什么是“无精子症”?

精子缺乏 is the medical term used when there are no sperm in the ejaculate. 它可能是“阻碍”的,” where there is a blockage preventing sperm from entering the ejaculate, or it can be “nonobstructive” when it is due to decreased sperm production by the testis.

无精子症常见吗?

是的. Around 10 percent of infertile men and 1 percent of all men have azoospermia. 想象一个有50人的体育场,000人参加比赛——大约5,000 to 7,其中500人会不孕, 其中500人是无精子症!

无精子症的原因是什么?

我们知道许多潜在的原因, 包括一些遗传疾病，如克氏综合症, 化疗或放疗等医学治疗, 娱乐性药物，如某些麻醉药, and anatomical abnormalities such as varicoceles or absence of the vas deferens on each side. 也许最明显的原因是输精管切除术, 是什么阻止精子加入射精中的其他液体. 在大多数情况下, 虽然, 无精子症可能是由于我们不完全了解的因素造成的, 比如遗传条件, 胎儿/儿童睾丸发育不良或环境毒素.

我的精液分析显示是无精子症，我该怎么办?

除了去看男性不育专家, the first step would be to get a repeat semen analysis at a lab that has a lot of experience doing semen and sperm tests, 因为不同的测试和实验室的结果可能会有很大的不同. 也, having small numbers of sperm can change the management/treatment options drastically, so the first step should be getting proper confirmation of the finding.

Can we tell whether it is due to a blockage problem versus a “factory” problem?

不是百分之百准确，但我们有一些好的指标. First, a very careful physical exam is crucial to assess the reproductive structures. In addition, lab tests such as FSH and inhibin B can give an indication of testicular function.

无精子症是否意味着睾丸不能产生精子?

不一定. 睾丸可以制造精子, but it might not be enough to have any noticeable amount come out in the ejaculate.

无精子男性应该接受诊断性睾丸活检吗?

在过去, almost all men with azoospermia underwent a biopsy to distinguish obstructive from nonobstructive causes and to try to get an even more specific diagnosis. 然而，在现代实践中，活检很少单独进行. 在大多数情况下, we can predict with high accuracy whether or not a man has an obstructive cause of azoospermia. Since we have started performing testicular dissections to search for sperm, we have learned that different areas of the testis might show different patterns of nonobstructive azoospermia. 例如, one area might show decreased production of mature sperm (hypo spermatogenesis or maturation arrest), while another area might show the complete absence of sperm precursor cells (Sertoli-cell-only syndrome). 因此, 在现代, doing a diagnostic biopsy does not often change the ultimate management for men with nonobstructive azoospermia. 对于那些人, 我们提供显微解剖睾丸精子提取(microTESE), which gives the best chance of finding sperm that can be used for assisted reproductive techniques (ART). 有时, 在microTESE的时候, we will send a tiny specimen for pathological evaluation to rule out a precursor to malignancy called intratubular germ cell neoplasia (ITGCN).

有哪些治疗方法?? 最好的治疗方法是什么?

当然, 这取决于原因, 但是对于任何一个推荐十大正规网赌平台, 最好的治疗方法是基于多种因素定制的方法, 比如伴侣的年龄和生殖功能, 体检结果, 验血结果, 长期和短期的家庭目标，甚至财务状况. 根据怀疑的病因，可能有许多治疗方法. 如果有阻塞(或输精管结扎史), 对一些男性来说，重建可能是最好的治疗方法. 在其他, removing offending agents such as medications or recreational drugs might be the first step. 有时 there may be hormonal abnormalities that need to be addressed, 在一小部分男性中, 治疗可以增加精子产量. 在一些男人身上, surgery to fix anatomical abnormalities or varicoceles can be pursued, and in others the best option is to go directly into the testicle to attempt retrieval of sperm that could be used for ART. It is very important that these procedures are performed by the few physicians with proper training, expertise and experience to optimize outcomes and chances of retrieving sperm. 最后, men with azoospermia should always remember that countless couples across the world have formed families with unsurpassed happiness and love by becoming parents by using donor sperm or by adopting an infant or child. After being evaluated (see below why it is so important to be evaluated), 这些都是情侣们完全可以选择的道路.

睾丸素不是由睾丸产生的吗? 一个男人可以有正常的睾丸激素而没有精子吗?

是的，是的. 精子来自睾丸小管中的“生殖细胞”. Testosterone comes from “Leydig” or “interstitial” cells in between the tubules. 因为间质细胞比生殖细胞更有弹性, 它们通常会部分或全部发挥作用, 即使是在受损或发育不良的睾丸中.

Why should men with azoospermia be evaluated and counseled by a specialist?

在被诊断为无精子症之后, men are undoubtedly concerned about their chances of starting a family, but often they do not think about the potential relationship of infertility to their general health. 然而, studies have found significant medical conditions (including cancer) in up to 6 percent of infertile men who were 虽然t to be healthy, and the risk seems to correlate with semen and hormonal abnormalities. 更重要的是, evaluation by a specialist is imperative to rule out any dangerous underlying medical conditions, to help couples optimize their chances of building the family they desire and to give guidance regarding risk and screening for medical conditions later in life.

取回精子的程序是什么?

对于患有阻塞性无精子症的男性, there is often an abundance of sperm within the reproductive structures, 获取精子的方法多种多样. 其中包括睾丸精子提取, 睾丸精子抽吸, 显微手术附睾精子抽吸等. 选择是基于两个推荐十大正规网赌平台的因素, patient priorities and the preferences of the reproductive endocrinologists. 对于患有非阻塞性无精子症的男性, 有多种方法可供选择, but the procedure most likely to find usable sperm for use with in vitro fertilization and intracytoplasmic sperm injection is microTESE. 由该领域经验丰富的专家执行, this procedure involves careful dissection through the tubules of the testis to search for the tissue most likely to be actively making sperm. This allows for maximum yield of sperm with maximum preservation of other tissues in the testis, 包括产生睾丸素的间质细胞.

我还有更多的问题——我该怎么办?

联系 a specialist regarding your individual evaluation or management.