Trace elements and male reproductive health, classification of infertility, and key points of the four diagnostic methods in Traditional Chinese Medicine

Which trace elements are closely related to male fertility?

In addition to protein, carbohydrates, fats, vitamins, water, and elements such as sodium and potassium, human reproductive activities also require trace elements such as iron, copper, zinc, magnesium, manganese, and selenium.

Zinc is particularly closely related to male fertility. Zinc deficiency can affect the pituitary gland, the command center for human fertility, leading to reduced secretion of gonadotropins and impaired sperm production. More importantly, zinc is involved in at least 70 enzymes in the body, especially DNA polymerase, RNA polymerase, and thymidine kinase. Zinc deficiency also causes abnormalities in the prostate enzyme system, affecting semen liquefaction and normal sperm motility, leading to degeneration of the acrosome and sperm membrane, significantly reducing sperm's ability to swim or penetrate the egg, thus causing infertility. Prasad used zinc supplementation to restore gonadal function and significantly improve secondary sexual characteristics. Clinically, methods such as eating apples can be used to treat infertility caused by zinc deficiency.

How is infertility classified?

(1) Classification based on the course of the disease or medical history

The World Health Organization classifies infertility into primary and secondary types based on the course of the disease or medical history. Primary male infertility refers to a man's infertility as a condition in which he has never fathered a child with a woman.

Secondary male infertility refers to a man who has impregnated a woman, regardless of whether that woman is his current spouse or the outcome of the pregnancy.

(2) Classification by etiology

From an etiological perspective, the World Health Organization classifies factors leading to male infertility into the following 16 categories: sexual and/or ejaculatory dysfunction; immunological causes; no clear cause found; isolated seminal plasma abnormalities; iatrogenic causes; systemic causes; congenital abnormalities; acquired testicular damage; varicocele; male accessory gland infections; endocrine causes; idiopathic oligospermia; idiopathic asthenospermia; idiopathic teratospermia; obstructive azoospermia; idiopathic azoospermia.

(3) Classification according to traditional Chinese medicine theory

It is divided into kidney deficiency, liver stagnation and blood stasis, qi and blood deficiency, and damp-heat accumulation.

What are the key points of the four diagnostic methods in Traditional Chinese Medicine for male infertility?

The diagnosis of male infertility includes both traditional Chinese medicine (TCM) diagnosis and modern medical diagnosis. In today's scientifically advanced world, TCM diagnosis still holds significant advantages. The four diagnostic methods-inspection, auscultation and olfaction, inquiry, and palpation-are essential for examining diseases. Each of these methods has its unique function and cannot replace the others. Therefore, in clinical application, they must be organically combined, a process known as "integrated diagnosis and treatment."

(1) Medical history taking

Inquiry plays a crucial role in the four diagnostic methods for male infertility. Many aspects of male infertility, such as the patient's medical history, symptoms, past health conditions, and family history, can only be obtained through this process. Especially since male infertility involves sex and marital issues, and due to the influence of traditional beliefs, many patients find it difficult to discuss. Therefore, it is essential to pay attention to methods and strategies during the inquiry. Through concern and reassurance, a patient and detailed inquiry is necessary to gain a clear understanding of the condition, while maintaining confidentiality.

When taking a medical history for male infertility, it is essential to understand the patient's marital and reproductive status, the cause of the disease, the course of the disease, previous treatments, medical history, lifestyle habits, dietary preferences, life experiences, work environment, psychological state, and family medical history, all of which are related to male infertility. By taking a medical history, it is possible to obtain a thorough understanding of the patient's condition in order to provide appropriate treatment.

The main focus should be on understanding the patient's and their spouse's attitudes and desires regarding sexual activity; the frequency, duration, and positions of intercourse, with particular attention to whether intercourse occurred during ovulation.

The main focus is on understanding the patient's age at marriage, sexual function, the harmony of their sex life, whether they use contraception, whether their spouse has had an abortion or miscarriage, and for remarried individuals, their age at remarriage, the interval between their two marriages, their wife's age and health status after marriage, and whether she has given birth before.

In particular, it is important to know whether the patient has been to an epidemic area, has a history of exposure to chemical toxins or radiation, has any special habits such as smoking or drinking, has a history of long-term consumption of cottonseed oil, or has a history of unsafe sexual practices. It is also important to know whether the patient has had mumps.

(2) Visual diagnosis

Inspection is a medical practice where doctors use their vision to purposefully observe the entire body and its parts, as well as its excretions (including the color, quantity, and quality of semen), in order to understand the state of health or disease. The main content of inspection is to observe the spirit, complexion, form, and posture of the body in order to infer changes within the body.

Pay attention to secondary sexual characteristics: These are the physical signs of sexual function that correspond to the body's developmental stage. Observing the Adam's apple and breasts can reveal a man's secondary sexual characteristics, while directly examining the external genitalia is particularly significant for diagnosing male infertility.

(3) Auscultation and olfaction

Auscultation includes two parts: listening to speech and smelling odors.

(4) Palpation

Palpation is a diagnostic method in which a physician uses their fingers to touch and press on a patient to obtain information about their condition. It includes both pulse diagnosis and palpation. In andrology, palpation primarily involves touching and pressing the patient's breasts, external genitalia, and anus to assess the temperature, hardness, tenderness, and presence of lumps in the affected area, thereby determining the location and nature of the disease. Palpation of the external genitalia involves touching and pressing the penis, scrotum, testicles, spermatic cord, epididymis, and prostate to understand the condition and determine the location of the lesion.