Fertility problems caused by testicular torsion, small testis, and unilateral testicular absence.

**303.** **Testicular Torsion and its Diagnosis and Treatment**

Testicular torsion is not a rare disease; according to foreign reports, it can occur in young men under 25.

The incidence rate is higher in adolescents. Testicular torsion inevitably leads to testicular ischemia, and the testicle cannot...

Prolonged ischemia. Animal experiments conducted abroad using dogs have found that after 2 hours of testicular ischemia,

It does not affect spermatogenesis or endocrine function; 4 hours of ischemia will stop spermatogenesis for 60 days, but it has...

No impact on endocrine function; after 6 hours of ischemia, spermatogenesis is lost, and some endocrine function is affected.

Damage; after 10 hours of ischemia, the spermatogenic and endocrine functions of the testes are completely destroyed. Clinically...

Similarly, in cases where surgery is performed within 5 hours of testicular torsion, the testicular salvage rate is 80%.

If the testicle is twisted for more than 10 hours, only 20% of testicles can be saved.

Testicular torsion is caused by a congenitally long mesentery, which is related to movement.

Testicular torsion is related to strong contractions of the cremaster muscle caused by movement, trauma, or sleep.

The most obvious symptoms of this acute condition are pain in the scrotum and testicles, and in severe cases, testicular swelling. Use Doppler...

Diagnosis can be made using ultrasound and isotope testicular scanning.

Once testicular torsion is diagnosed, manual reduction should be performed immediately, followed by surgical intervention.

Reduction or fixation. Since testicular torsion usually occurs from the outside in, manual manipulation is used.

During repositioning, the repositioning should be performed from the inside out according to the direction of the cremaster muscle's resistance. After repositioning, the muscle should still...

Surgical fixation is required to prevent recurrence. Surgical treatments include torsion reduction and testicular fixation, and necrotic testicular fixation.

Removal of the dead testis and prophylactic fixation of the contralateral testis.

**304.** **Does having small testicles affect fertility?**

To determine if the testicles are normal, one should first understand the normal function of the testicles at different ages.

Normal size. From birth to age 12, the testes are in a relatively quiescent developmental period.

The typical volume is 1–4 ml (measured by water displacement, the same below), for 12-year-olds.

Later, when boys enter puberty, their testicles rapidly increase in size, and in adulthood...

The volume is 16–25 ml, with an average of 19.8 ml. It is generally believed that the adult testis...

Testicles with a volume less than 10 ml are called small testicles, which can cause infertility. The function of such testicles...

The ability to reduce significantly often results in two situations:

(1) Impaired spermatogenesis in the testes, with sperm count often less than 1000.

Most patients are infertile if their semen contains 10,000 sperm per cubic millimeter or no sperm at all.

(2) The endocrine function of the testes is impaired, and the level of testosterone in the blood is very low.

Low development of male secondary sexual characteristics, such as sparse facial hair, pubic hair, and armpit hair; pronunciation is...

A childlike voice, in severe cases, can exhibit feminine characteristics, and most individuals with this voice experience low libido and sexual function.

So, how does small testis occur? There are two main reasons:

One type is congenital testicular hypoplasia, which is caused by a condition called Klinefelter syndrome.

This disease is caused by a condition affecting approximately 1 in 400 male infants. It is primarily caused by sex chromosome abnormalities.

The abnormality refers to an abnormality occurring during meiosis in the mother's egg (24XX), resulting in a mismatch with the Y sperm.

When the sperm (23Y) combines, an abnormal chromosome 47XXY is produced; it could also be the father's sperm.

An abnormality occurred during the formation of the embryo, resulting in a 47XXY embryo. Individuals with this condition may experience intellectual development issues.

The delay is normal or slightly delayed because the testes can still secrete a certain amount of male hormones.

The individual may still have libido and sexual function, but the testes' ability to produce sperm is impaired, resulting in abnormal semen quality.

The patient has no sperm or very few sperm, thus losing their fertility. Treatment for this condition mainly involves...

It supplements the male hormone testosterone; the aim is to help patients restore their male physique and maintain sexual function.

As for fertility, there is currently no good way to restore it.

Another type is congenital adrenal hyperplasia, which is caused by congenital 21-hydroxycorticoids.

This is caused by an enzyme deficiency. It occurs because the adrenal glands are involved in the process of synthesizing cortisol from cholesterol.

In this process, cortisol synthesis is reduced if 21-hydroxylase is lacking, as this enzyme is involved.

Less; conversely, the synthesis of androgens (testosterone) in the adrenal glands increases significantly. In excess...

Under the influence of androgens, patients exhibit precocious puberty, showing male characteristics before the age of 10.

Secondary sexual characteristics, but the testes are small. This is because the adrenal glands produce testosterone...

This inhibits the pituitary gland's secretion of gonadotropins, thereby suppressing testicular development.

Precocious puberty, also known as pseudoprecocious puberty, causes impaired spermatogenesis in the testes, leading to infertility.

For this disease, some people abroad use cortisone to treat it, which can lower plasma testosterone levels.

This, in turn, increases the secretion of gonadotropins by the pituitary gland, leading to the development of the testes.

**305.** **Can a person conceive without one testicle?**

The absence of one testicle is generally caused by either congenital or acquired factors.

Caused by factors. Congenital absence is most commonly seen in unilateral cryptorchidism, ectopic testis, etc.; acquired absence...

Surgical removal of one testicle is commonly seen in cases of testicular disorders, such as testicular tuberculosis or testicular tumors.

In addition, surgical resection of testicular tissue caused by severe damage in car accidents, workplace injuries, or war wounds.

Besides, it is also a common cause of testicular agenesis. Due to many congenital unilateral testicular agenesis...

Testicular agenesis usually means that one testicle has failed to descend into the scrotum and is "hidden" inside the body.

It is located in another part of the body, therefore it is not a true testicle. Nevertheless, because this undescended testicle is located in...

The human body is at a high temperature, so sperm production is basically impossible; therefore, from a reproductive perspective...

This discussion can be mentioned alongside the latter.

Whether or not a woman can have children if she is missing one testicle depends on the specific circumstances.

Let's analyze this in detail. We know that sperm is the seed of life, and the testicles are the factory that produces sperm.

Normally, only one side has a healthy testicle, which can lead to infertility.

It will be quite large. But objectively speaking, it can't be determined solely by the number of testicles.

To discuss fertility in the context of existing conditions. Take varicocele as an example: varicocele affects one side of the body...

At the same time as the disease occurs, the affected side can transmit harmful factors such as metabolic waste products to the affected side through the trachea.

On the healthy side, there are also two testes, but neither is fertile. Some cases involve unilateral testicular diseases.

The disease, due to timely surgical removal, did not affect the healthy side, allowing the remaining side to...

Only the testicles enlarge compensatorily, and the workload of both testes is shifted to one side, which can also be normal and not affect the testicles.

Fertility. Therefore, the key issue is still the quantity and quality of sperm.

Nevertheless, the fertility situation for men lacking one testicle is generally not optimistic.

But there's no need to be overly worried. As long as you seize the opportunity and understand the woman's ovulation...

If they have intercourse at the right time, the hope of having a son is not entirely impossible.