Thaum lub sij hawm kuaj fertility ntawm ob niam txiv, ib tug spermogram yog systematically nqa tawm nyob rau hauv tus txiv neej. Los ntawm kev ntsuam xyuas qhov sib txawv ntawm cov phev, qhov kev kuaj mob lom no ua rau nws tuaj yeem hloov kho ntau yam spermatic txawv txav, xws li azoospermia, tag nrho cov phev tsis muaj.

Azoospermia yog ib qho phev txawv txav uas tshwm sim los ntawm qhov tsis muaj cov phev nyob rau hauv ejaculation. Nws pom tseeb ua rau muaj menyuam tsis muaj menyuam hauv cov txiv neej, vim tias thaum tsis muaj phev tsis tuaj yeem ua rau tsis muaj menyuam.

Azoospermia cuam tshuam tsawg dua 1% ntawm cov txiv neej hauv cov pej xeem, lossis 5 txog 15% ntawm cov txiv neej infertile (1).

Raws li qhov ua rau, muaj ob hom azoospermia:

Secretory azoospermia (los yog NOA, rau cov uas tsis yog-obstructive azoospermia)

Spermatogenesis yog impaired lossis tsis tuaj thiab cov noob qes tsis tsim cov phev. Qhov ua rau ntawm qhov teeb meem spermatogenesis tuaj yeem yog:

• hormonal, nrog hypogonadism (tsis tuaj los yog txawv txav hauv kev tso tawm ntawm cov tshuaj hormones poj niam txiv neej) uas tuaj yeem yog qhov tshwm sim (piv txwv li Kallmann-Morsier syndrome) lossis tau txais, vim tshwj xeeb ntawm cov qog pituitary uas hloov pauv kev ua haujlwm ntawm hypothalamic-pituitary axis lossis tom qab kev kho mob. (xws li kws khomob);
• Cov noob caj noob ces: Klinefelter Syndrome (tseem muaj ib qho X chromosome ntxiv), uas cuam tshuam rau 1 ntawm 1200 tus txiv neej (2), kev txawv txav ntawm cov chromosomes, (microdeletion, piv txwv li poob ntawm ib feem, ntawm Y chromosome hauv particular), translocation (ib ntu. ntawm chromosome detaches thiab txuas mus rau lwm tus). Cov chromosomal abnormalities yog lub luag hauj lwm rau 5,8% ntawm cov txiv neej infertility teeb meem (3);
• ob sab cryptorchidism: ob lub noob qes tsis tau nqis los rau hauv bursa, uas cuam tshuam cov txheej txheem ntawm spermatogenesis;
• kab mob: prostatitis, orchitis.

Obstructive lossis excretory azoospermia (OA, obstructive azoospermia)

Cov noob qes yeej tsim cov spermatozoa tab sis lawv tsis tuaj yeem raug sab nrauv vim muaj qhov thaiv ntawm cov ducts (epididymis, vas deferens lossis ejaculatory ducts). Qhov laj thawj tuaj yeem yog keeb kwm:

• Congenital: cov kab mob hauv lub cev tau hloov pauv los ntawm embryogenesis, ua rau tsis muaj vas deferens. Hauv cov txiv neej uas muaj cystic fibrosis, kev hloov pauv hauv CFTR noob tuaj yeem ua rau tsis muaj vas deferens;
• kis kab mob: cov hlab ntsws tau raug thaiv tom qab muaj kab mob (epididymitis, prostatovesiculitis, prostatic utricle).

Cov tsos mob tseem ceeb ntawm azoospermia yog infertility.

Kev kuaj mob ntawm azoospermia yog tsim thaum lub sij hawm sib tham txog kev xeeb tub, uas nyob rau hauv cov txiv neej systematically muaj xws li ib tug spermogram. Qhov kev ntsuam xyuas no suav nrog kev tshuaj xyuas cov ntsiab lus ntawm ejaculate (cov phev), ntsuas ntau yam tsis zoo thiab sib piv cov txiaj ntsig nrog cov qauv tsim los ntawm WHO.

Hauv qhov xwm txheej ntawm azoospermia, tsis muaj phev pom tom qab centrifugation ntawm tag nrho cov ejaculate. Txhawm rau kuaj mob, txawm li cas los xij, nws yog ib qho tsim nyog yuav tsum ua ib qho, lossis ob qho spermograms, txhua 3 lub hlis sib nrug, vim spermatogenesis (sperm production cycle) kav txog 72 hnub. Thaum tsis muaj phev ntau tshaj 2 mus rau 3 lub voj voog sib law liag, kev kuaj mob ntawm azoospermia yuav raug ua.

Ntau yam kev ntsuam xyuas ntxiv yuav raug ua kom kho qhov kev kuaj mob thiab sim txheeb xyuas qhov ua rau ntawm azoospermia:

• kev kuaj mob nrog palpation ntawm cov noob qes, ntsuas qhov ntim ntawm cov noob qes, palpation ntawm epididymis, ntawm vas deferens;
• seminal biochemistry (los yog biochemical kev tshawb fawb ntawm phev), txhawm rau txheeb xyuas ntau yam khoom zais (zinc, citrate, fructose, carnitine, acid phosphatase, thiab lwm yam) muaj nyob rau hauv cov ntshav plasma thiab pib los ntawm cov qog sib txawv ntawm qhov chaw mos (seminal vesicle, prostate). , epididymis). Yog hais tias lub txoj yog obstructed, cov kua yuav ntxhov thiab biochemical tsom xam yuav pab tau los nrhiav rau theem ntawm cov chaw khuam siab;
• Kev ntsuam xyuas hormonal los ntawm kev kuaj ntshav, suav nrog kev ntsuam xyuas tshwj xeeb ntawm FSH (follicle-stimulating hormone). Qib FSH siab qhia txog kev puas tsuaj rau cov qog nqaij hlav; qis FSH theem ntawm kev koom tes siab (ntawm theem ntawm hypothalamic-pituitary axis);
• serology los ntawm cov ntshav mus kuaj, nyob rau hauv thiaj li yuav zoo rau ib tug kab mob, xws li chlamydiae, uas yuav yog los kuj ua kev puas tsuaj rau lub excretory huam;
• scrotal ultrasound los xyuas cov noob qes thiab kuaj xyuas qhov txawv txav ntawm vas deferens lossis epididymis;
• ntshav karyotype thiab kev kuaj caj ces los nrhiav qhov txawv txav ntawm caj ces;
• testicular biopsy muaj xws li sau, nyob rau hauv cov tshuaj loog, ib daim ntawm cov ntaub so ntswg nyob rau hauv lub testis;
• X-ray lossis MRI ntawm lub caj pas pituitary yog qee zaum muaj yog tias xav tias muaj kab mob siab.

Nyob rau hauv cov xwm txheej ntawm secretory azoospermia ntawm hormonal keeb kwm tom qab kev hloov pauv ntawm hypothalamic-pituitary axis (hypogonadotropic hypogonadism), kev kho hormonal yuav raug npaj los kho cov tshuaj hormonal secretions tsim nyog rau spermatogenesis.

Hauv lwm qhov xwm txheej, kev tshawb nrhiav cov spermatozoa tuaj yeem ua tau nyob rau hauv cov qe ntshav thaum lub sij hawm kuaj qog nqaij hlav (cov txheej txheem hu ua TESE: TEsticular Sperm Extraction) yog tias nws yog secretory azoospermia, los yog hauv testicular biopsy. epididymis (MESA txheej txheem, microsurgical epididymal phev aspiration) yog tias nws yog obstructive azoospermia.

Yog tias cov phev tau sau tseg, lawv tuaj yeem siv tau tam sim ntawd tom qab biopsy (synchronous collection) lossis tom qab khov (asynchronous collection) thaum IVF (hauv vitro fertilization) nrog ICSI (intracytoplasmic phev txhaj). Cov txheej txheem AMP no cuam tshuam ncaj qha txhaj ib leeg phev mus rau txhua tus oocyte paub tab. Txij li thaum cov phev raug xaiv thiab fertilization "yuam", ICSI feem ntau muab cov txiaj ntsig zoo dua li cov IVF ib txwm.

Yog tias tsis muaj phev tuaj yeem sau tau, IVF nrog cov phev pub dawb tuaj yeem muab rau ob leeg.