Inta lagu jiro baaritaanka bacriminta ee lammaanaha, shahwada shahwada ayaa si nidaamsan loogu sameeyaa ninka. Marka la qiimeeyo cabbirrada kala duwan ee shahwada, baaritaanka bayooloji wuxuu suurtogal ka dhigayaa in la cusbooneysiiyo cilladaha shahwada ee kala duwan, sida azoospermia, guud ahaan maqnaanshaha shahwada.

Azoospermia waa cillad aan caadi ahayn oo lagu garto maqnaanshaha shahwada buuxda ee shahwada. Sida iska cad waxay keentaa dhalmo la'aan ragga, sababtoo ah maqnaanshaha shahwada ma jiri karto bacrin.

Azoospermia waxay saamaysaa wax ka yar 1% ragga guud ahaan, ama 5 ilaa 15% ragga madhalayska ah (1).

Iyadoo ku xiran sababta, waxaa jira laba nooc oo azoospermia:

azoospermia qarsoodi ah (ama NOA, loogu talagalay azoospermia aan xannibnayn)

spermatogenesis waa daciif ama maqan yahay, xiniinyahauna ma soo saaraan shahwo. Sababta cilladdan spermatogenesis waxay noqon kartaa:

• hormoon, oo leh hypogonadism (maqnaanshaha ama aan caadiga ahayn ee dheecaanka hormoonnada jinsiga) kuwaas oo laga yaabo inay ku dhashaan (Kallmann-Morsier syndrome tusaale ahaan) ama la helay, gaar ahaan burooyinka pituitary ee bedelaya shaqada dhidibka hypothalamic-pituitary ama ka dib daaweyn. (tusaale kiimoterabiga);
• genetics: Klinefelter syndrome (joogitaanka koromosoomka X dheeraadka ah), kaas oo saameeya 1 ee 1200 rag ah (2), cilladaha qaab dhismeedka koromosoomyada, (microdeletion, ie lumin jajab, gaar ahaan Y koromosoomyada), guurid (hal qayb koromosoomyada ayaa kala go'a oo ku dheggan mid kale). Cilladahan aan caadiga ahayn ee koromosoomyada ayaa mas'uul ka ah 5,8% dhibaatooyinka dhalmo la'aanta ragga (3);
• cryptorchidism laba geesood ah: labada xiniinyaha ayaan hoos ugu dhicin bursa, taas oo wax u dhimaysa habka shahwada;
• caabuqa: prostatitis, orchitis.

Azoospermia xannibaad ah ama soo saarista (OA, azoospermia xannibaad ah)

Xiniinyaha ayaa runtii soo saara shahwada laakiin dibadda lagama saari karo sababtoo ah xannibaadda dhuumaha (epididymis, vas deferens ama marinnada shahwada). Sababtu waxay noqon kartaa asal ahaan:

• lagu dhasho: marinnada siminalka ayaa laga beddelay embryogenesis, taasoo keentay maqnaanshaha xididdada dhiigga. Ragga qaba cystic fibrosis, isbeddel ku yimaadda hidda-wadaha CFTR wuxuu sababi karaa maqnaanshaha vas deferens;
• faafa: marinnada hawadu way xidhmeen ka dib caabuq (epididymitis, prostatovesiculitis, utricle prostate).

Calaamadaha ugu muhiimsan ee azoospermia waa dhalmo la'aan.

Ogaanshaha azoospermia waxaa la sameeyaa inta lagu jiro la-tashiga dhalmo la'aanta, taas oo ragga si nidaamsan ay ugu jirto shahwada. Baadhitaankani wuxuu ka kooban yahay falanqaynta waxa ku jira shahwada (shahwada), qiimaynta cabbirro kala duwan iyo barbardhigga natiijooyinka iyo heerarka ay dejisay WHO.

Haddii ay dhacdo azoospermia, shahwo lama helo ka dib markii la gooyey dhammaan shahwada. Si kastaba ha ahaatee, si loo ogaado cudurka, si kastaba ha ahaatee, waxaa lagama maarmaan ah in la sameeyo hal, ama xitaa laba kale oo shahwada, mid kasta oo 3 bilood u dhexeeya, sababtoo ah spermatogenesis (wareegga wax soo saarka shahwada) waxay qaadataa ilaa 72 maalmood. Maqnaanshaha wax soo saarka shahwada in ka badan 2 ilaa 3 wareeg oo isku xigta, waxaa la ogaan doonaa azoospermia.

Baadhitaano dheeraad ah oo kala duwan ayaa la samayn doonaa si loo nadiifiyo ogaanshaha iyo isku dayga in la ogaado sababta keentay azoospermia:

• baaritaan caafimaad oo leh garaaca xiniinyaha, cabbiraadda mugga xiniinyaha, palpation of epididymis, of vas deferens;
• biochemistry seminal (ama cilmi-baarista biochemical ee shahwada), si loo falanqeeyo dheecaanno kala duwan (zinc, citrate, fructose, carnitine, fosfatas acid, iwm) oo ku jira plasma seminal oo ka soo jeeda qanjidhada kala duwan ee xubinta taranka (seminal vesicle, prostate). , epididymis). Haddii waddooyinka la xannibo, dheecaannadan waa la qasi karaa oo falanqaynta biochemical ayaa caawin karta in la helo heerka caqabadda;
• Qiimaynta hoormoonka ee tijaabada dhiiga, oo ka kooban gaar ahaan qiimaynta FSH (hormoonka kicinta follicle-ka). Heerka sare ee FSH wuxuu muujinayaa dhaawaca xiniinyaha; heerka hoose ee FSH ee ka qaybgalka sare (heerka dhidibka hypothalamic-pituitary);
• serology by blood test, si loo raadiyo caabuq, sida kalamiidiyae, taas oo laga yaabo ama laga yaabo inay waxyeelo u geysato marinka qashinka;
• ultrasound-ka xiniinyaha si loo eego xiniinyaha oo lagu ogaado cilladaha aan caadiga ahayn ee vas deferens ama epididymis;
• karyotype dhiiga iyo tijaabooyinka hidde-sidaha si loo eego cillad hidde-sidaha;
• xiniinyaha laga qaado oo ka kooban ururin, suuxdin, cad cad oo gudaha xiniinyaha;
• raajada ama MRI ee qanjidhada pituitary ayaa mararka qaarkood la bixiyaa haddii la tuhunsan yahay pathology sare.

Haddii ay dhacdo azoospermia sirta ah ee asalka hoormoonka ka dib isbeddelka dhidibka hypothalamic-pituitary (hypogonadotropic hypogonadism), daaweynta hoormoonka ayaa la soo jeedin karaa si loo soo celiyo dheecaanka hoormoonka lagama maarmaanka u ah shahwada.

Xaaladaha kale, baaritaanka qaliinka ee shahwada waxaa lagu sameyn karaa xiniinyaha inta lagu jiro xiniinyaha xiniinyaha (farsamada loo yaqaan TESE: shahwada dhuuxa) haddii ay tahay azoospermia sir ah, ama biopsiga xiniinyaha. epididymis (farsamada MESA, microsurgical epididymal shahwada shahwada) haddii ay tahay azoospermia xannibaya.

Haddii shahwada la ururiyo, waxa la isticmaali karaa isla markaaba ka-qaadista ka dib (ururinta synchronous) ama baraf ka bacdi (ururinta asynchronous) inta lagu jiro IVF (bacriminta gudaha vitro) iyadoo la isticmaalayo ICSI (intracytoplasmic sperm injection). Farsamadan AMP waxa ay ku lug leedahay in si toos ah hal shahwo lagu duro oocyte kasta oo qaan-gaar ah. Maadaama shahwada la doortay iyo bacriminta "lagu qasbay", ICSI guud ahaan waxay bixisaa natiijooyin ka wanaagsan kan IVF-ga caadiga ah.

Haddii aan la qaadi karin shahwo, IVF oo leh shahwo la deeqay ayaa la siin karaa lamaanaha.