Low sperm motility and varicocele increase the risk of infertility.

**Inadequate varicocele may lead to sperm death in the womb.**

Sperm under a microscope

Millions of us are together.

Shaking its head and wagging its tail, it squeezed around haphazardly.

They all share the surname Li.

This poem about sperm is an early work by Taiwanese writer Li Ao.

Li Ao was an eccentric and unconventional figure. A scholar of literature and history, with a profound understanding of both Chinese and Western learning, he was renowned for his essays that challenged tradition, feudalism, tyranny, and exposed the ills of society, advocating for political democracy and freedom of speech. His writings, discussing both ancient and modern times, were often shocking and unconventional, establishing a unique style characterized by sharp thinking, unique insights, and frank expression. Furthermore, a fondness for banter and humor was a significant feature of Li Ao's writing style, which is vividly demonstrated in this poem about sperm.

Indeed, sperm are living beings, and they could very well become a living person.

At 37 degrees Celsius, motile sperm can survive for 4 to 8 hours or more; in the vagina, they can survive for 0.5 days; in the cervix, for 2 to 8 days; and in the uterus and fallopian tubes, for 2 to 2.5 days. However, if the temperature is lowered, sperm can survive for several weeks; if frozen with liquid nitrogen, sperm can survive even longer, and can even be preserved indefinitely.

Sperm is essential for the continuation of human life and is a crucial factor in male fertility. Therefore, male infertility is definitely caused by a problem with sperm.

Low sperm motility is one of the important causes of male infertility. Patients with asthenospermia must pay attention to correcting bad lifestyle habits during treatment, such as quitting smoking and alcohol, eating less spicy food, avoiding excessive fatigue, and actively treating the underlying cause.

Traditional Chinese medicine (TCM) believes that the production, presence, and motility of sperm depend on kidney yang. Therefore, insufficient kidney yang leads to cold and weak sperm, or insufficient kidney yin can cause low sperm motility due to inadequate nourishment. Alternatively, inherent weakness of qi and blood, or internal damp-heat in the seminal vesicle, can also result in low sperm motility and weak movement. TCM considers asthenospermia to require diagnosis and treatment based on syndrome differentiation. For those with insufficient kidney yang, tonifying the kidney and strengthening yang should be emphasized, but medications should not be too warming or drying to avoid depleting kidney essence and worsening the condition. For those with insufficient kidney yin, the focus should be on nourishing kidney yin and replenishing kidney essence, but medications should not be too cold to avoid damaging kidney yang.

Furthermore, a certain number of sperm abnormalities can also affect fertility, and the impact of different sperm abnormalities on fertility varies. More than 70% of sperm heads are abnormal, which may affect fertility; more than 10% have conical sperm heads or more than 50% have irregular sperm heads, both considered abnormal. More than 25% of sperm have midpiece defects or tail abnormalities, which are also considered abnormal. More than 0.5% of sperm are immature, indicating an obstacle in sperm production or maturation. If 70% of sperm are abnormal, especially if the wife has a history of recurrent miscarriages, chromosome testing should be performed to rule out the possibility of chromosomal abnormalities in the male partner.

Male sperm plays a crucial role in the quality of fertilized eggs, embryos, and fetuses. Many problems, including embryonic arrest, recurrent miscarriages, premature births, stillbirths, fetal malformations, intellectual disabilities, and developmental abnormalities, are closely linked to an excessive number of abnormal sperm in men. The World Health Organization has clear guidelines for the amount of normal and abnormal sperm: the percentage of abnormal sperm in a normal person's semen is less than 3%, while a percentage greater than 5% indicates abnormal testicular spermatogenesis. To have a healthy baby, if a man's sperm abnormality rate exceeds 2%, the underlying cause should be investigated and treated. Pregnancy should only proceed after sperm quality has improved to a satisfactory level.

Sperm quality is crucial for healthy offspring. If abnormalities in semen are detected, prompt examination at a reputable hospital is essential for targeted treatment. If there are no issues with infection or immunity, and the low testicular function is due to environmental, dietary, or unhealthy habits, a balanced diet and good hygiene practices are important. For those with micronutrient deficiencies, mild varicocele, or prostatitis, comprehensive treatment is necessary. For the sake of a healthy and intelligent next generation, it is best to avoid pregnancy if sperm quality is substandard.

Varicocele is a recognized major cause of male infertility. Approximately 10%–15% of men have varicocele. Among patients with varicocele, 30%–40% also experience infertility, highlighting the close relationship between varicocele and infertility. In varicocele, 50%–80% of patients have abnormal semen analysis, showing low sperm count, low motility, and abnormal sperm morphology.

Varicocele can cause increased scrotal temperature due to blood stasis in the spermatic veins, and the testicular temperature can rise by 1-2 degrees Celsius. Prolonged elevated temperature can affect sperm production, leading to azoospermia and oligospermia; the epididymis is also not conducive to sperm maturation. However, spermatogenesis disorders mainly occur at the primary spermatocyte and spermatocyte stages.

Patients with varicocele may experience a dull, aching pain, like a small bag of worms crawling into the scrotum, or perhaps no pain at all. However, when standing, the varicose veins can be seen or felt in the spermatic cord area. Straining the abdomen to increase abdominal pressure will make the varicose veins appear more pronounced; a few may also experience neurasthenia. In more severe cases, there may be a feeling of heaviness in the scrotum, and lower back pain after prolonged standing, but these symptoms can be relieved by lying down and resting.

Patients with varicocele due to damp-heat accumulation experience burning and slight redness of the scrotal skin, which worsens after exertion and is slightly relieved by rest. They also experience a feeling of heaviness and pain upon palpation. The left spermatic cord is enlarged with varicose veins resembling earthworms. The tongue is red with a yellow, greasy coating, and the pulse is wiry and rapid. Treatment should focus on soothing the liver, dispersing stagnation, clearing heat, and promoting diuresis. Prescription: Artemisia capillaris 30g, Citrus medica, Litchi chinensis seed, Citrus reticulata seed, Dioscorea hypoglauca, Melia toosendan 12g each, Citrus reticulata peel 9g, Glycyrrhiza uralensis 5g. Decoct in water and take in 3 divided doses.

Medications that are effective for varicocele:

1. Bioflavonoids: Studies have shown that these drugs can reduce the diameter of blood vessels in subclinical varicocele, reduce the development of subclinical varicocele into symptomatic varicocele, and improve perineal pain symptoms caused by varicocele to some extent, but cannot stop the testicular growth arrest that has already begun.

2. Aescin: It can reduce capillary permeability, eliminate tissue swelling and edema, protect the collagen fibers of the vein wall, gradually restore the elasticity and contractile function of the diseased vein wall, and increase the tension and strength of the vessel wall. It can also directly act on the receptors in vascular cells, causing venous contraction, increasing the venous blood return rate, and reducing venous pressure, thereby improving the symptoms caused by varicocele.