Diagnosis and treatment of testicular failure

Spermatogenic failure patients, refers to the small infertility and testicular biopsy in patients with no mature sperm. Microrchis disease g


Spermatogenic failure patients, refers to the small infertility and testicular biopsy in patients with no mature sperm. Microrchis disease generally refers to the Klinefelter syndrome (47, XXY) for meiotic nondisjunction due to neutral (60% 40% occurs during spermatogenesis in oogenesis process); chimeric Klinefelter syndrome (46, XY/47, XXY) is due to the mitosis of fertilized eggs the sex chromosome separation, chimeric Klinefelter syndrome accounted for about 10%; there are rare situations, such as 48, XXYY, 48XXXY etc.. The incidence of Klinefelter syndrome was 1/1000 ~ 1/500. The phenotype of Klinefelter syndrome was male, and the typical clinical manifestations were as follows: small and hard testes (median testicular volume was 4 ml). Studies have shown that the incidence of breast cancer in patients with Klinefelter syndrome is 50 times higher than that of normal men. The serum testosterone level of patients with typical syndrome was decreased from 50% to 75%, and the levels of serum FSH and serum LH were increased in 90% patients with Klinefelter syndrome. Due to the increase of estradiol in the surrounding adipose tissue, the increase of estradiol / testosterone ratio caused the male breast hyperplasia. Testicular biopsy showed that the seminiferous tubules were generally hardened, and occasionally the individual seminiferous tubules contained Sertoli cells and spermatozoa. These patients need to solve two problems: low levels of androgens such as testosterone, with low testosterone supplementation recommendations, testosterone supplementation is not for the purpose of improving fertility, but for their own health (health problems of life and other body systems); fertility problems: such as semen in the sperm, then do IVF childbearing, but there is a risk that the fine day, the man has not taken the risk of sperm, can only temporarily save frozen eggs and the woman, generally recommended third generation IVF (preimplantation genetic diagnosis (PGD), namely before implantation, one cell embryos were screening to avoid the mother or the father of genetic disease transmitted to the next generation), such as no sperm, generally can only use a sperm bank to achieve fertility purpose; child; Some patients can consider microscopic fine, the use of surgical microscope may find sperm, and then through the test tube baby technology to achieve the purpose of fertility.

For small testis disease or testicular biopsy were found in patients with azoospermia sperm, sperm micro technology makes it possible to find in testicular sperm so as to have their own biological offspring, and less likely to testicular injury. Micro fine technology, surgical microscope can enlarge the field of vision of 20~25 times, in the seminiferous thicker and more opaque tube for sperm, greatly improving the efficiency of data show that find sperm, sperm micro technology to find the overall probability of sperm was 63% (a more detailed data show that the probability of finding sperm in spermatogenic dysfunction in patients with azoospermia, 81% mature, block 42%, the Sertoli cell syndrome was 24%), far higher than traditional testicular puncture in 45%, and on the testicular damage, micro fine technology in testicular tissue of 9.4 mg in 160000 can be found in sperm, while traditional testicular puncture technique on average in the testis of 720 Mg in 64000 sperm, in addition to avoid damage to the important blood vessels in the testis. Study on Klinefelter syndrome abroad show that the non chimeric no sperm in the semen of patients with Klinefelter syndrome about 50% micro sperm can be found even by ICSI sperm; Klinefelter's syndrome patients, their offspring also often have normal chromosomes (foreign literature 49/50), but also do not know the normal sperm Klinefelter syndrome the patient is derived from normal spermatogonial cells or by meiosis corrected; Klinefelter syndrome patients sperm acquisition is almost the same rate and general non obstructive azoospermia patients with Klinefelter syndrome is about 47% (50/106), non obstructive azoospermia patients is about 50% (188/379), but after using ICSI technology the insemination rate is lower than that of patients with non obstructive azoospermia, respectively 57% and 65%, pregnancy rate and abortion rate were similar, respectively 55 and 53%, 12 and 11.5%.

From No.3 Hospital of Beijing University professor Tang Wenhao



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