Definition of male infertility, causes, and its relationship with ejaculation and fertility

**IV. Infertility**

[Infertility] Male infertility refers to the inability of a wife to conceive after a couple has lived together for more than one year without using contraception, and the cause lies with the husband's condition.

Male infertility has many causes. For infertile patients, any obstruction in sperm production, transport, or the union of sperm and egg can lead to infertility.

Common causes include testicular hypoplasia, cryptorchidism, orchitis caused by mumps before puberty, varicocele, vitamin A and vitamin E deficiency, long-term exposure to high temperatures and radiation, and the production of sperm antibodies.

Congenital defects or stenosis of the vas deferens after trauma, diseases of the epididymis, vas deferens, seminal vesicles, and prostate, erectile dysfunction, anejaculation, retrograde ejaculation, etc.

Clinically, the main manifestation is infertility. Semen analysis shows a decrease in sperm count, less than 0.6 billion per milliliter, or sperm necrosis, abnormality, and poor motility.

The main causes of male infertility are as follows:

(1) Sexual dysfunction: Erectile dysfunction, nocturnal emission, premature ejaculation, priapism, anejaculation, etc. can all prevent semen from entering the vagina.

(2) Sperm abnormalities: no sperm, low sperm count, poor sperm quality.

(3) Semen abnormalities: hematospermia, leukorrhea, semen non-liquefaction, etc.

(4) Semen output disorder: Congenital malformations or traumatic malformations of the male external genitalia and inflammation of the reproductive organs can all block the vas deferens, preventing semen from being output normally.

Or due to various reasons, the internal sphincter of the bladder may not close properly or may not close at all, resulting in retrograde ejaculation during intercourse, where semen cannot be ejaculated normally, preventing sperm from combining with the egg.

[Ejaculation and Fertility] Some couples can have sexual intercourse, the man can ejaculate, and the woman's examination shows no abnormalities, but they are unable to conceive.

Why is this? Generally speaking, most people who ejaculate are fertile, but a minority of people who ejaculate are not fertile.

The reasons are:

(1) Oligospermia or azoospermia caused by various reasons; due to the lack of sperm production or reduced sperm production, although there is ejaculation, there are no sperm in the semen or the sperm count is too low, which can cause infertility.

(2) Vas deferens obstruction: Although the testes produce sperm, the sperm cannot be discharged from the body due to the obstruction of the sperm output duct, resulting in infertility.

(3) Abnormal sperm outflow channel: The testes can produce sperm and ejaculate, but the semen is not ejaculated into the woman's vagina, but is ejaculated outside the vaginal opening, such as congenital abnormalities such as hypospadias and epispadias.

Another cause is retrograde ejaculation, where there is a sensation of ejaculation, but semen flows backward from the posterior urethra into the bladder, leading to infertility.

The main cause is abnormal bladder neck or abnormal nerve function that controls the lower urinary tract.

[Age Affects Sperm Quality] As men age, their fertility gradually declines.

Compared to the limited number of eggs a woman can produce, a man's ability to produce sperm is much stronger. However, the "motility" of sperm in older men is clearly less than that in younger men.

As people age, sperm motility becomes increasingly sluggish.

People generally believe that men can have children even at 80 years old, but this is actually a very one-sided view.

Sperm motility decreases by about 0.7% every year. At age 22, only 25% of men have abnormal sperm motility, but by age 60, this proportion has risen to about 85%.

[Proper Sexual Lifestyle] Poorly managed sexual life can not only affect quality of life but may even lead to infertility; conversely, properly arranged sexual life can increase the chances of pregnancy for infertile couples.

Among infertile women, a significant number engage in intercourse during menstruation, mistakenly believing that it increases the chances of pregnancy.

In fact, having sex during menstruation can stimulate the body to produce antisperm antibodies, which can cause immunologic infertility.

It can also lead to ascending bacterial infection, inflammation of the fallopian tubes, or fallopian tube blockage, resulting in infertility.

Some couples develop the habit of urinating immediately after intercourse to prevent urinary tract infections, which is perfectly acceptable from a hygiene perspective.

However, this practice may not be appropriate for infertile couples in the long run, as it can lead to excessive leakage of semen, especially during intercourse during ovulation. This habit should not be maintained indefinitely.

Studies have shown that men are better able to adapt to high-intensity work than women.

The high-intensity work has little impact on their fertility.

However, high-intensity exercise and prolonged training can lead to a decrease in testosterone, which has a negative impact on libido and semen health.

Generally speaking, overly thin men have lower testosterone levels, resulting in poorer penile erection and libido.

Long-distance runners are a typical example.

They train intensely, have little body fat, and many suffer from infertility.

For them, the problem can be solved simply by gaining weight appropriately.

[Frequency of sexual activity] About 70% of the infertile patients who seek treatment at a certain sexual rehabilitation center have a history of frequent sexual intercourse, especially during the honeymoon period when they have sex 1 to 2 times a day for 1 to 3 months.

Some infertile couples still maintain the habit of having frequent sexual intercourse.

Their mindset is "one in a hundred shots will hit the mark".

During normal male intercourse, ejaculation is 2-6 ml, containing more than 30 million sperm. 70% of the sperm have normal motility, but only 1%-5% reach the uterine cavity, and finally only one sperm combines with an egg to form a fertilized egg.

This indicates that the sperm rejection rate is extremely high.

If couples have sex too frequently, the sperm supply will be insufficient and the quality will be poor, which will affect fertilization.

In addition, sperm, as an antigen, can cause women to produce antisperm antibodies when they are frequently stimulated, which can cause sperm to agglutinate or lose their vitality, directly affecting fertilization.

It is evident that excessive sexual intercourse often leads to the opposite of what one desires.