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Organize | Xiaodi Mi
Experts interviewed | Li Yan, First People’s Hospital of Shanghai Jiaotong University
Source | Medical Class Obstetrics and Gynecology Channel
Men’s infertility is a common problem for male doctors, and has always lacked effective treatment methods. There are many reasons for male infertility, 10%-15%are due to non-obstruction sperm-free (NOA) . In NOA, the sperm in the testicles is damaged, which is usually related to the dysfunction of the hypothalamus-pituitary-testicular axis .
NOA used to be the forbidden area of the male doctor’s surgery, but in recent years, with the development of in vitro fertilization-embryo transplantation technology (IVF-EF), the emergence of single sperm micro-injection technology (ICSI) in the cells, and testicles under microscope With the help of sperm, as long as you find a mature sperm, you can realize the desire of the offspring .
At the 23rd International Reproductive Association Alliance Conference and the 5th Pujiang Reproductive Medicine Forum, Xiaobian interviewed Professor Li Yan of the First People’s Hospital of Shanghai Jiaotong University on the issue of non -obstructive sperm -free.
The cause of “sperm -free” is very common!
NOA is mainly due to various reasons for testicular spermatogenic dysfunction (see Table 1). Professor Li Yan said: “The first cause of sperm disorders is genetic factors. This is the reason why we are the most unwilling to know and the least unwilling to see.”
“In the sperm’s sperm, 5%of sperm may have genetic defects; and in the mother’s eggs, 5%-10%of some problems are also. Therefore Inheritance to Zi Dai. But the inherited problem cannot be avoided by anyone. “
In addition to genetic factors, some reasons for the day after tomorrow will also cause sperm disorders, such as environmental factors, lifestyle, and psychological factors.
Professor Li Yan pointed out that the takeaway bento box contains the substance that affects the occurrence of sperm, and it is not recommended to use it frequently. At the same time, the length of sleep time will also affect the occurrence of sperm.
“Studies have shown that 7-8 hours of sleep is most conducive to physical health.” Professor Li Yan continued, “In addition, I don’t recommend boys to make sauna, because sperm is afraid of heat.” It can be seen that lifestyle is for sperm for sperm. It did have an impact that it could not be underestimated.
However, for patients, there is no need to be too nervous. Because of the tension and anxiety emotions, it will aggravate sperm disorders.
Treatment technology brings dawn to patients!
In recent years, with the advancement of treatment technology, patients have become possible from “sperm -free” to “essence”. Professor Li Yan believes that we have made good progress in the following aspects.
■ Use of endocrine drugs
Most male patients who are caused by the cause of no sperm-sperm caused by hypothalamus-pituitary axis shaft dysfunction will significantly benefit from using drugs to promote gonadotropin to release hormones (GNRH) or adenoids (ie HCG, HMG, reorganize FSH). [2 2 ]. If you choose to use hormone therapy to repair the testicular function, then most NOA patients can choose not to perform surgery.
The other type of drugs for treating NOA and hidden sperm patients to increase hormone parameters are aromatase inhibitors, such as Anenotzozozozozozozozozozole .
Professor Li Yan said: “Taking the aromatic enzyme inhibitors as the core, combined with hormone therapy, and combined with a comprehensive treatment method of similar PDE5 inhibitors, some sperm -free patients can produce sperm.”
■ Apply micro -surgical technology to the field ofrology
Several spermatic techniques about NOA include testicular sperm absorption (TESA), sperm map (TE -SA), traditional testicular biopsy (TESE) and testicular microcosque (MD -Tese). Studies have shown that for NOA patients, MD -Tese is a safer and more effective sperm acquisition technology .
Professor Li Yan said that through drug treatment, the possibility of sperm can be increased to 10%. Coupled with micro-surgical technology, patients may increase sperm to 30%-40%. Such progress is happy.
■ Sperm frozen and preservation technology
After frozen and thawing, only 33%of sperm of NOA patients can be used for ICSI . However, with the advancement of sperm frozen and preservation technology, it can provide conditions for better application IVF-EF and ICSI technology.
In addition, the in vitro culture technology and stem cell technology of testicular tissue are expected to glow and heat in the field ofrology.
From animals to people, facing huge challenges!
Professor Li Yan said: “In the past, we had very little understanding of the field ofrology. It was like a blind man. Now we have touched the head of the elephant, but this is not enough. We need to know a complete elephant!”
“We are facing challenges every day, and the biggest challenge is: when patients use sperm cell injection technology and microscopic technology, they still cannot find sperm. For this part of the patient, we can only persuade him to use the donor sperm.”
It can be seen that there are certain limitations in micro -surgical technology.<!-2510: Organize terminal page
“In addition, in the process of transition from animal experiments to clinical applications, because there are many blind spots, it is not feasible that the feasible technology on animals will be feasible.There is an incredible gap. “
We must realize that microscopic technology and stem cell technology are only solved some problems.Professor Li Yan emphasized that these issues are just starting points, not ending!In the future, we still have a long way to go …