Tuesday, June 23, 2020

Male infertility azoospermia

Azoospermia refers to more than three semen tests, and no sperm was found, or there was no sperm after high-power microscopy after semen centrifugation, which is called azoospermia. Azoospermia is divided into obstructive azoospermia and non-obstructive azoospermia. For the former, the testes have normal spermatogenic function, and the semen cannot be ejected from the body due to obstruction of the vas deferens, ejaculatory duct, or epididymal duct; the latter refers to the testicular spermatogenic dysfunction, which cannot produce or only produces a small amount of sperm, resulting in no semen sperm. The causes of obstructive azoospermia include epididymal dysplasia, vas deferens dysplasia, seminal vesicle dysplasia or absence, prostate and ejaculatory dysplasia, and Müllerian or mesenteric cyst, genital tract infection, urogenital system trauma surgery Trauma and other factors. After a reasonable evaluation, such patients can choose to reopen the surgery or perform epididymal testicular puncture for second-generation test-tube babies (intrafollicular sperm injection technique) to obtain offspring.

The causes of non-obstructive azoospermia are relatively complex, including genetic abnormalities, endocrine abnormalities, adolescent mumps and other infectious diseases, iatrogenic factors caused testicular torsion and necrosis, dye waste and other physical and chemical factors, and environmental pollution and other factors .

In view of this, for outpatients with azoospermia, clinicians often need to use relevant auxiliary examination to make judgments on patients—obstructive azoospermia or non-obstructive azoospermia. The inspection includes the following:

1. Examination of male sexual characteristics, including beard, laryngeal knot, armpit, perineal hair, penile deformity, bilateral testis size, texture, fullness of epididymis, whether the vas deferens is absent, and whether there is varicocele, etc.;

2. Evaluation of the patient's sex hormone levels and spermatogenic function-five items of sex hormones and inhibin B to assess the patient's spermatogenic function;

3. Seminal plasma biochemistry and transrectal color Doppler ultrasound are also essential, which is very necessary to identify the cause of azoospermia;

4. Examination of genetics, including abnormal chromosome karyotype (46, XY for normal males) and deletion of gene fragments of sex chromosome Y chromosome microdeletion. If there are genetic abnormalities, it is often necessary to use three generations of test tubes (pre-implantation genetic diagnosis, PGD) or use sperm from the sperm bank to obtain offspring.

5. The key step in judging the patient's fertility is the testicular epididymal puncture biopsy. The specimen tissue taken out of the puncture biopsy is observed under a microscope for sperm and spermatogenic cells. In recent years, the development of microscopic testicular sperm extraction has brought the gospel to azoospermia, which can not only find spermatogenic fragments to the greatest extent, but also significantly reduce the degree of damage to patients.

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