SART生育专家 - 泌尿科与男性生殖健康

你好，我是医生。

Hi, this is Doctor.

我是比尔·皮托，来自SART生育专家节目。

Bill Pitot here for SART Fertility Experts.

我的嘉宾是医生。

My guest is Doctor.

阿贾伊·南贾，堪萨斯大学医学院泌尿学教授兼副主席。

Ajay Nangia, Professor and Vice Chair of Urology at the University of Kansas Medical School.

南贾医生。

Doctor.

非常感谢您来参加我们关于男性生育能力的讨论。

Nangia, thank you very much for joining us for a discussion about men's fertility.

谢谢您的邀请。

Thank you for having me.

这是我们的荣幸。

It's our pleasure.

南贾医生，

Doctor.

男性什么时候应该因为生育问题去看泌尿科医生呢？

Nangia, when should a man see a urologist about fertility issues?

在美国，不孕不育的定义是夫妻自然尝试一年未孕。

So the definition of infertility in The United States is one year of trying naturally with their partner.

超过这个时间，就应该考虑做检查了。

And beyond that point then they should be probably evaluated.

有时候，如果男女双方年龄偏大，想加快检查进度，这个时间可以调整。

Sometimes that can be adjusted if there are issues of male and female age that they want to expedite their workup.

但在欧洲，不孕不育的定义实际上是两年，这跟统计数据有关：大约85%的夫妻在一年内怀孕，剩下15%中有一半会在第二年怀孕。

In Europe though, the definition of infertility is actually two years and part of that is related to the statistics that approximately eighty five percent of couples achieve a pregnancy by one year and half of the remaining fifteen percent achieve it in their second year.

也就是另外7.5%。

So another seven point five percent.

所以在有强制规定的国家，有时他们想先尽量自然怀孕，再花钱做辅助生殖。

So in a mandated world, sometimes they want to maximize natural before paying for assisted reproduction.

美国并没有强制规定，只有大约15个州有一些相关要求。

US doesn't have a mandate per se other than somewhat in about 15 states.

但尽管如此，美国生殖医学会（ASRM）的定义是一年。

But nevertheless, the ASRM, American Society of Reproductive Medicine definition is one year.

所以到了那个时间点，或者如果他们有其他问题，比如我之前说的，不仅仅是男方或女方的年龄，还有比如做过输精管结扎术，那就不需要等一年。

And so by that point, or if they have other issues, as I said, not just male age or female age, but obviously a vasectomy that would require not waiting a year.

如果他们还有其他已知疾病，比如做过化疗，或者有睾丸外伤或癌症病史，有时候就需要更早进行检查，因为他们已经知道生育能力可能受到了影响。

And if they had other known diseases, they've had chemotherapy, or they've had history of testicular trauma or cancer, sometimes that would warrant progressing much, much earlier when they already know there was a compromise to their potential fertility.

当男性因为生育问题去看泌尿科医生时，医生通常会建议做精液分析吗？

When a man does go to see a urologist about fertility issues, would it be usual for the doctor to recommend a semen analysis?

是的。

Yes.

我觉得重要的是要记住，这是医学院直接教出来的，80%的诊断来自病史，20%来自体格检查，当然，这可能是初步鉴别诊断的基础。

I think what's important though to always remember, and this comes out straight out of medical school, is eighty percent of a diagnosis is actually made from a history, twenty percent from a physical, and of course, maybe that's the initial part in terms of creating differentials.

但当然，实验室检查也很重要。

But yes, of course, laboratory testing is important.

但我想告诉大家，一个男人不仅仅是一份精液分析报告。

But I like to tell everybody that a man is not a semen analysis.

不孕不育也不只是精液分析的问题。

Infertility is not a semen analysis.

因此，虽然我们确实需要一份基础的精液分析，但更重要的是病史和体格检查，从而确定从时机到既往病史、用药情况，以及，天哪，检查时发现睾丸缺失等所有问题，这些可能都不需要精液分析。

And as such, although yes, we do need a baseline semen analysis, but the important part is the history and the physical, and therefore defining everything from timing to pre existing conditions or medications and issues of, God forbid, missing testicles on the exam that may not require semen analysis.

有时男性会因睾丸癌或输精管切除术而来就诊。

Sometimes testicular cancer men show up or equally a vasectomy.

精液分析可能并不合适。

The semen analysis may not be appropriate.

但对于那些没有这些既往顾虑的人来说，精液分析确实是下一步。

But generally in people who have not had all of those kind of pre existing concerns, and yes, a semen analysis is the next step.

你提到了时机，我想知道你能不能多解释一下你指的是什么。

Now you mentioned timing, and I wonder if you could tell us a little bit more about what you mean by that.

这其实正成为我感兴趣的一个研究课题。

So this is becoming actually an interesting research question of mine.

我的很多研究问题都来自临床实践。

And many of my research questions come from clinical practice.

这些年来，我已经行医将近二十五年了，我发现了一个关于两性知识的重要问题，很多人其实并不了解。

And over the years, which now is nearly twenty five years of practice, I have discovered one important thing that people do not know about the birds and the bees.

说到这个，我们第一次知道要生孩子就得有性行为，阴茎和阴道之类的，大家都会有点不好意思地笑。

And in that light, I mean, yes, we all kind of giggle when we first learn that to have babies you have to have sex and intercourse penis and vagina kind of thing.

但之后很少有人真正教我们怎么才能怀上孩子。

But nobody then teaches very well on how to have a child.

有些知识就像以前在操场上听来的，现在则是通过网络。

And some of that is off the playground like we used to do in the old days and now through the internet.

如果一个月里频繁地、随意地发生性行为，那么受孕的时机自然会出现。

But timing of intercourse to have a child can occur when people have a lot of random sex over a period of month.

对，那些就是没计划、意外怀孕的情况，我管这叫‘哎呀宝宝’。

Fine, yes, those are the ones that aren't planned necessarily and happen like oops babies as I call it.

但如果是有人积极备孕，规划生活，想通过安排性行为时间，在九个月后迎来孩子，那他们首先得了解女性的月经周期是怎么回事，也就是说，从这次月经开始到下次月经开始算一个周期，很多人其实并不清楚这一点。

But when someone is actively trying and planning their life and trying to time their intercourse to have a potential child nine months later, then they need to understand that first of all, what's going on on the female cycle events, meaning what's the definition of a cycle From the beginning of the period to the next one that starts, they don't always know that.

在28天的周期里，月中是哪一天？

When is the middle of the month in a twenty eight day cycle?

那是排卵期吗？

Is that ovulation?

如果他们学过一些基础生物学，也许他们会知道，但现在不一定了。

Well, if they learn any basic biology, maybe they would know that, not necessarily these days.

我不知道高中、大专或大学里教什么，但不用说，他们不一定知道这些。

I don't know what they teach in high school or junior college or college, but needless to say, they don't always know that.

所以，和你的泌尿科医生以及你伴侣的妇产科医生聊聊，了解什么时候是合适的同房时间，会非常有帮助。

So it would be very helpful to have a conversation with your urologist as well as your partner's OBGYN about when is the appropriate time to have intercourse?

当然，我认为，信不信由你，虽然你可以从网上学到很多，但我们在研究中也发现，市面上那些定义排卵期的产品、应用程序，以及网上告诉你的那些信息，其实……

Absolutely, I think that believe it or not, as much as one can learn it from the internet, one of the things in our research study we're finding is products on the market, apps that define ovulation, what there is on the internet in terms of telling you that.

归根结底，我遵循的是美国生殖医学会关于优化自然生育力的建议。

At the end of the day, I actually go by optimizing natural fertility by the American Society of Reproductive Medicine.

那里有一份给夫妇们的事实说明书，他们可以在遇到问题之前就去那个网站，按照那些指导来做。

And there's a fact sheet for couples to go to that website maybe before they even have trouble and go follow those guidelines.

从时机来说，就像我说的，排卵前每隔一天开始，到用不用润滑剂，再到要避免的东西，比如热水浴缸和浴缸，还有毒素。

Everything from timing, as I indicated, starting before ovulation every other day, to lubricants or not lubricants, to things to not use like hot tubs and bathtubs, to toxins.

这些其实在美国生殖医学学会的情况说明书里都写得很清楚。

So they're all actually well described in a fact sheet by the American Society for Reproductive Medicine.

那可以在asrm.org网站上找到。

That would be available to asrm.org.

对，谢谢

Correct, Thank

你。

you.

那我们回到精液分析的话题。

So let me come back to semen analysis.

显然，就像你说的，在做精液分析之前，详细的病史和体格检查很重要。

And obviously, as you said, a good history and a physical examination would be important before doing a semen analysis.

你能简单给我们讲讲正常的精液参数是什么，以及哪些因素可能导致异常吗？

And could you briefly review for us what are normal semen parameters and then what might cause those things to be abnormal?

所以我就

So I

几乎每天都会进行这样的对话。

have this conversation every day virtually.

而我最核心的讨论点就是“正常”这个词到底意味着什么。

And my biggest fundamental discussion is about what this word normal means.

其实我不太喜欢这个词。

I don't like that word actually.

它只是一个参考值，对吧？

It's a reference value, all right?

为什么“正常”这个词不合适呢？原因在这里。

And here's the reason why the word normal doesn't work, okay?

因为对于男性来说，并不存在一个所谓的“正常数值”。

Because no normal number exists for the male species, so to speak.

只有一个范围。

There is a range.

我会稍微详细解释一下这个，告诉病人，世界卫生组织是根据将近八百到九百名在一年内让伴侣怀孕的男性来制定这个标准的。

And I kind of go into a little bit of detail of this to explain to patients that the WHO created this criteria based on nearly eight hundred, nine hundred men who achieved a pregnancy within one year, I.

也就是说，

E.

在生育能力的定义范围内，然后他们把这个数据画出来，发现分布范围很广，从第五百分位到第五十百分位，也就是说，百分之九十五的人高于这个值，到百分之五十的人高于这个值，你把它画成图表。

Within the definition of fertility, and then just grafted out and proved that there is a spread, quite a large spread where the fifth percentile, fiftieth percentile, meaning when ninety five percent of people are higher than that to fifty percent of people are higher, and you're gonna graph it out.

但不幸的是，在参考值这个领域里，你不能把整个范围都当作正常值。

And unfortunately, what happens in the world of reference values is you cannot use the whole range for what's considered normal.

你必须设定一个统计上的起点，就像是在沙地上画一条线。

You have to create a statistical starting point, a kind of a line in the sand, if you will.

我们说的是第五百分位，意思是在统计上，所有东西都在那5%的范围内。

And we talk about the fifth percentile, which means this statistically everything's in the 5% kind of world.

所以，任何高于这个值——低于5%和高于95%的数值——就是参考值的临界点，也就是从这里开始算正常。

So anything above numbers that are 5% below and 95% above is where the cutoff, the peak cutoff of a reference value in this case begins.

这个值就是每毫升1500万，活动率40%，正常形态4%。

And that is 1.5, 15,000,000 per cc, 40% motility, 4% normal forms.

这些都是从这群所谓的生育能力正常的男性中统计出来的。

And that's all created statistically from this group of, if you will, fertile men.

不过，有一点我必须强调，这些数值的定义是针对有生育能力的男性的。

Now, the important thing though, I have to just highlight is the definition of those values was for fertile men.

如果一个男性按照这些参考值来看是正常的，但已经超过一年还没怀上，那么这些数值其实就不那么相关了。

In a man or who has normal values based on those reference values, who has gone beyond a year, technically those values are not totally as relevant.

可能是精子存在功能性问题，对吧？

There could be a functional problem of the sperm, right?

所谓的正常定义，也就是我讨厌的参考值，是指正常生育发生的情况。

The definition of normal, which I hate, as I said, or reference value is when normal fertility occurs.

所以，即使一个男性精子数量按这些参考值是正常的，但超过一年才怀上孕，也不能百分之百说这些数值是正常的。

So even a man with a normal sperm count based on those reference values who has taken more than a year to achieve a pregnancy cannot 100% say that those numbers are normal.

所以我觉得可以这么说，既然只需要一个精子就能怀孕，那么这些正常数值的重要性就不如让精子到达卵子那里。

So I guess it's fair to say that since it only takes one sperm, those normal values are less important than getting the sperm to the egg.

没错。

That's right.

关键是精子怎么到达卵子。

It's the way the sperm gets to the egg.

再说一次，这能发生真是奇迹。

And again, it's amazing it ever happens.

说实话，我真的觉得任何人能怀孕都是奇迹。

It really truly amazes me that anyone ever gets pregnant, be honest.

但每七万到七十万个精子中，只有一个能穿过阴道和宫颈，到达输卵管。

But one in seventy to seven 100,000 sperm make it beyond the vagina slash cervix to the fallopian tube.

七万到七十万分之一，具体数字取决于你看的文献。

One in seven hundred thousand, 70 to 700,000, depending on what literature you read.

而且有些

And some

这些文献比较老了，对吧？

of this is old literature, right?

然后在输卵管的某个地方，受精必须发生。我常跟夫妻们打比方说，精子就像足球场上的那片草叶。

And then at some point in the fallopian tube, fertilization has to occur where as I described to couples, a sperm is like the blade of grass on a football field.

明白吗？

Okay?

而输卵管的长度就相当于一个足球场的长度。

And the length of the fallopian tube is the length of the football field.

对吧？

All right?

而卵子的大小相当于一个足球。

And the egg is the size of a football.

对吧？

All right?

在这么大的空间里，那根草叶居然能找到那个足球。

Somehow in all of that, the blade of grass finds the football.

而且它有很多……

And it's got lots of...

而且这条路也不是直的。

It's not a straight shot either.

精子顶体找到卵子，我称之为信标，这真是个奇迹。抱歉，我是说找到卵子。

It's a miracle that the beacon, as I call it, acrosome of the sperm or finding the Sorry, finding the egg.

还有一种化学趋向性，就是利用化学路径，他们认为是像信标一样找到卵子。

And a kind of a chemotaxic meaning uses a chemical pathway, they think as a beacon to find the egg.

真的很神奇。

It's really amazing.

所以精子的功能，以及DNA碎片化或活性氧等因素，确实会起作用。

So the functionality of that sperm and things then like DNA fragmentation or reactive oxygen species do play a role.

子宫的免疫异常也可能起作用，攻击精子。

Immunological abnormalities of the uterus can play a role and attack the sperm.

精子在最佳环境中，也就是月中没有敌意的情况下，只能存活24到48小时。

The sperm can only live for twenty four, forty eight hours in the best environment where it's not hostile in the middle of the month, so to speak.

所以不仅仅是数量问题，还要有足够多的精子到达卵子那里。

And so it's not just the number, it's getting enough, you know, to the egg.

你知道，人们常说，精子不会问路。

You know, sperm don't ask for directions, as they say.

确实。

True.

而且你知道，它们需要很多

And you know, they need a lot

精子才能到达那里。

of them to get there.

你之前提到过一件事，就是输精管结扎术。

You mentioned something before, and that was vasectomy.

显然，很多男性做输精管结扎是为了避孕，但后来他们可能又想要孩子了。对于已经做了结扎的情况，有什么办法吗？

Obviously, many men have a vasectomy to prevent conception, and at some point they may decide that they now want to have children again, what can be done for a vasectomy that has taken place?

能逆转吗？

Can it be reversed?

做这个逆转手术有多难？

And how difficult is it to do that?

是的，给你一个概念，仅在美国，每年就有大约五十万到六十万例输精管结扎手术。

Yes, and just to put that into perspective, just in The US, nearly five hundred thousand, 600,000 vasectomies are done.

而这只占了美国避孕措施的约百分之十一。

And that only accounts for about eleven percent of the contraception done in this country.

但尽管如此，大约有百分之六的男性考虑过做输精管复通术。

But nevertheless, about six percent of men consider having it reversed.

这又是旧数据了，但不管怎样。

And this is again, old data, but nevertheless.

在这种情况下，需要考虑的问题是：距离做输精管结扎术已经过去多少年了？

And in that equation, then the question is that needs to be considered is how many years from vasectomy?

女性伴侣的年龄多大？

How old is the female partner?

有没有女性方面的因素？

Are there any female factors?

有没有与输精管结扎术相关的男性因素？

Are there any male factors associated with vasectomy?

我们开始看到的情况是，有些男性做了输精管结扎术后，恰好又在使用睾酮，这会抑制或阻止精子生成。

And what we're starting to see is men who had a vasectomy then happened to be on testosterone, which inhibits or prevents sperm production.

所以必须停止使用睾酮，然后让睾丸功能重新启动。

So that has to be stopped and then rebooted in terms of the testicular function.

但不用说，男性做了输精管结扎后，最明显的考虑就是可以逆转。

But needless to say, when man has had a vasectomy, the obvious consideration is you can reverse it.

这需要使用显微手术，可能需要三个半小时到四个小时。

It's using microsurgery, it can take three and a half, four hours.

手术中使用的缝线非常非常细，是比头发还细的尼龙线，而且要用很大的显微镜，比你在《实习医生格蕾》里看到的那些戴在眼镜上的镜头大得多。

It's using very, very thin stitches, nylon that are smaller than a human hair and using a very big microscope, many times much bigger than what you see in Grey's Anatomy on TV with those lenses on the glasses.

放大倍数高达20到25倍。

This is up to 20 to 25 times the magnification.

重新连接的过程很复杂，很精细，需要技术，而且完全可行。

And the reconnection is complicated, it's detailed, it takes skill and it's very doable.

至于效果如何，统计数据表明确实有效，但还是要取决于一些变量，我。

And the statistics on does it work is absolutely it does work, but it has to be again based on some variables, I.

也就是说。

E.

从做输精管结扎到现在的时间长短，以及堵塞位置更靠后、在睾丸后部叫附睾的地方，还有女方的年龄，就像我刚才说的。

The length of time from vasectomy, the blockage further back into the back of the testicle called the epididymis and the female age, as I said.

而且确实有很好的统计数据，基于一项老研究，但样本量很大，研究了大量患者，男性按结扎后的时间长短分组，成功率从百分之七十五到百分之十五或二十不等。

And there are good statistics actually based on an old study, but again, of a large number of patients that were studied and the groups of men were subdivided by length, how long they were from their vasectomy and anything from seventy five percent to fifteen or twenty percent.

不幸的是，如果出现疤痕组织，成功率可能会降到零。

And unfortunately, yes, could go down to zero if they're scarring.

好，让我打断你一下，

Well, let me interrupt you for

如果男性觉得输精管复通术对他来说不是个好选择，

a second and say a man chooses that that's a bad option for him.

考虑到费用、等待结果的时间，那么对于做过输精管结扎、想用自己的精子生孩子的男性，还有其他选择吗？

The cost, the length of time he might have to wait until finding out if it works, is there another option for a man who's had a vasectomy who wants to conceive a child with his own sperm?

有。

Yes.

所以，你知道，我一直受到非常有道德的导师和医生的教导。

So, you know, again, I've been taught by very ethical mentors and Doctor.

我在克利夫兰诊所跟着安东尼·托马斯医生的时候，他常说，男性做完输精管结扎后，有五种方式可以有孩子。

Anthony Thomas from Cleveland Clinic used to say when I was with him, there are five ways a person post vasectomy can have a child.

其中两种是生物学上的。

There are two that are biological.

一种是输精管复通术，也就是用他自己的精子，让伴侣自然怀孕。

One is a vasectomy reversal, meaning his sperm and getting his partner pregnant naturally.

还有一种就是体外受精，具体叫胞浆内单精子注射，我们可以从睾丸或附睾里取精子，不用做复通手术，然后在体外把精子注入每个卵子里，卵子来自女性伴侣，在体外分裂，现在大概五天后再放回女性体内。

And then there is the ability to do in vitro fertilization, a specific type called intracytoplasmic sperm injection, where we can get sperm from the testicle or the epididymis without undoing the vasectomy and sticking one sperm into each egg outside the body, of course, from the female partner, and then divides outside the body and then they put it back about five days nowadays into the female partner.

所以这就是体外受精的方法，它绕过了结扎，但当然还是生物学上的。

So that's the in vitro method that bypasses, but yet is of course biological.

不过为了全面起见，我总是会和夫妻讨论其他选择，比如捐精、领养、寄养，当然也可以什么都不做。

Now, just to be complete though, I always talk to couples about donor sperm as an alternative, adoption as an alternative, foster care as an alternative, of course do nothing.

有时候他们来只是聊聊，并不想采取任何行动。

Sometimes they're here just to talk about it and don't want to pursue anything.

但如果男方想用自己的精子，夫妻想用自己的精子，听起来有两种选择：一种是输精管复通术，另一种就是像你说的，通过手术取精子然后做ICSI。

But if a man wants to use his own sperm, a couple wants to use their own sperm, it sounds like there are two options that would be a vasectomy reversal or one of these surgical procedures to remove sperm and then do ICSI, as you said.

对，完全正确。

That's right, exactly.

你之前提到过润滑剂，我们知道很多夫妻会使用润滑剂让性生活更舒适。

You mentioned something earlier about lubricants, and we know that many couples use lubrication to make sex more comfortable for them.

润滑剂对男性生育能力或者生育能力有什么问题吗？是的，绝对有。

Are there issues with lubricants and male fertility, or fertility Yes, in absolutely.

总的来说，我……你……

General, I You

知道，再说回一些基本的生理知识，阴道pH值会从酸性和有敌意的状态——这是一种防御机制或抗感染机制——变成月中时的碱性状态。

know, again, going back to some fundamentals about the birds and the bees, you know, the vaginal pH changes from being acidic and hostile, which is a defense mechanism or anti infection mechanism, to being alkaline in the middle of the month.

宫颈和阴道里的黏液也会发生变化。

And the mucus changes in the cervix and in the vagina as well.

这叫做排卵痛。

It's called Mittelshmerz.

所以在月中，自然润滑的情况下，pH值环境会更好。

So the environment is better on a pH level in the middle of the month with natural lubrication.

现在，如果他们需要一些帮助，因为不幸的是，怀孕往往是一件麻烦事。

Now, if they need some support, because often unfortunately getting pregnant is a bit of a chore.

这不像做爱那样，但你不需要掐着时间。

It's not like an act of making love, but you're not gonna have to time this.

他们一天下来已经很累了。

They're tired at the end of the day.

他们做爱是为了让精子到达，为了生孩子，而不仅仅是为了亲热。

They're having sex to have sperm delivered and have sex to have a baby, not just to have lovemaking.

这样一来，自然润滑可能会稍微差一些。

And in so doing, lubrication can be a little bit less efficient naturally.

这时候有人可能会说，那药店里架子上那些普通的润滑剂怎么样呢？

And that's when one could say, well, what about average lubricants out on the shelf in a pharmacy?

嗯，它们里面通常含有一些成分，是为了防止产品分解，同时也有消毒作用，不会引起不适。比如KY果冻，我并不是对它有什么顾虑或问题，但它含有盐酸作为载体，这对精子不好，会杀死精子。

Well, often they have products in them that are designed to prevent them breaking down obviously, and be disinfectant in their own rights and not cause the med like, you know, KY jelly is not because I have any concerns or problems with it, but it's in a carrier which has hydrochloric acid that's not the good thing, kills the sperm.

所以必须使用对精子友好的润滑剂，市面上只有一两种，而且不仅仅是润滑作用，还要减少夫妻之间的摩擦或不适。

So they have to be sperm friendly lubricants of which there are only one or two and not just the act of lubrication to make it less concerning or friction for the couple.

所以润滑剂的酸碱度很重要。

So the pH of that lubricant matters.

而且有些润滑剂必须经过验证，证明它们不会杀死精子。

And then some of them have to be validated to prove they don't kill sperm.

市面上确实有几款已经做过这种验证。

That's actually been done with a couple of them on the market.

当有人因为怀孕困难来找我时，我会推荐这些。

And ones I recommend when they come in knowing that they're having trouble.

如果一对夫妻想怀孕，他们可以跟你或像你这样的人聊聊，咨询哪种润滑剂最适合他们。

A man and woman could then talk with you or someone like you to get advice about which kind of lubricant would be best for them if they're trying to achieve a pregnancy.

没错。

Exactly.

很好。

Very good.

你知道吗，你提到了很多影响怀孕的因素，都跟男性有关。

You know, you've mentioned an awful lot of things that can inhibit pregnancy that involve men.

我想，告诉一个男人他有身体上的问题，不管是精子的问题，还是精子到达卵子的路径有问题，这消息对他来说肯定很难接受。

And I would imagine that giving that news to a man that he has problems that are physical, either with his sperm or with the way the sperm is going to get to the egg, can be quite troubling.

你能跟我们说说，在这种情况下你是怎么给男性做咨询的吗？

Can you tell us a little bit about how you counsel men under those circumstances?

可以，这确实是个很好的问题。

Yes, and that's actually a very good question.

我觉得我们作为医生有时候会忘记，我们可以一直用医学术语讲，但说到底，听我们说话的人是不懂医学的，就像我不懂我汽车的机械原理一样。

I think what we forget as clinicians, sometimes we can talk in med speak all we want, but at the end of the day, someone who doesn't know medicine, like I don't know the mechanics of my car, is listening.

这样一来，他们就会想，什么，什么，什么，什么，什么？

And in so doing, they're like, you know, what, what, what, what, what?

他们其实没听进去多少，然后就会想，天哪，有问题了，我影响到了我的男子气概。

They're not actually hearing much and they're like, oh my God, there's a problem and I've affected my manhood.

我不会成为一个好父亲。

I'm not gonna be a good father.

我没法当父亲了。

I'm not gonna be able to be a father.

男子气概，所有让我觉得自己有阳刚之气的东西，现在都受到了挑战。

Machismo, everything that makes me virile is being challenged right now.

然后他们突然就进入了某种心理防御状态，或者震惊，或者觉得太丢人了，因为从来没有人跟男人谈这些，不像女人之间经常聊，因为我们没接触过这些。

And all of a sudden they're like in kind of mental defensive mode or in shock, or it's too embarrassing for them because no one ever talks to men like often ladies talk to each other because we're not exposed to this.

我们从小作为男孩，做的事就是拍拍后背，互相取笑，讲究男子气概，绝不能表现出任何软弱的迹象。

Everything we do as a child, as a male child is kind of slap on the back, making fun of each other, machismo, never show any signs of weakness.

所以跟医生谈自己的阴茎和睾丸，感觉特别别扭，更别说还要被检查了，而年轻女孩和女人从做乳房检查和宫颈涂片检查那天起就习惯了。

So then to talk about your penis and your testicles to a doctor is so like alien and let alone being examined, whereas young ladies and women expect it from the day they have their breast exams and their pap smears.

我们男人直到因为这种问题去看医生，才第一次经历这些。

We don't have any of that until some doctor ends up seeing you for this kind of problem.

所以很多时候，他们就像受惊的鹿一样，愣在那里。

And so they're kind of endearing headlights a lot of times.

所以他们处于否认、震惊和尴尬的状态。

And so they're in kind of denial mode and shock mode and embarrassed mode.

所以很多时候要让他们明白，你不能用像“低”或“零”这样的词。

And so getting through to them many times, you can't use words like low or zero.

我的意思是，可以用“零”这个词。

I mean, can use zero.

有时候你确实得用“零”这个词。

Sometimes you have to use the word zero.

但“低”这个词，你知道，有点贬义，会让人觉得自己不够好。

But low, it kind of, it just has a derogatory, you know, it kind of makes people feel inadequate.

所以我会说“下降”或者“游得不太好”之类的。

So I say words like decreased or they're not swimming as well or whatever.

而且我总是要确保他们明白，这不是问题的全部。

And I always have to make sure that they realize that it's not the be all and end all of the problem.

我是说，他们特别纠结于“我曾经想过坏事，也做过坏事”这件事。

I mean, they get terribly focused on I thought about something bad once and I did something bad once.

这是不是我现在要为此付出代价的罪过？

Is this the guilt that I'm gonna pay the price for now?

我就说，不，这不是你的错。

And I'm like, no, it's not your fault.

有点像《心灵捕手》那种风格。

Kind of goodwill hunting kind of style.

我会尽量跟他们解释，这是夫妻双方的问题，不是单方面的责任，就像我喜欢说的那样。

I'm like, I really try to explain to them that this is a couple's problem and not a single person is blamed as I like to call it.

但他们往往不这么想，有时候确实会那样想。

And they like to think, unfortunately they sometimes think like that.

他们会觉得所有负担都压在自己身上。

That they feel that burden is now all on them.

我就得说，看，不是这样的，没有你们俩，什么事都不会发生。

And I have to say, look, no, nothing ever happens without both of you.

你们得互相支持，你支持你的妻子或伴侣，反过来也一样，这样我们才能一起度过难关。

And you have to be each other's support structure, you for your wife and partner, whatever, and similarly the other way around and we'll get through this.

当他们开始放松，意识到你不是敌人，或者说你不是来贬低他们的，他们往往会放松下来，敞开心扉，也许会说更多。

And when they start relaxing and realizing you're not the enemy, to speak, or you're not there to belittle them, then often they relax, open up, maybe explain a little bit more.

我会安抚他们，让他们安心，有点像给他们做赦免，然后说，看，不是你在大学抽的那根大麻的问题，那根本不是问题。

I calm them down, I reassure them, I kind of do absolution on them and say look, no it's not that one joint you smoked in college, that's not the problem.

有时候不是，不是你在大学时得的那次性病。

Sometimes no, no, it's not the one time you had STD when you were in college.

你知道，可能是，但不是那样。

You know, it can be, but not like that.

通常是由严重的感染之类引起的。

Often it's caused a bad infection and stuff.

而且，有趣的是，做过输精管结扎术的男性，他们真的想要孩子吗？

And often, interestingly enough, in the guys who've had a vasectomy, do they of course really want a child, right?

还是他们是为了伴侣才这么做的？

Or are they doing it for their partner?

我必须确保他们真的想要，并且愿意成为未来的父亲。我称之为医学中的社会工作，这是他们爱情的结合，他们真的理解他们正在尝试做的事情的意义。

And I have to make sure that they really do and they want to be a potential father and I kind of call it the social work of medicine and that this is a union of their love and they really understand the concept of what they're trying to do.

并且要真正深入了解，在亲密关系层面。

And kind of really get under the skin in the sense of being intimate.

所以听起来你在说的是，当男性去看泌尿科医生时，他应该预料到两到三件不同的事情。

So it sounds like what you're saying is that when a man sees a urologist, he should be able to anticipate two or three different things.

一是好的咨询、好的评估、好的病史、好的体检、好的解释，说明可能有哪些因素阻碍怀孕，还有一双理解你的耳朵，明白这是团队合作，你的工作是帮助他，并且你理解当发现生育问题时可能会有心理上的打击，你会陪他一起走到最后。

One is a good consultation, a good evaluation, a good history, a good physical exam, a good explanation of what possible things may be getting in the way of achieving a pregnancy, and an understanding ear that this is a team project, that your job is to help him, and that you understand that there may be psychological insults, if you will, when you discover that you've got a fertility problem, and that you're there to work with him to get him all the way through to the other side.

没错。

Exactly.

总结得很准确。

That summary's exact.

非常好。

Very good.

还有没有其他建议，想告诉正在收听这个播客、想了解男性不育的男性听众？

Are there other nuggets that you would want a man to know listening to this podcast who's trying to understand male infertility?

虽然不是说痛苦需要陪伴，但每个人都有自己的问题。

So, not that misery loves company, but everyone's got problems.

每个人都觉得别人那边更好。

Everyone thinks that it's better on the other side.

我多少了解大脑的运作，但请记住，你并不孤单。

I know how brains work somewhat, but just remember you're not alone.

一千五百万对夫妻，这并不能让情况变得更好，但至少让你知道，很多人都在为这个问题挣扎，比你想象的多得多。

15,000,000 couples, that doesn't make any better, but just to know that a lot of people struggle with this more than you think.

而且，这不是互相指责的游戏，对吧？

On top of which, it's not a blame game, right?

这不是在追究谁的责任。

It's not a blame game.

这是去发现问题的所在，以积极的态度去面对，努力让生活向前，去拥有孩子。

It is a discovery of the situation to be positive and trying to move their lives forward to have children.

我觉得有些误解需要被澄清。

I think some myth busting has to happen.

穿平角裤还是三角裤，其实差别不大。

Boxes or briefs doesn't make a really big difference.

泡热水澡或者泡浴缸，是的，如果你停下来，那确实会有影响。

Hot tubs and bathtubs, yeah, that does make a difference if you stop.

药物、吸烟，是的，这些确实有一定的影响。

Drugs, smoking, yes, there's some degree of that.

我通常会说，如果某样东西让你头疼、让你宿醉，那它很可能也在伤害你的睾丸，因为那是另一个大脑。

Usually what I say is if it hurts your brain and you get a hangover, it's probably hurting your testicles too because that's the other brain.

所以很多时候，这些简单的事情、时机、教育，还有真正、真正、真正按照我说的去做，就像是一种解脱。即使他们之前做过什么傻事，或者得过什么病，能帮他们卸下内疚或自责的包袱，对他们来说就是巨大的解脱，对吧？

So in many ways, these simple things and timing and education and really, really, really doing what I said is kind of an absolution in many times where, all right, even if they've done something stupid along the way or had some disease, the fact that you can take away a sense of guilt or blame is a huge weight off their shoulders, right?

让他们知道你是站在他们这边的，他们并不孤单。

That you're on their side and that they're not alone.

而且，你知道，我虽然不想这么说，但对年轻夫妻来说，不孕不育就像老年人得癌症一样。

And you know, I hate to say a fertility for a young couple is like an older person getting cancer.

这真的是一个非常非常可怕的诊断，会深深侵蚀你的灵魂。

It's really a horrible, horrible diagnosis that gnaws into your soul.

而且母亲节快到了，我告诉你，我以前从没觉得母亲节是个让人难受的日子，直到有一天有人问我：那那些没能有孩子的人怎么办？

And here we have Mother's Day coming up and I will tell you that I never thought of Mother's Day as a negative day until one day someone said, What about all the people who have not been able to have children?

确实。

Sure.

你觉得母亲节和父亲节对他们来说是什么感受？

What do you think Mother's Day and Father's Day feels to them?

你是

You're

我当时完全震惊了。

And I just totally blew my mind.

我就想，天哪。

I'm like, oh my goodness.

你知道，母亲节和父亲节本来是庆祝父母的好日子。

You know, it's a joyous day hopefully to celebrate mothers and fathers.

每个人都有自己的父母，至少据我所知是这样。

Everyone does have one, last time I checked.

不管他们好不好。

You know, for good or for bad.

而且真的要成为他们的支持者，帮助他们度过我所说的那种每隔一个月就来的过山车般的经历。

And to really be their champion and to help them navigate what I call a rollercoaster every So month that goes

你真正想找的泌尿科医生，是能帮你解决男性因素问题的人，是能成为团队一员帮你找到解决方案的人，我想这就是你的意思。

you're really looking for, when you're looking for a urologist to help you with a male factor problem, looking for somebody who's gonna be part of a team to help you find a solution, I guess is what you're saying.

当然。

Absolutely.

我觉得我们总是忘记一件事，那就是不是他们和我们。

I think the one thing we always forget, it's not them and us.

不是男性一方或女性一方。

It's not the male side or the female side.

不是那些不关心男性伴侣或精子数量的女性妇科医生，对吧？

It's not the female gynecologist who don't care about the male partner or your sperm number, right?

那不应该这样。

Which that should not be the case.

专攻生殖的泌尿科医生之所以做得好，是因为他们和妇科医生团队合作，因为最终的目标是这对夫妇的结果，而不是因为我们自己的地盘。

The reason why urologists who specialize in reproduction do well is they work as a team with the gynecologist because the end product is the outcome for the couple, not because of our own turf I

我想团队里最重要的成员其实是男方和他的伴侣。

guess really the most important players on the team are the man and his partner.

没错。

That's right.

而且其他所有人都是来帮助他们实现目标的。

And that everybody else is there to help them achieve their goals.

没错。

That's right.

这确实是个因素，你不想跳来跳去。

It's very much a factor that you don't wanna play leapfrog.

你不想忽略其中一方。

You don't wanna ignore one partner.

你不能忽略其中一方。

You don't ignore one partner.

而且你真的意识到，你需要对双方都进行检查，因为超过百分之五十的情况是双方都有问题。而且我觉得，生殖问题在这方面很独特，对吧？

And you really realize that you've gotta do a workup on both partners since 50 plus percent is both partners And many I think the fact that reproduction is unique that way, right?

即使从技术上讲可能或可能不是，我讨厌用“病人”这个词，但双方都是你的病人。

Even though there may be technically or may not be, I hate the word there, patient, but both of them are your patients.

所以我想，对于正在收听这个播客的男性来说，他是你典型的寻求组建家庭的病人，走进你的办公室或像你这样的同事的办公室，关键信息是：有训练有素的人准备帮助你，而且有很多事情需要评估，才能给你最好的结果。

So I guess, you know, for the man who is listening to this podcast, who is your average patient who's seeking to create a family and has walked into your office or a colleague's like your office, the takeaway message is there are people who are well trained, are ready to help you, and there are multiple things that need to be evaluated in order to give you the best outcome.

这样说对吗？

Would that be fair?

非常对。

Very fair.

很好。

Very good.

医生。

Doctor.

Nangia医生，感谢您参加SART生育专家节目。

Nangia, I want to thank you for joining us on SART Fertility Experts.

我们非常感谢您对这个影响很多人的问题的专业知识和见解。

We really appreciate your knowledge and your insight into this problem which affects so many people.

这是我的荣幸。

My pleasure.

谢谢邀请我。

Thanks for having me.

本播客中表达的信息和观点不一定反映ASRM及其附属机构的观点。

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates.

这些内容仅供一般信息参考，不能替代与医生的咨询。

These are provided as a source of general information and are not a substitute for consultation with a physician.