Pakayezetsa kubereka kwa banjalo, umuna umapangidwa mwadongosolo mwa mwamuna. Pounika magawo osiyanasiyana a umuna, kuyezetsa kwachilengedwe kumeneku kumapangitsa kuti zitheke kusinthira zolakwika zosiyanasiyana za umuna, monga azoospermia, kusowa kwathunthu kwa umuna.

Azoospermia ndi vuto la umuna lomwe limadziwika ndi kusapezeka kwathunthu kwa umuna mu umuna. Mwachionekere kumabweretsa kusabereka kwa amuna, chifukwa ngati palibe umuna sipangakhale umuna.

Azoospermia imakhudza amuna osakwana 1% mwa anthu ambiri, kapena 5 mpaka 15% ya amuna osabereka (1).

Kutengera zomwe zimayambitsa, pali mitundu iwiri ya azoospermia:

Secretory azoospermia (kapena NOA, ya azoospermia yosasokoneza)

Spermatogenesis imawonongeka kapena kulibe ndipo ma testes satulutsa umuna. Zomwe zimayambitsa vuto la spermatogenesis zitha kukhala:

• mahomoni, okhala ndi hypogonadism (kusowa kapena kusakhazikika pakutulutsa kwa mahomoni ogonana) omwe amatha kukhala obadwa nawo (mwachitsanzo, matenda a Kallmann-Morsier) kapena opezeka, makamaka chifukwa cha zotupa za pituitary zomwe zimasintha magwiridwe antchito a hypothalamic-pituitary axis kapena pambuyo pa chithandizo. (monga mankhwala amphamvu);
• majini: Klinefelter syndrome (kukhalapo kwa X chromosome yowonjezera), yomwe imakhudza 1 mwa amuna 1200 (2), kusakhazikika kwa chromosome, (microdeletion, mwachitsanzo, kutayika kwa chidutswa, cha Y chromosome makamaka), translocation (gawo limodzi chromosome imachoka ndikumangirira ina). Zolakwika za chromosomal izi ndizomwe zimayambitsa 5,8% yazovuta zakusabereka kwa amuna (3);
• Bilateral cryptorchidism: ma testes awiri sanatsikire mu bursa, zomwe zimasokoneza njira ya spermatogenesis;
• matenda: prostatitis, orchitis.

Obstructive kapena excretory azoospermia (OA, obstructive azoospermia)

Machende amatulutsadi spermatozoa koma sangatulukire kunja chifukwa cha kutsekeka kwa ma ducts (epididymis, vas deferens kapena ducts). Chifukwa chake chingakhale choyambira:

• congenital: thirakiti la seminal lasinthidwa kuchoka ku embryogenesis, zomwe zimapangitsa kuti vas deferens zisawonongeke. Mwa amuna omwe ali ndi cystic fibrosis, kusintha kwa jini ya CFTR kungayambitse kusapezeka kwa vas deferens;
• kupatsirana: njira zodutsa mpweya zatsekedwa chifukwa cha matenda (epididymitis, prostatovesiculitis, prostatic utricle).

Chizindikiro chachikulu cha azoospermia ndi kusabereka.

Kuzindikira kwa azoospermia kumapangidwa panthawi yofunsira kusabereka, komwe mwa amuna mwadongosolo kumaphatikizapo spermogram. Kuwunikaku kumakhala ndi kusanthula zomwe zili mu umuna (umuna), kuyesa magawo osiyanasiyana ndikuyerekeza zotsatira ndi miyezo yokhazikitsidwa ndi WHO.

Muzochitika za azoospermia, palibe umuna umapezeka pambuyo pa centrifugation ya ejaculate yonse. Koma kuti adziwe matenda, m'pofunika kuchita chimodzi, kapena awiri spermograms, aliyense 3 miyezi motalikirana, chifukwa spermatogenesis (umuna kupanga mkombero) kumatenga masiku 72. Kupanda kupanga umuna pa 2 mpaka 3 motsatizana, kuzindikira kwa azoospermia kudzapangidwa.

Mayesero osiyanasiyana owonjezera adzachitidwa kuti athetse matendawa ndikuyesera kudziwa chomwe chimayambitsa azoospermia:

• kuyezetsa kwachipatala ndi ma testicular palpation, kuyeza kuchuluka kwa testicular, palpation ya epididymis, vas deferens;
• Seminal biochemistry (kapena biochemical kafukufuku wa umuna), kuti aunike zosiyanasiyana katulutsidwe (zinki, citrate, fructose, carnitine, asidi phosphatases, etc.) zili mu seminal plasma ndi ochokera ku tiziwalo timene timatulutsa maliseche (seminal vesicle, prostate). , epididymis). Ngati njirazo zikulephereka, zotsekemerazi zimatha kusokonezeka ndipo kusanthula kwa biochemical kungathandize kupeza kuchuluka kwa chopingacho;
• kuyezetsa kwa mahomoni poyesa magazi, komwe kumaphatikizapo kuyesa kwa FSH (follicle-stimulating hormone). Kuchuluka kwa FSH kumawonetsa kuwonongeka kwa testicular; mlingo wochepa wa FSH wokhudzidwa kwambiri (pa mlingo wa hypothalamic-pituitary axis);
• serology poyesa magazi, kuti muwone matenda, monga chlamydiae, omwe angayambitse kapena kuwononga thirakiti la excretory;
• scrotal ultrasound kuti muwone ma testes ndikuwona zolakwika za vas deferens kapena epididymis;
• karyotype ya magazi ndi kuyesa kwa majini kuti awone kusakhazikika kwa chibadwa;
• testicular biopsy yopangidwa ndi kutolera, pansi pa opaleshoni, chidutswa cha minofu mkati mwa testis;
• X-ray kapena MRI ya pituitary gland nthawi zina imaperekedwa ngati matenda apamwamba akukayikira.

Pakachitika secretory azoospermia ya chiyambi cha mahomoni kutsatira kusintha kwa hypothalamic-pituitary axis (hypogonadotropic hypogonadism), mankhwala a m'thupi angaganizidwe kuti abwezeretse kutulutsa kwa mahomoni kofunikira paumuna.

Nthawi zina, opaleshoni yofufuza spermatozoa ikhoza kuchitidwa mwina mu testicular biopsy (njira yotchedwa TESE: TEsticular Sperm Extraction) ngati ndi secretory azoospermia, kapena testicular biopsy. epididymis (njira ya MESA, microsurgical epididymal sperm aspiration) ngati ndi obstructive azoospermia.

Ngati umuna wasonkhanitsidwa, ukhoza kugwiritsidwa ntchito nthawi yomweyo biopsy (kusonkhanitsa synchronous) kapena pambuyo kuzizira (asynchronous collection) pa IVF (in vitro fertilization) ndi ICSI (intracytoplasmic sperm injection). Njira ya AMP imeneyi imakhudza kulowetsa mwachindunji umuna umodzi mu oocyte wokhwima. Popeza umuna umasankhidwa ndi umuna "kukakamizidwa", ICSI nthawi zambiri imapereka zotsatira zabwino kuposa IVF wamba.

Ngati palibe umuna womwe ungasonkhanitsidwe, IVF yokhala ndi umuna woperekedwa ikhoza kuperekedwa kwa okwatiranawo.