ϫᐂ ү۰ᖎ̬ .................................................................................. iii நְܜԔ .................................................................................. ix 1 ᄂ៉շّ̙θ෧ᒚ۞࿅ΝăனдᄃϏֽ ........................ 1 œ 2 շّϠതր ................................................................... 4 œ 3 շّ̙θ̝߹Җঽጯ̈́ঽЯ ............................................ 9 œ 4 ჟ୵̶ ژ.......................................................................... 16 œ 5 ჟ̄ං͌া ...................................................................... 21 œ 6 ჟ̄߿જ˧̙֖া .......................................................... 25 œ 7 ჟ̄་ԛা ...................................................................... 29 œ 8 ԩჟ̄ԩវᄃշّ̙θা .............................................. 32 œ 9 շّکԌຏߖᄃϨҕჟ̄া .................................. 35 œ 10 ჟ̄া .......................................................................... 39 œ 11 ̙θাշّ۞ෲႬᄋෞҤ .............................................. 43 œ
நְܜԔ ّΑਕᅪᘣᄃշّ̙θাߏշّጯ۞˟̂߹Ą 1998 ѐ˾ ڇᘽ˯ξĂݎΑਕᅪᘣ۞ۢᙊᄃڼᒚд࿅Ν˩ೀѐ̚ѣ።Ϋّ ۞ซणĄТॡมӄθԫఙ۞൴ځĂ˵ග̙θা۞ڼᒚֽࢭّ ۞ซणĄ ࠎ˞ჟӉඕЪјΑĂࣧώՏѨౌᅮࢋજࣶ˯ᆆ۞Ķჟķঔጼ ఙĂᖣϤӄθԫఙΪᅮࢋಏ˘ჟ̄ӈਕјΑĂឰѣᖪᖪП፟۞շ ّͽ˘ࠎˠͭ۞ေຐĄݎΑਕᅪᘣ۞˾ڇᘽᄃӄθԫఙĂ ֭Ⴭࠎ 20 ͵ࡔઈ̂۞˟ีᗁጯ൴ځĄ ̙θাߏکԌࡊܝ෧૱֍۞યᗟ̝˘Ăࡗ 15% ۞͈؍ѣѩӧ ᙱĄĶ̙ԂѣˬĂ̂ࠎޢķ Ă઼̚ˠ็؟ତ۞ᑅ˧ٺҘ͞ ۤົĂග̙θাֽ͈؍ం̂۞͕நᑅ˧Ą ̙θাሕᖟ۞়ঽۢᙊă෧ᕝԫμᄃڼᒚౌܧ૱ኑᗔĄ˘ా Қ۞ᑭߤᄃ٩ҕᇴፂĂߏغזϒ૱ᔘߏ̙ϒ૱ĉତ˭ֽިᆃᏱĉ ̂кᇴ۞ঽଈऻُౌ˘ᐝᙳͪĄഇޞᗁरдܧ૱ѣࢨ۞࠻෧ॡม ̰ਕྋᛖĂԓ୕ऻُΗ˵ົར۩Ą тਕѣ˘ώૉͪ۞३ᚱֻዦĂధкႷೊٕధΞ҃˺ܓ ྋĂΞଓĂӪมଂϏѣ̬շّ̙θা۞ି३ᚱĄ
xii
շّ̙θা Ъဦ३ ۤۍ൴Җ
12 ّཛྷו፬৵Ҳ૱ٙᄵ൴۞ّཛྷҲ૱ .............................. 50 œ 13 ֯ک৵ҕা .................................................................. 55 œ 14 ߖҒវள૱ᄃշّ̙θা .............................................. 61 œ 15 Y ߖҒវពεᄃշّ̙θা ................................... 64 œ 16 Аّ͇ᗕᏮჟგε .................................................. 67 œ 17 ߟڒහপͩা .................................................................. 71 œ 18 46, XX շّা࣏ཏ .......................................................... 76 œ 19 ̙θাշّ۞ᇆညጯᑭߤ .............................................. 80 œ 20 շّ̙θা۞ᘽڼۏᒚ .................................................. 85 œ 21 ჟ৶ᐖਔѡૺ̈́ڼᒚ .................................................. 89 œ 22 ᏮჟგГତ͘ఙ̈́Ꮾჟგઘ༝ӚЪ͘ఙ ...................... 93 œ 23 ઘ༝˱ᄃ༝˱ჟ̄ᕜפఙ .............................................. 98 œ 24 डჟგܡ̝ঽЯ̈́ڼᒚ ........................................ 102 œ 25 ፬פჟఙ .................................................................... 106 œ 26 ̙θাᄃّΑਕᅪᘣ .................................................... 111 œ 27 ᒖဩٽጱշّ̙θ ............................................ 114 œ 28 ᔳ༝া၆շّ̙θ̝ᇆᜩ ............................................ 117 œ
ϫᐂ Ъဦ३ ۤۍ൴Җ
xiii
29 ٩ඵᄃշّ̙θা ........................................................ 120 œ 30 ੧ᄃշّ̙θা ........................................................ 122 œ 31 ᒉዳᄃշّ̙θা ........................................................ 124 œ 32 ۲ࡡᄃշّ̙θা ........................................................ 126 œ 33 ྻજᄃշّ̙θা ........................................................ 128 œ 34 ඊ፟͘۞̙༊ֹϡᄃշّ̙θা ........................ 131 œ 35 ͕நᑅ˧ᄃշّ̙θা ................................................ 134 œ 36 Ѯߖᄃշّ̙θা ........................................................ 137 œ 37 ̼ᄃշّ̙θা .................................................... 139 œ 38 ˠ̍Ϡതԫఙдշّ̙θা۞ᑕϡ ............................ 149 œ 39 ჟ̄ᅙҖᄃᄂ៉ჟ̄ॕᙑ۞ன ڶ................................ 153 œ 40 շّ̙θ۞Ꮩથ ............................................................ 160 œ ܢᐂ ᄂ៉շّጯᗁጯົ̝շّ̙θڼᒚ͔ .................... 164
1
ᄂ៉շّ̙θ෧ᒚ۞ ࿅ΝăனдᄃϏֽ ү۰Ęѯ႔ᓏ ᗁर
ଂ࿅ΝזனдĂᄂ៉շّ̙θ෧ᒚ۞α֧࣎༫Ξͽྏᑢт ˭ٙЕĈ
็ٕགྷរᒚ۞ڱॡ
1960 ѐͽ݈
၁ᙋ෧ᒚฟؕ۞ѐ
1960-1980
շّ̙θјࠎշࡊ۞ຽ
1980-1993
ྏგϠതࡊԫ ICSI
1993 ͽޢ
д็ᒚڱॡƂᄂ៉շّ̙θ෧ᒚ۞পᕇߏĈ 1. ՟ѣຽ ۞ۢᙊᗁᒚĂϔிֶᏥ۞ߏˠ̠Ϻ̠۞ઐ͞Ăᗁर۞͞˵к ᛳٺགྷរᒚڱĄ 2. ̃ˠࠎ۞̙θ෧ᒚĄࡇѣ͌ᇴ۞کԌࡊᗁϠ ણᄃշّᗁጯ۞෧ᒚĂΒ߁˘̈ొ̶ᗁϠ၆շّ̙θѣᎸĂ ࣇ˵ઇۤົ˯۞ିّֈĂឰϔி၆ّ۞ّϠநăϠതѣྵૄ ώ۞ໄهĄ
2
շّϠതր ү۰Ęڒϖ ځᗁर
շّϠതրΒ߁˞༝˱ (testis)ăઘ༝˱ (epididymis)ăᏮჟ გ (vas deferens)ăडჟგ (ejaculatory duct)ăᐼჟᝃ (seminal vesicle)ăᛷ᜕ཛྷ (prostate)ăԌཛྷ (bulbourethral gland) ඈĞтဦ 2-1ğĄ̚༝˱۞ΑਕΒ߁˞ᄦౄჟ̄ᄃயϠ༝( ⟮testosterone)Ąдࡣࡩ൴ֈ۞࿅̚Ă༝˱۞൴ֈՙߏٺؠӎѣ Y ߖҒ វ̈́ Y ߖҒវ˯ߏӎѣ SRY ૄЯĄ ༝˱జ˘࣎ݓ၁۞ඕᖐٙΒᖬĂჍࠎϨቯĄଂϨቯؼҩ ۞ඕᖐ༝˱ထ̶ј̂ࡗ 250 ࣎̈ཧĂՏ࣎̈ཧ̰ѣ 1 Ҍ 4 ୧ჟ̈გ (seminiferous tubule)ĂՏ˘୧ჟ̈გ ࡗܜ50 ̶̳Ă ᜇᖒд̈ཧ̰Ăჟ̄۞ᄦౄಶдჟ̈გ̰ԆјĞтဦ 2-2ğ Ą ჟ̄۞ᄦౄдჟ̈გ̝˯ϩࡪ (epithelium) ԆјĄ˯ϩ ࡪ۞јΒ߁Ϡതࡪ (germ cell) ᄃΫћӀࡪ (Sertoli cell) Ğтဦ 2-3ğ ĄΫћӀࡪࠎ˘ّ͚ࡪĂ͚˞ჟ̈გ۞ၹ ౄĂιТॡ˵ߏჟ̈გ۞ᒉዳࡪĂ̙ᕝ۞೩ֻዳ̶ගϠത ࡪĂֹܳϠതࡪ൴ֈјჟ̄Ą
շّ̙θ̝ ߹Җঽጯ̈́ঽЯ
3
ү۰ĘૺԈѯ ᗁर
շّ̙θ̝߹Җঽጯࢍྤफ़ ֶፂᄂ៉շّጯᗁጯົĂ̙θ̈д 2011 ѐ੫၆ᄂ៉гડշ ّ̙θাᓜԖপᇈ̶۞ژಡӘĄᇹώᄓะଂϔ઼˝˩˛ѐ˘͡Ҍ ˩˟͡ࠎഇ˘ѐĂϤέ̂ăέΔၷᓁăΔᗁăາЍ̈́ј̂ᗁੰ̝ շّᗁጯົ̙θ̈јࣶВТԆјĂВᄓะ 308 ЩᇹώซҖࢍ ̶ژĄ Ր෧۞̙θշّĂঽΫѣ 1 ז2 ѐĂΚ 56% ࠎкĂ 3 ѐΚ 12.7% Ă 4 ѐΚ 6.0% Ă 5 ѐΚ 7.3% Ą ܑ 3-1
Ꭾଈ̙θঽΫ̝ॡม̶Ҷڶې ঽΫѐᇴ
ˠᇴ
Ѻ̶ͧ
<1 1-2 2-3 3-4 4-5 5-6 >6
2 42 42 19 9 11 26
1.3 28.0 28.0 12.7 6.0 7.3 17.4
4
ჟ୵̶ژ ү۰Ę ޜ؟ڒᗁर
ٙᏜჟ୵̶( ژsemen analysis)ĂಶߏշّಏѨड۞ჟ ୵Ăਖ਼Ҍ၁រ̼ވរ̶̈́ژĄѩ˘ՎូĂੵ˞Ξͽ˞ྋྍҜշّ ჟ୵̚ჟ̄۞хдଐԛ̈́ჟ̄۞ݡኳĂ˵ΞͽᑒӄԧࣇᎡᑭϠ തΞਕхд۞યᗟ়ٕঽĄЯѩĂჟ୵̶ߏژෞҤշّϠതਕ ˧˘࣎ࢦࢋ۞̍Ă͍дշّ̙θাଈ۰۞෧ᕝ˯ĂՀԷႊ࠹ ༊ࢦࢋ۞֎ҒĄ
ჟ୵۞ଳะ ჟ୵̶˘ژฟؕࢦࢋ۞ՎូĂಶߏྏצפ۰۞ჟ୵ĂЯ ̶۞ژඕڍटזצٽଳะ͞ё۞ᇆᜩĂ߇ϒቁ۞ଳะ͞ёĂΞͽ ᑒӄԧࣇזՀቁ۞ᇴፂĄͽ˭ܮЕଳะჟ୵ٙυืڦຍ۞ ೀีࢦᕇĈ 1. ଳะჟ୵݈༰ᇒ 2~7 ͇Ą ༰ᇒ۞ॡม͉ൺĂჟ୵ณ̈́ჟ̄ᇴณົഴ͌ć҃༰ᇒ۞ॡม͉ ܜĂჟ̄߿જ˧Ξਕົ˭ࢫĄ
5
ჟ̄ං͌া ү۰Ęች۾Ϡ ᗁर
݈֏ ෧ᕝշّ̙θাॡĂࢦࢋ۞˘ีᑭរಶߏჟ୵̶ژĄдჟ ୵̶̚ژĂົѣͽ˭Чણᇴ۞ീณඕڍĞҭ่̙ࢨٺдѩٙЕ ۞ğĈჟ୵ณ (semen volume)ăᓁჟ̄ᇴ (total sperm number)ă ჟ̄፧( ޘsperm concentration)ăᓁ߿જ˧ (total motility)ăѣड़߿ જ˧ (progressive motility)ăх߿( ޘvitality)ăჟ̄ԛၗ (sperm morphology)Ăͽ̈́ᅕែ( ޘpH value)Ą ֱણᇴ۞ϒ૱ࣃߏགྷϤ̶̂ژఢሀ۞ࡁտඕڍٙĞ͵ ࠧϠᖐ 2010 ѐğ Ăϒ૱ࣃ۞˯ă˭ࢨЧߏܑ 95 Ѻ̶Ҝᇴ (percentile) ̈́ 5 Ѻ̶ҜᇴĄࢋڦຍ۞ߏЯࠎ࣎ˠჟ୵ݡኳົᐌॡ มԼតĂ߇ჟ୵̶̙ژਕΪઇ˘ѨĂ҃ߏᅮҌ͌ેҖ˟ƂˬѨĂ ྵਕ࣎פˠჟ୵ݡኳ۞ૄࣃ (baseline data)Ą
6
ჟ̄߿જ˧ ̙֖া ү۰Ęች۾Ϡ ᗁर
݈֏ дჟ୵ݡኳ̶۞ژણᇴ̚Ăᄃҋᘃθѣᙯ۞࣎ણᇴಶߏ ჟ̄߿જ˧ĞΒ߁ᓁ߿જ˧ (total motility) ᄃѣड़߿જ˧ (progressive motility)ğ Ąᕇдܕഇٙ൴ܑ۞͛ᚥ̚ĞBuck Louis ඈጯ۰ 2013 ѐ̈́ Bjorndahl ି 2010 ѐ۞ኢ͛ğ ĂΞͽԱזᙋፂĄ͍ߏ ྻϡˠ̍Ϡത۞јΑத˵ᄃჟ̄߿જ˧िि࠹ᙯĂՀពჟ̄߿ જ˧дߙֱܑ˯ޘჟ̄۞צθ˧Ą
ؠཌྷ дീณჟ̄߿જ˧ॡĂॲፂາ۞͵ࠧϠᖐ 2010 ѐ۞ᇾ Ăߏჟ̄ѣځពഫજĞྮशࠎۡቢٕ̂ԛğ۞ჟ̄ᇴϫҫ Бొჟ̄۞ᇴϫּͧؠཌྷࠎѣड़߿જ˧ (progressive motility)ć҃ Бొົજ۞ჟ̄ᇴϫҫБొჟ̄۞ᇴϫּͧಶߏᓁ߿જ˧ (total motility)Ą҃ѣड़߿જ˧ᇾ۞˭ࢨĞ5 Ѻ̶Ҝᇴğࠎ 32% Ăᓁ߿ જ˧ᇾ۞˭ࢨࠎ 40% Ą˲ߏҲٺѩ˟ણᇴᇾ۞˭ࢨĂಶჍ̝ ࠎჟ̄߿જ˧̙֖া (asthenozoospermia)Ą
7
ჟ̄་ԛা ү۰Ęڒϖ ځᗁर
̦ᆃߏჟ̄་ԛা ჟ̄་ԛা (teratozoospermia) ᖎಏ۞ᓾಶߏჟ̄۞ݭၗ̙ϒ ૱Ąॲፂ͵ࠧϠᖐ ٺ2010 ѐ̳ٙҶ̝ௐ̣ۍჟ୵̶ژણ҂ᇾ ࣃ (reference value)âҜշّ̝ჟ̄ࡶֶ Kruger/Tygerberg ጯ۰ٙ೩۞ᚑॾᇾֽᑭߤĂჟ̄۞ݭၗЪྍᇾ۞ࠎϒ૱ ჟ̄Ăٙᑭߤ۞ჟ̄̚ĂΪࢋඈ ٺٕ̂ٺ4% ̝ჟ̄γݭϒ૱Ă ӈࠎϒ૱Ą࠹ͅ۞Ăٙᑭߤ۞ჟ̄̚Ă̈ ٺ4% ۞ჟ̄ݭၗϒ ૱Ăಶߏჟ̄་ԛাĄ
ࣃ˘೩۞ߏĂ Kruger/Tygerberg ጯ۰ٙ೩۞ෞҤ͞ྵڱ ࠎኑᗔĂυᅮ פ5-10 ̿۞ჟ୵ཉ˯ͯࠟٺٸĂͽߦͩߖҒ (Papanicolaou stain)Ăдពᙡڵᙡ˭ ̂ٸ1000 ࢺĂ៍၅֭ᐂ Ҍ͌ 200 ჟ̄۞ݭၗĄࡶܧܝଂְϠതԫఙ۞ᗁᒚੰٙâ ਠ۞ᗁੰᑭរٕވϔมᑭរಏҜĂޝᙱซҖᇹ۞ᑭߤĄ
8
ԩჟ̄ԩវᄃ շّ̙θা ү۰ĘዑྈϠ ᗁर
͈۞؍Їң˘͞ჟ̄༊ઇγֽۏĂו፬ҺࠪࡪயϠ၆ԩ ჟ̄۞ԩវĂপჍࠎԩჟ̄ԩវ (antisperm antibody)Ąॲፂ Cline ᗁरд 2009 ѐٙ൴ܑ۞ಡӘ̚Ă̂ࡗѣ 10-15% ۞շّ̙θ া ࡗ15-20% ّ̙̃θাߏЯԩჟ̄ԩវ͔Ą̂ొ̶ϒ૱۞ ّ̙֭̃ົ၆Ω˘Η۞ჟ̄யϠԩჟ̄ԩវĂྎࣧЯϫ݈̪̙ ĂΪਕᄲ˯ޓ౹ౄّ̃ତצշّĂග˞࣎ҺࠪপధĂˠᙷ ̖ͽᓄࢉϠϠ̙िĄࠎ̦ᆃົயϠԩჟ̄ԩវѣޝкଯኢĂΒ ߁അགྷϠതրຏߖঽΫĞт٣җෂğٕ۰ߏѣ༝˱͘ఙٕຫ๋ ঽΫĂٕഅགྷତצᏮჟგඕ͘ఙඈඈĂҭߏ̂ొ̶ࣧЯ̪̙ځĄ շّ̃Ϲडჟ̝ޢĂ˼༱ჟ̄̂ᐌӈֽ̄זझᐚௐ˘ ᙯΙĂॡтڍѣԩჟ̄ԩវĂົ෭ܢдჟܑ̄ࢬĂጱჟ̄ົ జ̄झᐚᕆ୵᚜ၟጿд̄झට̝γĂჟ̄ಶ̙ਕז྿ᏮӉგᄃӉ ̄ඕЪĄԩჟ̄ԩវтڍඕЪٺჟ̄۞ԍొࢫົҲჟ̄۞߿જ ˧Ăಶზჟ̄စࣁ఼࿅̄झᐚז྿ᏮӉგĂтჟ̄ᐝొܑࢬᕆ ѣԩჟ̄ԩវĂჟ̄˵̙ࡍٽ࿅Ӊ̄γಛ۞( ځzona pellucida) ᄃӉ̄צჟĂซ҃ౄј̙θĄΩγĂ͌ᇴԩჟ̄ԩវົו፬ ّ̚Ϩҕ̈́λጥࡪ͔൴Һࠪͅᑕֽᗼჟ̄ϠјĂౄјჟ
9
շّکԌຏߖ ᄃϨҕჟ̄া ү۰Ęౘ࣒ཐ ᗁर
کԌຏߖߏکԌࡊܝ෧˩̶૱֍۞়ঽ̝˘Ăͽշّ҃ ֏Ăд˘ਠکԌࡊܝ෧̚ĂΞਕ่ѨٺඕϮᄃᛷ᜕ཛྷ۲̂âਠ ៍֏҃˯هĂϤٺշ̃Ϡநၹౄ̙ТĂЯѩĂکԌຏߖкͽ̃ ّࠎĂ҃ͷࢋߏͽާّ჻ܑۆனĄͽշّ҃֏ĂکԌຏ ߖтֶڍ൴Ϡ۞ଐԛ̶ֽᙷĂ̂˯Ξ̶ࠎާّ̈́ၙّᙷ̂Ă ҃ࡶͽ൴Ϡ۞ҜཉֽᄲĂ૱֍۞Ξ̶ࠎ჻ۆăᛷ᜕ཛྷ̈́ۆ༝˱ ̈́ઘ༝˱ۆඈೀĄ૱֍াېΒ߁ѣᐛԌăྋԌূ൭ăྋԌ ӧᙱă൴፵ăࠦರăԌ୵፩ٕೋਙඈাېĂтྵͧڍᚑࢦ۞ଈ ۰ࠤҌΞਕனҕԌăᓘԌҌࠤҌЯԌྮրຏߖ͔۞ୀҕা ඈĂӮѣΞਕ൴ϠĄΩγĂдা̶ొ࣎ېĂυืপҾᄲߏ۞ځ тڍѣާّᛷ᜕ཛྷ൴ۆĂ૱ົҡᐌѣ྆ާ۞ࢦޢাېனĂੵѩ ̝γĂࡶᛷ᜕ཛྷ൴ۆซणјࠎၙّᛷ᜕ཛྷ൴ۆĂଈ۰૱ົЯЧ ଵԌা҃ېҌܝ෧ಶ෧ĂΒ߁ѣᐛԌăྋԌӧᙱăົౚొূ൭ٕ ණ൭ă˭ཛొূ൭ඈাېனĂЯѩĂд੫၆ѩᙷଈ۰ڼᒚ˯Ă ᗁरܮᅮՀྎг˞ྋଈ۰۞࿅ΝঽΫĂͧྵਕૉઇϒቁ۞෧ ᕝĄ༊Ăѣ͌ᇴշّଈ۰ߏЯࠎඪ۟ඪۆĞܸჍඪ൴ۆğ҃ Ҍܝ෧Ր෧Ă҃Ϥ఼ٺ૱ѩᙷଈ۰૱Ъ׀ѣԌྮրܡĞтඕ
10
ჟ̄া ү۰Ęڒϖ ځᗁर
1992 ѐĂ༊̙θা۞ڼᒚซˢಏ˘ჟ̄ពڦड (intracytoplasmic sperm injection, ICSI) ̝ޢĂྋՙ˞ధкշّჟ̄ං͌া ۞યᗟĄЯࠎΪࢋጴᖣ˘ჟ̄Ăಶѣ፟ົͽ ICSI ˠ̍Ϡതࡊ ԫૻ࢝צჟĂ҃྿זᘃθ۞ϫ۞Ąܕѐֽ̏ѣధк۞ ICSI ᚗᚗౙ ᜈኚϠĄҭߏдշّ̙θা۞ଈ۰̚Ă̪ѣ 15-20% ߏᛳٺჟ ̄া (azoospermia)ĄϺӈĂдଈ۰ٙड۞ჟ୵̚Ա̙זЇңჟ ̄Ąޝព۞ĂࣇۡڱତӀϡ ICSI ԫఙ྿צזθ۞ϫ۞Ą
ჟ̄া۞෧ᕝᄃࣧЯ ჟ̄া۞෧ᕝυᅮѣҌ͌Ѩჟ୵̶۞ژᑭវĂགྷ࿅ᗓ͕ ޢĂ˭פᆸᗓ͕Օ፥ۏᑭរߏჟ̄۞ᑭរඕڍĄ ౄјჟ̄া۞ࣧЯҌ̫̪ϏԆБځᒢĂֶঽЯΞ̶ј༝˱ ݈ă༝˱ᄃ༝˱ޢĄ૱֍۞ࣧЯΒ߁ߖҒវள૱ăჟ൴ۆă̙ ༊۞͘ఙγ๋ăăА͇ྋ࣠ၹౄள૱ăјˠམཛྷۆăߋܦഇ ൴ֈ̙։ăᔳ༝াă༝˱ԮᖼăෲႬᄋள૱ăᏬडडăૄЯள ૱ඈĄᓜԖ˯Ă̪ѣధкଈ۰ᛳࣧٺЯ̙ځĄ
11
̙θাշّ۞ ෲႬᄋෞҤ ү۰ĘเԠኰ ᗁर
݈֏ շّ۞ϠതΑਕΞ̶ࠎჟ̄۞ᄦౄᄃჟ̄۞ྻਖ̶਼ొ̂Ą ჟ̄ᄦౄ۞Ҝཉߏ༝˱Ąჟ̄ᄦౄԆјޢĂజᏮਖ਼זઘ༝ĂГڻ Ꮾჟგਖ਼זडჟგԌ̚ĄᖣϤౚఀݎᄃडჟ۞જүĂჟ ̄ଵវγĂ҃አଠჟ̄ᄦౄ۞Я̄âߏइ࠹̢ᇆᜩ۞ෲႬ ᄋրĄ࣎րଂ˯ഫ۞˭ෛĞhypothalamus ĂҜٺมཝ ˭͞ğ Ă̚זഫ۞ཝ˭ཛྷ (pituitary gland)ĂГ˭זഫ۞༝˱มኳ (testicular interstitium)Ăԛј˘࣎ˬ࣎ᆸ৺۞ෲႬᄋአଠրĂଠ טჟ̄۞ϠјĞ֍ဦ 11-1ğ Ą
˭ෛ۞ෲႬᄋ ˭ෛΞᄲߏϠതෲႬᄋ۞༼ޠᕇĂд˭ෛ྆ࢬ۞ৠགྷ̮ ົ༼ّޠгăฉഇّг̶کĶّཛྷו፬৵ᛖٸ৵ķ ĂᖎჍĶّᛖ ৵ķ Ğgonadotropin releasing hormone Ăᒺᆷ GnRHğ ĂѩෲႬᄋົ ו፬ཝ˭ཛྷ݈ཧ (anterior pituitary) ۞ࡪĂֹّک̶ཛྷו፬৵ (gonadotropins)ĂГΝו፬Հ˭ഫ۞༝˱Ą
12
ّཛྷו፬৵Ҳ૱ ٙᄵ൴۞ّཛྷҲ૱ ү۰ĘเԠኰ ᗁर
݈֏ ّཛྷו፬৵̶کณ࿅ҲĂТॡ༝⟮̶کณ˵ໂҲ۞ଐԛĂΨ ઇĶّཛྷו፬৵Ҳ૱ٙᄵ൴۞ّཛྷҲ૱ķ(hypogonadotropic hypogonadism)Ąଐԛયᗟдཝ˭ཛྷ۞ّཛྷו፬৵̶̙ک ֖ĄࣧЯΞͽߏࣧ൴ّĞidiopathic Ăٕ primary Ă˫ჍࠎА͇ ّĂࡻ͛ߏ congenitalğ ĂٕߏѨ൴ّĞsecondary Ă˫Ⴭّ͇ޢĂ ࡻ͛ߏ acquiredğ Ąͽ˭ಶᓜԖܑனᄃ̶ᙷ۞ͧྵү˘ᄲ ځĂТॡ၆ڼᒚ͞ڱᄃڼᒚΞਕ۞ഇඕڍઇ˘ፋநĄ
ّཛྷו፬৵Ҳ૱ٙᄵ൴۞ّཛྷҲ૱۞ᓜԖ ܑன ᓜԖܑனͽّཛྷҲ૱۞াࠎېĄΒ߁ّᇒҲăّΑਕε አăБ֗˧ăវͨංழඈĄাېᅮॲፂঽଈߏࣧ൴ّٕѨ ൴ّ۞়ঽ҃ؠĄ
13
֯ک৵ҕা ү۰ĘเԠኰ ᗁर
݈֏ ֯ک৵ҕা (hyperprolactinemia) ߏҕ֯̚ک৵ (prolactin) ፧ޘ࿅۞˘ঽၗĄঽଈ૱׀൴ѣّཛྷΑਕҲ૱ (hypogonadism) ۞ଐԛĂጱّΑਕᅪᘣ (erectile dysfunction) ᄃ̙θা ۞யϠĄώౢܝ੫၆֯ک৵۞Αਕᄃک̶አଠĂᄃ֯ک৵ᄃ ϠതΑਕ۞ᙯܼઇคĂГჸ൏д֯ک৵ҕাтңّ͔ཛྷΑ ਕҲ૱۞፟ᖼĂͽ̈́ϫ݈၆֯ک৵ҕা۞࠹ᙯڼᒚซणĂᄃт ңԼචঽଈ۞ϠതΑਕઇ˘࣎எˢ۞ᄲځĄ
֯ک৵۞Αਕᄃአଠ፟ט ֯ک৵ߏཝ˭ཛྷ݈ཧ̶ٙ࣎˘۞کᷴ H ᙷෲႬᄋĂүϡΞ ͽֹܳ֯ཛྷ۞൴ֈᄃ۞֯کજүĂТॡ˵ણᄃϠതΑਕ۞አ ༼Ąд౦ᙷĂ֯ک৵ಶߏԷႊϠܜ፬৵۞Αਕćдࣲ֯ᙷĂඕ ၹ˵ᄃϠܜ፬৵࠹ҬćдጎᙷજۏĂࡶາϠ۞ρဂ̷ੵཝ ˭ཛྷ݈ཧĂТॡྃ·֯ک৵̝γ۞ٙѣ݈ཧෲႬᄋĂົ൴னρဂ
14
ߖҒវள૱ᄃ շّ̙θা ү۰Ęڒϖ ځᗁर
շّ̙θাΞਕᄃߖҒវள૱ѣᙯ ॲፂለ߷کԌࡊᗁጯົ۞ࢍĂдշّ̙θা۞ଈ۰̚Ăࡗ ѣ 40%~50% ߏᛳࣧٺЯ̙̝ځշّ̙θাĄᗁጯछࣇ࠹ܫĂ ֱࣧЯ̙۞ځౄჟᅪᘣ఼૱ᄃߖҒវள૱ٕૄЯள૱ѣᙯĄ ॲፂଯҤĂѣᇴ˼࣎ૄЯᄃˠᙷ̝ϠതѣᙯĂҭߏϫ݈дᓜ Ԗ˯Ă੫၆շّ̙θাଈ۰Ăਕᑭീ۞࠹ᙯีϫΪΒ߁˞Ĉ 1. ߖ Ғវள૱Ą 2. ᝃཚញჯাૄЯ (cystic fibrosis transmembrane conductance regulator, CFTR) ࡎតĄ 3. Y ߖҒវពε (Y chromosome microdeletion)Ą̚੫၆Аّ͇Ꮾჟგεଈ۰ٙซҖ۞ CFTR ૄЯࡎតᑭീĂᄃ੫၆ჟ̄ං͌াଈ۰ٙซҖ۞ Y ߖҒវ ពεᑭീĂٺώ३̚ౢ༼ѣซ˘Վ۞ᄲځĄ ˠᙷѣ 23 ၆ߖҒវĂΒ߁ 22 ၆វߖҒវᄃ 1 ၆ّߖҒវĞӈ X ߖҒវᄃ Y ߖҒវğ Ąϒ૱շّߖҒវјࠎ 46, XY ẵّࠎ 46, XX ĄߖҒវள૱Ξͽᖎಏડ̶ࠎߖҒវᇴϫ˯۞ள૱Ăּт к˘ٕ࣎͌˘࣎ߖҒវć̈́ߖҒវඕၹ˯۞ள૱ĂּтߖҒវ۞
15
Y ߖҒវព εᄃշّ̙θা ү۰Ęڒϖ ځᗁर
Y ߖҒវពεߏշّ̙θা૱֍۞ࣧЯ ̝˘ дˠᙷ Y ߖҒវܜᓖ˯ѣధкଠט༝˱ౄჟΑਕ۞ૄЯĂܕ 20 ѐ۞ࡁտ൴னĂొЊշّ̙θাଈ۰۞ Y ߖҒវѣពε (microdeletion) ۞ଐԛĄЯࠎֱૄЯ۞εĂጱჟ̄Ϡј۞ ᅪᘣĄ˘ડม۞ߖҒវజЩࠎ AZFĞazoospermia factor Ă ჟ̄াЯ̄ğ Ąѣ Y ߖҒវពε۞շّੵ˞ౄჟΑਕᅪᘣͽ γĂ̙ົѣܑன۞ݭள૱Ą Y ߖҒវពεϫ݈̏జᄮࠎ ߏ่Ѩڒߟٺහপͩা (Klinefelter’s syndrome, 47, XXY)Ă૱֍ ౄјշّ̙θা۞็Я̄Ą
Y ߖҒវពε̝ᑭീ Y ߖҒវពεЯࠎε۞ડાྵ̈âͽڱਠߖҒវ ᑭߤ͞ڱᑭរֽĂυื٩פҕ୵̚۞Ϩҕ DNA ĂֹϡჸЪ 㤲ాᗆͅᑕ (polymerase chain reaction, PCR) ֽᑭീĄϫ݈Ă̙֭