Etiology And TCM Syndromes Of Male Infertility

Background:Nowadays, people are much more frequently subjected to fast life rhythms, burdened working tasks, severely psychological pressure, unhealthy lifestyle, changes of dietary structure and exposure to toxic chemicals, which aggravates the complexity of the causes of Male Infertility. A recent epidemiological survey has revealed that about 10-15% couples suffer from infertility worldwide, during which male infertility accounts for 40% approximately. The world health organization (WHO) has predicted that infertility will be the third-largest diseases, affecting the human life and health, which ranks only secondary to tumor and cardio-cerebrovascular disease. However, there is a shortage for literature of epidemiological investigation and consistent decision on the basic type of syndrome about male infertility recently, which contributes to the unclear causes and uniform of the basic symptom types in male infertility. Accordingly, the research on the etiology and basic type of syndrome rules in male infertility is in urgent need and necessity nowadays.Objective: In the present study, we aim to conducte a clinical survey on the patients suffering from male infertility under the guidance of Prof. Jia Yusen from the East Hospital Affiliated to Beijing University of Chinese Medicine, and make a profound discussion on the etiology and basic type of syndrome and investigate the normal morphology sperm rate in male infertility patients to lay foundation for the clinical practice. According to the results of the Clinical Questionnaire, we summarized the related causes in etiology and basic type of syndrome of male infertility. Then we discussed the etiology and symptom rules of male infertility included in this study, which could lay the foundation for the therapeutic effects and epidemiologic study in male infertility.Methods:The clinical epidemiology methods used in this study were on the basis of "WHO Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male" and "Clinical Questionnaire for the Infertile Male" affiliated to the "Criteria of Diagnosis and Therapeutic effect of Diseases and Syndromes in Traditional Chinese Medicine (TCM)" under the guidance of State Administration of Traditional Chinese Medicine. A total of 517 male infertility patients conforming to the inclusion criteria were included in this study and conducted for questionnaire. Then the data base was established reasonably.Results:According to the results of the Clinical Questionnaire from the 517 male infertility patients, we found that the TCM syndromes were much complicated and the frequency of the single TCM syndrome were as follows:Syndrome of downward diffusion of damp-heat accounting for 47%, syndrome of Kidney Jing deficiency accounting for 35.2%, syndrome of liver Qi stagnation accounting for 23%, syndrome of Kidney Yang failure accounting for 22.6%, syndrome of Kidney Yin deficiency accounting for 22.2%, syndrome of spleen and stomach weakness accounting for 14.7%, and syndrome of blood stasis accounting for 7.5%. During the intersectional TCM syndromes, syndrome of Kidney Jing deficiency mixing up with syndrome of downward diffusion of damp-heat accounts for the most high frequency. The results of the 7 basic TCM syndromes analyzed by multivariable linear and logistic regression method have revealed that:1. Frequent staying-up has a negative correlation with the syndrome of Kidney Jing deficiency; 2. The syndrome of Kidney Yang failure has a positive correlation with burdened working pressure, and a negative correlation with body mass index (BMI); 3. Smoking has a positive correlation with the syndrome of Kidney Yin deficiency. Frequent staying-up has a positive correlation with the syndrome of Kidney Yin deficiency. Burdened working pressure has a negative correlation with the syndrome of Kidney Yin deficiency.4. Ages have a negative correlation with the syndrome of liver Qi stagnation. Burdened working pressure has a positive correlation with the syndrome of liver Qi stagnation; 5. No significant differences were found between the indexes and the syndrome of downward diffusion of damp-heat; 6. Alcohol consumption has a negative correlation with the syndrome of spleen and stomach weakness. Infertility with varicocele has a positive correlation with the syndrome of spleen and stomach weakness; 7. No significant differences were found between the indexes and the syndrome of blood stasis. Results of the normal morphology sperm rate have investigated that: ① Follicle stimulating hormone (FSH) and testosterone (T)/luteotropic hormone (LH) have a negative correlation with the normal rate of sperm morphology. Follicle stimulating hormone (FSH)/luteotropic hormone (LH) and testosterone (T)/estrogen 2 (E2) have a negative correlation with the normal rate of sperm morphology; ② Comparison between the serous testosterone (T) and the normal morphology sperm rate:No significant differences were found between the serous testosterone (T) at 350ng/ml and 230ng/ml level and the normal rate of sperm morphology. However, the nearly difference was found between the serous testosterone (T) at 350ng/ml level and the normal rate of sperm morphology (P=0.068> 0.05). ③ Comparison between ages and the normal morphology sperm rate:Ages have a negative correlation with the normal rate of sperm morphology. However, we found that there was an up-regulation of prevalence rate with age increasing. ④ Comparison among the primary infertility, secondary infertility and the normal morphology sperm rate: No significant differences were found between the primary infertility and secondary infertility. However, the nearly difference was found (P= 0.054>0.05).Conclusion:(1) The results of the basic TCM syndromes analyzed by multivariable linear and logistic regression method have revealed that the single TCM syndrome of male infertility is most frequently referred to the syndrome of downward diffusion of damp-heat, and the compound TCM syndrome is most frequently referred to the syndrome of Kidney Jing deficiency mixing with the syndrome of downward diffusion of damp-heat. (2) In the present study, we found that frequent staying-up, body mass index (BMI), burdened working pressure, smoking, ages, alcohol consumption and varicocele have a close correlation with Male Infertility. (3) The normal morphology sperm rate might have a close relationship with the sex hormone, which is mainly referred to the FSH and T/LH and less consanguineous with the total serum testosterone.