Classification of male infertility causes, treatment and dietary therapy, and warnings about Viagra.

Male infertility is caused by sexual dysfunction, accounting for approximately 1% to 5% of all male infertility cases. Excluding this factor, the causes of male infertility can generally be divided into three main categories.

1. Pretesticular causes: Secondary hypogonadism caused by pituitary or hypothalamic lesions.

2. Testicular causes: Primary hypogonadism caused by interstitial lesions of the testes or spermatogenesis disorders caused by seminiferous tubule lesions.

Congenital testicular dysfunction mainly refers to chromosomal abnormalities. Those related to fertility are mainly sex chromosome aberrations, and the main clinical manifestations include Klinlefelter syndrome, superandrogen syndrome, and true and false hermaphroditism.

Congenital absence or incomplete descent of the testes, testicular torsion leading to atrophy, testicular trauma or surgical damage to the testes themselves or their blood supply can all lead to spermatogenesis disorders.

Systemic diseases such as hyperadrenocorticism or hypoadrenocorticism, hyperthyroidism or hypothyroidism, endocrine diseases such as diabetes, nutritional and metabolic diseases such as hypoproteinemia and vitamin deficiency, as well as febrile diseases, especially viral infections such as measles or mumps virus and gonorrhea or non-gonococcal infections such as mycoplasma infection, all affect spermatogenesis.

Radiation exposure can cause oligospermia, and long-term excessive exposure can permanently stop spermatogenesis.

Cytotoxic substances and chemicals can cause testicular damage. For example, industrial hazards such as lead, arsenic, zinc, aluminum, and aniline, as well as drugs such as sulfonamides, nitrofurantoin, alkylating agents, hormones, spironolactone, serotonin, monoamine oxidase inhibitors, cyclophosphamide, methotrexate, colchicine, and large amounts of aspirin can all affect sperm production.

Varicocele leads to increased local temperature, insufficient oxygen and nutrition to the testes, and the backflow of blood from the adrenal and renal veins contains testicular toxic substances such as adrenal steroid hormones, catecholamines, and serotonin, thus affecting spermatogenesis and semen quality. Statistics show that one-third of male infertility is related to varicocele.

3. Subtesticular causes include inflammation and obstruction of the seminal ducts, congenital absence of the vas deferens, retrograde ejaculation, urethral malformations, and immune reactions, all of which can lead to infertility. Statistics show that approximately 10% to 20% of infertility cases are caused by immune factors.

Treatment for male infertility targets the underlying cause. For men with infertility due to sexual dysfunction, guidance on sexual activity is essential. In some cases, even with only a slightly low sperm count, intercourse around the time of the partner's ovulation may lead to pregnancy. Avoiding all factors that affect fertility, such as stress, malnutrition, exposure to radioactive substances, certain medications that inhibit spermatogenesis, and infections, may restore fertility in some cases. Drug therapy can be used for infertility caused by hypothalamic-pituitary-gonadal axis dysfunction. Surgical treatment is chosen for cases of sperm duct obstruction.

1. Drug therapy includes hormone therapy and nutritional therapy.

(1) Hormonal drug treatment: for cases of oligospermia or poor semen quality.

① Human chorionic gonadotropin (HCG): Currently, clinically available HCG includes interstitial cell-stimulating hormone (ICSH) and follicle-stimulating hormone (FSH). It stimulates spermatogenesis in the seminiferous tubules of the testes and stimulates interstitial cell development to release testosterone. It is used for patients with hypopituitarism, low FSH levels, and secondary testicular spermatogenesis dysfunction. The dosage is 1000U, administered intramuscularly every other day, for 10-12 weeks as one course of treatment.

②Chrostachysmolamine: Inhibits the feedback effect of estradiol on the hypothalamus, promotes the secretion of GnRH and pituitary gonadotropins, which is beneficial to spermatogenesis. The dosage is 25-50 mg daily, taken orally for 25 days and then stopped for 5 days, for 3-6 months.

③ Testosterone: Low-dose testosterone directly stimulates spermatogenic epithelial cells, promoting spermatogenesis and improving sperm motility; high-dose testosterone, on the other hand, inhibits spermatogenesis. However, once the medication is stopped, a rebound effect occurs after about six months, leading to elevated gonadotropins and sperm counts exceeding pre-treatment levels, which persists for several months. Specific usage: Low-dose testosterone treatment: methyltestosterone 10-15 mg daily, or 1-methylhydrotestosterone 50 mg daily. High-dose testosterone treatment: testosterone propionate 50 mg, intramuscular injection three times a week, for 12 weeks as one course of treatment. Or testosterone enanthate, 200 mg intramuscular injection every 3 weeks, for 9 weeks as one course of treatment.

(2) Nutritional drug therapy has uncertain efficacy. The following drugs may be beneficial for infertility of unknown cause.

① Sufficient protein and vitamins A, B and E.

② Glutamic acid 0.6-2g, orally, 3 times a day, for 2-3 months as one course of treatment; or arginine 2-4g, orally daily.

③ Supplementing with certain trace elements, such as zinc preparations, may be beneficial.

2. Surgical treatment for male infertility with a clear cause, such as obstruction of the sperm duct or varicocele, can be corrected through surgery.

3. Other methods

(1) Corrective intercourse techniques: men with oligospermia may increase the chances of conception by having intercourse around the time of their partner's ovulation. For cases with high semen volume but low sperm concentration, the technique of segmented ejaculation is used to remedy the situation, that is, only the first part of ejaculation is injected into the vagina, because in about 90% of cases, there is a higher sperm concentration and better sperm motility in the first 1/3 of ejaculation.

(2) Artificial insemination: Artificial insemination is performed using the husband's own semen. Pregnancy may occur in some cases of oligospermia and asthenospermia, but this method is more suitable for men with sexual dysfunction or genital malformations.

(3) There are three methods to treat male immunological infertility.

① Artificial insemination using sperm from donors.

② Immunosuppressive therapy: Adrenocortical hormones are the first choice, and currently used methods include low-dose continuous therapy and periodic therapy.

③ Sperm treatment: After removing the antigens on the surface of the sperm by filtration or washing, artificial insemination may result in pregnancy, but the effect is not satisfactory.

According to Traditional Chinese Medicine (TCM) theory, innate essence needs the nourishment of acquired essence to be replenished and strengthened, while acquired essence requires the transformation and vaporization of innate essence to be produced. Dietary nutrition is the material basis for acquired essence; therefore, dietary therapy can nourish the kidneys and replenish essence. Based on the theory that the kidneys store essence, dietary supplements should include foods that nourish the kidneys and replenish essence, such as: yam, eel, ginkgo, sea cucumber, frozen tofu, tofu skin, peanuts, walnuts, sesame seeds, dates, honey, grapes, lotus seeds, edible fungi, dog meat, mutton, and animal penises. These can enhance libido and increase fertility.

Traditional Chinese medicine's approach to dietary supplementation aligns with Western medicine's nutritional science, sharing the same viewpoint. Western medicine believes that sufficient protein and vitamins can promote sperm production, and that vitamins A, B, and E can enhance reproductive function. Some trace elements, such as zinc, manganese, and selenium, also have a significant impact on male fertility. Zinc participates in testosterone synthesis and is related to sperm motility and fertilization. Zinc deficiency can lead to male hypogonadism, smaller testes, and reduced or absent sperm production. Manganese deficiency can impair sperm maturation, leading to oligospermia or azoospermia. Selenium deficiency can reduce the energy source required for sperm motility, thus decreasing sperm motility.

[Ingredients] 1 turtle, 15g of white fungus, salt and ginger to taste.

[Administration] Slaughter and clean the turtle, then cut it into pieces; soak the white fungus in water, then stew it together with the turtle meat and ginger. After it is cooked, add salt to taste. Eat the turtle meat and white fungus and drink the soup. Take one dose daily for 5-7 days.

[Efficacy] Nourishes Yin and reduces internal heat. Suitable for infertility caused by semen non-liquefaction.

[Ingredients] 10g each of Asparagus cochinchinensis, Ophiopogon japonicus, and Ligustrum lucidum, 15g of Cordyceps sinensis, and 30ml of honey.

[Administration] Decoction of the above four ingredients in water, add honey and drink. Take warm, one dose per day, for several consecutive days.

[Efficacy] Nourishes Yin and reduces internal heat. Suitable for infertility caused by semen non-liquefaction.

[Ingredients] 15g ginseng, 20g astragalus, 25g yam, 5 sparrow eggs.

[Administration] Decoction of all herbs, remove dregs, add sparrow eggs and simmer for a short while. Take warm, eat the sparrow eggs and drink the soup, one dose per day for several days.

[Efficacy] Strengthens the spleen and kidneys. Suitable for infertility caused by poor sperm motility.

[Ingredients] 1 pair of deer penises, 15g each of Morinda officinalis and Epimedium.

[Preparation] Boil the above three ingredients together until the deer penis is thoroughly cooked, then chop it into small pieces. Eat the deer penis and drink the soup, one dose per day, for several days.

[Efficacy] Tonifies kidney qi and strengthens the spleen and stomach. Suitable for infertility caused by poor sperm motility.

[Ingredients] 15g each of Morinda officinalis and Cuscuta chinensis, 10g each of Cinnamomum cassia and Cistanche deserticola, 20g of dog penis, 100g of mutton, and appropriate amounts of Sichuan pepper, ginger, cooking wine, MSG, lard, and salt.

[Preparation] Place Morinda officinalis, Cuscuta chinensis, and Cistanche deserticola into a gauze bag, tie the opening, and set aside. Soak the dog penis in water until it swells, wash it, stir-fry it until crispy, then soak it in warm water for half an hour. Place it in a pot of boiling water along with the washed mutton. After the water boils, add Sichuan peppercorns, ginger, cooking wine, and cinnamon. Simmer over low heat until the dog penis is 70% cooked. Then, put the herb bag into the pot and continue to simmer. Once the dog penis and mutton are tender, remove them, cut them into pieces, place them in a bowl, and season with MSG, salt, and lard. Eat the meat and drink the soup.

[Efficacy] Tonifies the kidneys and enhances male virility. Can be used as an adjunct treatment for infertility (low sperm motility).

[Ingredients] 15g each of Rehmannia glutinosa (processed), Dioscorea opposita, Rubus idaeus, Lycium barbarum, and Cuscuta chinensis; 10g of jujube peel; and 12g of Alisma plantago-aquatica.

[Administration] Place all seven ingredients in a clay pot, add an appropriate amount of water, and simmer to make a decoction. Drink the decoction. Take twice daily, in the morning and evening.

[Efficacy] Nourishes the kidneys and promotes sperm production. Suitable for infertility caused by abnormal semen and kidney essence deficiency.

[Ingredients] 15g each of Cibotium barometz, Rosa laevigata, and Lycium barbarum, and 200g of lean dog meat.

[Preparation] Wash and cut the dog meat into pieces. Place it in a pot with the dog spine, rose hips, and wolfberries, add an appropriate amount of water, and simmer for 40 minutes. Eat the meat and drink the soup. Regular consumption is beneficial.

[Efficacy] Tonifies the kidneys and strengthens yang. Can be used as an adjunct treatment for infertility.

[Ingredients] 1 pair of lamb kidneys, 12g of Cistanche deserticola, 10g each of Rehmannia glutinosa and Lycium barbarum, and 8g of Morinda officinalis.

[Preparation] Wash the lamb kidneys, dice them, and put them in a pot with Cistanche deserticola, wolfberry, and Morinda officinalis. Add an appropriate amount of water and simmer for 60 minutes until the lamb kidneys are tender. Eat the meat and drink the soup. Once a day.

[Efficacy] Tonifies the kidneys and enhances male virility. Can be used as an adjunct treatment for infertility.

[Ingredients] 15g each of ginseng and rehydrated shiitake mushrooms, 20g each of yam and astragalus, 5 sparrow heads, 1 hen, and appropriate amount of seasonings.

[Preparation] Clean the chicken and sparrow heads, removing feathers and washing them thoroughly. Place them in a pot with enough water to cover and bring to a boil. When the chicken is about 70% cooked, add astragalus root, yam, shiitake mushrooms, scallions, ginger, salt, and cooking wine. Reduce heat and simmer until tender. Soak the ginseng in boiling water and steam for half an hour. Drink the soup, eat the chicken, and chew the ginseng.

[Efficacy] Strengthens the spleen and stomach, replenishes kidney qi. Suitable for those with poor sperm motility due to spleen and kidney qi deficiency.

[Ingredients] 1 pair of deer penises, 100g of Cistanche deserticola, 100g of japonica rice.

[Preparation] Remove the membrane from the deer penis, wash and finely chop it; soak the cistanche in wine overnight, scrape off the wrinkled skin, and finely chop it. Wash the rice, add water and cook into porridge. When the porridge is almost cooked, add the deer penis, cistanche, and appropriate amounts of scallion, Sichuan pepper, salt, and MSG for seasoning. Serve as a side dish for several days.

[Efficacy] Tonifies the kidneys and strengthens yang. Can be used as an adjunct treatment for infertility.

[Ingredients] 250g rice, salt to taste.

[Directions] Wash the rice and put it in a pot with an appropriate amount of water to cook porridge. When the porridge is almost done, skim off one bowl of porridge oil (the rice foam that appears on the surface of the porridge when it boils). Separately, stir-fry some salt and add it to the porridge oil. Take on an empty stomach, once a day.

[Efficacy] Nourishes and strengthens the kidneys. Can be used as an adjunct treatment for male infertility caused by thin and weak semen.

[Ingredients] 50g walnut kernels, 15g goji berries, and appropriate amount of rice.

[Directions] Crush the walnut kernels, wash the rice, add goji berries, walnut powder, and an appropriate amount of water, and cook into porridge. Take once daily, regularly.

[Efficacy] Nourishes Yin and tonifies the kidneys. Can be used as an adjunct treatment for infertility.

[Ingredients] 250g each of goji berries, dried longan pulp, walnut kernels, and white rice sugar; 7000ml of good liquor; 500ml of glutinous rice wine.

[Administration] Place all the above-mentioned herbs in a fine gauze bag, tie the opening, put the bag into a jar, soak it in good quality liquor and glutinous rice wine, seal the jar, and store it in a cellar for 3 weeks. Take 50-100ml twice a day.

[Efficacy] Tonifies the kidneys and spleen, nourishes blood and blood, and has anti-aging effects. Suitable for symptoms such as deficiency of both spleen and kidney, sallow complexion, lethargy, soreness and weakness of the lower back and knees, impotence, premature ejaculation, low sperm count and infertility.

[Ingredients] 60g goji berries, 30g angelica root, 90g prepared rehmannia root, 1500ml good wine.

[Administration] Process the above-mentioned herbs into small pieces, place them in a silk bag, put the bag into a porcelain container or other suitable container, add wine and seal it. Shake it several times a day. After 14 days, open the container, remove the herb bag, and the clear liquid is ready. Take 3 small cups twice a day, morning and evening. Do not exceed the recommended dosage.

[Efficacy] Nourishes Yin and replenishes blood. Suitable for infertility caused by insufficient essence and blood in the liver and kidneys.

[Ingredients]6g Angelica sinensis, 6g Poria cocos, 6g Lycium barbarum, 6g Achyranthes bidentata, 6g Eucommia ulmoides, 6g longan pulp, 6g walnut kernels, 6g raisins.

[Dosage] Soak the above-mentioned herbs in 500ml of white wine for 7 days before drinking. Take 15-20ml three times a day.

[Efficacy] Nourishes essence and strengthens the body, invigorates the kidneys and spleen, regulates menstruation and promotes fertility.

[Ingredients] 120g fresh mutton, 60g Cistanche deserticola, 120g japonica rice.

[Administration] Chop the mutton and Cistanche deserticola and put them in a pot with water and rice. Cook together. When almost cooked, add seasonings according to personal taste. Cook until the rice is soft and porridge-like. Take on an empty stomach in 4 divided doses while warm.

[Efficacy] Tonifies kidney yang, nourishes essence and blood, and strengthens the spleen and stomach. Treats infertility due to low sperm count and impotence due to deficiency.

[Ingredients] 60g sparrow eggs.

[Preparation] Boil sparrow eggs in water until cooked, remove the shells, and they are ready to eat. Consume twice daily.

[Efficacy] Tonifies kidney yang, nourishes essence and blood, and regulates the Chong and Ren meridians. Treats impotence and infertility.

[Ingredients] 1 young chicken (about 1000g), 1 turtle (about 500g), 10g white pepper, 100g brown sugar, 1000ml white wine.

[Preparation] Slaughter the chicken, remove feathers and internal organs. Kill the turtle, remove its shell, cut it into pieces, and stuff the turtle pieces, along with pepper and brown sugar, into the chicken cavity. Add an appropriate amount of white wine to an earthenware pot, enough to cover the chicken; add more or less as needed. Simmer over low heat until the meat is tender. Eat the meat and drink the broth, consuming it within 2-3 days. Repeat the process after half a month.

[Efficacy] Tonifies the kidneys and strengthens yang. Primarily treats kidney deficiency, impotence, and infertility.

This little blue pill, created by accident, has caused a storm on our planet that cannot be underestimated. Behind its creation-generating $400 million in foreign exchange for its parent company, Pfizer-lies the physiological and psychological needs of men worldwide, both those with and without erectile dysfunction. Viagra (brand name Sildenafil) is hailed by some as a "miracle drug" for treating erectile dysfunction. However, experts warn that this little blue pill can affect sperm motility and reduce male fertility.

American scientists observed the effects of Viagra on the sperm of men aged 18 to 44 in a laboratory setting. The results showed that sperm motility decreased by 50% due to Viagra. Sperm must travel a relatively long distance within the female reproductive tract to fertilize an egg. Viagra "slows down" sperm, inevitably reducing the success rate of conception. They pointed out that the dosage used in the test was smaller than the usual dose; therefore, the impact of Viagra on sperm motility would be more severe in normal use. Researchers said that most Viagra users are older men whose fertility is no longer a concern, so pharmaceutical manufacturers have not paid attention to the impact of Viagra on reproductive ability. Researchers pointed out that many young people currently using Viagra do not have the indications for its use and are simply abusing it. Frequent use of this drug by young people will ultimately affect their reproductive ability. Therefore, young men without erectile dysfunction who want to have children should not take Viagra.