Article 74: Treatment, Surgical Indications, and Artificial Insemination for Immunological Infertility
◇A Guide to Caring for Your Husband's Health as a Good Wife◇
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Treatment and recuperation of common diseases
Treatment of immunological infertility
Since most cases of immunologic infertility are caused by genital inflammation, such as orchitis, epididymitis, seminal vesiculitis, and prostatitis, antibiotic treatment is necessary. After treatment, antibodies significantly decrease or disappear. Even in cases without obvious symptoms of infection, antibiotic treatment may reduce antibodies, indicating possible latent genital inflammation.
Immunosuppressants can be used, such as prednisone 5 mg three times daily for 6 months; or dexamethasone 0.75 mg three times daily, then twice daily for one month, followed by a maintenance dose of 0.75 mg once daily for two months, for a total of 3-6 months. High-dose short-term pulse therapy is more effective than low-dose treatment. For women, methylprednisolone 96 mg should be taken daily from days 21 to 26 of the menstrual cycle, with a low maintenance dose from days 15 to 20 of the cycle, for 1-3 months.
The following Chinese herbal formula can be used: 30g of Salvia miltiorrhiza, 15g of peach kernel, 15g of red peony root, 12g of Angelica sinensis, 15g of Astragalus membranaceus, 30g of wolfberry, 20g of Cuscuta chinensis, 15g of deer antler powder, 12g of Alpinia oxyphylla, and 12g of Cyperus rotundus. One dose per day, decocted in water and taken orally. 30 doses constitute one course of treatment.
For semen containing autoantibodies against sperm, intrauterine insemination can be performed after washing.
Which male infertility patients require surgical treatment?
Some male infertility patients have organic lesions that cannot be resolved with medication and require surgical treatment. These mainly fall into the following categories:
1. Genital malformations or developmental abnormalities: Common ones include cryptorchidism, urethral stricture, urethral fistula, hypospadias, epispadias, and severe Peyronie's disease.
2. Obstructive azoospermia: including obstructive azoospermia caused by congenital absence of the vas deferens or seminal vesicles; segmental hypoplasia of the vas deferens; iatrogenic injury or ligation of the vas deferens; congenital stenosis of the ejaculatory duct orifice, etc.
3. Varicocele: Varicocele has an incidence rate of 20% to 35% in male infertility. High ligation of the spermatic vein can restore fertility in some patients.
4. Organic sexual dysfunction: including erectile dysfunction caused by severe penile trauma, pelvic fracture, vascular factors (such as venous fistula) or neurological diseases, as well as some patients with retrograde ejaculation caused by organic lesions.
Indications for artificial insemination
1. Indications for artificial insemination with husband's sperm:
(1) Male factors:
Paraplegia, hypospadias, or retrograde ejaculation are absolute indications.
Sexual dysfunction, mainly impotence, anejaculation, or severe premature ejaculation, is most commonly indicated by abnormal semen analysis when treatment is ineffective and the patient is eager to conceive. This is especially relevant for patients who have not responded to long-term treatment and have lost confidence in the treatment.
Too much or too little semen.
Antisperm autoimmune disease.
Sperm aggregate and coagulate in large quantities.
(2) Female factors:
Anatomical abnormalities of the cervix, such as cervical flaring or inflammation.
Poor, thick, or absent cervical mucus can hinder sperm motility, survival, and capacitation.
Cervical mucus contains antisperm antibodies.
Sexual dysfunction, such as vaginismus, that has not responded to treatment.
2. Indications for donor insemination:
(1) Azoospermia, which is considered untreatable after examination.
(2) Severe oligospermia, with unsatisfactory treatment results.
(3) Certain serious sperm defects.
(4) Immunological infertility.
(5) Those with hereditary diseases, severe intellectual disability, or who have given birth to a child with birth defects and whose chromosomes show abnormalities.