Panguva yekuongorora kubereka kwevakaroorana, spermogram inoitwa mumurume zvine hurongwa. Nekuongorora maparameter akasiyana esperm, iyi biological ongororo inoita kuti zvikwanise kugadzirisa akasiyana spermatic abnormalities, senge azoospermia, kusavepo kwembeu.

Azoospermia is abnormality yesperm inotaridzwa nekushaikwa zvachose kwembeu muejaculate. Zviri pachena kuti zvinotungamirira kukushaya mbereko muvarume, nokuti kana pasina urume hapagoni kuita chibereko.

Azoospermia inobata isingasviki 1% yevarume muhuwandu, kana 5 kusvika 15% yevarume vasina mbereko (1).

Zvichienderana nechikonzero, kune marudzi maviri e azoospermia:

Secretory azoospermia (kana NOA, yeasina-obstructive azoospermia)

Spermatogenesis inokanganisa kana kusavapo uye ma testes haaburitse urume. Chikonzero chechirwere ichi che spermatogenesis chinogona kuva:

• mahomoni, ane hypogonadism (kusavapo kana kusajairika mukuburitswa kwemahomoni epabonde) anogona kunge ari ekuzvarwa (Kallmann-Morsier syndrome semuenzaniso) kana kuwanikwa, kunyanya nekuda kwemamota epituitary anoshandura kushanda kweiyo hypothalamic-pituitary axis kana mushure mekurapwa. (semuenzaniso chemotherapy);
• genetics: Klinefelter syndrome (kuvapo kweimwe X chromosome), iyo inobata 1 mu1200 varume (2), kusaenzana kwechimiro chekromosomes, (microdeletion, kureva kurasikirwa kwechidimbu, cheY chromosome kunyanya), translocation (chikamu chimwe yechromosome inobvisa uye inonamatira kune imwe). Aya machromosomal abnormalities anokonzera 5,8% yematambudziko ekushaya mbereko kwevarume (3);
• bilateral cryptorchidism: ma testes maviri haana kuburuka mu bursa, iyo inokanganisa nzira ye spermatogenesis;
• utachiona: prostatitis, orchitis.

Kuvhiringidza kana kuburitsa azoospermia (OA, obstructive azoospermia)

Ma testes anonyatso gadzira spermatozoa asi haagone kubuditswa kunze nekuda kwekuvharika kwema ducts (epididymis, vas deferens kana ejaculatory ducts). Chikonzero chinogona kunge chiri chekutanga:

• congenital: maturakiti e seminal akashandurwa kubva ku embryogenesis, zvichikonzera kusavapo kwevas deferens. Mune varume vane cystic fibrosis, kuchinja muCFTR gene kunogona kukonzera kusavapo kwevas deferens;
• kutapukira: nzira dzemhepo dzakavharwa zvichitevera hutachiona (epididymitis, prostatovesiculitis, prostatic utricle).

Chiratidzo chikuru che azoospermia kusabereka.

Kuongororwa kweazoospermia kunoitwa panguva yekubvunzurudzwa kwekushaya mbereko, iyo muvarume zvakarongeka inosanganisira spermogram. Kuongorora uku kunosanganisira kuongorora zviri mukati meiyo ejaculate (semen), kuongorora ma paramita akasiyana uye kuenzanisa zvakabuda nezviyero zvakatarwa neWHO.

Muchiitiko che azoospermia, hapana urume hunowanikwa mushure mecentrifugation yeese ejaculate. Kuti uongorore, zvisinei, zvakakosha kuita imwe, kana mamwe maviri spermograms, imwe neimwe mwedzi mitatu yakasiyana, nokuti spermatogenesis (kutenderera kwekugadzirwa kweurume) kunotora mazuva anenge 3. Mukushaikwa kwekugadzirwa kwembeu pamusoro pe72 kusvika ku2 inoteedzana cycle, kuongororwa kwe azoospermia kuchaitwa.

Yakasiyana-siyana yekuwedzera bvunzo ichaitwa kunatsiridza kuongororwa uye kuyedza kuona chikonzero cheiyi azoospermia:

• kuongororwa kwekiriniki nekuputika kwema testes, kuyerwa kwe testicular volume, palpation ye epididymis, ye vas deferens;
• seminal biochemistry (kana biochemical study yesperm), kuitira kuongorora zvakasiyana-siyana secretions (zinc, citrate, fructose, carnitine, acid phosphatases, etc.) iri museminal plasma uye ichibva kune dzakasiyana siyana dzesikarudzi (seminal vesicle, prostate). , epididymis). Kana nzira dzakadzivirirwa, izvi zvakavanzika zvinogona kuvhiringidzwa uye kuongorora biochemical kunogona kubatsira kutsvaga chiyero chechipingamupinyi;
• kuongororwa kwehomoni nekuongororwa kweropa, kunosanganisira kunyanya kuongororwa kweFSH (follicle-stimulating hormone). FSH yakakwirira inoratidza kukuvadzwa kwe testicular; yakaderera FSH nhanho yekubatanidzwa kwepamusoro (pamwero we hypothalamic-pituitary axis);
• serology nekuongorora ropa, kuitira kutsvaga hutachiona, hwakadai sechlamydiae, iyo inogona kana inogona kukonzera kukanganisa kune excretory turakiti;
• scrotal ultrasound yekutarisa ma testes uye kuona kusagadzikana kwevas deferens kana epididymis;
• karyotype yeropa uye genetic tests kutsvaga genetic abnormality;
• testicular biopsy inosanganisira kuunganidza, pasi peanesthesia, chidimbu chetishu mukati me testis;
• X-ray kana MRI yepituitary gland dzimwe nguva inopiwa kana chirwere chepamusoro chichifungidzirwa.

Kana pakaitika secretory azoospermia yehomoni mavambo zvichitevera kuchinjwa kwe hypothalamic-pituitary axis (hypogonadotropic hypogonadism), kurapwa kwehomoni kunogona kutaurwa kuti kudzorere kuburitswa kwehomoni kunodiwa kuspermatogenesis.

Mune zvimwe zviitiko, kutsvaga kwekuvhiya kwespermatozoa kunogona kuitwa mumatestes panguva ye testicular biopsy (tekiniki inonzi TESE: TEsticular Sperm Extraction) kana iri secretory azoospermia, kana mu testicular biopsy. epididymis (MESA maitiro, microsurgical epididymal sperm aspiration) kana iri inodzivisa azoospermia.

Kana urume hukaunganidzwa, hunogona kushandiswa pakarepo mushure me biopsy (synchronous collection) kana mushure mekutonhora (asynchronous collection) panguva yeIVF (in vitro fertilization) neICSI (intracytoplasmic sperm injection). Iyi nzira yeAMP inosanganisira kuisa jekiseni urume rimwe chete mune yega yega oocyte yakura. Sezvo urume hwasarudzwa uye kusangana "kumanikidzwa", ICSI kazhinji inopa mhedzisiro iri nani pane yakajairika IVF.

Kana pasina urume hunogona kutorwa, IVF ine urume hwakapihwa inogona kupihwa kune vaviri vacho.