Causes and treatment strategies for immunological infertility, commonly used Western medicines for male infertility and the effects of traditional Chinese medicine treatment.
The cause of male immunological infertility is autoimmune disease resulting from the production of antisperm antibodies. Antisperm antibodies are produced because the blood-testis barrier in the male testis is disrupted, and antigens in the semen stimulate the body's immune system to produce antibodies, leading to an immune response that damages the normal morphology and function of sperm, thus causing immunological infertility.
Immunological infertility generally has no obvious clinical symptoms and signs, but some patients may experience semen allergy during sexual intercourse. Specifically, after sexual intercourse, the partner may experience unbearable itching of the vulva, vagina, perineum, eyelids, lips and the whole body, and may even develop urticaria. In severe cases, it may also cause throat obstruction, difficulty breathing, palpitations, sweating and shock.
Clinically, the detection of antisperm antibodies is crucial for diagnosing immunologic infertility. However, antisperm antibodies can affect sperm production by acting on spermatogenic cells, or they can cause decreased sperm motility, sperm agglutination, and prevent sperm from penetrating cervical mucus and the zona pellucida of the egg. They can also act on the fertilized egg, leading to embryonic death.
Clinically, men with immunological infertility may not have abnormal semen analyses, but they still cannot impregnate their partners. Conversely, some men with immunological infertility can impregnate their partners, but this often leads to recurrent miscarriages. Therefore, men with immunological infertility are often referred to as "miscarriage men." Thus, when investigating the causes of infertility in men, it is best to undergo immunological testing simultaneously to rule out immunological infertility.
The main treatment methods for male immunological infertility are as follows.
(1) Immunosuppressive therapy: Glucocorticoids are used, and several courses of treatment are administered according to the partner's menstrual cycle, which can increase the chances of conception. However, high-dose hormone therapy can cause adverse reactions such as irritability, weight gain, mood changes, edema, and rash.
(2) Treatment of the underlying cause: When the reproductive system is infected, edema and obstruction of the vas deferens, as well as the destruction of the blood-testis barrier by microorganisms, can lead to the production of antibodies. Therefore, inflammation of the male reproductive tract should be treated aggressively, and anti-infective treatment should be initiated as early and timely as possible. If infertility is caused by testicular tissue damage and epididymal lesions resulting in autoantibodies against sperm, surgical treatment should be performed to eliminate the lesions of the immune response, which may also improve fertility.
(3) Behavioral therapy: Frequent ejaculation is used to expel as many sperm and seminal plasma containing immune substances from the reproductive tract as possible, thereby accelerating the disappearance of autoimmune phenomena. After ceasing frequent ejaculation, consciously use contraception 1-2 weeks before the partner's ovulation. Having sex during the ovulation period may result in conception.
(4) Traditional Chinese medicine treatment: Traditional Chinese medicines that promote blood circulation, remove blood stasis, clear heat and detoxify can also inhibit immune response and reduce the production of antisperm antibodies.
It is important to emphasize that the following principles can be followed when choosing a treatment method. When choosing etiological treatment or immunosuppressive therapy based on one's own condition, it can be combined with traditional Chinese medicine and behavioral therapy. If the above methods fail, intrauterine insemination (IUI) may be considered. This method uses a special sperm washing solution to remove antibodies attached to the surface of the sperm, minimizing the harmful effects of antibodies before artificial insemination to achieve pregnancy. This method is also recognized by the medical community as an effective treatment for immunological infertility.
Different treatment methods are used depending on the specific condition. Treatment includes both causal treatment and symptomatic treatment. The specific treatment directions are as follows.
(1) Promotes spermatogenesis in the testes.
(2) Maintain the patency of the vas deferens. Actively treat sexual dysfunction and maintain normal sexual life. For those with congenital absence of the vas deferens, obstruction of the vas deferens, or vasectomy, surgical treatment should be actively pursued.
(3) Improve sperm function. Patients with reproductive tract inflammation should be treated with antibiotics. Vitamin E, vitamin C, and zinc preparations such as zinc protein complex can all improve sperm function. For patients with immunological infertility, using condoms can eliminate or reduce the stimulation of sperm antigens on the female. High-dose short-term use of immunosuppressants and artificial insemination with sperm washing are helpful in treating immunological infertility.
(4) Assisted reproductive technology. Artificial insemination includes two main categories: donor sperm artificial insemination (AID) and husband sperm artificial insemination. In recent years, in vitro assisted reproductive technology has developed rapidly, especially intracytoplasmic sperm injection (ICSI), which has been used to treat oligospermia, asthenospermia, and azoospermia, and has achieved good results.
(1) Gonadotropin therapy: including human chorionic gonadotropin and human menopausal gonadotropin, which are applicable to various sexual dysfunctions caused by insufficient gonadotropin secretion.
(2) Thyroxine: Thyroxine supplementation may improve fertility in people with hypothyroidism.
(3) Glucocorticoids: Patients with congenital adrenal hyperplasia can be treated with glucocorticoids.
(4) Dopamine receptor agonists: Patients with high prolactin levels can be treated with dopamine receptor agonists after ruling out pituitary tumors. Commonly used drugs include bromocriptine and cabergoline.
(5) Androgens: The commonly used drug is testosterone undecanoate. Androgens can inhibit sperm production through the hypothalamic-pituitary-gonadal axis. However, its clinical treatment of male idiopathic infertility has many adverse reactions, and its efficacy is uncertain.
(6) Gonadotropin-releasing hormone: This is a method to increase the endogenous gonadotropins in the pituitary gland to replace human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG).
(7) Anti-estrogenic drugs: mainly clomiphene and tamoxifen. The mechanism is that the drugs compete with estrogen receptors at the hypothalamic and pituitary levels and lead to an increase in the secretion of GnRH, FSH and LH. They mainly stimulate Leydig cells to produce testosterone and also promote sperm production.
(8) Kallikrein: It is believed that it can stimulate sperm motility and sperm production. Other mechanisms may include improving sperm metabolism, increasing testicular blood supply, stimulating Sertoli cell function, and increasing gonadal output.
(9) Recombinant human growth hormone: It is believed to enhance the function of testicular interstitial cells and increase semen volume.
(10) Carnitine: It is currently believed to improve sperm motility and epididymal function and is a drug commonly used in the treatment of male infertility.
(11) Various amino acids, antibiotics, zinc, vitamins, etc.
Traditional Chinese medicine (TCM) has a long history of treating male infertility, developing numerous herbal formulas over its long course. Based on the TCM principles of viscera, qi and blood, and the Eight Principles of Differentiation, male infertility can be categorized into several patterns, including kidney yang deficiency, kidney yin deficiency, spleen and kidney yang deficiency, qi and blood deficiency, liver qi stagnation, phlegm-dampness accumulation, damp-heat accumulation, and blood stasis. Different formulas are then used to treat each pattern. In addition, there are external medications and acupuncture treatments for male infertility. Currently, TCM treatment for male infertility, provided the diagnosis is accurate, is quite effective.
Treatment for male infertility typically lasts for three months per course. This is determined by the spermatogenesis cycle, which takes approximately 74 days, with about 16 days spent transporting sperm within the epididymis. The total time is close to three months. Therefore, a course of treatment for male infertility usually lasts about three months. Patients undergoing drug treatment should not be impatient or believe the medication is ineffective; effectiveness will only be seen after consistently taking the medication for three months.