Necessary to distinguish obstructive azoospermia (excretory infertility), and non-obstructive (secretory infertility) azoospermia, either expressed patospermiyu.
For obstructive azoospermia, characterized by:
normal size of testicles
normal levels of hormones
the absence of sperm cells in the centrifuged ejaculate
inflammatory diseases of the genital organs
operations on the organs of the pelvis and scrotum
palpation definition of pathology appendages and the vas deferens.
In non-obstructive azoospermia observed:
signs of hypogonadism
single sperm cells or sperm in the ejaculate
hormonal changes
genetic and chromosomal changes
history - the toxic effect
orchitis.azoospermia
The best way to treat obstructive azoospermia, microsurgical reconstruction is the fulfillment of the seminiferous paths with simultaneous reception of sperm from the area, located proximal to the obstruction. The resulting material can be simultaneously used in a cycle of IVF-ICSI. In this part of the sperm exposed to cryopreservation, and is used in the case of an unsuccessful operation.
A more difficult issue is the treatment in the IVF-ICSI in patients with non-obstructive forms besplodiya.Optimalnym way to get non-obstructive azoospermia with sperm in a cycle of IVF-ICSI is bilateral multifocal testicular biopsies using microsurgical techniques. It is well known, non-obstructive azoospermia that can be stored focal spermatogenesis. Regardless of the results of hormonal and genetic studies, even when gipergonadotropnom hypogonadism with bilateral multifocal microsurgical sperm is possible to obtain a biopsy (65%).
In non-obstructive azoospermia hypogonadotropic hypogonadism in the background of the first step should be to stimulating gonadotropins therapy.
When expressed patospermii against genetic abnormalities, hypogonadism (except for hypogonadotrophic), obstructive symptoms, varicocele, the absence of ACAT - may conduct empirical therapy, with no effect (or immediately) the patient is included in the program of auxiliary reproductive technologies.
In non-obstructive azoospermia, azoospermia of unknown origin, patospermii any degree (except for proven unilateral obstruction), the first step should be excluded varicoceles, including subclinical. Conducting stimulating therapy advisable after varicocele treatment.
The combination of non-obstructive (unexplained) patospermii (azoospermia), and sperm antibodies conduct stimulating treatment is contraindicated.
In idiopathic infertility may be treated with anti-estrogens or gonadotropins, as well as vitamin and herbal stimulants spermatogenesis with a balanced content of minerals. However, the effectiveness of the treatment of infertility does not exceed 5%.
Azoospermia, the optimal methods of treatment, obstructive azoospermia and nonobstructive
