Fertility: Indications for IVF, Recurrent Miscarriage and Varicocele
76. In what situations is in vitro fertilization (IVF) necessary?
Infertility is a major threat to men's ability to continue their family line. However, with advancements in medical technology, some men with natural fertility issues may find solutions. In vitro fertilization (IVF) is one of the more effective methods. Men should consider IVF in the following situations.
(1) Asthenospermia requires a certain number of sperm with good motility for normal conception. When the sperm density or proportion of sperm with good motility in a man's semen is insufficient or the sperm abnormality rate is too high, making natural conception impossible, he can seek help from "in vitro fertilization" technology.
(2) Immunological factors: When the titer of antisperm antibodies in a man's body is high, it can cause severe sperm agglutination and immobilization, impairing the man's ability to conceive. In this case, in vitro fertilization (IVF) can also be chosen.
(3) Unexplained infertility: Both partners have undergone thorough medical examinations, but no factors that could cause infertility can be found. This is called unexplained infertility. In this case, in vitro fertilization (IVF) can also be tried.
(4) If a man with azoospermia is unable to provide sperm for some reason, he can also undergo in vitro fertilization by donating sperm from another person.
Of course, there are also some situations where in vitro fertilization is not suitable:
(1) Either party providing gametes suffers from severe mental illness, acute infection of the reproductive or urinary system, sexually transmitted diseases, or has bad habits such as alcoholism or drug abuse.
(2) Either of the gametes is exposed to teratogenic doses of radiation, toxins, or drugs and is in the period of action.
(3) The woman’s uterus is not capable of carrying a pregnancy or she has a serious physical illness that prevents her from carrying a pregnancy.
It is important to note that the above indications and contraindications should not be applied mechanically. When undergoing in vitro fertilization (IVF), the wishes of both partners, as well as social, familial, and economic factors, should also be considered.
**77. What is second-generation IVF?**
Second-generation in vitro fertilization (IVF), also known as intracytoplasmic sperm injection (ICSI), is a micro-fertilization technique developed based on in vitro fertilization-embryo transfer (IVF-ET). It achieves the goal of assisting pregnancy by directly injecting sperm into the cytoplasm of oocytes and has a very promising future in the treatment of male infertility.
Second-generation in vitro fertilization (IVF) ICSI technology is mainly suitable for: ① severe oligospermia, asthenospermia, and teratospermia (low sperm count and low sperm motility); ② irreversible obstructive azoospermia (such as failed recanalization after vasectomy, congenital absence of vas deferens, or acquired blockage of the vas deferens due to infection such as tuberculosis); ③ spermatogenesis disorders (excluding those caused by genetic defects); ④ immunological infertility; ⑤ IVF failure; ⑥ sperm acrosome abnormalities; ⑦ cases requiring preimplantation genetic testing.
With the increasing number of infertile couples, ICSI (Intracytoplasmic Surgery) has become widely used worldwide to treat male infertility, making it possible for infertile men to become biological fathers. However, in most cases of infertility, the cause is unknown (e.g., primary infertility), and treating male infertility with this technology carries the risk of passing on genetic diseases to the next generation.
78. Are recurrent miscarriages always the woman's fault?
Newlyweds usually plan to have a child after marriage, but some families experience considerable anxiety due to the wife's recurrent miscarriages. Recurrent miscarriages not only cause significant harm to the pregnant woman's health but also place a substantial financial burden on the family, posing a serious threat. Is recurrent miscarriage always the woman's problem? The answer is no. Male asthenospermia (low sperm motility) can also lead to recurrent miscarriages.
Asthenospermia refers to low sperm motility in men. If less than 25% of a man's sperm are grade A (low sperm count), it is considered asthenospermia. Asthenospermia is one of the causes of male infertility, and men who want children should pay close attention to it. Many pregnant women experience premature birth or miscarriage during pregnancy, which may be due to poor sperm quality. Therefore, asthenospermia should be taken seriously.
The effects and harms of asthenospermia:
(1) Impact on eugenics: Eugenics usually refers to the union of the best sperm and egg, but it is very difficult for patients with asthenospermia to achieve eugenics. Conception with asthenospermia has a certain degree of randomness. Even in mild asthenospermia, sperm motility is lower than normal, which means that sperm quality cannot be guaranteed. Conception under such circumstances has certain drawbacks from the perspective of eugenics.
(2) Impact on conception: Male asthenospermia can affect fertility, but it does not mean that conception is impossible. Some patients have more severe asthenospermia, while others have milder cases. Therefore, in many cases, even if the male has asthenospermia, the female can still conceive successfully. However, such conception still carries certain risks.
(3) It can easily lead to premature birth or miscarriage. Many pregnant women experience premature birth or miscarriage during pregnancy, which may be caused by insufficient sperm quality. Therefore, asthenospermia should be given sufficient attention.
**79. Can varicocele cause infertility?**
Varicocele is caused by obstructed blood flow in the veins of the spermatic cord, leading to the vein walls becoming twisted and dilated, resulting in varicocele. It can also be accompanied by testicular atrophy due to poor blood flow and impaired sperm production due to elevated testicular temperature, ultimately causing male infertility.
Varicocele causes infertility primarily due to damage to the testicles:
(1) After varicocele, due to the obstruction of blood return in the spermatic vein, a large amount of residual venous blood accumulates in the scrotum, which can cause the temperature in the scrotum to rise slowly, on average 0.6℃ higher than the normal temperature in the scrotum. Sperm production requires a temperature environment slightly lower than body temperature. Excessively high temperature will affect sperm production and reduce sperm motility.
(2) Due to blood stasis in the venous blood circulation pathway in the testis, the blood circulation of the testis and epididymis is affected, and the circulation cycle is much slower than normal. The supply of essential nutrients and oxygen required for sperm formation is severely lacking, and the waste products produced during tissue cell metabolism are difficult to be carried out of the body by the blood. This physiological environment will seriously affect the normal production and activity of sperm.
(3) Due to the obstruction of blood circulation in the scrotum, the local temperature of the scrotum rises, the blood and oxygen supply to the testes is insufficient, and the absorption of nutrients is also hindered. This adverse physiological environment will inevitably affect the production and development of sperm. It further affects the endocrine function of the interstitial cells in the seminiferous tubules of the testes, causing disorders in the secretion of androgens and other hormones, thereby interfering with the normal production of sperm.