Due to various reasons, many patients suffer from infertility, and both spouses and the entire family are very anxious. Many couples ultimately choose to assist in pregnancy (artificial insemination and in vitro fertilization), and some patients are very interested in conservative treatment. So, how do male infertility patients seek medical attention and develop personalized treatment strategies for different conditions? Chen Liang, Department of Andrology, Peking University First Hospital
There are generally three treatment options for male infertility: conservative treatment (drug therapy), artificial insemination, or in vitro fertilization. Generally, when formulating treatment strategies, the principle of degradation should be adopted, which is to follow the above process step by step. However, the most important factor to consider is the age of the female partner. If the female partner is older and has poor ovarian function, it is recommended to undergo in vitro fertilization treatment as early as possible to avoid losing treatment opportunities. If the goal is not achieved after standardized drug treatment, artificial insemination should be considered; If the goal has not been achieved or artificial insemination cannot be performed, consider in vitro fertilization. The treatment of all diseases is the same, from simple to complex, and from non-invasive to invasive principles.
If both spouses are young or do not agree to artificial insemination or in vitro fertilization due to various reasons, medication can be chosen: the purpose of medication is to improve semen routine parameters and increase the probability of pregnancy; Special attention should be paid to the cycle of medication. Since the cycle of human spermatogenesis is 70-74 days, and the maturity in epididymis is about 12 days, the sperm is discharged for about 3 months. Therefore, if empirical drug treatment is taken, the course of treatment should generally be 1-2 spermatogenesis cycles, that is, 3-6 months. Special reminder: medication should not be interrupted, as the spermatogenic cycle is continuous, so it is generally about one month after medication before a follow-up examination. If it is a patient with low levels of gonadotropin and the use of chorionic gonadotropin and urotropin, the general duration of medication is about 18 months. In addition, the precautions for the male partner during the medication period include: avoiding smoking, drinking less (preferably abstaining from alcohol), strengthening exercise, controlling weight, preferably engaging in aerobic exercise such as running or swimming every day, staying away from radiation, playing less with computers and mobile phones, staying away from various harmful chemicals such as paint, chemical raw materials, phenol and other organic solvents, not washing sauna, and not wearing tight underwear for a long time. As the saying goes, if you don't quit smoking and continue to drink excessively, even the elixir won't improve your sperm quality.
If you want to adopt artificial insemination, you must have at least 10 million high-quality sperm (A+B), and it is generally recommended to do it continuously for about 3-4 cycles. Data shows that the cumulative success rate of artificial insemination for 3 cycles is about 10-20%. In vitro fertilization (IVF) refers to the technique of removing an egg from the body, fertilizing it with sperm in vitro to form an embryo, and then transplanting it into the body. The success rate is over 55% in the Reproductive Center of Peking University Hospital.
Whether to adopt IVF technology or not, especially considering the age of the female partner, female fertility is closely related to age: by the age of 35, female fertility is only 50% of that at the age of 25, by the age of 38, it is only 25%, and by the age of 40 and above, it is less than 5%. The success rate of IVF is closely related to the age of women: women aged 30-40 have a success rate of 30-40%, women aged 40-45 have a success rate of 5-10%, and women over 45 have a lower success rate. Therefore, based on the age of the female partner, a suitable diagnosis and treatment plan can be adopted.