Male infertility: Evaluation and sperm retrieval
Male infertility: Evaluation and sperm retrieval
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DOI：
10.1097/01.grf.0000197267.02541.ae
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发表时间：
2006-03-01
影响因子：
1.5
通讯作者：
Schlegel, PN
中科院分区：
文献类型：
--
作者：
Schlegel, PN
对于所有不育男性，建议进行完整的病史和体格检查，以确定男性因素不育的潜在可纠正原因。ASRM实践委员会建议，对不育夫妇中男性和女性的初步评估应平行进行，并同时启动。1虽然有阴性生殖史和正常精液分析的男性不需要进一步评估，但大多数男性因素患者应进行进一步检查。男性评估的目标是确定不孕症的可纠正原因，对成功取精的机会进行分类（对于射精中没有精子的男性），并确定与不孕症相关的重大医疗问题。男性不育可能是重要医学病理学的唯一初始症状。不育男性患睾丸肿瘤的风险是普通人群男性的17倍，精液分析无法提供睾丸肿瘤存在与否的信息。在严重少精子症或无精子症男性中常见的其他疾病包括垂体瘤和其他形式的获得性低促性腺激素性性腺功能减退症。最后，仔细的病史和体格检查可以提供足够的关于接触有毒物质的信息，以使患者免于接触有毒物质，并消除积极干预的必要性。无精子症可分为梗阻性无精子症和非梗阻性无精子症。典型的非梗阻性无精子症患者睾丸较小（<15 mL），附睾扁平。有些人可能有隐睾症的历史。对非梗阻性无精子症（NOA）患者进行激素检查，通常显示血清促卵泡激素（FSH）升高，睾酮和雌二醇水平低、正常或接近正常。阻塞的男性通常有正常的睾丸体积，更充分或扩张的附睾，和正常的FSH水平。阻塞的患者可能有双侧先天性输精管缺如或输精管切除术史。精子优化
For all men with infertility, a complete history and physical examination is recommended to identify potentially correctable causes of male factor infertility. The ASRM Practice Committee recommended that initial evaluation of men and women in an infertile couple proceed in parallel and be initiated at the same time. 1 Although men with a negative reproductive history and normal semen analyses require no further evaluation, most male factor patients should have further testing. The goals of male evaluation are to identify correctable causes of infertility, categorize the chance of successful sperm retrieval (for men who do not have sperm in the ejaculate), and identify significant medical problems associated with infertility. Male infertility can be the only initial symptom of significant medical pathology. Men with infertility are at 17-fold greater risk of having a testis tumor than men in the general population, and a semen analysis provides no information on the presence or absence of testicular neoplasms. Other medical conditions that are not uncommonly detected in men with severe oligospermia or azoospermia include pituitary tumors and other forms of acquired hypogonadotropic hypogonadism. Finally, a careful history and physical examination may provide enough information on exposure to toxic substances to remove the patient from the exposure and obviate the need for aggressive intervention. Azoospermia may be categorized into obstructive azoospermia and nonobstructive cases. Typically, the man with nonobstructive azoospermia will have small testes (, 15 mL) with a flat epididymis. Some men may have a history of cryptorchidism. Hormonal evaluation of a man with nonobstructive azoospermia (NOA) will typically demonstrate an elevated serum folliclestimulating hormone (FSH), with low, normal, or nearly normal testosterone and estradiol levels. Obstructed men will typically have normal volume testes, a more full or dilated epididymis, and normal FSH levels. Obstructed patients may have bilateral congenital absence of the vas deferens or a history of vasectomy. Optimization of sperm