Ngesikhathi sokuhlolwa kokuzala kombhangqwana, i-spermogram yenziwa ngendlela ehlelekile endodeni. Ngokuhlola imingcele ehlukene yesidoda, lokhu kuhlolwa kwezinto eziphilayo kwenza kube nokwenzeka ukuvuselela okungavamile kwesidoda okuhlukahlukene, njenge-azoospermia, ukungabikho ngokuphelele kwesidoda.

I-Azoospermia wukungajwayelekile kwesidoda esibonakala ngokungabi bikho ngokuphelele kwesidoda ku-ejaculate. Kusobala ukuthi kuholela ekungazali emadodeni, ngoba uma singekho isidoda angeke kube khona ukuvundisa.

I-Azoospermia ithinta angaphansi kwe-1% yamadoda kumphakathi jikelele, noma u-5 kuya ku-15% wamadoda ayinyumba (1).

Ngokuya ngesizathu, kunezinhlobo ezimbili ze-azoospermia:

I-Secretory azoospermia (noma i-NOA, ye-azoospermia engavimbeli)

I-Spermatogenesis ikhubazekile noma ayikho futhi amasende awakhiqizi isidoda. Isizathu salokhu kukhubazeka kwe-spermatogenesis kungaba:

• amahomoni, ane-hypogonadism (ukungabikho noma okungavamile ekukhiqizweni kwamahomoni ocansi) okungenzeka kube ukuzalwa (i-Kallmann-Morsier syndrome ngokwesibonelo) noma etholwe, ikakhulukazi ngenxa yamathumba e-pituitary ashintsha ukusebenza kwe-hypothalamic-pituitary axis noma ngemva kokwelashwa. (isb ukwelapha ngamakhemikhali);
• izakhi zofuzo: I-Klinefelter syndrome (ukuba khona kwe-X chromosome eyengeziwe), ethinta indoda eyodwa kwayi-1 (1200), ukungahambi kahle kwesakhiwo se-chromosome, (ukususwa kwe-microdeletion, okungukuthi ukulahleka kwengxenye, ye-Y chromosome ikakhulukazi), ukudluliselwa (ingxenye eyodwa i-chromosome iyahlukana futhi inamathele kwenye). Lokhu kungavamile kwe-chromosomal kubangele u-2% wezinkinga zokungazali (5,8);
• i-cryptorchidism yamazwe amabili: ama-testes amabili awazange ehlele ku-bursa, okuphazamisa inqubo ye-spermatogenesis;
• ukutheleleka: i-prostatitis, i-orchitis.

I-azoospermia evimbelayo noma ephumayo (OA, i-obstructive azoospermia)

Amasende akhiqiza i-spermatozoa ngempela kodwa awakwazi ukukhishwa ngaphandle ngenxa yokuvaleka kwemigudu (epididymis, vas deferens noma i-ejaculatory ducts). Imbangela ingaba ngemvelaphi:

• i-congenital: amapheshana e-seminal ashintshiwe asuka ku-embryogenesis, okuholela ekungabini kwe-vas deferens. Emadodeni ane-cystic fibrosis, ukuguqulwa kofuzo lwe-CFTR kungabangela ukungabikho kwe-vas deferens;
• ezithathelwanayo: imigudu yokuphefumula ivalekile kulandela ukutheleleka (epididymitis, prostatovesiculitis, prostatic utricle).

Uphawu oluyinhloko lwe-azoospermia ukuzala.

Ukuxilongwa kwe-azoospermia kwenziwa ngesikhathi sokubonisana nokungazali, okuthi emadodeni kuhlanganisa ngokuhlelekile i-spermogram. Lokhu kuhlola kuqukethe ukuhlaziya okuqukethwe kwe-ejaculate (isidoda), ukuhlola imingcele ehlukahlukene nokuqhathanisa imiphumela namazinga asungulwe yi-WHO.

Uma kwenzeka i-azoospermia, asikho isidoda esitholakala ngemva kwe-centrifugation ye-ejaculate yonke. Kodwa-ke, ukwenza ukuxilongwa, kuyadingeka ukwenza eyodwa, noma amanye ama-spermograms amabili, izinyanga ezi-3 zihlukene, ngoba i-spermatogenesis (umjikelezo wokukhiqiza isidoda) ihlala cishe izinsuku ezingama-72. Uma kungekho ukukhiqizwa kwesidoda emijikelezweni emi-2 kuye kwemi-3 elandelanayo, kuzotholakala ukuxilongwa kwe-azoospermia.

Kuzokwenziwa izivivinyo ezengeziwe ezengeziwe ukuze kucwengwe ukuxilongwa futhi kuzanywe ukuhlonza imbangela yale azoospermia:

• ukuhlolwa komtholampilo nge-palpation yama-testes, ukukalwa kwevolumu ye-testicular, palpation ye-epididymis, ye-vas deferens;
• i-seminal biochemistry (noma ucwaningo lwe-biochemical lwesidoda), ukuze kuhlaziywe ukukhishwa okuhlukahlukene (i-zinc, i-citrate, i-fructose, i-carnitine, i-asidi phosphatase, njll.) equkethwe ku-plasma yesidoda futhi evela ezindlala ezihlukene zesitho sangasese (i-seminal vesicle, prostate). , i-epididymis). Uma izindlela zivimbekile, lezi zimfihlo zingaphazamiseka futhi ukuhlaziywa kwe-biochemical kungasiza ekutholeni izinga lesithiyo;
• ukuhlolwa kwamahomoni ngokuhlolwa kwegazi, okuhlanganisa ikakhulukazi ukuhlolwa kwe-FSH (i-follicle-stimulating hormone). Izinga eliphezulu le-FSH libonisa ukulimala kwamasende; izinga eliphansi le-FSH lokubandakanyeka okuphezulu (ezingeni le-hypothalamic-pituitary axis);
• i-serology ngokuhlolwa kwegazi, ukuze kubhekwe ukutheleleka, njenge-chlamydiae, engase ibangele noma ibangele ukulimala kwe-excretory tract;
• i-scrotal ultrasound ukuhlola ama-testes futhi ibone ukungahambi kahle kwe-vas deferens noma i-epididymis;
• i-karyotype yegazi kanye nokuhlolwa kofuzo ukuze kubhekwe ukungavamile kofuzo;
• i-testicular biopsy ehlanganisa ukuqoqa, ngaphansi kwe-anesthesia, ucezu lwethishu ngaphakathi kwesende;
• i-X-ray noma i-MRI ye-pituitary gland ngezinye izikhathi inikezwa uma kusolwa i-pathology ephezulu.

Uma kwenzeka i-azoospermia eyimfihlo yomsuka wamahomoni kulandela ukuguqulwa kwe-axis ye-hypothalamic-pituitary (hypogonadotropic hypogonadism), ukwelashwa kwamahomoni kungase kuphakanyiswe ukuze kubuyiselwe uketshezi lwama-hormone oludingekayo ku-spermatogenesis.

Kwezinye izimo, ukuseshwa kokuhlinzwa kwe-spermatozoa kungenziwa kumasende ngesikhathi se-testicular biopsy (isu elibizwa nge-TESE: I-TEsticular Sperm Extraction) uma kuyi-azoospermia eyimfihlo, noma ku-testicular biopsy. i-epididymis (isu le-MESA, i-microsurgical epididymal sperm aspiration) uma kuyi-azoospermia evimbelayo.

Uma isidoda siqoqwa, singasetshenziswa ngokushesha ngemva kwe-biopsy (iqoqo elivumelanayo) noma ngemva kokuqandisa (iqoqo elivumelanayo) ngesikhathi se-IVF (i-in vitro fertilization) ne-ICSI (i-intracytoplasmic sperm injection). Le nqubo ye-AMP ihilela ukujova ngokuqondile isidoda esisodwa ku-oocyte evuthiwe ngayinye. Njengoba isidoda sikhethiwe futhi ukuvundiswa "kuphoqelelwe", i-ICSI ngokuvamile inikeza imiphumela engcono kune-IVF evamile.

Uma singekho isidoda esingaqoqwa, i-IVF enesidoda esinikelwe ingase inikezwe umbhangqwana.