Can testicular development disorders cause infertility
(1) Congenital testicular development Insufficiency syndrome:Also known as microorchidism, Klinefelter first discovered and described small testicles and pubertal breast development as clinical features in 1942. In 1959, Jacobs et al. first used cytogenetic methods to discover a patient with congenital testicular agenesis syndrome and confirmed that he had chromosomal abnormalities. Individuals with congenital testicular agenesis syndrome manifest themselves as males. The physical signs are not obvious in childhood and adolescence, but during puberty and development, they gradually develop female body shapes such as breast enlargement, beard, pubic and armpit hair sparse, narrow shoulders, and wide hips.
(2) Cryptorchidism: The testis descends into the scrotum with the retroperitoneum during the fetal period. If during the descent, it stays at any abnormal location, such as the waist, abdomen, the inner ring of the inguinal canal, the inguinal canal or near the outer ring, it is called cryptorchidism. About 80% of patients with cryptorchidism may develop testicular tumors or trauma, spermatic cord torsion, and psychological disorders, but more often lead to abnormal reproductive function.
(3) Anorchiosis: It can be divided into 3 categories: ① Absence of testicles. ② The testicles, epididymis and part of the vas deferens are lacking. ③The testicles, epididymis and vas deferens are all lacking. Its cause is unknown. The testicles may be damaged by toxins during the embryonic stage or testicular atrophy may be secondary to vascular occlusion and trauma. Unilateral anorchia occurs mostly on the right side and is often accompanied by cryptorchidism on the contralateral side. Bilateral anorchia often leads to gender abnormalities and eunuch-like syndrome due to the lack of interstitial cells that secrete male hormones. There are also some patients without eunuch-like disease who may have ectopic interstitial cells.
Why cryptorchidism affects fertility
Cryptorchidism means that the testicles of a boy have not descended into the scrotum after birth. It can stay in the waist, abdomen, and inguinal canal. near the ring, inguinal canal, or outer ring.
Why do the testicles of patients with cryptorchidism stay in the above locations? It turns out that during the embryonic stage, the testicles were originally located on both sides of the retroperitoneal spine and below the kidneys.During the fertilization process, the testicles gradually descend into the scrotum when they are nearly 6 months pregnant. If the testicles are blocked during their descent, they can stop at different locations to form cryptorchidism. Sometimes the testicles on both sides do not descend, which is called bilateral cryptorchidism; when one testicle does not descend, it is called unilateral cryptorchidism.
The testicular epithelial germ cells that produce sperm must develop normally in an environment slightly lower than the body temperature of 1.5 to 2°C. The temperature in the scrotum is slightly lower than the body temperature, which is a suitable place for the development of testicular germ cells. In patients with cryptorchidism, the higher temperature in the body hinders the development of germ cells. In severe cases, there may be no sperm production at all. In mild cases, the sperm count is often reduced, or all sperm are dead, or the sperm motility is extremely low, causing infertility.
In unilateral cryptorchidism, although one testicle is located in the scrotum, damage to the other testicle can cause damage to the normal testicle, which is the so-called \”sympathetic orchidosis\”. This is because patients with unilateral cryptorchidism have underdeveloped testicles on both sides, or the antibodies and humoral factors produced by the testis on the cryptorchid side affect the development of the testis on the normal side, causing sympathetic damage, which can cause infertility.
Another serious complication of cryptorchidism is that the chance of malignant transformation is 30 to 50 times higher than that of normal testicles, and the most common one is seminoma cell carcinoma. Therefore, patients with cryptorchidism must be treated as early as possible.
Cryptorchidism may still decline naturally within the first year of life, but the chance of natural decline is significantly reduced after one year. . If the testis does not decline after the age of 10, irreversible damage may occur to the testicles. Therefore, patients with cryptorchidism can be treated with human chorionic gonadotropin at the age of 2 to 9 to promote the descent of the testicles; surgical treatment can be performed at about the age of 10 to move the testicles downward and fix them in the scrotum.
Can orchitis cause infertility
Orchitis is an inflammatory lesion of the testicles caused by various pathogenic factors. It can be divided into non-specific, Viral, fungal, spirochetal, parasitic, damaging and chemical types. Specific orchitis is mostly caused by epididymal tuberculosis invading the testes and is very rare. Nonspecific orchitis and mumps orchitis are clinically common, which are one of the common causes of male infertility.
(1) Acute non-specific orchitis: Acute non-specific orchitis mostly occurs in urethritis , cystitis, prostatitis, patients after prostatic hyperplasia resection and long-term indwelling catheters. The infection spreads to the epididymis through lymph nodes or vas deferens, causing epididymo-orchitis. Common pathogenic bacteria are Escherichia coli, Proteus, Staphylococcus and Pseudomonas aeruginosa. Bacteria can spread to the testicles through the blood, causing simple orchitis. However, the testicles have rich blood supply and have strong resistance to infection, so this situation is rare.
(2) Chronic non-specific orchitis:Chronic orchitis is mostly caused by incomplete treatment of non-specific acute orchitis. It can also be caused by fungal, spirochetal and parasitic infections.
(3) Acute mumps orchitis: Mumps is the most common testicular disease The cause of mumps, about 20% of mumps patients are complicated by orchitis. It is more common in the late puberty period. The testicles are highly swollen and purple-blue visible to the naked eye. When the testis is cut open, due to interstitial reaction and edema, the testicular seminiferous tubules expand. Histological observation shows edema and vasodilation, a large number of inflammatory cells infiltrating, and the seminiferous tubules have degeneration to varying degrees. As orchitis heals, the testicles become smaller and softer. The seminiferous tubules are severely atrophied, but Leydig cells are preserved, so testosterone secretion is not affected.
Orchitis usually appears 3 to 4 days after mumps. The scrotum shows erythema and edema. One or both testicles are enlarged and have high tenderness. Hydrocele can occasionally be seen. Generally, mumps lesions can be detected. After about 10 days of symptomatic treatment, the testicular swelling subsides. In about 1/3 to 1/2 of the patients, testicular atrophy can be observed 1 to 2 months after the onset of the disease. Generally, unilateral testicular involvement does not affect fertility. About 30% of patients with orchitis caused by mumps have irreversible sperm damage, and the affected testicles are highly atrophic. If bilateral infection occurs, the testicles can atrophy, causing sperm production disorders and infertility, but androgen function is generally normal. .
This article is provided by Baidu Reading and is excerpted from \”The Clear \”Conception\” Plan\” Author: Sun Jianqiu and Xie Yingbiao