I ka wā o ka nānā ʻana i ka hānau ʻana o ka kāne, ua hoʻokō ʻia kahi spermogram i loko o ke kāne. Ma ka loiloi ʻana i nā ʻāpana like ʻole o ka sperm, ua hiki i kēia hoʻokolokolo koʻikoʻi ke hōʻano hou i nā ʻano like ʻole o ka spermatic, e like me ka azoospermia, ka nele o ka sperm.

ʻO ka Azoospermia kahi maʻi ʻino i hōʻike ʻia e ka nele piha o ka sperm i ka ejaculate. He mea maopopo ke alakaʻi i ka infertility i nā kāne, no ka mea i ka nele o ka sperm ʻaʻole hiki ke hoʻomoʻi.

Hoʻopilikia ka Azoospermia ma lalo o 1% o nā kāne ma ka heluna nui, a i ʻole 5 a 15% o nā kāne hānau ʻole (1).

Ma muli o ke kumu, ʻelua ʻano o ka azoospermia:

ʻO ka azoospermia huna (a i ʻole NOA, no ka azoospermia non-obstructive)

ʻAʻole i loaʻa ka spermatogenesis a ʻaʻole hoʻohua mai nā hōʻike i ka sperm. ʻO ke kumu o kēia hemahema spermatogenesis hiki ke:

• hormonal, me ka hypogonadism (ʻaʻole a i ʻole ʻino i ka huna ʻana o nā hormones sex) i hānau ʻia (ka maʻi Kallmann-Morsier ma ka laʻana) a i loaʻa paha, ma muli o nā maʻi maʻi pituitary e hoʻololi i ka hana o ka hypothalamic-pituitary axis a i ʻole ma hope o ka mālama ʻana. (e laʻa me ka chemotherapy);
• genetics: Klinefelter syndrome (ke ʻano o kahi chromosome X hou), e pili ana i ka 1 i loko o 1200 kāne (2), ke ʻano ʻino o ke kino o nā chromosomes, (microdeletion, ʻo ia hoʻi ka nalowale o kahi ʻāpana, o ka Y chromosome ma ke ʻano), ka unuhi ʻana (hoʻokahi māhele. o ka chromosome wehe a pili i kekahi). ʻO kēia mau chromosomal abnormalities ke kuleana no 5,8% o nā pilikia male infertility (3);
• cryptorchidism bilateral: ʻaʻole i iho nā ʻaoʻao ʻelua i loko o ka bursa, kahi e hoʻopilikia ai i ke kaʻina hana o ka spermatogenesis;
• ka maʻi: prostatitis, orchitis.

Obstructive or excretory azoospermia (OA, obstructive azoospermia)

Hoʻopuka maoli nā hōʻike i ka spermatozoa akā ʻaʻole hiki ke hoʻokuʻu ʻia ma muli o ka paʻa ʻana o nā auwai (epididymis, vas deferens a i ʻole ejaculatory ducts). No ke kumu paha ke kumu:

• congenital: ua hoʻololi ʻia nā ʻāpana seminal mai ka embryogenesis, ka hopena i ka nele o nā vas deferens. I nā kāne me ka cystic fibrosis, hiki i ka hoʻololi ʻana i ka gene CFTR ke kumu i ka nele o nā vas deferens;
• maʻi: ua paʻa nā ala ea ma hope o kahi maʻi (epididymitis, prostatovesiculitis, prostatic utricle).

ʻO ka hōʻailona nui o ka azoospermia ka infertility.

Hana ʻia ka maʻi o ka azoospermia i ka wā o kahi kūkākūkā infertility, i loko o nā kāne me ka systematically loaʻa kahi spermogram. Aia kēia hōʻike i ka nānā ʻana i ka ʻike o ka ejaculate (semen), ka loiloi ʻana i nā ʻāpana like ʻole a me ka hoʻohālikelike ʻana i nā hopena me nā kūlana i hoʻokumu ʻia e ka WHO.

I ka hopena o ka azoospermia, ʻaʻohe sperm i loaʻa ma hope o ka centrifugation o ka ejaculate holoʻokoʻa. No ka hana ʻana i ka maʻi maʻi, akā, pono e hana i hoʻokahi, a i ʻole ʻelua mau spermograms ʻē aʻe, i kēlā me kēia 3 mahina ma ke kaʻawale, no ka mea, ʻo ka spermatogenesis (sperm production cycle) e mau ana ma kahi o 72 mau lā. I ka loaʻa ʻole o ka hana sperm ma luna o 2 a 3 mau pōʻaiapili, e hana ʻia ka maʻi o ka azoospermia.

E hoʻokō ʻia nā hoʻokolohua ʻē aʻe e hoʻomaʻemaʻe i ka maʻi a hoʻāʻo e ʻike i ke kumu o kēia azoospermia:

• kahi hoʻokolohua lapaʻau me ka palpation o nā hōʻike, ana i ka nui o ka testicular, palpation o ka epididymis, o nā vas deferens;
• seminal biochemistry (a i ʻole biochemical study o ka sperm), i mea e kālailai ai i nā mea huna like ʻole (zinc, citrate, fructose, carnitine, acid phosphatases, etc.) i loko o ka plasma seminal a mai nā ʻāpana like ʻole o ka ʻāpana genital (seminal vesicle, prostate. , epididymis ). Inā keakea ʻia nā ala, hiki ke hoʻopilikia ʻia kēia mau mea huna a hiki ke kōkua ka ʻimi biochemical i ka huli ʻana i ka pae o ka mea pale;
• he loiloi hormonal ma o ka ho'āʻo koko, e komo pū ana me ka hoʻāʻo ʻana o FSH (follicle-stimulating hormone). Hōʻike ka pae FSH kiʻekiʻe i ka pōʻino testicular; kahi haʻahaʻa haʻahaʻa FSH o ke komo kiʻekiʻe (ma ke kiʻekiʻe o ka axis hypothalamic-pituitary);
• serology ma ka ho'āʻo koko, i mea e ʻimi ai i kahi maʻi, e like me ka chlamydiae, i hiki a i ʻole ke hōʻino i ka ʻāpana excretory;
• kahi ultrasound scrotal e nānā i nā hōʻike a ʻike i nā mea ʻino o nā vas deferens a i ʻole ka epididymis;
• he karyotype koko a me nā hoʻāʻo genetic e ʻimi ai i kahi ʻano ʻino;
• he biopsy testicular e pili ana i ka hōʻiliʻili ʻana, ma lalo o ka anesthesia, kahi ʻāpana ʻiʻo i loko o ka testis;
• Hāʻawi ʻia kahi X-ray a i ʻole MRI o ka pituitary gland i kekahi manawa inā manaʻo ʻia kahi maʻi maʻi o luna.

I ka hopena o ka azoospermia huna o ka hormonal kumu ma hope o ka hoʻololi ʻana o ka hypothalamic-pituitary axis (hypogonadotropic hypogonadism), hiki ke noi ʻia ka mālama hormonal e hoʻihoʻi i nā mea huna hormonal e pono ai no ka spermatogenesis.

Ma nā hihia ʻē aʻe, hiki ke hana ʻia kahi ʻimi ʻokiʻoki no ka spermatozoa i loko o ka testes i ka wā o ka biopsy testicular (technique i kapa ʻia TESE: TEsticular Sperm Extraction) inā he azoospermia huna, a i ʻole ka biopsy testicular. epididymis (meSA technique, microsurgical epididymal sperm aspiration) inā he azoospermia obstructive.

Inā hōʻiliʻili ʻia ka sperm, hiki ke hoʻohana koke ʻia ma hope o ka biopsy (hōʻiliʻili synchronous) a i ʻole ma hope o ka maloʻo (asynchronous collection) i ka wā IVF (in vitro fertilization) me ICSI (intracytoplasmic sperm injection). Hoʻokomo pololei kēia ʻenehana AMP i hoʻokahi sperm i loko o kēlā me kēia oocyte makua. Ma muli o ke koho ʻia ʻana o ka sperm a "hoʻoikaika ʻia", hāʻawi ʻo ICSI i nā hopena maikaʻi aʻe ma mua o ka IVF maʻamau.

Inā ʻaʻole hiki ke hōʻiliʻili ʻia ka sperm, hāʻawi ʻia ka IVF me ka sperm hāʻawi ʻia i nā kāne.