!"#$%
&
' ()*+
,
-
%
&
./012213456738$
9:;*<=>.?@01ABCDE!9
FG0(#H0!I9JK "F
LMNOI06P Q,BLR$
=>.
?SK CTIUL0VW "MNNO
)6X6!YPG0(#0Z"3"[.\*"W
M]]NLJ )O7!^R$ "Y6.7
R$2=>.\K 52 "3"[W
)^P.1* _R0`9G0(#,
)"FH0.?:5;WCa0b
c)\dUSM"e )].]]]G0(#"W=7>!=6>.
?;Z\Lfg(c)a0bc)\R_M]]N
)Y]]R(h E!6<]]R(iTi0j`0
a0^N=>.
\05W1k\K C3"Fl
0FbB"Cf Vm +9IZ2R
j`06!6PMN<7!6!NPMNO06!^PMNOO.
JMNN]! )n62f Vm 5
"$ChQ
!Zb )OPG0(#Z3"[oh
M"B=6<>.\) h4NN78)pKp
"EI0Z\qWPG0(# 3
"[=^>.
c4NO<80rK4NN68=6O>!=Y7>R1*d6X7PG0(
# )M*).cKq0f s
r 4NN8=Y]>+9oI99M5.t2L
0_:7P 017PZgmZR$
R$.
\ 2M,"L9 AB0`!Z R
(!" 01R1"GR1F9hBR
b!uv.0`9w" 0"FH0F_"B
"3!``0FWx!v`SRWH5W.\
J"EF\Lg()"R(`!+v
`w" 0"FH5WRkiTi!iy.
\R1AzG0(#{09F0
2,*"CG0(#,"FH002
|C"FH0"GZ"H9a4q0@
MC\fJ8.JR0jR5x",9"C
0 h0F0 "#!;0!
"G$01"HC9a}\.bfJ*00`9A
"Fk !
"#$%&'()*+, /010
2./0103015k
14 !567$( !"#
$%&')*+, /010
2./0104
/4 89)*+:;<=
>4
0(#
!"#$%
&
' ()*
+,
-
%
&
.\K 5x]]G0(#
@ Y]GR<0
)7GR~=>!=.\$W1R1* )
7]XO]R$H0=Y^>.
9$~49;h0i8kR$2R
d, •0x49;h0ii8R$
2"E*+,.
2kqR$(95L0
R$0(!;095L0 R$#.
%95LR$(0M0
D|M;+995L .\ A
WL0 0(W )Y]P!0 )Y]P
0 )0(#]P.1ABC hv`!,
12R$H0B"FH"R(40$8R;
X6P)M400€0z8=>!=6>!==N>.
141414;++*$?9@
\3x•W\W1A5xdMNO]"WM
NO<5O7]]G0(#Z66L7Q5
95L0 +9ktR1BI0 #
6
OP!0(6^P! )67P=Y^>.t0@` c 95L
#WP! 0(W6P! )WP=6N>.?SK 3
x9M]]]OX]PGH{0=Y^>.\5
, 9 )7]XO]R$0.\95R$
1{+"0Z~0A5W1.\I
1{0Z02,o. 95L 2
)6]XY]P30 # )]X6]P.\d7X6]P
95L )0(0#.J95LL90%
W )7X]PG=>.
u5xC)qK4]]]8=6N>WZ]
OQLb`+9I09$~ )_6P
GZ"3"[;I0x _ +
F.\K 5C‚fƒMNO7I09$~0
xZQR=]>k
! "# "#
?Lb aK 6P ]P
?K P 66P
VK9 YP ^P
\„ 7P 7P
?Luv a„ P 6]P
? YP YP
KK„K P ^P
b 6P OP
?L …X \
aUR_
aK YP 7P
†/ 6P OP
uD YP 6P
i KD ^P 7P
\q P 6P
J P 7P
1414/4;++*>
Y
tJ!I0S !K WQ)"FL
MNOI06P=>.J5xC)‡J`
qL4NN78!I0ZR10 )^P"W]PL=>.ˆ,
"L9_!WQ)"FC)bMl9F4]]]80\,\H
bR_u4NNN8 +9I0ZR10 )]P"W
7P=6>!=<>.\ 5x5_]]]L"FHC
)SM?x4NN]8!0 0(6N.P!95L #
6O.P! ).7P0%95L.6P=Y>.\K
)‡J`qL4NN]8!I0 0(W7Y.7P! #W
6.P! )6.7P0%95LN.NP=>.u5
xC)J9zV{q50A5]]]L0
"FH00aau‰\ccdMNN6}NN^!",9"C
D|M;!I02W7Y.7P!0W
67.<P00%95LWN.NP=]>.
FI2cJb0c\bK 5xJRk
$ % &' "# "#
SM?x=Y> NN] OY!YP 7!<P
abc\dUS=6> NNN <!7^P O6!Y6P
J9zŠLa=> ]] <P 6OP
J9z/xu=Y> ]] 7N!YP Y]!<P
F95LL9c\bZ!K J9zŠ%a~4]]8=>I
H"#+R$76!^P! "@!O7P!I
@9W<P.\K J9zV{q54NNO8!Ic\b
6<!P! "^7!YP {0;x!!NP e =]>.
7
?;K J9z/xu=Y>Ic\bY]!<P! "7<!^P {
0;x.\ {0S‹!OPw9!Y!^^P"[!!OP
0!N7P"G0.\K bJR\) 95L0
2I _04Y^!7P 016]!<P8!0%
95LWI]!NP.c\b)9 eWI
+<O!^P!;"GO!P=O>.\K J9z
q\) 0x 95L0;xW )]X7P
00^7!YP 02e$=^>.
\K CTIUL0VW "MNNOf
JIG0(#0W )6X6!YPZ"3"[.
($ )*+,-.!/0 $ )-1/
14/414>?5A
1.2.1.1. Vô sinh do rối loạn quá trình trưởng thành và phúng noón
be EWQ)củaALo!W0"#C
,R_!0@R1"#!9W950#x.
#xe W )]P95L02.
\3x•WW14N^<8L 0 #xe
~e"L9k
Jkc9R1"#X9W95k
a F95LRT9W95!+R_0@
",! 9W95zwG Gzw`
)4ac 8! 9W95"[ M9W+
F4xcKK8! zwR !pK!
Œ DLz!zH G0M.
<
Jk• xMR1"#X9W95
aLB E! G| E.
?:"H"FH R$(9@**#
x! EB"C1Ž**e 0_
@0 #.
J6kc9#x
Xc9#x1k\R$D+Z3R1Y]012B
R 99+ $.U+
1CRQEA5R! )!0E#
0F"5!z*"!)M`| w" A0 +
L0B#"ycf .?:"H"FH R$
(9 D E GD.
Xfx#xkqAz!"L9
9KWGC9#x1.J95L ~e
BxW ** E{01BC
.
JYk\3R__Qw G{)
J7k2 M 013R_C0@R1
"#X9W95.
J<k2 M "R(3
R_5FGC0@R1"#X9W95.
J^kb203R_0@R1"#X9W9501
x R$9+.
1.2.1.2. Vô sinh do bệnh lý toàn thân và những cơ quan ngoài hệ sinh dục
^
X Lk\!!`
X Wk / "R$! aK s! d
p K!R(`
X R‹kc9R‹!dL!|
1.2.1.3. Vô sinh do viêm nhiễm đường sinh dục dưới
5z"R$R1W )]P2"W
01FLL9`!+?!p!
?9\ ! 59"3"bf L"
0)RZ1)MC@R10 "R(
#.\ R$(95L0 05z
"R$R1!0$
-
9$•
•
50"FHo"G
L" !"
•
(&
-
9$•
•
B"E""R(WQ).
...Y. 3
?3*‘! e3!B
@ +,93
1.2.1.5. Vô sinh do tắc vòi tử cung
0;W6]XY]P95L020I
9MZR_\L9.?F_WC00;R
_W*{0;0 xM0;\? 3R__ G
xM G))M".
J95L",z@B.5B
?9\ GJKK KKZ2 "3
"[.\K ‚K !0Wx5P05,
+.JW05,^7PH0.JFLH
O
{0;\?!+L D|#"
B01?9 .
5dBL9)RZ"WA 0‘C0;
R3R_"W1 C0;B*%"W
5 C0;!CB_.USBL9
zw’L,’!`*3R_1 C0;
L95*‘!`*{0;xL95{0;
x Gˆ“T.
u"L9SL93R_0;k
X? \?
Xbj`0;\?!J 0;x...
X?j`Z0;\?!3ˆ“T
Xq\?
1.2.1.6. Vô sinh do tổn thương thực thể ở tử cung
XTD_k\R$*L90R$L9w9
G"[ !95*R$(BL90 0`9,
j`LD_Q GZ.
Xb 9#k?)Z3$%90!w"
9K#o0;x G5L_R1
#.
Xl)Ju\?
XU*a\?d,C` mŒ.
1.2.1.7. Các bất thường bẩm sinh của TC
N
?H`0H`R$L9)9!"[ !*)
RZ"W)M.?H`97
XJ"Bk
V 5 L9 x • 9
XVKXf K
XJk
J3!d!x5k\R$”
`5x.
Jd!3!R$0MhL"
J3k9G+ 907P9
:5`0Q).
XJ0M
/L9H`3W+!W1,7H.?
B0M,9 ,.
XJ
q H`9+WG!D+50M
,!dX301L" ! G5
3!0ML
XJB)
\+|Z2 "3)!R$”01Z
G*‘K .=^>!R$GZfx\K!9R‹
,h.
]
1.2.1.8. Vô sinh không rõ nguyên nhân:
/0M!M;
"R(+m95L d0( G#.
14/4/4>A?5B/CD
J95L0+"R"R( k
XJ95L .
•J95LR1
•J95L
XJ2 L9)ZA9B@02
0FxM ".
1.2.2.1. Nguyên nhân do rối loạn quá trình tạo tinh trùng
.....J9$L W4R1 8
234 5!+)*)-
•fxVk"L9*" BM
WR1L9.• xM0+R$0F
C0@R1"# G9W95B9"3Q3
(0WW R1)#"ycf0qf
.f`Q)QH), G
,"W0.a*9FA5W(01x
+xB 9,./L9x9F
K z{BŠ! "W5" KVpqiˆXZ{
\R1LB`9,)€"Wx
V.
2*6"78+9
JR$0jB*ŽC"0**
R$.J#"qf!\K K R$.U
Wycf@ H"#+* G./FH
fuˆ LŽ)"R(Q.
2$ : ;<='>$
XfxbKX‚k\5LR$| !R_
A_Ž !,`!90L~!L+0
9.a*" Wˆ•f #"
qf!ycf L+.fxbKXsD)9+
" ,CJc\7
XfxqKKu aKaKKkaBo9
BM R1!0$0d{!H`
9 GLF!,.
230+*+:+*+.$';
•c)D+QF Kkf R1H) #
" K ~Q~R‹!R( K#d!
G 9B+R$9)D+p K.
• W“ Qx
V#"“ QxŽxW9W95)D+
R1.c9 xB95LC
MW“ oZ,0~9WR(` G .
?W cK GW ŽB)
D+“ K=<>.
• Mb
b W @9R19W95 .J
pU h K K KK0@#zWW
AW0 C9W95.U "+)9W
)RZ"WR(b R_S"F)RZ
W5AWWb C9W95.?R(+ *
U Žj"W**W RL,!
U !xWBf
!9W.
Mb "FH@9K d95L.JW
9B 9xM9W)"FH9W
9W*(.JW )dR_x
G"3@~.UA~+"#0`U "B"FH
9W95Ra GuKK =6>.
•ˆ kqR(ˆ Žx
WWqf!`Q))#"p K 0L9
xM .ˆ M ?
G HW9.f) 5jWB
BM0W ;dRZ.
1.2.2.2. Nguyên nhân tại tinh hoàn
J95LZ 9G+.? –
#0H*!R(!0xMC .
2?+@0<='
XV Z5)LWG01,
+]!]]7P./FHAW13`9‹A]]\K K
“5{gX6,.\95Bz"
*A50CL=6>.
XV 5G01,+]!]P.V"x
MC HWB"R(@oA "C
5.JW5L+9"R( x‹e:"H
?\ G•ui.\f?ˆ0"HR(pufH
‹0‹e "@C 5.
6
2?+@0'A B%
V {)B5 G5.F95
L!R$BGR+R_!j`!z0w G
0!D { "R(Q.j`W
+~ "+ 00`90:"H
j`0@‘,"R(L{.J –*C
0F95{";~){~ G) .\
R$(RF9W){~) .
23C++D/E/F+GH+@0
aR$ D10 Q–6Cm.Uh
K "R$9Bd0@{RR1"W` BH
dZ+m" .\:GX6Pn[_"C.\9
5<]P6"[ DA5.?
Q"DC .
X\ wk\ oZ5‘! 3 GZ
e0B+99$+9"R(.
X\ gk\ o "R$"DR$
C.*oZ"@.
X\ ‘kJo"H ‘.
X\ R(k\ o"HZgC‘0
B$H|4G8DR10 !95WG
R(Z0F0H*Sk—\ ;D ˜
Y
X\ "H4 ""8k\ 0H*9
"3!"H!o20‘.*)D _
G! 9BA dg9g.
23C++DI'A +J
Xa+R$0FR(k
•fxVK™KK
qx9G+CR(M:n7]]!
z{BY^ŠŠ^.
aLB5 1!0e ! ~!R$
R16
6
"{.Š|@ H•D|
W#"ycf0qfM "K K
)!w" D"H$z{"#dW 9 .
•fxŠ••
fx9:n]]]1.\R$+R$
0FL! 0FxMj WC
BZx".aLB)R$ G
0.aL:"R(z{"#.
Xa+R$0F+ez{BkJR$ +
R$5Jc\1*05Jc\R$.
•u+" 5z{B•
JMN^<!\K 0š™™<R$(
@H+" 1Z,DCz{B•QL
*9 9K0"R)9WQh0F" pšy.V9F
LB!F5x"E"R(20+"
pšy5Q"W09BR1"L9R$"R(
7
%95L.0A$•5Q01@
pšy!pšy!pšy.20+" D)9 60@9R$j
"W2 QR)D+@
9)D+@+*.
f9!v`w" +" 5z{B•"EA
"R(ZJ.?:"HCD|9R$(9
_ C0+" z{B• #k@ G
BG4`"@›7n8.V) R1",a
0\dUS +9 )]PL9_ W
Q)R_*.
•u+" 5z{BR$
J$9FL! hB%_0F5Q
2_•#2BR–3{Ž!
W W9W9! 9 0+)j
5.ˆKK?y\•5"R(+9$~Cz{B
x^BL9 5.U "F)9W
o+)j5Bx‘C
D_9BD_ .
qL @GF!WQ)D|
H!D| ycf0W +9"3.cA)D+
\K K H)RZw" D"H$0 z{"#.?
"W90jR"FH"R(95L9R01v`ic?ie
0jB L 0"x[~K.
23C++D/E C+GK ++GL
?+R$0F+eC@"R( 2W"30F
hC@.
•\@",;
<
U D{DW QRZj"WA
",@ Z9ˆ *{ 01F@!
A",@B"LD950 0@
Cx"R(.
•fx +"
q–9FG5Jc\R$.q)M9BC
@HW.
•fxN•]
aR$"@NG0L 00
G0oZL.JWG0ZL‹"
@""R(.Fw" kV+9R@
R+"9")€"WW9W+e.
VB"FH95L5.?:$i?ci"B .
2M+N'O +P+
qR(€C"€L9K
‹0 o” .?6x".
/k?eR:$"R(E€e
004MA8.
/kc$"R(E€%9)e
0.
/6k\+9"R(E€95ZRWL"x.
/FHE€v`3"BZL G_
Z Q Gv`L9D_*R1 GR(
;+)o" AR€.
"FHE€d"B 9;"
E=<>.
^
27: ; Q R+*<0@"SG+@,T<C+%+*<0@'9'
aB +9W ,.?W ,
"0 .
aLR$ 5K ~!`"F!H"#
@R"G*BR$!
#"ycfM!qf0K K R$ GM‘.
J95L 9F+" ~5Jc\1*0
z040*05 QH80+R$0H* !
+"!LHd5 "R0 0WDe01D.
12BW9R$0jRB"FH"R(
95Lx:W cK
2P+G4.$+G+
a–9"R(D"Ho)jh!A"D)9
Z" 95 ! _+ Gx+ GZ
" F@.
F95L +R$+eJc\!DH!H
G– L.
f9R"FH"R(95L.?:@v`\“c“"B
"FHi?ci.
2U@R!+GF/0VO+GF
fH9B3R_"WW ,!xM
H3R_.?W ,"Gj)"01D!WDe01
W ,zH3R_0#.
2U@/-'+@0
aQH3`9%90$ 5 )6]P.
\K BD+ZLH0 G0M.
O
aB)RZ"W 0 %90$
~Ž!W(05 .a`0
"R("FHS95LL90 05
.
1.2.2.3. Nguyên nhân sau tinh hoàn
2-'I'8DUW+
X5 +0E*
X59WF+0E*k
•5F9W+ 0w
•5F9WE* 0w
•5F9WE* 0w
•5F9Wx
X5e
fWz"_"R$(0105F./B
H.
X5" +
?HW",R_0`!)x9~e"B.
2A X8DUW+
\R$"R(L"0D|
H"#+9@.
2Y,@O/E/F+GH+H +Z+UF
?+R$w G{)ZR_0`!" G
R_CR_0`Bj"W A*H0
@ xM).
N
•Š+R(;kU H0j"R(~e
R0 Qx" .Š|@
R1B (.
•Š+`
? (WR$RL)
"R( .c ( :_H1
)9dd.
•VD+kUR_0`"CR_x"B (R
BD+"R(!+9 )A".
• R$R_
U R_R_ ("R($"R
@CR$#0 L" CR$0("B.
1.2.2.4.Một số yếu tố ảnh hưởng đến khả năng sinh tinh trùng:
\!DH!" !"!$A!z
R$!W"M!D_!9` "F)RZAW G
W1)M
* Chế độ ăn uống:
?W"MW+Rkp| !pp4"G
p80ŽB)RZAW5 0L9)
.\W0aB)RZ"WQ )RZ
AW59W950W5 .\W0p%9 ~
~@!W0“ŽL93R_@!W?
)R(0+R(@.
]
ˆ,"L9FQ"B oxM"R$x
Fh*“ K9W!W*L9!BxW
.
a| SM9_@9W!)"""
@6]P!W:Q~%‹)""]P.
* Tăng nhiệt độ tinh hoàn:
tR$!"ZR$+_L )
]
?.\
R$( D G w!QŽH
R.\ A!R$+9+ehC Ž
9"3W D.c56O!7 ?BxWQ
$<.J xW!"
BL93R_pUJC@.\ K0?c.4NNO8=^>
AL*5F "E`M")
0M:@H.\)9S oZ2
DWDK"R$!B RW#L0"F0W
"M!j"W)00.
\ 5xa0b)\dUS!A
5Y]]G0(#"W0!`+9LF
DW"R$:+R$0F""C@
+ 019_4]]8=7>.J !5x9S
+9+R(@)1ZL0
R$2FRk/,W!(!(9
!(;
* Sức nóng:
* Hoá chất:
Jz" GR!?0C9L
BL9)0L90.eF0R(S
B)RZAW)=6<>=^>.J5xa0
b)\dUSS +9+R(@)Z2R$e
0R(.
?dL!~BL9)RZ5Q.
/G! DS"R(`"5Q0
BL90.lm‹‹A+9)01F
+#0.
\dL02_"E"R(F5xx
"D+"WQ~‹!)R(0+
R(@.?"BAW5QZ
! G$~9W.udL"E
"R( ` B L9 ) @ R ? K K! “9KK
U K.f,W2_"AW5
=^>=Y>.
\ 5xJ!WQ)) S +9
FWDe01dL!0F`"!"
"0R$"F) 01WDe=7>.
* Ảnh hưởng của phóng xạ:
\95 " L+9)01D!
95 !0@*H)RZ_.\9
5!WWDe01DR$" !+) W
"FH)RZBj"W0#.J !G@
QB#RDBL93R_
z{B0L9+R$ZW=6]>.U "!Z2L
DH"B"FHR!R$B2@R1HD"B
9)M)CL.
* Từ trường:
JR$`odR$01,+0R$"
BL93R_Q=6]>.u5x!M]]!
S"E`dR$"B95L)RZ"W
0L90=66>=^>.\ R$9!dR$
C9W"R( ZWH"!WH" G
"R$j9F".ˆ,"L9!R$ odR$ "
"L901, 0R$"SB)RZ
W"WQ "59W95=6]>.
* Các thuốc điều trị các bệnh lý nội khoa:
\K ‚fƒ4]]]8!"R(`B)RZ"W
Rk W ! ?KKK! c„K! c K!
J ™ !J„ K!? K=6>.
)14148E$F%G4
$ 8:
JW
? G KL9xW9W
95!BxW0K
?KKK œW01 K!xW
c„K \"AW5Q
c K •W"C K
J ™ \"AW5Q
J„ K •WQ
? K •WQ
?"FHRR$xWQ.f,
W~~"#+"FHR"F)RZF"WQ
0L90$.\ "e!e )O]P
6
R$(B#7M=^>=67>./#$!3R_z
{BZ@"FH+S"R(`./L92
3R_B9F .
* Các bệnh toàn thân:
?– L"F*F)RZ"W "C
!RF"R(e–.?–+*
GR~!#_!+R_!j` "FxWx
M .
c9`*j"W "F;R1"#9W950
WxWxM .c9*L9 W!
j"W)!K !2!)xM
.?–0F"R$5!9Wh!W"F"R(
)Q.t2L–*!
R$) GR !C9W "C
R_"FHRRDH!H.
* Các yếu tố khác:
X\3kJ1"W )Y]3#"\K K A
),! #"cfaˆ} {Wˆ
M,!I KnK K)0BMqf!ycf !
#"iS)7P.cA)@)6]PZ37]
XO].\95!0[A9 "K 3
0 W.JFR$ 3 B9"$
0)M).
Xˆ (R$D95.cR(@)"WD+
9 GR$D95.JR(!W5 (]XY9
Y
G_2Ž)""C@0MR(
@0 ~ ~.
Xfmk?Fox +9G
4ž]"Wn98)K K K0)""C@.
J–dMZ5SR(@9).
X\`B* G`BS"R( L
~.JR(F5x +9`BQx)RZ
"WR(0+R(@%.
X\$*| R1D+BM+
R(@.
Xu+R1"G $B)R(0"
"C@.
XJF5x +9+R(@D+0 3
F_3 #"pK _x`94d<
"WR8R_"R_01#"pKHMŸ
XcKk/EF5xxoAMŸ,
| )RZ"WQ)D+‹ASR)
MC1.
7