Azoospermia
Azoospermia concept: To confirm the diagnosis, the semen must be analyzed 3 or more times and the semen must be centrifuged and precipitated and still no sperm must be found under the microscope. 2-7 days of abstinence is required for semen collection. The semen sent for examination must indeed be semen. The incidence of azoospermia is 19%-30% of male infertility.
1. Classification
(1) Pre-testicularity: refers to the testes themselves function normally, but the testes do not develop or do not produce sperm secondary to hypothalamic and (or) pituitary endocrine dysfunction.
(2) Testicular sex: refers to the loss of the ability of the testes themselves to produce sperm due to various causes.
(3) Post-testicular sex: refers to the normal ability of the testes to produce sperm, but the sperm transport ducts are obstructed or congenitally absent, for example: epididymal tuberculosis, bilateral epididymitis, bilateral vas deferens combined with absence of seminal vesicle glands, ejaculatory duct obstruction, etc.
2.Etiology
(1) Sperm production disorder of the testes: The testes are the only organ that produces sperm. The testes themselves are impaired in their ability to produce sperm
(2) Infectious factors: Mostly due to mumps, other infections can also cause this disorder.
(3) Congenital factors: some people are born without the ability to produce sperm. This abnormality is found in the study of chromosomes and genetics, or is known through biopsy.
(4) 6% of male infertility patients have varying degrees of chromosomal abnormalities, with the rate of chromosomal abnormalities in azoospermia patients even reaching 10%-15%.
(5) Ejaculatory dysfunction: non-ejaculation and retrograde ejaculation belong to this
(6) obstruction or deficiency of the vas deferens
(7) Decreased ability of the testes to produce sperm due to advanced age.
(8) Other factors: such as nutritional disorders, industrial hazards, radiation exposure, febrile diseases, allergic reactions and bad habits such as tobacco and alcohol addiction.
3.Examination
(1) History taking and physical examination: pay special attention to the development of male secondary sexual characteristics and reproductive organs, measurement of testicular volume, examination of epididymis, vas deferens, etc.
(2) Endocrine examination: observe the serum FSH, LH, T and PRL, etc.
(3) Testicular biopsy: the spermatogenic function of testicular varicocele and the development of interstitial cells can be directly examined
(4) Fructose determination: to identify the presence of vas deferens obstruction
(5) karyotype analysis: for testicular dysplasia, external reproductive organ malformation and unexplained azoospermia
(6) Ultrasonography: mainly used for syringomyelia, epididymal hematoma, varicocele, epididymal cyst, epididymal inflammation, etc.
4.Treatment
For low testicular function caused by pre-testicular and hypothalamic and/or pituitary dysfunction, hormone replacement therapy can be used, currently two approaches: one is to use HMG and HCG together, and the other is LHRH
(1) For testicular azoospermia, if FSH is significantly elevated, or if testicular biopsy confirms a severe and irreversible spermatogenic disorder, the options are: artificial insemination by donor sperm, adoption of a child or no child.
(2) Post-testicular azoospermia: In cases of proven local obstruction of the epididymis and obstruction of the upper end of the vas deferens, surgical removal of the obstruction may be performed.
(3) Assisted reproductive technology: mainly refers to intracytoplasmic single sperm injection technology (ICSI), vas deferens absence or obstruction, long segment vas deferens obstruction, long segment ejaculatory duct failure or underdevelopment and obstruction, and those who cannot use vas deferens reconstruction and recanalization, can use epididymal sperm aspiration technology or testicular biopsy to obtain sperm for ICSI to help conception.