Azoospermiya – the violation of a spermatogenesis which is characterized by lack of spermatozoa as a part of semen. Depending on the reasons distinguish an obstructive and not obstructive azoospermiya. Azoospermiya is followed by impossibility of conception a natural way, and in certain cases - and by means of auxiliary reproductive technologies. Azoospermiya is diagnosed in the course of inspection of the reproductive status of the man (ultrasonography, biopsies of a small egg, determination of level of hormones, spermograms, ASAT). At an obstructive azoospermiya microsurgical restoration of passability of semyavynosyashchy ways is required; at a sekretorny form of pathology – performing the stimulating hormonal therapy. In case of impossibility of natural conception resort to use of EKO (IKSI).
Azoospermiya – the form of male infertility caused by lack of spermatozoa in an eyakulyata. In andrology and urology allocate several options of violation of a spermatogenesis: oligozoospermiya, astenozoospermiya, teratozoospermiya, azoospermiya. Besides the combined forms of pathology meet: oligoastenozoospermiya, oligoteratozoospermiya, astenoteratozoospermiya and so forth. From all factors of infertility at men about 10-20% fall to the share of an azoospermiya. Sperm pathology, including an azoospermiya, is always reflection of trouble of male reproductive health therefore the main efforts of experts have to be directed to identification and elimination of the reasons of this state.
Physiology and violations of a spermatogenesis
The spermatogenesis – process of education and maturing of men's gametes begins in the pubertatny period and proceeds till an extreme old age. Formation of spermatozoa happens in wavy seed tubules of testicles and includes three consecutive phases: proliferation of spermatogoniya, meiosis and . Most actively this process proceeds at a temperature of 34 °C that is provided with an anatomic arrangement of testicles in a scrotum, out of an abdominal cavity. Final maturing of spermatozoa happens in a small egg appendage. Duration of a full cycle of a spermatogenesis at the man makes about 73-75 days.
Any adverse factors can break process of education and maturing of spermatozoa, leading to various forms of a patospermiya, the most frequent among which are:
- oligozoospermiya - decrease in quantity of live spermatozoa (less than 20 million in 1 ml of an eyakulyat)
- astenozoospermiya – existence less than 50% of spermatozoa with the movement of 1 type (progressive linear) and 2 types (slow linear or progressive nonlinear) or less than 25% of spermatozoa with the movement of 1 type. The quantity and a form of spermatozoa at the same time are normal.
- teratozoospermiya – more than a half of spermatozoa have deviations in a structure of a head and a tail. Mobility and quantity of cages are not changed.
- azoospermiya – spermatozoa in semen are absent.
The detailed characteristic of the reasons and forms of an azoospermiya is given below.
Taking into account the causes the azoospermiya can be obstructive, not obstructive (sekretorny) and temporary. Impassability of semyavynosyashchy ways therefore spermatozoa cannot get in is the cornerstone of an obstructive form of an azoospermiya eyakulit. At the same time men's gametes are formed in enough, have normal morphology and mobility. Congenital anomalies (an aplaziya of semyavynosyashchy channels), inflammatory processes (orkhit, the epididymite, vezikulit, prostatitis), injuries of bodies of a scrotum, to the varikotsela, inguinal hernias, a striktur of an urethra, operation on bodies of a scrotum (a vazorezektion, a gryzhesecheniye, operations at the gidrotsel), etc. can be the reasons leading to an obstructive azoospermiya.
At a sekretorny (not obstructive) azoospermiya formation of spermatozoa in testicles is initially broken. The bilateral kriptorkhizm, the epidemic parotitis complicated orkhoepididimity, tumors of testicles, radiation exposure, toxic influence of salts of heavy metals and pesticides can serve as the factors causing a similar state. Violation of a spermatogenesis as a sekretorny and obstructive azoospermiya can take place at a gipogonadizm, a mukovistsidoza, diabetes, a tseliakiya, hypophysis tumors, spine injuries, syphilis and other pathology.
The temporary azoospermiya is characterized by passing functional violations from gonads and can develop against the background of sharp diseases, stresses, reception of medicines (steroid hormones, antibacterial and antineoplastic means), frequentation of saunas and baths. Temporary decrease in production of spermatozoa is noted at sexually active men at frequent sexual intercourses.
The main specific symptom of an azoospermiya is male infertility. At the same time sexual function can remain not broken with the man. Other clinical symptoms accompanying an azoospermiya are connected with the main disease. So, at a gipogonadizm at the man backwardness of secondary sexual characteristics is defined: poor pilosis, a constitution on female type, a ginekomastiya. The Sekretorny azoospermiya is quite often accompanied by a hypoplasia of testicles, a micropenis, decrease in a libido, erectile dysfunction.
At various forms of an obstructive azoospermiya the discomfort, pain, hypostasis or a swelling of a scrotum can disturb the man. At a palpation testicles of the normal sizes and a form are defined, and appendages of testicles are increased at the expense of a congestion of spermatozoa in it. The obstructive azoospermiya can be followed by a retrograde ejaculation.
Diagnostics of an azoospermiya
The reasons and form of an azoospermiya can be established only by experts (andrologists, urologists, endocrinologists) on the basis of comprehensive examination of men's reproductive system. When collecting the anamnesis the frequency of sexual activity and duration of the period of infertility, the postponed diseases, professional harm, a way of life of the patient and other factors is specified. At fizikalny survey the constitution type, expressiveness of secondary sexual characteristics, a condition of external genitals is estimated.
For an exception of pathology of male genitals ultrasonography of bodies of a scrotum, TRUZI of a prostate gland, UZDG of vessels of a scrotum, etc. is carried out. The important analyses allowing to judge male fertility in general and azoospermiya in particular are the spermogram and determination of level of antispermalny antibodies in blood. The research of the hormonal status at an azoospermiya (testosterone, Prolactinum, an estradiol, LG, FSG) allows to judge gipotalamo-hypophysial regulation of activity of gonads.
For the purpose of STD exception as azoospermiya factor, inspection of the patient on an infection is carried out by the IFA, RIF, PTsR methods. The posteyakulyatorny analysis of urine is made for an exception of a retrograde ejaculation. Differential diagnostics of forms of an azoospermiya is promoted by carrying out a diagnostic biopsy of a small egg.
Treatment of an azoospermiya
In all cases of an azoospermiya treatment is directed to elimination of the reason which caused violation of male fertility. So, the main solution of a problem of an obstructive azoospermiya is carrying out the reconstructive operation providing restoration of passability of semyavynosyashchy ways: plasticity of an urethra, imposing of a vazo-vazoanastomoz or vazo-epididimoanastomoz, expeditious elimination to a varikotsela, etc. Success of restoration of fertility after surgical elimination of obstruction of semyavynosyashchy ways makes 27-56%. For correction of the endocrine frustration which led to a sekretorny azoospermiya the replaceable or stimulating hormonal therapy is appointed. By means of a course of treatment of male infertility of hormonal genesis in certain cases it is possible to achieve emergence of spermatozoa in an eyakulyata.
If, despite the undertaken surgical and conservative treatment of an azoospermiya, pregnancy at the partner and occurs, auxiliary reproductive technologies, the most effective of which is IKSI, come to the rescue. For the procedure of extracorporal fertilization spermatozoa receive in the course of an open or aspiration biopsy from a small egg (TESA/TESE) or an appendage of a small egg (MESA, PESA). At the ineradicable reasons of an azoospermiya successful treatment of male infertility is not possible. In this case for fertilization couple is recommended to use donor sperm. In general chances of conception or by means of the VRT methods are higher in the natural way at men with an obstructive form of an azoospermiya, in comparison with sekretorny.