Male Infertility 男性不孕症

Non-genetic Causes of Male Infertility

Penis: Hypospadias, Epispadias, Penile curvature

Testes: Cryptorchidism (undescended testes), Testicular torsion, Testicular atrophy, Varicocele, Traumatic injury

Vas deferens: Congenital absence of the vas deferens, Infection and inflammation of the reproductive tract

Endocrine: Hypogonadism, Hyperprolactinemia

Sexual dysfunction: Ejaculation disorders leading to inability to ejaculate or semen not entering the vagina properly, causing infertility, Erectile dysfunction preventing successful intercourse

Environmental and lifestyle factors: Long-term wearing of overly tight underwear, Excessive heat exposure, Smoking and alcohol consumption. These factors can negatively affect sperm quality and lead to male infertility.

基因以外的男性不孕症原因

陰莖：尿道上裂、尿道下裂、陰莖彎曲

睪丸：隱睪症、睪丸扭轉、睪丸萎縮症、精索靜脈曲張、意外傷害

輸精管：先天性輸精管缺損、精道感染發炎

內分泌：性腺功能低下症、泌乳激素過高症

性功能障礙：射精障礙造成無法射精，精液不能正常進入陰道導致不孕；陽痿無法完成性交等等。

環境及生活形態：長期穿過度緊身下著、過度悶熱、抽煙喝酒，容易影響到精蟲狀態導致男性不孕。

Male Infertility Evaluation Items

General Medical History Review:
Includes assessment of family medical history, reproductive history, sexual activity, medication history, social habits, and occupational background.

Basic Semen Analysis:
Evaluates sperm count, concentration, morphology, and motility to determine the possibility of male infertility.

Advanced Semen Analysis:
Includes the Hyaluronic Binding Assay (HBA) and Sperm DNA Fragmentation Analysis.

• HBA (Hyaluronic Binding Assay):
  This test predicts sperm maturity and fertilization potential. Mature sperm are capable of binding to hyaluronic acid in the matrix surrounding the egg's cumulus cells. When binding occurs, enzymes are secreted from the acrosome of the sperm head, allowing the sperm to penetrate the egg's shell and fertilize it.

• Sperm DNA Fragmentation Analysis:
  If all standard infertility tests are normal but infertility or recurrent miscarriage persists, a sperm DNA fragmentation test may be considered. Using molecular biology techniques, this test identifies potential causes of male infertility. It includes:

  • Y chromosome microdeletion analysis in cases of oligospermia (low sperm count) or azoospermia (no sperm)

  • Sperm DNA fragmentation detection

  • Assessment of mitochondrial membrane potential in sperm

男性不孕症檢查項目

一般病史詢問：家族病史、生殖史、性生活史、藥物史、社交史及工作史等等。

進行精液檢查：針對精子數量、濃度、型態、活動力，來判斷是否有男性不孕症的可能。

進階精液檢查：精子結合力檢查HBA，和精蟲DNA片段分析。

• HBA：男性不孕症檢查中，可以透過HBA檢查預測精蟲表現及受精機率。精蟲與卵子外圍卵丘細胞的基質——透明質酸結合，這時精蟲頭部的頂體區會分泌酵素，使精蟲能繼續進入卵子外殼並穿進卵子內部。
• 精子DNA片段分析：若所有不孕症檢測都過關，卻還是不孕或流產，可考慮做精子DNA碎片分析。利用分子生物檢測方式，診斷男性不孕症之成因，其檢查項目包括：稀少精蟲症或無精蟲症之Y染色體基因微缺損之檢查、精蟲DNA碎片化檢測、精子粒線體膜電位檢測。

Male Infertility Treatment Methods

Intrauterine Insemination (IUI):
In cases of male infertility, motile sperm are selected from the semen sample, washed, and then inserted into the female partner's uterine cavity at the appropriate time to increase the chances of fertilization.

Intracytoplasmic Sperm Injection (ICSI):
As part of the IVF process, ICSI involves using a microscopic injection needle to directly inject a single sperm into the cytoplasm of an egg to achieve fertilization.

Electroejaculation (EEJ):
For individuals who are unable to ejaculate normally, electroejaculation uses electrical stimulation to induce ejaculation and retrieve sperm.

Microsurgical Testicular/Epididymal Sperm Extraction (micro-TESE/PESA):
In cases of obstructive azoospermia (no sperm due to blockage), sperm may be retrieved directly from the testicles or epididymis through microsurgery.

Sperm Donation (Donor Sperm IVF):
For men diagnosed with azoospermia or who have genetic disorders, donor sperm IVF may be considered as a treatment option.

男性不孕症治療方式

人工受孕 (IUI)：於男性不孕症療程中會篩選出精液中活動力較好的精蟲後，在適當的時間內將洗滌好的精蟲植入到女方的子宮腔內。

單一精蟲顯微注射 (ICSI)：單一精蟲顯微注射是指在試管嬰兒療程的卵子授精環節中，直接以顯微鏡注射針的方式將一隻精蟲注入卵子細胞質內完成受精。

電激取精 (EEJ)：針對無法正常射精的個案，電激取精會以直流電的方式誘發射精。

顯微睪丸/副睪取精手術 (TESE/PESA)：阻塞型無精症造成的男性不孕症可考慮進行顯微睪丸/副睪取精手術，是經由顯微手術從睪丸或副睪中取得精蟲。

精子受贈（借精試管 IVF）：若男性不孕症個案是無精症或本身患有遺傳性疾病，可考慮借精試管療程。