Txiv neej infertility - yuav ua li cas? Ua rau thiab kho

Cov txheej txheem:

Txiv neej infertility - yuav ua li cas? Ua rau thiab kho
Txiv neej infertility - yuav ua li cas? Ua rau thiab kho
Anonim

Txiv neej tsis muaj menyuam

Nyob hauv lub neej niaj hnub no, kwv yees li 10-25% ntawm tsev neeg muaj menyuam tsis taus. Contrary to ib txwm xav, ib tug poj niam tsis yog ib txwm "ua txhaum" ntawm qhov tsis muaj menyuam hauv tsev neeg. Raws li kev txheeb cais, los ntawm 30 mus rau 50% ntawm cov niam txiv tsis tuaj yeem muaj menyuam vim txiv neej tsis muaj menyuam. Xws li thaj chaw ntawm tshuaj raws li andrology thiab urology yog daws qhov teeb meem no.

Yuav ua li cas txiv neej kev ua haujlwm ua haujlwm

txiv neej infertility
txiv neej infertility

Cov txiv neej cov kab mob hauv lub cev xeeb tub tsis yog nyob hauv lub plab me me xwb, tab sis sab nraum nws. Lub ntsiab txiv neej hormone testosterone yog lub luag haujlwm rau kev tsim cov kab mob hauv nruab nrog cev. Nws yog tsim los ntawm cov noob qes nyob rau hauv lub scrotum. Lawv kuj tsim cov phev, uas taug kev los ntawm cov noob qes mus rau epididymis rau kev noj haus thiab kev loj hlob. Tom qab maturation, cov phev mus los ntawm vas deferens mus rau lub seminal vesicles cia. Lub voj voog ntawm kev tsim cov phev puv puv yuav siv sijhawm li 72 teev. Thaum lub sij hawm ejaculation, nws sib tov nrog lub zais zis ntawm lub caj pas prostate, raws li ib tug tshwm sim ntawm ejaculation yog tsim - seminal kua uas muaj spermatozoa.

Lub peev xwm tsim cov xeeb ntxwv (fertility) ntawm cov txiv neej nyob ntawm qhov zoo ntawm cov phev, nws tag nrho kev loj hlob thiab maturation.

txheej txheem no tshwm sim nrog kev koom tes ntawm cov tshuaj hormones:

  • Testosterone;
  • Luteinizing hormone (LH) - nkoos spermatogenesis hauv Leydig hlwb;
  • Follicle-stimulating hormone (FSH) - txhawb nqa spermatogenesis hauv Sertoli cells.

Hauv Sertoli hlwb, cov phev tsis paub qab hau tsim cov spermatozoa thiab loj tuaj. Muab phev motility tshwm sim nyob rau hauv lub epididymis. Cov phev npaj rau fertilization yog khaws cia rau hauv vas deferens kom txog thaum ejaculation.

Sperm yam ntxwv

Cov yam ntxwv ntawm phev
Cov yam ntxwv ntawm phev

Tus phev npaum li cas nyob ntawm lub hnub nyoog ntawm tus txiv neej, nws txoj kev sib deev thiab tus cwj pwm ntawm tus kheej. Kev sib deev tsis tu ncua txo qhov ntim ntawm cov phev, tab sis nws rov qab los tom qab 2-3 hnub ntawm abstinence.

Ib txwm ejaculate ntim yog 1-6 ml, phev muaj cov tshuaj tiv thaiv alkaline nrog pH ntawm 7-7, 6. Cov ntsuas no tsis tso cai rau cov spermatozoa poob lawv txoj kev mus rau hauv acidic ib puag ncig ntawm qhov chaw mos. Tsis poob lawv cov khoom, lawv ncav cuag lub tsev me nyuam kwj dej ntawm lub ncauj tsev menyuam, uas nws pH yog 7.5, thiab los ntawm qhov ntawd nkag mus rau hauv lub tsev menyuam thiab mus rau hauv cov hlab ntsha fallopian kom fertilize ib lub qe loj.

Spermatozoon muaj lub taub hau thiab tus Tsov tus tw nrog ib qho nruab nrab (caj dab) nruab nrab ntawm lawv. Nws ua rau rectilinear thiab translational txav los ua kom muaj peev xwm sib ntsib nrog lub qe. Ib milliliter ntawm ejaculate muaj 40 txog 120 labspermatozoa. Ntawm cov no, kwv yees li 60% yog mobile, 15-20% yog immobile. Mature thiab atypical cov ntaub ntawv ntawm spermatozoa muaj nyob rau hauv tib qhov piv ntawm cov phev (60% - paub tab, 15-20% - atypical).

Nrog kev sib deev tsis tu ncua (ntau dua ib zaug txhua 2-3 hnub), cov kua dej hauv lub cev muaj cov phev tsis paub tab ntau, nrog kev zam lossis tsis tshua muaj kev sib deev, ntau cov spermatozoa deformed nyob rau hauv cov phev.

Txoj kev kawm ntawm cov muaj pes tsawg leeg thiab zoo ntawm cov phev (spermogram) yog ib qho kev soj ntsuam ua feem ntau hauv kev kuaj mob ntawm txiv neej infertility.

Kev faib cov txiv neej tsis muaj menyuam

Classification ntawm infertility
Classification ntawm infertility

Qhov ntau yam ua rau txiv neej tsis muaj menyuam ua rau nws nyuaj rau xaiv lub hauv paus rau kev faib tawm. Cov ntaub ntawv ntawm kev muaj menyuam tsis muaj menyuam raug txheeb xyuas hauv andrology:

  • Secretory infertility. Pathology yog kev tsim cov phev uas tsis muaj zog lossis tsis zoo los ntawm cov noob qes, nrog rau cov phev tsis txaus rau fertilization. Kev xeeb tub tuaj yeem tshwm sim los ntawm qhov tshwm sim ntawm qhov tshwm sim thiab kis tau qhov tsis zoo.
  • Obstructive lossis excretory infertility. Nrog rau daim ntawv no ntawm infertility, phev mature nyob rau hauv txaus kom muaj nuj nqis, tab sis tsis tuaj yeem nkag los ntawm vas deferens mus rau hauv cov zis. Qhov laj thawj yog ib qho teeb meem ntawm txoj kev ntawm lawv txoj kev thauj mus los.
  • Combined infertility. Kev sib xyaw ntawm ntau hom kev xeeb tub (immunological, secretory, obstructive) nrog rau kev sib ntxiv ntawm cov txheej txheem inflammatory.
  • Immunological infertility. Lub cev ntawm tus txiv neej secretes antibodies nrog antitesticular functions, uas testicular ntaub so ntswg yog ib tug txawv teb chaws keeb. Cov tshuaj tiv thaiv nkag mus rau hauv cov hlwb ntawm cov noob qes, ua txhaum lub hematotesticular barrier, provoke tsim cov tshuaj tiv thaiv rau spermatozoa. Daim ntawv no ntawm kev xeeb tub yog tshwm sim los ntawm kev raug mob rau cov qe menyuam.
  • Cov txheeb ze infertility. tshwm sim tawm tsam keeb kwm ntawm kev noj qab haus huv ntawm ob tus txij nkawm, qhov teeb meem ntawm daim ntawv no ntawm kev xeeb tub tsis tau kawm me ntsis.

Dab tsi ua rau txiv neej tsis muaj menyuam?

Cov yam ntxwv ntawm tus txiv neej infertility tsos yog conditionally muab faib mus rau hauv lub ntsiab sawv daws yuav, uas muaj ntau tshaj li lwm leej lwm tus, thiab ntxiv sawv daws yuav, ua ke nrog lawv. secretory infertility (hypogonadism) yog tus cwj pwm los ntawm kev ua haujlwm tsis zoo ntawm spermatogenesis thiab testicular function. Hypogonadism tuaj yeem yog thawj lossis theem nrab. Nyob rau hauv thawj daim ntawv ntawm secretory infertility, muaj ib tug ntau ntawm excretion ntawm gonadotropins nyob rau hauv cov zis, ua rau ib tug txo nyob rau hauv cov nyhuv ntawm cov noob qes nyob rau hauv lub functions ntawm lub caj pas pituitary. Hauv daim ntawv thib ob ntawm hypogonadism, cov qog pituitary cuam tshuam tsis zoo rau kev tso tawm gonadotropins, txo lawv cov naj npawb. Muaj cov ntaub ntawv ntawm secretory infertility uas tsis nrog hormonal ntshawv siab.

Causes secretory infertility:

Varicocele. Feem ntau ua rau txiv neej infertility. Nws zoo li provokes varicose veins ntawm testicle thiab spermatic qaum. Cov ntu no ntawm cov txiv neej kev ua me nyuam yog lub luag hauj lwm rau excretion ntawm phev. Qhov tshwm sim ntawm varicocele yog ntshav stasis, ntshav tsis txaus rau cov nqaij mos, thiab cuam tshuam ntawm nws txoj haujlwm. Cov yam ntxwv ua rau muaj kev loj hlob ntawm pathology - qhov nce ntawm qhov kub thiab txias ntawm qhov chaw mos rau lub sijhawm ntev (mus ntsib chav da dej thiab saunas, hnav cov ris tsho sov sov, ris tsho hauv qab ua los ntawm cov khoom hluavtaws), kev vibration, ua haujlwm txaus ntshai (tus tsav tsheb txoj haujlwm).

Testicular dropsy. Cov kua dej ntau dhau hauv lub scrotum vim muaj ntau yam laj thawj (xws li inguinal hernia). Qhov xwm txheej no provokes compression ntawm cov noob qes, ua txhaum ntawm nws cov ntshav ncig, uas txo lossis tag nrho cov spermatozoa tsim.

Cryptorchism. Nyob rau hauv qhov kev loj hlob ntawm lub cev xeeb tub, cov noob qes tsis nqis los rau hauv lub scrotum, tab sis nyob twj ywm hauv plab kab noj hniav. Nws raug kuaj pom thaum muaj hnub nyoog ntxov thiab yuav tsum tau kho phais ua ntej tus tub mus txog hnub nyoog 7 xyoo. Yog tias qhov no tsis ua tiav, cov noob qes yuav tsis tuaj yeem tsim cov phev vim yog qhov kub thiab txias hauv lub cev ntau dua li qhov chaw sab nraud. Txawm hais tias cov noob qes tsim cov phev me me, lawv yuav tuag tam sim.

Mumps. Mumps, lossis mumps, yog ib yam kab mob sib kis uas cuam tshuam rau cov qog ua kua qaub. Nws kis tau los ntawm huab cua tee, thaum lub cev raug rau siab intoxication. Ib qho teeb meem ntawm parotitis yog orchitis, los yog o ntawm cov noob qes, uas cov spermatogenic cov ntaub so ntswg ntawm lub cev (epithelium) raug cuam tshuam.

Lwm yam kab mob sib kis. Cov teeb meem ntawm kev sib deev kis kab mob (syphilis, gonorrhea, chlamydia, thiab lwm yam) ua rau kev puas tsuaj ntawm cov qog nqaij hlav, ua rau tsis muaj peev xwm tsim cov spermatozoa. Lwm yam kab mob sib kis (typhus, brucellosis, tuberculosis) muaj cov txiaj ntsig zoo sib xws, ua rau muaj kev phom sij rau lub cev thiab hyperthermia tseem ceeb.

Hormonal disorders. Hauv hom kev xeeb tsis muaj menyuam, spermatogenesis cuam tshuam vim qhov tsis txaus ntawm testosterone thiab lwm yam tshuaj hormones poj niam txiv neej. Yog vim li cas rau qhov no tej zaum yuav yog ib tug ntau ntawm prolactin (hyperprolactinemia, qog los yog o ntawm pituitary caj pas, theem nrab hypogonadism. pathologies ntawm endocrine system: thyroid, pancreas, qog adrenal, rog rog muaj ib tug zoo xws li cov nyhuv.

kab mob caj ces thiab caj ces. Muaj ntau tus chromosomal abnormalities (Shershnevsky-Turner syndrome, Klinefelter's syndrome, Nuan's syndrome, Kartagener's syndrome), nrog rau gonadal dysgenesis, uas ua rau ib tug txiv neej infertile. Cov kab mob keeb kwm yav dhau (polycystic raum kab mob, cystic fibrosis) muaj cov txiaj ntsig zoo sib xws.

Kev raug mob thiab qog nqaij hlav, qog nqaij hlav qog. Cov ua rau muaj xws li kev raug mob, tsis tuaj, cov qog nqaij hlav, qog ntawm prostate thiab lwm qhov chaw ntawm lub cev xeeb tub.

Kev ua ntawm lwm yam tsis zoo. Hauv qeb no yog:

Cov nyhuv ntawm lwm yam tsis zoo
Cov nyhuv ntawm lwm yam tsis zoo
  • Cov teebmeem ntawm cov tshuaj ntawm qee pawg kws tshuaj (nitrofurans, cytostatics, acetylsalicylic acid, narcotic analgesics, tshuaj tua kab mob, sulfonamides, tshuaj hormonal uas muaj estrogens, androgens, cortisone);
  • Ionizing hluav taws xob;
  • Cia haus cawv, haus luam yeeb;
  • Kev phom sij rau kev ua haujlwm (raug lead, phosphorus, mercury, manganese compounds, ammonia, tshuaj tua kab).
  • Hypovitaminosis cuam tshuam rau spermatogenesis, uas tuaj yeem ua rau cov khoom noj tsis txaus, kev tshaib plab. Tsis muaj cov vitamins ntawm pab pawg A, C, D, E cuam tshuam lub zog thiab tag nrho cov spermatogenesis.

High kub. Mus ntsib chav sauna lossis da dej, caij tsheb kauj vab, hnav khaub ncaws nruj lossis ris tsho hauv qab ua los ntawm cov khoom hluavtaws, kev ua haujlwm cuam tshuam nrog kev ua haujlwm ntawm qhov kub thiab txias (foundry, bakery, chav boiler).

Kev ntxhov siab ntev thiab hnub nyoog. Kev kis rau cov xwm txheej no txo cov phev zoo thiab kev txav mus los.

Nyob rau hauv rooj plaub ntawm unilateral los yog ob tog ua txhaum ntawm kev thauj cov spermatozoa los ntawm vas deferens, peb tab tom tham txog obstructive infertility.

Causes of obstructive (obstructive) infertility:

  • Epididymitis. Cov txheej txheem zoo ib yam li qhov tshwm sim ntawm kev cuam tshuam ntawm cov hlab ntsha hauv cov poj niam. Epididymitis yog ib qho teeb meem ntawm o ntawm epididymis, thaum gluing thiab ntxiv obliteration ntawm vas deferens tshwm sim.
  • Kev raug mob thiab kev raug mob. Kev xeeb tub tshwm sim los ntawm kev raug mob thaum lub sijhawm phais ntawm lub ureters, prostate, zais zis, qhov quav, thiab tseem ua rau muaj kev raug mob rau lub scrotum.
  • Tumors of the epididymis. Cov ntaub so ntswg hypertrophy tshwm sim los ntawm qhov pom ntawm cov hlwv thiab cov qog ua rau compression ntawm vas deferens.
  • Congenital anomalies. Cov no muaj xws li hypospadias (kev tawm ntawm cov urethral inflow nyob rau hauv qis peb ntawm noov), tsis muaj epididymis, los yog efferent kwj dej noob.
  • Aspermatism. Lub ntsiab lus ntawm aspermatism tseeb yog ib qho kev cuam tshuam ntawm lub paj hlwb cortex ntawm kev ua haujlwm ntawm cov chaw zov me nyuam. Yog li ntawd, tsis muaj phev tawm thaum sib deev ntawm ib lub sij hawm twg. False aspermatism yog tus cwj pwm los ntawm kev tawm ntawm cov phev tsis mus rau hauv cov zis, tab sis mus rau hauv lub zais zis (retrograde ejaculation). Yog vim li cas rau qhov tshwm sim no yog qhov tshwm sim ntawm ntshav qab zib mellitus, ntau yam sclerosis, o ntawm lub cev xeeb tub, kev raug mob ntawm tus txha caj qaum, zais zis thiab prostate kev phais, kev mob tshwm sim ntawm cov tshuaj tiv thaiv kev ntxhov siab thiab kev ua kom tsis muaj zog.

Lwm yam ua rau. Lwm yam ua rau txiv neej infertility muaj xws li:

ejaculation ntxov ntxov
ejaculation ntxov ntxov
  • Impotence (erectile dysfunction) - nws tsis yooj yim sua kom muaj kev sib deev tag nrho.
  • ejaculation ntxov ntxov - tshem cov phev ua ntej qhov chaw mos tso rau hauv qhov chaw mos.
  • Kev sib deev tsis tu ncua lossis tsis tu ncua.
  • Lub neej kev sib deev ntau dhau - nrog kev sib deev nrog ntau tus neeg koom tes, kev pheej hmoo ntawm kev cog lus STDs nce, kev tiv thaiv thiab lub cev lub cev poob qis, tsis muaj sijhawm txaus rau kev loj hlob ntawm cov phev nquag.
  • Kev tsis paub txog kev sib deev.

Psychological ua rau txiv neej infertility:

  • Cov tub hluas uas loj hlob hauv tsev neeg qhov twg, raws li kev tswj hwm kev loj hlob, lawv tau tsim ib qho kev ua tsis zoo ntawm lub cev thiab lub siab lub ntsws, tsim kom muaj lub siab "culling" complex nyob rau hauv cov neeg laus.
  • Ib tug txiv neej uas loj hlob los ntawm kev tiv thaiv ntau dhau, lossis hauv tsev neeg uas nws niam tsis muaj kev txiav txim siab, feem ntau tseem yog menyuam mos uas tsis xav kom muaj kev sib tw rau nws tus poj niam.
  • Ib tug txiv neej uas tau hloov ib tug txiv nyob rau hauv ib tsev neeg tsis tiav tej zaum yuav muaj "txiv txoj kev nyuaj" cuam tshuam nrog kev tsis txaus siab los ntawm kev mob siab rau cov kev nyuaj uas cuam tshuam nrog kev saib xyuas me nyuam, subconsciously nws tsis xav muaj menyuam.
  • Ntawm lub neej muaj nuj nqis ntawm ib tug txiv neej uas tau tsa lub bar ntawm qhov tseem ceeb heev, tsis muaj chaw rau me nyuam.

Kev kis tus kabmob ntawm txiv neej tsis muaj menyuam

Epidemiology ntawm txiv neej infertility
Epidemiology ntawm txiv neej infertility
  • Pathologies ntawm endocrine system - 19.8% ntawm cov txiv neej infertility;
  • Varicocele – 16%;
  • Extragenital pathologies, kab mob ntev ntawm cov plab hnyuv siab raum - 10%;
  • Kab mob - 9.7%;
  • Immunological yam - 4.5%;
  • Cov qog nqaij hlav - 3%;
  • Idiopathic infertility (ntawm tsis paub etiology) - 5%;
  • Lwm yam - 5%.

daim duab kho mob

Tsis muaj cov tsos mob tshwj xeeb ntawm txiv neej infertility, lawv nyob ntawm qhov ua rau ua rau tus mob no. Cov tsos mob tseem ceeb yog qhov tsis muaj cev xeeb tub hauv ib tus khub sib deev, uas tsis muaj qhov yuav tsum tau ua ua ntej rau qhov no hauv tus poj niam. Txhawm rau kom paub meej qhov tshwm sim ntawm kev xeeb tub, tus poj niam kuj raug kuaj.

Yog tias qhov ua rau muaj menyuam tsis taus yog mob, qog, raug mob ntawm tus txiv neej cov plab hnyuv siab raum, qhov tshwm sim ntawm kev xeeb tub tuaj yeem ua rau tso zis tsis zoo, mob hauv lub scrotum thiab hauv plab plab, ib qho thiab ob sab ntawm qhov loj ntawm qhov loj. scrotum, qhov loj ntawm cov leeg ntawm nws daim tawv nqaij (nrog varicocele).

Cov kab mob Hormonal yog tshwm sim los ntawm gynecomastia (kev loj hlob ntawm cov qog mammary), txo qis libido, txo qhov loj ntawm cov noob qes.

Diagnosis

Kev kuaj mob
Kev kuaj mob

Ua ntej tsim kev kuaj mob ntawm "txiv neej infertility", ob tus txij nkawm tau muab rau kev kuaj mob. Cov khub niam txiv pib lawv qhov kev ntsuam xyuas feem ntau nrog ib tug txiv neej. Nws suav nrog cov khoom hauv qab no:

Anamnesis noj. Tus kws kho mob soj ntsuam tus neeg mob cov lus tsis txaus siab, tus lej ntawm cov kab mob thiab kev ua haujlwm ntawm lub plab hnyuv siab raum, ua rau muaj kev phom sij rau kev ua haujlwm thiab tus cwj pwm tsis zoo (kev haus luam yeeb, cawv). Nws yeej yuav txaus siab rau cov txiv neej sib deev thiab tus naj npawb ntawm lawv cev xeeb tub.

kev tshuaj ntsuam dav dav. Andrologist yuav pom qhov muag ntsuas cov yam ntxwv ntawm kev loj hlob ntawm cov yam ntxwv ntawm kev sib deev. Yog hais tias lub cev plaub hau yog insignificant, lub cev belongs rau eunuchoid hom, muaj gynecomastia, tsis muaj androgens. Muaj cov noob qes thiab lawv qhov loj me yog kawm (feem ntau lawv tau kwv yees sib npaug rau 4.6 cm, ib txwm muaj kev sib npaug ntawm cov leeg), cov xwm txheej ntawm cov leeg ntawm cov phev qaum thiab scrotum (varicocele tsis suav nrog). Kev ntsuam xyuas qhov quav ntawm qhov quav yog ua los txiav txim qhov mob ntawm cov kab mob hauv lub plab thiab prostate.

Kev ntsuas kev sib deev thiab kev ua haujlwm ntawm kev ua me nyuam. Raws li tus neeg mob, tus kws kho mob sau tseg hauv keeb kwm kho mob tus naj npawb ntawm kev sib deev (ib txwm tsawg kawg 2-3 ib lub lis piam), Qhov zoo ntawm erection, qhov xwm ntawm ejaculation (ib txwm, qeeb, ntxov ntxov).

Tom qab kev kuaj mob, tus neeg mob raug xa mus rau kev kuaj mob. Tom qab 3 hnub ntawm abstinence, nws pub phev rau kev tshawb fawb.

Sperm parameters are normal:

  • Ejaculate ntim - 2 ml lossis ntau dua;
  • Tus naj npawb ntawm cov phev hauv 1 ml yog 20 lab lossis ntau dua;
  • Ph-react - alkaline nrog qhov taw qhia ntawm 7, 2 lossis ntau dua;
  • Morphology - ntau dua 30% ntawm cov phev yuav tsum muaj qhov tseeb;
  • Motility - Tsis pub dhau ib teev ntawm ejaculation, ntau dua 50% ntawm cov spermatozoa txav mus rau tom ntej lossis 25% txav mus nrawm nrawm;
  • Kev muaj peev xwm - ntau dua 50% cov phev nyob;
  • Mar-test rau kev tshem tawm ntawm kev tiv thaiv kab mob tsis muaj menyuam - tsawg dua 50% ntawm cov phev nrog cov khoom sib txuas;
  • Kev muaj flora thiab agglutination - tsis yog;
  • Viscosity is normal;
  • Liquefaction - hauv 60 feeb;
  • Leucocyte suav hauv 1 ml yog tsawg dua 1 lab;
  • Zinc suav - 2.4 µmol;
  • Fructose - 13 µmol tag nrho;
  • Tus nqi ntawm citric acid yog 52 µmol hauv tag nrho ejaculation.

Muaj peev xwm ua txhaum cai:

Muaj peev xwm ua txhaum cai
Muaj peev xwm ua txhaum cai
  • Oligospermia - nyob phev suav tsawg dua 20 lab ib ml;
  • Leukospermia - cov ntsiab lus nce ntawm leukocytes (tso nyob rau hauv cov kab mob thiab cov kab mob inflammatory);
  • Asthenozoospermia - tus naj npawb ntawm cov phev motile qis dua li qub;
  • Hypospermia - qhov ntim ntawm ejaculation qis dua li qub;
  • Azoospermia - tsis muaj phev hauv ejaculation;
  • Polyspermia - qhov ntim ntawm cov phev yog siab dua tus qauv (ntau dua 10 ml), tau sau tseg hauv cov kab mob ntawm cov kabmob ntawm cov kabmob ntawm cov menyuam yaus, nrog rau kev sib deev tsis tshua muaj;
  • Aspermia - tsis muaj ejaculation vim tsis muaj ejaculation;
  • Teratozoospermia - ntau tshaj ib nrab ntawm cov spermatozoa muaj cov yam ntxwv tsis xws luag (ob lub taub hau, txawv txav ntawm lub caj dab thiab tus Tsov tus tw).

Yog tias muaj qhov tsis txaus ntseeg ntawm cov txheej txheem inflammatory hauv cov plab hnyuv siab raum los yog muaj cov kab mob, tus neeg mob tau kuaj kab mob:

  • PCR los txiav txim tawm tsam kev sib deev;
  • Smear los ntawm cov urethra los txiav txim STDs;
  • Sowing ejaculate los txiav txim siab tus neeg sawv cev ntawm tus kab mob (ua nrog nce ntawm cov leukocytes);
  • Kev tshawb fawb txog kev ua haujlwm biochemical ntawm prostate secretion rau qabzib, alkaline phosphatase, α-glycosidase, citric acid, zinc.

Kev tshawb fawb Hormonal txiav txim siab qib ntawm cov tshuaj hormones hauv qab no:

  • Testosterone,
  • YProlactin,
  • YEstradiol,
  • FSH and LH.

Qib ntawm cov dawb radicals hauv cov phev hlwb raug kawm, txij li thaum muaj ntau ntau ntawm cov pa oxygen reactive, fertilizing muaj nuj nqi ntawm spermatozoa txo, lawv ua inactive, thiab cell membrane ntawm txiv neej kab mob puas lawm.. Thaum kawm txog cov tshuaj tiv thaiv acrosomal uas tshwm sim thaum sib cuag ntawm cov phev nrog lub qe, nws txiav txim siab seb cov phev puas tuaj yeem yaj lub plhaub ntawm lub qe thiab nkag mus rau hauv. Tsuas yog cov spermatozoa noj qab nyob zoo nrog cov morphology ib txwm muaj peev xwm ua tiav cov tshuaj hloov pauv ntawm lawv lub taub hau rau cov tshuaj tiv thaiv zoo li no.

Kev tshuaj xyuas microscopic ntawm spermatozoa

microscopic kuaj
microscopic kuaj

Kev kuaj xyuas microscopic ntawm spermatozoa siv lub tshuab ntsuas hluav taws xob thiab cytogenetic tsom xam muab lub tswv yim:

  • Hais txog tus lej ntawm chromosomes thiab lawv qhov zoo,
  • Hais txog cov qauv ntawm ejaculate plasma,
  • Txog qhov ua tau ua txhaum ntawm cov qauv sab hauv ntawm cov phev.

Yog tias txoj kev tshawb no tshawb pom qhov txawv txav ntawm chromosomal, tus neeg mob tau sab laj los ntawm kws kho caj ces. Ib qho kev sim rau kev kuaj pom cov tshuaj tiv thaiv kab mob ntawm cov chav kawm G, A, M yog ua nyob rau hauv kev kuaj mob ntawm immunological sterility. Kev ntsuam xyuas Shuvarsky thiab Kutzrok-Miller yuav pab txheeb xyuas qhov tsis sib haum xeeb ntawm lub ncauj tsev menyuam.

Instrumental diagnosis of txiv neej infertility:

  • YThyroid ultrasound;
  • X-ray ntawm pob txha taub hau thiab "Turkish eeb" los txiav txim cov qog pituitary;
  • Y Doppler ultrasound, transperitoneal ultrasound ntawm scrotum - rau kev kuaj mob ntawm varicocele, hydrocele, varicose leeg ntawm lub plab me me;
  • Transrectal thiab transabdominal ultrasound rau kev kuaj mob ntawm epididymis, prostate, qhov loj thiab cov qauv ntawm cov noob qes, kuaj pom cov kev hloov pauv hauv cov hlab ntsha hauv cov hlab ntsha thaum muaj kev cuam tshuam lossis pathologies ntawm vas deferens;
  • Scrotal thermography rau kev kuaj mob ntawm varicocele;
  • Testicular biopsy - rau kev kuaj pom zoo ntawm idiopathic azoospermia nrog cov qe ntshav loj thiab FSH qib hauv cov ntshav. Qhov tshwm sim ntawm txoj kev tshawb no tej zaum yuav yog normospermatogenesis - muaj tag nrho cov hlwb rau tsim cov phev, hypospermatogenesis - ib tug tsis tiav cov hlwb, aspermatogenesis - tag nrho cov hlwb nyob rau hauv lub seminiferous tubules.
  • Vasography - x-ray ntawm cov kwj dej thiab cov hlwv los txiav txim siab qhov kev cuam tshuam.

Ib txoj hauv kev ntawm kev kuaj mob sai sai ntawm kev xeeb tub yog cov phev nti los txiav txim seb tus naj npawb ntawm cov phev, tsim los ntawm Californian cov kws tshawb fawb. Nws tuaj yeem siv hauv tsev nrog ob peb tee dej phev xwb. Tus nqi ntawm cov nti yog kwv yees li 40 €.

Kev kuaj tsis muaj menyuam rau cov txiv neej hauv tsev

Txiv neej infertility test tom tsev
Txiv neej infertility test tom tsev

Niaj hnub no muaj lub sijhawm tshwj xeeb los ua cov txheej txheem tag nrho cov txheej txheem kom paub txog kev ua haujlwm ntxiv hauv tsev. Tus nqi tag nrho yuav yog $ 25. Nws yog qhov pheej yig dua li qhov kuaj phev tag nrho ua los ntawm lub chaw sim.

Qhov kev kuaj hu ua SpermCheck fertility. Nws cov neeg tsim khoom yog cov kws tshaj lij los ntawm University of Virginia (USA). Qhov kev sim no tau ua tiav los ntawm ib pab neeg ntawm ntau dua 200 tus txiv neej cov neeg mob. Cov kws tshawb fawb tau thov: qhov tseeb yuav yog tsawg kawg 96%. Ua ntej, qhov sib txawv tsim nyog rau kev sim tshuaj raug tso tawm. Nws tso cai rau txiav txim siab qhov ua tau zoo ntawm vasectomy. Lub invention tau ntse siv tau ntev, txij li xyoo 2008.

Tam sim no leej twg tuaj yeem ua tus txheej txheem zoo ib yam li kev kuaj cev xeeb tub. Yog li ntawd, siv ob peb tee ntawm phev los kos cov lus xaus txog kev xeeb tub. Tom qab ntawd, koj yuav tsum xaiv - seb puas yuav tiv tauj tus kws tshaj lij.

Cov nuj nqis ib txwm yog 200-500 lab spermatozoa ib milliliter ntawm phev. Txhawm rau kos cov lus xaus uas tsim nyog, ib tus yuav tsum paub txog cov txheej txheem ntawm World He alth Organization. Raws li lawv, infertility yog pom tseeb thaum tus naj npawb no txo mus rau 2 lab. Thaum tus naj npawb ntawm spermatozoa txo mus rau 2 - 20 lab, muaj peev xwm ntawm conception ib txhij txo. Txoj kev tshiab yog tsim los ntawm lub hauv paus yooj yim - qhov kev ntsuam xyuas yog raws li cov ntsuas - cov tshuaj tiv thaiv rau cov phev proteins. Lawv qhov ntim yog txiav txim siab los ntawm txoj kev biochemical. Txhua yam ua tiav hauv tsev, ze rau qhov yooj yim.

Kev kho txiv neej tsis muaj menyuam

Thawj theem ntawm kev kho tus txiv neej infertility yog kev kho lossis phais kho tus kab mob hauv qab, ua raws li kev txhawb nqa ntawm spermatogenesis. Ob qho tib si cov pa thiab lwm txoj kev kho mob yog siv los kho kev xeeb tub.

Kev kho mob zoo

Kev kho cov txiv neej infertility
Kev kho cov txiv neej infertility

Kev siv cov vitamins thiab minerals. txhawm rau tsim cov tshuaj steroids thiab txhim kho spermatogenesis, cov vitamins ntawm pawg A, D, K, D, E (tocopherol) yog siv. Multivitamin complexes Aevit (vitamin A thiab E), Undevit, Gendevit, vitamin thiab ntxhia npaj Unicap, Centrum yog siv.

Sedatives thiab nootropics. Cov txiv neej uas txo qis fertility feem ntau qhia chim siab thiab txo qis kev ua si, lawv raug kev nyuaj siab thiab neurosis. Txhawm rau tiv thaiv kev ua haujlwm ntau dhau thiab qaug zog ntawm lub paj hlwb, txhawm rau txhim kho lub paj hlwb, cov tshuaj uas muaj phosphorus hauv lawv cov muaj pes tsawg leeg (Lipocerebrin, Calcium glycerophosphate) yog siv. Bromine npaj, rho tawm ntawm valerian, motherwort, tincture ntawm Eleutherococcus yog pom zoo raws li sedatives. Cov teeb meem tshwm sim ntau dua ntawm lub hauv nruab nrab lub paj hlwb (kev puas siab puas ntsws infertility) yuav tsum tau siv ib txoj kev kho tus kheej nrog rau tus kws kho mob hlwb thiab tus kws kho mob hlwb.

Hepatoprotectors. Cov no yog cov tshuaj uas txhim kho daim siab ua haujlwm: Karsil, Hofitol, Methionine, Essentiale-Forte, Heptral, Ovesol. Nyob rau tib lub sijhawm, nws raug nquahu kom ua raws li kev noj haus No. 5 (raws li Pevzner), uas muab kev txwv rau kev noj zaub mov ntawm marinades, pickles, zaub mov muaj roj, thiab siv cov seasonings.

Biostimulants. Txhawm rau txhim kho cov metabolism, ua kom cov kab mob hauv lub cev xeeb tub, ua kom lawv cov ntshav ua haujlwm zoo, ua kom cov ntaub so ntswg thiab cov plab hnyuv siab raum, biostimulants siv: aloe extract, Apilak, vitreous lub cev., FiBS, Splenin, Methyluracil, Pentoxyl.

Kev kho mob secretory infertility hauv txiv neej

Kev kho mob secretory infertility hauv cov txiv neej
Kev kho mob secretory infertility hauv cov txiv neej

Primary hypogonadism. Thawj (hypergonadotropic gonadism) yog kho nrog androgens. Lawv txoj haujlwm yog los txhawb cov spermatogenesis thiab inhibit zus tau tej cov gonadotropins FSH thiab LH. Cov no yog Testosterone, methyltestosterone, thiab lwm yam. Yog tias lub zog androgenic ntawm cov noob qes khaws cia, cov tshuaj tau noj rau 2-3 lub hlis. Qhov no yog ua raws li kev so rau tib lub sijhawm thaum lub sijhawm noj luteinizing hormone choriogonin.

Txhawm rau kom cov spermatozoa nce ntxiv thiab nce lawv txoj kev txav mus los, androgens (Andriol, Proviron) tau noj tsawg kawg nkaus. Cov txiv neej qis dua tau qhia kom noj cov tshuaj hormones anabolic (retabolil, nerobol).

txhawm rau txhim kho spermogram tsis, qhib lub caj pas pituitary, txhim kho spermatogenesis, hloov kho nrog cov tshuaj uas muaj cov tshuaj testosterone ntev ntev (testenat) yog siv. Kev tshem tawm ntawm cov tshuaj tom qab kawm ob lub hlis muab qhov cuam tshuam nrog cov tshuaj tiv thaiv ntawm lub cev.

Nyob rau hauv hyperlactinemia, prolactin ntau lawm inhibitors (bromocriptine) yog siv los ua kom libido, txhawb zog, txhim kho spermogram tsis, thiab kuj kho gynecomastia.

Secondary hypogonadism. Nrog tsis muaj luteinizing hormone, testosterone synthesis txo, spermatogenesis qeeb. Rau kev kho mob ntawm tus kab mob no, LH npaj (pob cev xeeb tub, choriogonin) yog siv rau 1.5-2 lub hlis, ua ke nrog testosterone. Yog tias tsis muaj FSH txaus, folistamine lossis anthrogon raug tshuaj los ua kom spermatogenesis rau 1.5-2 lub hlis.

Txhawm rau txhawb kev ua haujlwm ntawm pituitary thiab hypothalamus, progestins (clomiphene) lossis antiestrogens (tamoxifen, zitosonium) raug sau tseg, kev noj haus (ib hlis nrog 10-hnub so) tuaj yeem rov ua dua 6 zaug.

Kev kho mob ntawm excretory infertility hauv txiv neej

Kev kho tus txiv neej no tsis muaj menyuam pib nrog kev kho qhov ua rau tus mob no. Yog tias kev xeeb tub yog tshwm sim los ntawm cov teeb meem ntawm prostatitis, vesiculitis, orchitis, urethritis, kev kho mob nrog tshuaj tua kab mob thiab tshuaj tiv thaiv kab mob. Tsis tas li ntawd, massage, physiotherapy, acupuncture thiab lwm txoj kev yog siv. Txhawm rau normalize metabolism thiab txhawb cov spermatogenesis, hepatoprotectors, adaptogens, biostimulants, vitamins raug sau.

Kev kho tus txiv neej tsis muaj menyuam

Kev kho mob phais
Kev kho mob phais

Kev phais yog qhia rau obstructive aspermia.

Tactics ntawm kev ua haujlwm kom rov qab kho qhov patency ntawm lub plab zom mov yog nyob ntawm tus qauv ntawm cov kab mob:

  • Vasovasostomy (kev cuam tshuam ntawm vas deferens raug tshem tawm);
  • Vasoepididymostomy (cov vas deferens txuas nrog cov tubules ntawm cov appendages);
  • Kev tshem tawm ntawm prostate los ntawm urethra.

qeb hnub nyoog rau cov haujlwm no yog cov tub hluas (qis dua 30).

Yog tias cov txiv neej laus raug kuaj pom tias muaj aspermia, lwm txoj kev muab phev rov siv tau rau kev pabcuam fertility technologies:

  • Percutaneous testicular puncture;
  • Percutaneous puncture ntawm epididymis;
  • Qhib gonadal koob biopsy;
  • Kev cuam tshuam Microsurgical kom tau txais cov ntsiab lus ntawm epididymis.

Rau secretory infertility, kev cuam tshuam kev phais hauv qab no yog ua:

  • Embolization lossis sclerotherapy ntawm cov leeg ntawm zes qe menyuam cuam tshuam (nrog varicocele);
  • Puncture lossis sclerosing (nrog hydrocele);
  • Laparoscopy lossis kev siv cov txheej txheem classical (rau cryptorchidism, ua thaum yau).

Txoj kev kho autoimmune infertility:

  • Kev kho nrog glucocorticoids (Hydrocortisone, Desamethosone) nrog kev tiv thaiv kab mob, tiv thaiv kab mob thiab tshuaj tiv thaiv kab mob, daim ntawv thov - ntsiav tshuaj, tshuaj pleev, kho lub cev.
  • Sperm capacitation (ua thiab ntxuav) los npaj rau IVF lossis ICSI.

Pab txhawb kev tsim kho technologies

Assisted Reproductive Technologies
Assisted Reproductive Technologies

Lwm txoj hauv kev ntawm kev them nyiaj rau txiv neej:

  • Artificial insemination. Lub ntsiab ntawm txoj kev yog raws li nram no - pre-kho phev yog nkag mus rau hauv tus poj niam lub tsev me nyuam kwj dej los yog ncaj qha mus rau hauv lub uterine kab noj hniav. Nyob rau hauv cov ntaub ntawv ntawm tsawg concentration ntawm active phev nyob rau hauv cov phev ntawm tus txij nkawm los yog lawv tsis ua tiav, cov phev pub yog siv. Cov txheej txheem yog siv rau lub ncauj tsev menyuam (tsim cov tshuaj tiv thaiv rau cov spermatozoa ntawm tus txij nkawm los ntawm cov hnoos qeev ntawm lub ncauj tsev menyuam), nrog autoimmune infertility thiab sterility ntawm unexplained etiology.
  • In vitro fertilization. Hauv IVF, lub qe yog fertilized sab nraum poj niam lub cev. Ob peb daim ntawv luam tawm tom qab kev tsim tawm ntawm ovulation ntawm zes qe menyuam, nyob rau hauv ib lub tais Petri lawv tau fertilized nrog cov phev ntawm lawv tus txij nkawm. Tom qab ob peb hnub, cov zygotes zoo tshaj plaws (cov qe fertilized) raug xaiv thiab xa mus rau lub tsev menyuam.
  • ICSI. Txoj kev ICSI (Intracytoplasmic Sperm Injection) yog kev qhia cov phev mus rau hauv lub qe siv microsurgical manipulations. Rau kev ua tiav ntawm cov txheej txheem, ib qho spermatozoon siv tau txaus. Cov txiv neej cov hlwb tau txais los ntawm kev ua kom tiav lossis kev phais mob.
  • Kev niam yug los yog kev saws me nyuam. Nyob rau hauv cov ntaub ntawv ntawm pub niam mis, tus niam surrogate, nyob rau hauv lub moj khaum ntawm daim ntawv cog lus ua ntej, dais ib tug me nyuam loj hlob los ntawm ib tug zygote tau los ntawm cov kab mob. hlwb ntawm cov txij nkawm infertile.

cov lus qhia dav dav

Ua raws li cov hauv paus ntsiab lus ntawm kev noj qab haus huv
Ua raws li cov hauv paus ntsiab lus ntawm kev noj qab haus huv

Muaj cov cai yooj yim, ua raws li koj tuaj yeem txhim kho cov phev zoo. Cov lus pom zoo no tshwj xeeb tshaj yog rau cov txiv neej npaj qhov tsos ntawm tus menyuam hauv tsev neeg.

  • Ua raws li cov hauv paus ntsiab lus ntawm kev noj qab haus huv. Nws raug nquahu kom txwv tsis pub siv cov marinades, pickles, nqaij haus luam yeeb, khoom qab zib, kub txuj lom, zaub mov rog. Cov khoom lag luam pom zoo: nqaij liab, legumes, walnuts, parsley, dill, basil, celery, txiv hmab txiv ntoo tshiab thiab zaub hauv qhov ntau, rosehip decoction los yog infusion. Noj txiv lws suav nyob rau hauv txhua daim ntawv muaj txiaj ntsig zoo vim lawv cov ntsiab lus siab ntawm antioxidant lycopene.
  • Kev ua kom lub cev hnyav thiab tiv thaiv lub cev tsis ua haujlwm. Kev ua neej nyob tsis muaj zog ua rau cov ntshav stasis hauv plab hnyuv. Qhov tshwm sim ntawm qhov no yog kev tsis zoo ntawm cov phev, qhov txo qis hauv potency, kev loj hlob ntawm cov kab mob xws li varicose veins, hemorrhoids, dropsy ntawm lub noob qes. Kev nce hauv lub cev hnyav pab txhawb kev tsim cov tshuaj estrogen, poj niam cov tshuaj hormones, los ntawm cov ntaub so ntswg adipose. Kev kawm lub cev, taug kev, thiab ua gymnastic complexes yuav pab txo qhov kev pheej hmoo no.
  • Hnav cov ris tsho hauv qab kom noj qab nyob zoo thiab cov khaub ncaws. Txhawm rau kom tsis txhob cuam tshuam cov ntshav ncig hauv lub plab hauv plab, hauv lub scrotum, nws raug nquahu kom tsis txhob hnav ris tsho nruj (tshwj xeeb yog tias nws yog ua los ntawm hluavtaws), nruj ris.
  • Nyob zoo ntawm kev sib deev lub neej. Nquag, kev sib deev yuav tsum tsis pub tsawg thiab tsis pub ntau tshaj ib zaug txhua 2-3 hnub. Qhov tshwm sim ntawm kev sib cuag ntau dhau tuaj yeem yog kev tsim cov phev nrog ntau cov spermatozoa tsis paub tab, tsawg dhau - kev laus ntawm cov txiv neej cov kab mob. Tsis tas li ntawd, kev sib deev tsis tu ncua tiv thaiv ib tug txiv neej los ntawm cov tsos mob ntawm prostatitis thiab prostate adenoma.
  • Tiv thaiv kom tsis txhob muaj cua sov ntau dhau ntawm lub cev xeeb tub. Ib ntus nws tsim nyog tsis kam mus ntsib saunas thiab da dej.
  • Kev siv cov tshuaj pej xeem. Cov txiaj ntsig zoo hauv kev kho cov menyuam yaus yog kev siv cov khoom lag luam muv: muv paj ntoos (paj ntoos los ntawm muv honeycombs), paj paj ntoos, zib mu, muaj koob muaj npe jelly. Cov qauv rau kev siv paj paj paj thiab muv qhob cij yog 1/2 tsp. hauv ib hnub. Cov nroj tsuag tshuaj yog siv los normalize ntshav ncig nyob rau hauv lub plab hnyuv siab raum, nce testosterone secretion thiab phev zoo. Plantain, Ivan tshuaj yej, sage, knotweed yog brewed thiab noj 3-4 tbsp. l. ib hnub.

Kev kho tus txiv neej tsis muaj menyuam, nws lub sijhawm thiab kev ua tau zoo nyob ntawm qhov ua rau ntawm pathology, kev ua tiav ntawm kev ua raws li cov lus pom zoo ntawm cov kws tshwj xeeb, xaiv txoj kev kho. Kwv yees li 45-50% ntawm cov niam txiv uas muaj menyuam tsis taus yog "ua txhaum" ntawm ib tug txiv neej, raws li kev kho mob, nrhiav kev zoo siab ntawm kev ua niam txiv.

Pom zoo: