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Male factor infertility

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 17 Aug 2025
最后更新： 27 Jan 2025

小结

定义

病史和体格检查

关键诊断因素

  • inability of an opposite-sex couple to conceive
  • vasectomy
  • palpable and dilated testicular veins
  • erectile dysfunction and decreased libido
  • testis atrophy (testis smaller than 20 cm³)
  • body habitus, abnormal hair distribution, and gynecomastia
  • absent vasa or epididymis
完整详情

其他诊断因素

  • headaches, galactorrhea, and visual disturbance
  • anosmia
  • frequent respiratory infections
  • pain, blood, or pus with ejaculation
完整详情

危险因素

  • varicocele
  • cryptorchidism
  • prior chemotherapy or radiation therapy
  • current medications
  • cystic fibrosis and congenital bilateral absence of vas deferens (CBAVD)
  • Y chromosome abnormalities
  • Klinefelter syndrome (47,XXY)
  • endocrinopathy
  • previous infertility
  • genital tract infection
  • erectile dysfunction
  • retrograde ejaculation
  • obesity
  • testicular torsion or trauma
  • lifestyle factors including smoking, alcohol, and cannabis use
  • exposure to androgen
  • age >55 years
  • environmental toxin exposure
  • history of coronary artery disease or diabetes mellitus
  • history of STI
  • hot tub use
完整详情

诊断性检查

首要检查

  • sperm concentration
  • sperm motility
  • sperm morphology
  • seminal fluid parameters
完整详情

Tests to avoid

  • antisperm antibody (ASA) serology
  • sperm function testing
完整详情

需考虑的检查

  • sperm viability
  • sperm membrane function
  • hormonal assays
  • MRI of the pituitary and hypothalamus
  • color flow Doppler imaging
  • post-ejaculation urine testing for retrograde ejaculation
  • genetic analysis
  • sperm DNA assays
  • acrosome reaction test
  • sperm longevity test
  • electron microscopy
  • testicular biopsy
完整详情

治疗流程

急症处理

obstructive azoospermia

gonadotropin or gonadotropin-releasing hormone deficiencies

primary hypogonadism

high estrogen levels in combination with low testosterone

hyperprolactinemia due to pituitary adenoma

presence of antisperm antibodies

presence of varicocele and no other cause of infertility detected

idiopathic male infertility

持续性治疗

medical/surgical intervention ineffective, contraindicated, or unlikely to succeed

撰稿人

作者

Samuel Ohlander, MD

Assistant Professor

Co-Head of the Division of Andrology

University of Illinois

Chicago

IL

利益声明

SO declares that he has no competing interests.

Mahmoud Mima, MD

Assistant Professor

Department of Urology

University of Illinois

Chicago

IL

利益声明

MM declares that he has no competing interests.

Rodrigo Pagani, MD

Assistant Professor

Co-Head of the Division of Andrology

University of Illinois

Chicago

IL

利益声明

RP declares that he has no competing interests.

鸣谢

Dr Samuel Ohlander, Dr Mahmoud Mima, and Dr Rodrigo Pagani would like to gratefully acknowledge Dr Ali A. Dabaja, Dr Ahmad O. Hammoud, and Dr Benjamin Emery, previous contributors to this topic.

利益声明

AAD, AOH, and BE declare that they have no competing interests.

同行评议者

Peter N. Kolettis, MD

Associate Professor

Division of Urology

University of Alabama at Birmingham

Birmingham

AL

利益声明

PNK declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Salonia A, Bettocchi C, Boeri L, et al; EAU Working Group on Male Sexual and Reproductive Health. European Association of Urology guidelines on sexual and reproductive health - 2021 update: male sexual dysfunction. Eur Urol. 2021 Sep;80(3):333-57.全文  摘要

Practice Committee of the American Society for Reproductive Medicine in Collaboration with the Society for Male Reproduction and Urology. Electronic address: asrm@asrm.org. Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion. Fertil Steril. 2023 Nov;120(5):967-72.全文  摘要

Brannigan RE, Hermanson L, Kaczmarek J, et al. Updates to male infertility: AUA/ASRM guideline (2024). J Urol. 2024 Dec;212(6):789-99. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • 鉴别诊断

    • Cystic fibrosis (CF)
    • Primary hypogonadism
    • Hypopituitarism
    更多 鉴别诊断

  • 指南

    • Updates to male infertility: AUA/ASRM guideline (2024)
    • Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility
    更多 指南

  • 患者教育信息

    Erection problems

    Erection problems: questions to ask your doctor

    更多 患者教育信息
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