility), stay away from radiation, and avoid various harmful chemicals. Do not take saunas or wear tight underwear for long periods (saunas or tight underwear can raise local temperature, inhibiting sperm production. Studies show that a fever above 39°C may suppress sperm production for more than half a year).
Regarding the causes of male infertility: Approximately 40% of infertility cases are due to male factors, 40% to female factors, and 20% are due to currently unknown reasons, possibly involving both partners. There are many causes of male infertility, but apart from obvious varicocele, the cause is often unclear. Studies show that about 60–75% of cases remain unexplained. Therefore, in most cases, empirical treatment can be used, often with medication. In this case, medication generally follows a simple principle, similar to traditional Chinese medicine, where a single herb may be sufficient (e.g., Duzhen Decoction), while a long list of herbs may be less effective.
There are generally three treatment options for male infertility: medication, artificial insemination, or in vitro fertilization (IVF). If medication does not achieve the desired results, artificial insemination can be considered. If it still does not work or artificial insemination is not possible, IVF can be considered. Treating all diseases follows the principle of starting simple and non-invasive before moving to more complex and invasive methods. Higher technology should not be chosen, as the more artificial intervention, the more troublesome and expensive it becomes. Any intervention deviates from the natural state, and the more intervention, the greater the potential genetic risks.
First choice: Medication. Understand the role and duration of medication. 1. Medication effect: Taking medication to improve semen parameters increases the chance of pregnancy. 2. Medication cycle: The human sperm production cycle is 70–74 days, approximately 3 months. Therefore, if empirical medication is used, the course should generally last 1–2 sperm production cycles, i.e., 3–6 months. If the effect is poor, consider assisted reproductive technology (artificial insemination or IVF), and do not use expensive sperm-stimulating drugs indefinitely. 3. Medication should not be interrupted because sperm production is continuous. Generally, medication is taken for 1 month, with a follow-up test after about 25 days. For hypogonadotropic patients, medication is usually continued for 12–18 months.
Artificial insemination: Artificial insemination is generally recommended to be done for 3–6 cycles consecutively. Studies show that the cumulative success rate after 3 cycles is about 20%. However, the specific plan is determined by a reproductive gynecologist.
In vitro fertilization (IVF): 1. Only the first-generation IVF is recommended, not the second-generation, as the latter is more expensive and carries higher risks, though the final decision depends on the laboratory’s assessment. 2. If IVF is reached, the woman can only retrieve 10–15 eggs. Excessive ovulation induction increases the risk of hyperstimulation in women. If the woman’s ovarian function is poor, fewer eggs can be retrieved. Generally, the number of sperm from the male is sufficient, so there is no need to worry or use excessive medication.
Regarding the effectiveness of male infertility treatment: Generally, the worse the semen quality, the longer the infertility duration (treatment effectiveness is much lower after 4 years), or the older the woman (a woman’s fertility at 35 is only 50% of that at 25, at 38 it is only 25%, and above 40 it is less than 5%), the poorer the medication effect. In such cases, IVF may be considered.