A Comprehensive Analysis of Clinical Examinations for Male Infertility: Professional Protection for Men's Health

Clinical Examination for Male Infertility

1. Medical History and Physical Examination

A detailed and complete medical history can lead to an immediate diagnosis in some cases of infertility.

The physical examination should pay particular attention to the overall physique and appearance, noting any signs of male feminization or gynecomastia. Hair distribution, weight, and examination of vital organs such as the heart, liver, and lungs should be noted for any serious chronic diseases.

① Penile Examination. Penile hypoplasia, posterior scrotal penis, double penis, and micropenis are all extremely rare congenital penile malformations.

② Examination of the Scrotum and Groin. Check for surgical scars and sinus tracts or scar remnants from tuberculosis or other inflammations. Check for any abnormal masses in the scrotum (hydrocele and varicocele) and scrotal elephantiasis.

③ Testicular Examination. Testicular examination includes assessing testicular volume, firmness, and position. If the testicle cannot be palpated in the scrotum, the spermatic cord should be followed to the groin to check for cryptorchidism, or the suprapubic region, the base of the penis, the inner thigh, and the perineum should be examined to check for ectopic testicles. If the testicle is still not found after the above examinations, an ultrasound should be performed. If necessary, a CT scan or laparoscopy should be performed to diagnose abdominal cryptorchidism or congenital absence of the testicle.

④ Examination of the epididymis. The epididymis is located posterolaterally to the testicle. A normal epididymis has a head, body, and tail that are closely attached to the posterolateral aspect of the testicle; it is soft, smooth, and its boundaries can be palpated. If there is inflammation or tuberculosis of the epididymis, nodules can be palpated locally, and there may be tenderness. If there is local epididymal hypoplasia, local defects can be palpated.

2. Laboratory Tests

① Semen Analysis. Semen analysis is an important basis for assessing male fertility. Semen is composed of sperm produced by the testes and secretions from the epididymis, seminal vesicles, prostate, bulbourethral glands, and urethra. Therefore, damage or disease to the structure and function of the testes, vas deferens, and accessory glands can all affect semen quality. Furthermore, the human body is an integrated system; besides systemic diseases affecting semen quality, changes in the individual's environment, nutrition, exposure to harmful substances, smoking, alcohol consumption, and even changes in mental and emotional state can all cause variations in semen quality. Test results can vary significantly from person to person at different times. For example, one normally fertile male had his semen analyzed every two weeks, with sperm density ranging from a minimum of 2 million/ml to a maximum of 175 million/ml. Therefore, in clinical analysis, conclusions of normal or abnormality should not be drawn based on only one or two semen analysis results; sometimes, repeated testing is necessary.

Semen analysis results are also significantly influenced by the semen collection method. Factors such as ejaculation frequency, external temperature, cleanliness of the collection containers, pH levels, and the presence of chemical substances can all alter sperm count and motility. Some patients leave the first few drops of semen outside the container when collecting a semen sample, reducing the sperm count. This is because the sperm density is highest in the first ejaculation, and missing this portion reduces the sperm count. Therefore, it is crucial to be extremely careful when collecting a sample, ensuring that the portion with the highest sperm count is not missed. Furthermore, abstain from sexual intercourse and ejaculation for approximately 5 days prior to the semen collection.

② Testicular biopsy. The purpose of a testicular biopsy is primarily to assess the function of the testicular spermatogenic cells. This is an invasive procedure and can be somewhat painful for the patient. Endocrine hormone testing is often used instead of testicular biopsy. Analyzing the levels of endocrine hormones in the body provides a more definitive assessment of the function of the testicular spermatogenic cells.

③ Endocrine testing. Endocrine testing uses radioimmunoassay. Plasma levels of testosterone, estrogen, FSH, LH, and PRL are typically measured, and the functions of the hypothalamus, pituitary gland, and testes are assessed through clomiphene citrate stimulation, GnRH stimulation, and HCG stimulation tests, providing a reliable basis for analyzing the causes of testicular dysfunction. Primary testicular dysfunction, such as primary testicular hypoplasia, is characterized by atrophy of both germ cells and interstitial cells, and hormone measurements show low testosterone while FSH and LH are elevated.

④ Immunological examination. Obstruction of the vas deferens, testicular injury and inflammation, and infection of the epididymis and accessory glands can all lead to the formation of antisperm antibodies in men. Approximately 10% of infertile men have antisperm antibodies. For male infertility caused by immunological factors, semen and blood samples can be collected to check for antisperm antibodies.

⑤ Bacteriological and exfoliative cytological examination of the male reproductive system. Urogenital infections (such as those secondary to gonorrhea or tuberculosis) can cause epididymitis and orchitis, leading to testicular atrophy and obstruction of the vas deferens, resulting in infertility. Nonspecific inflammation of the male reproductive system can alter the biochemical composition of semen; patients with pyospermia often experience decreased sperm motility and necrospermia. Because reproductive system infections can simultaneously affect testicular spermatogenesis, many immature spermatogenic cells are often found in the semen. Prostatitis and seminal vesiculitis alter the composition of seminal plasma, resulting in changes in semen volume, pH, liquefaction time, and viscosity, all of which can cause male infertility or reduced fertility. Furthermore, mycoplasma and chlamydia infections of the urogenital tract are also important factors affecting sperm motility and causing male infertility.

Treatment of Male Infertility

Male infertility patients should promptly undergo thorough examinations at a well-equipped hospital to identify the cause of infertility and receive targeted treatment. Never blindly believe in so-called "ancestral secret recipes" and misuse unorthodox medicines from quack doctors, which can cause physical, mental, and financial losses.