Patient's question:
Is it true that any form of infertility can be treated?Doctor's answer:
Hello, let's first discuss what male infertility is.By definition, male infertility refers to a condition where a couple has been living together for 1 year or more without using contraception, but the wife remains unable to conceive, and the cause or etiology of the condition lies with the husband. In detail, it was once classified as either male infertility or male impotence. Male infertility referred to a situation where the husband could impregnate the wife, but the fetus could not survive, such as in cases of miscarriage or stillbirth. On the other hand, male impotence referred to a situation where the husband could not impregnate the wife. Currently, these two conditions are no longer distinguished in detail and are collectively referred to as male infertility.
The World Health Organization (WHO) defines infertility as: at least 12 months of non-contraceptive sexual intercourse without pregnancy. Currently, the widely accepted definition in China is: at least 2 years of non-contraceptive sexual intercourse without the wife becoming pregnant.
Next, let's discuss what primary male infertility is.
Primary male infertility refers to a man who has never been able to impregnate a woman, regardless of whether the woman is his wife, sexual partner, or others. This is essentially determined based on the patient's fertility history. It is different from the concept of idiopathic infertility and is not a diagnosis of unknown factors or etiology. Therefore, primary male infertility is not a diagnostic term for the cause. This is easily confused and should be distinguished.
Next, let's discuss what secondary male infertility is.
Secondary male infertility refers to a man who has previously been able to impregnate a woman, regardless of whether the woman is his current spouse or the outcome of the pregnancy, but has not been able to conceive in the last 12 months without using contraception. In general, secondary male infertility in men has a higher likelihood of restoring fertility. Therefore, distinguishing between primary and secondary infertility has clinical significance.
Finally, let's discuss the difference between relative and absolute infertility.
Relative and absolute infertility are general classification methods for male infertility patients. This classification method is important for judging the treatment effect and prognosis of male infertility patients.
Absolute infertility refers to a situation where the patient's fertility has been completely lost and is difficult to treat with current methods. For such patients, psychological counseling should be provided to explain the situation clearly and encourage them to adopt or use donated sperm for artificial insemination to make their wife pregnant, thereby fulfilling their desire to raise children.
Relative infertility refers to a situation where the patient's fertility has been damaged to some extent but has not yet reached complete infertility. With reasonable adjustments and treatment, there is still hope of restoring fertility. For such patients, measures such as lifestyle guidance, medication, and artificial insemination can be adopted based on different conditions.
Next, let's discuss the main classification methods for male infertility.
There are various classification methods for male infertility. Some people classify male infertility based on semen analysis results, such as oligospermia, asthenospermia, teratospermia, and azoospermia. Others classify it as sexual dysfunction infertility, abnormal semen infertility, and azoospermia. These classification methods are either superficial or vague. Therefore, WHO proposed a classification method based on etiological diagnosis, which is currently the most authoritative diagnostic classification method for male infertility in the world. It divides male infertility into 16 categories:
(1) Sexual dysfunction and/or ejaculation dysfunction;
(2) Immunological etiology;
(3) Unknown factors or etiology;
(4) Simple seminal fluid abnormalities;
(5) Iatrogenic etiology;
(6) Systemic etiology;
(7) Congenital abnormalities;
(8) Acquired testicular damage;
(9) Varicocele;
(10) Male accessory gland infection;
(11) Endocrine etiology;
(12) Idiopathic oligospermia;
(13) Idiopathic asthenospermia;
(14) Idiopathic teratospermia;
(15) Obstructive azoospermia;
(16) Idiopathic azoospermia.
Idiopathic male infertility includes idiopathic oligospermia, idiopathic asthenospermia, idiopathic teratospermia, and idiopathic azoospermia. It refers to a male infertility patient who has abnormal sperm but otherwise normal conditions, with the cause or etiology of the sperm abnormality being unknown, hence the term idiopathic male infertility. For example, idiopathic oligospermia refers to a situation where semen analysis only shows a reduction in sperm count, while testicular volume, function, endocrine function, and other semen tests are normal. The cause or etiology of the reduced sperm count is unknown, and once the cause or etiology is identified, it can no longer be called idiopathic oligospermia.
In WHO's etiological diagnostic classification of male infertility, there is a category of male infertility with "unknown factors or etiology." Some people often confuse it with idiopathic male infertility. As mentioned above, idiopathic male infertility refers to a situation where the fundamental cause or etiology of the condition is unclear, but the apparent cause or etiology is known, such as oligospermia or asthenospermia. On the other hand, male infertility with unknown factors or etiology refers to a situation where all tests are normal, not only is the fundamental cause or etiology unknown, but even the apparent cause or etiology has not been found. Therefore, it is completely "unknown factors or etiology."