N'oge nlele ọmụmụ nke di na nwunye ahụ, a na-eme spermogram n'usoro n'ime nwoke ahụ. Site n'ịtụle paramita dị iche iche nke sperm, nyocha nke ndụ a na-eme ka o kwe omume imelite ọdịiche dị iche iche nke spermatic, dị ka azoospermia, mkpokọta enweghị spam.

Azoospermia bụ ihe na-adịghị mma nke spam na-apụta site na enweghị spam zuru oke na ejaculate. O doro anya na ọ na-eduga n'ịmụ nwoke na-amụghị nwa, n'ihi na ọ bụrụ na enweghi spam, ọ nweghị ike inwe fatịlaịza.

Azoospermia na-emetụta ihe na-erughị 1% nke ụmụ nwoke n'ozuzu mmadụ, ma ọ bụ 5 ruo 15% nke ụmụ nwoke na-amụghị nwa (1).

Dabere na ihe kpatara ya, enwere ụdị azoospermia abụọ:

Azoospermia nzuzo (ma ọ bụ NOA, maka azoospermia na-adịghị egbochi)

Spermatogenesis adịghị emebi ma ọ bụ na-anọghị ya na testes anaghị emepụta spam. Ihe kpatara ntụpọ spermatogenesis a nwere ike ịbụ:

• hormonal, na hypogonadism (enweghị ma ọ bụ abnormality na secretion nke homonụ mmekọahụ) nke nwere ike ịbụ congenital (Kallmann-Morsier syndrome dị ka ihe atụ) ma ọ bụ nweta, karịsịa na pituitary tumor nke na-agbanwe ọrụ nke hypothalamic-pituitary axis ma ọ bụ mgbe ọgwụgwọ gasịrị. (dịka ọmụmaatụ chemotherapy);
• mkpụrụ ndụ ihe nketa: Klinefelter syndrome (ọnụnọ nke extra X chromosome), nke na-emetụta 1 n'ime mmadụ 1200 (2), mmebi nke usoro nke chromosomes, (microdeletion, ntụgharị nke iberibe, nke chromosome Y karịsịa), ntụgharị (otu akụkụ). nke chromosome na-ewepụ ma na-ejikọta ya na nke ọzọ). Ihe na-adịghị mma chromosomal ndị a na-akpata 5,8% nke nsogbu amụghị nwa nwoke (3);
• bilateral cryptorchidism: testes abụọ abanyebeghị na bursa, nke na-emebi usoro spermatogenesis;
• ọrịa: prostatitis, orchitis.

Azoospermia na-egbochi ma ọ bụ excretory (OA, azoospermia obstructive)

Nnwale a na-emepụta spermatozoa n'ezie mana enweghị ike ịpụpụ ha n'ihi nkwụsị nke ọwa (epididymis, vas deferens ma ọ bụ ejaculatory ducts). Ihe kpatara ya nwere ike ịbụ isi mmalite:

• congenital: a gbanweela traktị seminal site na embryogenesis, na-ebute enweghị vas deferens. N'ime ndị ikom nwere cystic fibrosis, mmụgharị na mkpụrụ ndụ CFTR nwere ike ime ka enweghi vas deferens;
• na-efe efe: egbochila ụzọ ikuku mgbe ọrịa butere ọrịa (epididymitis, prostatovesiculitis, prostate utricle).

Isi ihe mgbaàmà nke azoospermia bụ amụghị nwa.

A na-achọpụta nchoputa nke azoospermia n'oge a na-ahụ maka ịmụ nwa, nke n'ime ụmụ nwoke na-agụnye spermogram. Nyocha a na-agụnye nyochaa ọdịnaya nke ejaculate (semen), na-atụle ihe dị iche iche ma jiri ya tụnyere ụkpụrụ WHO guzobere.

Na omume nke azoospermia, ọ dịghị spam na-ahụ mgbe centrifugation nke dum ejaculate. Iji mee nchoputa, Otú ọ dị, ọ dị mkpa ime otu, ma ọ bụ ọbụna abụọ ọzọ spermograms, kwa ọnwa 3 dị iche iche, n'ihi na spermatogenesis (sperm mmepụta okirikiri) dịruru banyere 72 ụbọchị. Ọ bụrụ na enweghị mmepụta spam n'elu usoro 2 ruo 3 na-esote, a ga-eme nchọpụta nke azoospermia.

A ga-eme nyocha ọzọ dị iche iche iji mee ka nchọpụta ahụ dị mma ma gbalịa chọpụta ihe kpatara azoospermia:

• nyocha ụlọ ọgwụ na palpation nke testes, nha olu testicular, palpation nke epididymis, nke vas deferens;
• seminal biochemistry (ma ọ bụ biochemical ọmụmụ nke spam), iji nyochaa dị iche iche secretions (zinc, citrate, fructose, carnitine, acid phosphatases, wdg) ẹdude na seminal plasma na sitere na dị iche iche glands nke genital tract (seminal vesicle, prostate). , epididymis). Ọ bụrụ na a na-egbochi ụzọ ndị ahụ, ihe nzuzo ndị a nwere ike imebi na nyocha biochemical nwere ike inyere aka ịchọta ọkwa nke ihe mgbochi ahụ;
• nyocha nke homonụ site na nyocha ọbara, gụnyere ọkachasị nyocha nke FSH (hormone na-akpali follicle). Ọkwa FSH dị elu na-egosi mmebi nke testicular; obere FSH nke itinye aka dị elu (na ọkwa nke hypothalamic-pituitary axis);
• serology site na nyocha ọbara, iji chọọ ọrịa, dị ka chlamydiae, nke nwere ike imebi ma ọ bụ mebie traktị excretory;
• ultrasound scrotal iji lelee testes ma chọpụta ihe na-adịghị mma nke vas deferens ma ọ bụ epididymis;
• karyotype ọbara na nyocha mkpụrụ ndụ ihe nketa iji chọọ ihe na-adịghị mma nke mkpụrụ ndụ ihe nketa;
• biopsy testicular nke gụnyere ịnakọta, n'okpuru nhụsianya, otu anụ ahụ dị n'ime testis;
• A na-enye X-ray ma ọ bụ MRI nke gland pituitary mgbe ụfọdụ ma ọ bụrụ na a na-enyo enyo na ọ bụ ọrịa dị elu.

N'ọnọdụ nke azoospermia nzuzo nke sitere na hormonal na-esote mgbanwe nke hypothalamic-pituitary axis (hypogonadotropic hypogonadism), enwere ike ịnye ọgwụgwọ hormonal iji weghachi ihe nzuzo hormonal dị mkpa maka spermatogenesis.

N'ọnọdụ ndị ọzọ, a na-eme nyocha ịwa ahụ maka spermatozoa ma ọ bụ na testes n'oge biopsy testicular (usoro a na-akpọ TESE: TEsticular Sperm Extraction) ma ọ bụrụ na ọ bụ azoospermia nzuzo, ma ọ bụ na biopsy testicular. epididymis (usoro MESA, microsurgical epididymal spam aspiration) ma ọ bụrụ na ọ bụ azoospermia na-egbochi.

Ọ bụrụ na a na-anakọta spam, enwere ike iji ya ozugbo emechara biopsy (nchịkọta synchronous) ma ọ bụ mgbe oyi gachara (nchịkọta asynchronous) n'oge IVF (in vitro fertilization) na ICSI (intracytoplasmic sperm injection). Usoro AMP a gụnyere ịgbanye otu spam n'ime oocyte ọ bụla tozuru okè. Ebe ọ bụ na ahọpụtara spam na njikọta spam nwoke na nwanyị "na-amanye", ICSI n'ozuzu na-enye nsonaazụ dị mma karịa IVF.

Ọ bụrụ na enweghị ike ịnakọta spam, IVF nwere ike inye di na nwunye ahụ.