Clinical management of infertile men with nonobstructive azoospermia.
Clinical management of infertile men with nonobstructive azoospermia.
复制标题
具有非目标化植物学的不育男性的临床管理。
DOI：
10.4103/1008-682x.148719
复制
发表时间：
2015-05
影响因子：
2.9
通讯作者：
Esteves SC
中科院分区：
文献类型：
--
作者：
Esteves SC
寻求生育的非梗阻性无精子症（NOA）男性的临床管理一直是男科医生，泌尿科医生和生殖医学专家的挑战。本文综述了NOA临床管理的个人观点，包括15年来处理这种男性不育症的经验教训。提出了一种连续五步算法来管理此类患者。首先，对无精子症进行鉴别诊断，以确认/建立NOA是由于生精失败。第二，进行基因检测不仅是为了检测由Y染色体长臂微缺失引起的NOA男性，而且还为受影响的患者提供咨询，让他们了解精子回收成功的机会。第三，确定在手术取回尝试之前是否可以使用任何干预来增加精子产生。第四，选择最有效和高效的检索方法来搜索睾丸精子。最后，在处理回收的配子和培养精子注射产生的胚胎方面采用了最先进的实验室技术。一个协调的多学科努力是关键，以提供最好的机会，实现一个生物后代的男性与NOA。
The clinical management of men with nonobstructive azoospermia (NOA) seeking fertility has been a challenge for andrologists, urologists, and reproductive medicine specialists alike. This review presents a personal perspective on the clinical management of NOA, including the lessons learned over 15 years dealing with this male infertility condition. A five-consecutive-step algorithm is proposed to manage such patients. First, a differential diagnosis of azoospermia is made to confirm/establish that NOA is due to spermatogenic failure. Second, genetic testing is carried out not only to detect the males in whom NOA is caused by microdeletions of the long arm of the Y chromosome, but also to counsel the affected patients about their chances of having success in sperm retrieval. Third, it is determined whether any intervention prior to a surgical retrieval attempt may be used to increase sperm production. Fourth, the most effective and efficient retrieval method is selected to search for testicular sperm. Lastly, state-of-art laboratory techniques are applied in the handling of retrieved gametes and cultivating the embryos resulting from sperm injections. A coordinated multidisciplinary effort is key to offer the best possible chance of achieving a biological offspring to males with NOA.