男性肿瘤患者精液冷冻保存后常规参数分析

目的:了解男性肿瘤患者精液质量现状,探索保存男性肿瘤患者生育能力的方法。方法:对来源于2005~2013年浙江省人类精子库43例肿瘤自精保存患者的精液质量进行回顾性分析,检测项目包括精液体积、精子浓度、精子活力、精子冷冻复苏率等指标。比较肿瘤患者与供精志愿者(248例)之间精液质量的差异;并将肿瘤患者分为睾丸肿瘤组(22例)和非睾丸肿瘤组(21例),比较两组之间精液质量的差异。结果:43例肿瘤患者精液的平均精子浓度(60.90×106/ml)、前向运动精子百分率(41.07%)及精子冷冻复苏率(49.98%)均显著低于供精志愿者(分别为74.27×106/ml、51.79%和57.33%),P均<0.05;睾丸肿瘤组的冻后平均前向运动精子百分率(15.68%)与冷冻复苏率(42.81%)均显著低于非睾丸肿瘤组(分别为28.36%和57.53%),P均<0.05。结论:肿瘤患者精液质量普遍下降,进行自精保存的时机非常重要,应该加强自精保存的宣传力度。另外,睾丸肿瘤患者精液冷冻保存效果较差,精子库应对其冷冻复苏率低下的原因进行深入研究,优化冷冻保存技术,为患者提供更好的生育力保护。     

重庆市人类精子库捐精志愿者精液质量分析

目的:了解重庆市人类精子库捐精志愿者精液质量,探讨年龄对精液质量的影响。方法:收集重庆市人类精子库899例捐精志愿者精液样本,根据年龄分为5组:22~25岁、26~30岁、31~35岁、36~40岁、40岁,使用Makler板人工计数,分别进行精液体积(ml)、前向运动(PR)精子百分率(PR%)、精子总活力[(PR+NP)%]、精子浓度、精子总数及正常形态精子百分率检测,并与世界卫生组织《人类精液检查与处理实验室手册》第5版(以下简称WHO第5版)的参考值进行比较;各年龄段的精液参数指标采用中位数表示,比较精液质量差异。结果:899例捐精志愿者精液参数第5百分位数精液体积(1.8 ml)、精子浓度(25.0×10~6/ml)、精子总数(100.7×106)和正常形态精子百分率(4.3%)均高于WHO第5版第5百分位数参考值,PR%(31.0%)、(PR+NP)%(38.0%)低于WHO第5版第5百分位数参考值;精液参数中位数精液体积(4.0 ml)、精子浓度(88.0×10~6/ml)、精子总数(333.7×106)高于WHO第5版中位数参考值,正常形态精子百分率(11.6%)低于WHO第5版中位数参考值,PR%(55.0%)和(PR+NP)%(61.0%)与WHO第5版中位数参考值一致。精子浓度在22~25岁、26~30岁、31~35岁、36~40岁、40岁年龄组分别为88.0(1.0~270.0)×10~6/ml、96.0(5.0~335.0)×10~6/ml、100.0(3.0~200.0)×10~6/ml、105.0(15.0~225.0)×10~6/ml、90.0(22.0~159.0)×10~6/ml,在各年龄组间有显著性差异(P0.05),精液体积、PR%、(PR+NP)%、精子总数和正常形态精子百分率在各年龄组间无显著性差异(P0.05)。结论:重庆市人类精子库捐精志愿者精液质量普遍较好。随着年龄的增长,精子浓度呈显著性升高,但40岁以后精子浓度呈显著性下降。     

腹腔镜精索静脉高位结扎术对精子质量及妊娠结局的影响

目的探讨腹腔镜保留动脉精索静脉高位结扎术对精子质量的影响。方法回顾分析33例我院2011年4月至2012年7月因不育就诊的精索静脉曲张患者,并行腹腔镜保留动脉精索静脉高位结扎手术,分别比较手术前后精液各参数变化,包括精液容积(mL)、精子浓度(×10~6/mL)、前向运动精子百分率(%)、前向运动精子总数(×10~6)等。结果腹腔镜保留动脉精索静脉高位结扎术后精子浓度(29.20±26.69)×10~6/rnL、前向运动精子百分率(31.33±16.21%),前向运动精子总数(34.81±36.19)×10~6与术前精子浓度(13.72±17.43)×10~6/mL、前向运动精子百分率(17.06±10.25)%,前向运动精子总数(8.06±8.42)×106比较,均有统计学意义(P0.05),其中15例手术后1年中女方怀孕,妊娠率为48.48%。术后精液容积(3.80±1.24)mL与术前相比(3.66±1.60)mL差异无统计学意义(P0.05)。结论腹腔镜保留动脉精索静脉高位结扎术可以明显改善不育伴精索静脉曲张患者的精子浓度、前向运动精子百分率,前向运动精子总数,而精液容积无改善。48.48%不育症患者手术后1年内可使女性正常怀孕。     

恩替卡韦治疗男性慢性乙型病毒性肝炎对生殖功能影响的临床研究

目的:探讨恩替卡韦治疗男性慢性乙型病毒性肝炎后对其生殖功能影响。方法:收集2015～2018年慢性乙型肝炎男性患者接受初始恩替卡韦治疗56例,年龄18～45(33.14±5.38)岁;收集健康志愿者24例作为正常对照组[近期有怀孕生育史,21～45(32.62±5.94)岁]。观察乙肝治疗组和正常对照组在年龄、BMI、生殖激素水平、勃起功能(勃起功能国际问卷IIEF-5)及精液质量参数之间的差异。初始恩替卡韦治疗(0. 5 mg/d抗HBV治疗24周)后比较治疗前后乙肝治疗组BMI、生殖激素水平、勃起功能及精液质量参数之间的差异。结果:乙肝治疗组与正常对照组比较:年龄、BMI、生活习惯及生殖激素水平等因素中除了FSH水平和E2水平组间存在显著差异[FSH(3.92±1.29) mIU/ml vs(3.08±0.85) mIU/ml,P=0.003;E2(35.79±7.49) pg/ml vs(28.25±7.09) pg/ml,P<0.0001],其余均无明显差异。各项精液参数(精子总活动率、前向运动精子百分率、精子浓度及精子总数),乙肝治疗组均明显低于正常对照组[精子总活动率(37.75±13.33)%vs(49.58±9.27)%,P=0.004;前向运动精子百分率(30.70±10.03)%vs(42.46±8.90)%,P<0.0001;前向运动精子百分率(30.70±10.03)%vs(42.46±8.90)%,P<0.0001;精子浓度(51.51±19.50)×10~6/ml)vs(70.33±30.62)×10~6/ml,P=0.007及精子总数(160.2±51.8)×10~6)vs(225.91±97.97)×10~6,P=0.002]。乙肝治疗组IIEF-5评分显著低于正常对照组(19.32±2.34 vs 21.25±2.35,P=0.0006)。恩替卡韦治疗24周后,与治疗前的精液参数,精液量、精液pH、禁欲天数均比较无显著性差异。精子总活动率、前向运动精子百分率、精子浓度及精子总数较治疗前均有显著提升[分别为精子总活动率(37.75±13.33)%vs(44.1±11.89)%,P=0.004;前向运动精子百分率(30.70±10.03)%vs(38.30±7.42)%,P<0.0001;精子浓度(51.51±19.50)×10~6/mlvs(62.00±24.64)×10~6/ml,P=0.007及精子总数(160.21±51.8)×10~6vs(207.65±81.69)×10~6,P=0.0002)。同时治疗后乙肝治疗组IIEF-5评分较治疗前显著升高(20.13±1.82 vs 19.32±2.34,P=0.02)。结论:恩替卡韦治疗慢性乙型病毒性肝炎时,肝功能改善明显,勃起功能及精液质量明显提高。     

IVOS Ⅱ与SCA精子质量分析仪对精液检测结果的比较研究

目的:比较Hamilton-Thorn IVOSⅡ全自动精子质量分析仪(IVOSⅡ)及西班牙SCA全自动精子质量分析仪(SCA)的计算机辅助精液分析(CASA)系统对精液参数检验结果的差异性。方法:收集2018年9～10月99例就诊患者的精液标本,根据精子浓度分为3组:A组(15×10~6/ml)、B组[(15～50)×10~6/ml]和C组(50×10~6/ml)。采用IVOSⅡ、SCA及显微镜人工方法对同一精液标本同时检测,比较IVOSⅡ和SCA对精子浓度、前向运动精子百分率及活率检测的一致性以及重复性。结果:IVOSⅡ与SCA对A组精子浓度的检测结果显著高于显微镜人工方法[(10.24±4.60)×10~6/ml、(10.20±5.11)×10~6/ml vs(8.45±4.15)×10~6/ml,P0.05],但是IVOSⅡ与SCA对B组[(30.95±11.84)×10~6/ml、(31.81±12.90)×10~6/ml vs(29.14±10.65)×10~6/ml]以及C组[(102.14±45.97)×10~6/ml、(109.48±46.32)×10~6/ml vs(104.74±41.87)×10~6/ml]精子浓度的检测结果与显微镜人工方法相比无统计学差异(P0.05)。IVOSⅡ与SCA分别对B组的前向运动精子百分率[(24.21±14.62)%vs(23.92±15.42)%]与活率[(37.48±19.34)%vs(37.69±16.61)%]以及C组的前向运动精子百分率[(30.80±12.06)%vs(32.98±16.10)%)]与活率[(44.50±15.62)%vs(47.26±17.46)%)]的检测结果差异无统计学意义(P0.05),然而IVOSⅡ对A组的前向运动精子百分率[(18.54±12.96)%vs(22.90±12.88)%]与活率[(26.97±14.05)%vs(34.90±15.18)%]的检测结果显著低于SCA(P0.05)。SCA及IVOSⅡ对精子浓度、前向运动精子百分率、活率检测结果均具有良好的重复性(CV值均15%)。结论:IVOSⅡ与SCA精子质量分析仪对精子浓度、前向运动精子百分率和活率的检测结果均有较好的一致性,但对于低浓度精液的精子浓度、前向运动精子百分率和活率的检测结果可比性较差。     

左旋肉碱虾青素复合营养素治疗特发性少精子症和弱精子症的多中心临床观察

目的:研究左旋肉碱虾青素复合营养素(梦兰康)治疗特发性少精子症及弱精子症的临床疗效。方法:293例患者纳入本研究,其中少精子症73例,弱精子症220例。患者口服左旋肉碱虾青素复合营养素1袋,每日2次,连续服用3个月,分别于治疗前及治疗后第1、2、3个月进行精液分析检测及精子DNA碎片指数(DFI)检测。结果:服用左旋肉碱虾青素复合营养素1个月后及2个月后与用药前相比,少精子症患者精子浓度[(16.74±11.15)×10~6/ml、(17.56±9.92)×10~6/ml vs(10.96±6.09)×10~6/ml]、精子总数[(52.98±32.07)×10~6、(57.67±36.98)×10~6vs(29.78±17.48)×10~6]、前向运动精子百分率[(45.3±14.03)%、(46.42±10.69)%vs(39.8±11.66)%]均显著提高(P0.05);弱精子症患者前向运动精子百分率较用药前显著提高[(25.46±13.86)%、(27.33±12.88)%vs(19.23±8.32)%,P0.05]。服药3个月后与用药前相比,少精子症患者精液量[(3.63±1.39) ml vs(3.07±1.47) ml]、精子浓度[(20.56±14.7)×10~6/ml vs(10.96±6.09)×10~6/ml]、精子总数[(66.35±55.91)×10~6vs(29.78±17.48)×10~6]、前向运动精子百分率[(49.24±13.45)%vs(39.8±11.66)%]、正常形态精子百分率[(2.59±0.93)%vs(1.71±1.07)%]均显著提高(P0.05);弱精子症患者精液量[(3.85±1.59) ml vs(3.27±1.42) ml]、前向运动精子百分率[(29.11±13.58)%vs(19.23±8.32)%]、正常形态精子百分率[(2.57±1.15)%vs(2.01±1.14)%]均显著提高(P0.05)。服药1个月后少精子症及弱精子症患者精子DFI较服药前均无明显改善,连续服药2个月及3个月后,少精子症患者精子DFI较用药前显著下降[(18.66±10.83)%、(16.48±11.46)%vs(25.87±13.76)%,P0.05],弱精子症患者精子DFI较用药前显著下降[(19.35±11.54)%、(15.32±10.89)%vs(26.40±12.28)%,P0.05]。结论:左旋肉碱虾青素复合营养素(梦兰康)可以显著改善少精子症及弱精子症患者精液质量。     

精子DNA碎片指数与精液参数的相关性分析

目的:探讨精子DNA碎片指数(DFI)与精液参数的关系,并评价其在男性精子质量评估中的应用价值。方法:收集9 694例男性精液标本,采用流式细胞仪辅助的精子染色质结构分析法(SCSA)进行精子DFI和高DNA着色性(HDS)检测,根据WHO《人类精液检查与处理实验室手册》(第5版)精液参数参考值标准分为正常组和异常组,异常组再依据精子浓度、精子总活率和前向运动精子百分率异常程度分为A组:精子浓度(11.3～14.0)×10~6/ml,精子总活率30%～39%,前向运动精子百分率24%～31%;B组:精子浓度(7.5～11.2)×10~6/ml,精子总活率20%～29%,前向运动精子百分率16%～23%;C组:精子浓度(3.8～7.4)×10~6/ml,精子总活率10%～19%,前向运动精子百分率8%～15%;D组:精子浓度(0～3.7)×10~6/ml,精子总活率0～9%,前向运动精子百分率0～7%;按照不同DFI值分为15%、15%～30%和30%3组。分析DFI与精液参数的关系。结果:正常组DFI均显著低于异常组及其亚组(P均0.01);各异常亚组(A、B、C、D组)随着精子指标的降低DFI逐渐升高(P0.01)。根据DFI分组,发现DFI与年龄、禁欲时间、精液体积、精液pH、精子浓度、精子总活率、前向运动精子百分率、正常形态精子百分率以及HDS的差异均有统计学意义(P均0.01);相关性分析表明DFI与年龄、禁欲时间、精液体积和HDS存在正相关(r分别为0.15、0.10、0.05、0.15,P均0.01),而与精液pH、精子浓度、精子总活率、前向运动精子百分率和正常形态精子百分率存在负相关(r分别为-0.06、-0.27、-0.53、-0.52、-0.16,P均0.01)。多重线性回归分析表明精子总活率、精子浓度、年龄、禁欲时间和精液pH是与DFI相关的5个重要相关变量,标准化回归系数分别为-0.47、-0.19、0.12、0.07、-0.04,P均0.01。结论:DFI与精液参数存在中等相关性,二者可协同评估男性精子质量。     

CSRM数据报告:2008～2018年中国健康男性精液质量变化分析

目的探讨近10年中国健康男性精液质量的变化情况。方法中华医学会生殖医学分会(CSRM)收集2008~2018年向中国七家精子库8 989位捐精者基本情况及精液参数,按照WHO《人类精液检查与处理实验室手册》标准分析精液体积、精子浓度、前向运动百分率和正常形态率等参数。资料分析方法采用ANOVA分析、偏相关分析、线性回归分析等。结果研究对象总样本量为8 989人,平均年龄为(26.26±5.35)岁。2008~2018年间,精液体积、精子浓度、精子总数、总活力百分率、前向运动精子百分率、精子正常形态率各参数均值有统计学差异(P<0.001);偏相关分析控制年龄、BMI因素,结果显示精液体积、精子总数、前向运动百分率、精子正常形态率均与时间呈负性相关,系数分别为-0.177、-0.135、-0.104、-0.084(P<0.001)。线性回归分析显示精液体积、精子总数、前向运动精子百分率、精子正常形态率变化与时间相关,均呈下降趋势(β=-0.148、-9.988、-0.134、-0.695;P<0.001)。结论 2008~2018年间,中国健康男性精液质量随时间变化呈下降趋势。     

生殖支原体感染对男性不育患者精液质量的影响

目的:探讨泌尿生殖道生殖支原体(MG)在男性不育患者中的感染情况及其对精液质量的影响。方法:收集2015年3月~7月来南京军区南京总医院生殖医学中心门诊的352例不育患者的精液标本。MG感染采用实时荧光核酸恒温扩增检测技术(SAT)检测,精液分析根据《WHO人类精液检查与处理实验室手册》第5版进行操作,分析精液pH值、精液量、精子总数、精子浓度、精子总活力、前向运动精子百分率(PR)、不动精子百分率(IM)、精子DNA碎片化指数(DFI)等。数据统计用t检验(t-tests)与非参数检验(Wilcoxon test)方法。结果:不育患者MG感染率为3.4%(12/352);比较MG阳性与MG阴性不育患者间精液分析结果发现,MG阴性患者在精液量[(3.84±0.12)ml vs(2.85±0.14)ml,P=0.008]、PR[(23.57±0.99)%vs(15.86±1.72)%,P=0.032]均要显著高于MG阳性患者,DFI[(20.71±1.55)%vs(30.73±2.24)%,P=0.014]则显著低于MG阳性患者。而精液p H值(7.39±0.01 vs 7.38±0.02,P=0.774)、精子浓度[(60.05±4.29)×10~6/ml vs(52.96±15.78)×10~6/ml,P=0.683]、精子总数[(221.56±15.43)×10~6vs(154.15±46.37)×10~6,P=0.236]、精子总活率[(33.52±1.51)%vs(29.04±3.11)%,P=0.626]、IM[(62.34±1.69)%vs(60.95±5.63)%,P=0.691]组间均无统计学差异。结论:本研究证明:男性不育患者泌尿生殖道MG感染患者并不在少数,应引起重视;泌尿生殖道MG感染对精液质量有潜在负面影响,特别是精子活力。     

受孕女性配偶精液质量研究

目的:研究正常生育力(无避孕同居生活12个月内使配偶获得妊娠)男性精液质量水平,并分析到达妊娠时间(TTP)与精液参数相关性。方法:招募年龄在18⁵0岁之间,妊娠到达时间12个月内的男性,填写问卷、体检和精液分析,计算精液参数正常参考值范围,探讨TTP和其他生物学特征对精液质量的影响。结果:1 152例年龄范围1850岁之间,妊娠到达时间12个月内的男性,填写问卷、体检和精液分析,计算精液参数正常参考值范围,探讨TTP和其他生物学特征对精液质量的影响。结果:1 152例年龄范围18⁵0岁的男性接受精液检查,精液体积(ml)、精子浓度(106/ml)、总精子数(106)、活动率[(PR+NP)%]、前向运动精子[PR(%)]、正常形态精子百分率(%)、精子存活率(%)、前向运动精子总数(106)第5个百分位数值分别为1.5、17、39、41、33、5、53和17。年龄≥35岁组前向运动精子总数较少(P<0.01);高体质量指数(BMI>25.0)组正常形态精子百分率较低(P<0.01),低体质量指数(BMI<18.5)组精子浓度、总精子数、正常形态精子百分率和前向运动精子总数较低(P<0.05);吸烟降低精液体积(P<0.01);饮酒超过10 g/周减少精液体积、总精子数、正常形态精子百分率和前向运动精子总数(P<0.05);TTP与精子浓度、总精子数和前向运动精子总数呈负相关(P<0.01);对象禁欲时间550岁的男性接受精液检查,精液体积(ml)、精子浓度(106/ml)、总精子数(106)、活动率[(PR+NP)%]、前向运动精子[PR(%)]、正常形态精子百分率(%)、精子存活率(%)、前向运动精子总数(106)第5个百分位数值分别为1.5、17、39、41、33、5、53和17。年龄≥35岁组前向运动精子总数较少(P<0.01);高体质量指数(BMI>25.0)组正常形态精子百分率较低(P<0.01),低体质量指数(BMI<18.5)组精子浓度、总精子数、正常形态精子百分率和前向运动精子总数较低(P<0.05);吸烟降低精液体积(P<0.01);饮酒超过10 g/周减少精液体积、总精子数、正常形态精子百分率和前向运动精子总数(P<0.05);TTP与精子浓度、总精子数和前向运动精子总数呈负相关(P<0.01);对象禁欲时间5⁷ d组的精子浓度、总精子数和前向运动精子总数高于其他组(P<0.01)。结论:正常生育力男性精液参数第5个百分位数值与世界卫生组织的正常参考值范围基本相同;TTP数值与精液质量呈负相关。年龄、体质量指数和生活方式会对部分精液参数产生影响。     

Efficacy of sperm wash media in improving sperm motility

Spermatozoa from 15 fertile men were washed with Ham's F10 and incubated with two commercially available sperm nutrient media for 2, 4, 6, and 24 h. Both sperm capacitation medium (Irvine Scientific Co., Santa Ana, CA) and Pro-ception (Milex Products, Inc., Chicago, IL) proved to be capable of improving sperm motion characteristics. These media may be used for incubating sperm for intrauterine insemination or for in vitro fertilization.     

Stability of sperm characteristics in men with disturbances in sperm quality

Sixty-one men referred to our laboratory for semen analysis, and subsequently judged to exhibit some form of sperm pathology, were asked to return for a second analysis, not less than 2 months after the first, in order to assess the stability of the pathological changes observed. In almost half of the cases, the referring physician had, on his own initiative, started hormone or antibiotic treatment. The sperm parameters studied included sperm count, sperm motility judged by laser-Doppler spectroscopy, and sperm morphology and viability. The motility characteristics included percentage motile, their average velocity, and percentage swimming in a progressive manner, and their progressive velocity. In untreated subjects, there was no significant difference between the first and second analysis in any of the sperm parameters measured. This was also true for both oligozoospermic individuals (less than 20 x 10(6) sperm/ml) and the group with higher sperm concentrations. All parameters were highly correlated on the two occasions. The average coefficients of variation of the paired observations were highest for sperm count (approximately 25%) and lowest for sperm velocities and the proportion of abnormal and viable cells in the ejaculate (1-9%). No major differences in the extent of variation could be detected between the low and high sperm density groups. In general, the unsystematic antibiotic and hormone regimens (clomiphene or androgen) used by the referring physicians had no discernable effect on any aspect of sperm quality, indicating the need for more controlled and standardized programmes of treatment.     

Evidence favoring sperm selection over sperm competition in the interaction between human seminal plasma and sperm motility in vitro

The effect on sperm motility of sperm-sperm and sperm-seminal plasma interactions was studied among homologous and heterologous sperm. There were no significant interactions between sperm in vitro, but it was found that seminal plasmas of different donors have different effects on sperm motility, and different sperm react differently to the same seminal plasma. Sperm showed higher motility in a pure physiological solution than when mixed with seminal plasma, even if the plasma and sperm came from the same donor. Various plasma components are responsible for this modulation of sperm motility. It would appear that large numbers of sperm are adaptive, among other things, because they are involved in sperm selection.     

精索静脉曲张患者精子运动速度和ATP含量的比较研究

为了探究精索静脉曲张患者不育的原因，采用多次曝光法和生物发光法测定精索静脉曲张患者精子运动速度和三磷酸腺苷（ＡＴＰ）含量，并与有生育能力的健康男性精子进行比较，结果显示静索静脉曲张患者精子运动速度和ＡＴＰ含量显著低于正常对照组（Ｐ〈０．００１，Ｐ〈０．０１）。８例精索静脉曲张患者在作精索内静脉高位结扎术后６个月，其精子运动速度和ＡＴＰ含量与正常对照组无显著性差异（均Ｐ〉０．０５）。精子的ＡＴＰ含量     

Accurate sperm morphology assessment predicts sperm function

Sperm morphology has been associated with in vitro as well as in vivo fertilisation. The study aimed to evaluate the possible relation between the percentage of spermatozoa with normal morphology and the following sperm functional assays: (i) zona-induced acrosome reaction (ZIAR); (ii) DNA integrity; (iii) chromatin condensation; (iv) sperm apoptosis; and (v) fertilisation rates. Regression analysis was employed to calculate the association between morphology and different functional tests. Normal sperm morphology correlated significantly with the percentages of live acrosome-reacted spermatozoa in the ZIAR (r = 0.518; P < 0.0001; n = 92), DNA integrity (r = -0.515; P = 0.0018; n = 34), CMA(3) -positive spermatozoa (r = -0.745; P < 0.0001; n = 92), sperm apoptosis (r = -0.395; P = 0.0206; n = 34) and necrosis (r = -0.545; P = 0.0009; n = 34). Negative correlations existed between for the acrosome reaction, and DNA integrity, while negative associations were recorded with the percentages of CMA(3) -positive spermatozoa, apoptotic and necrotic spermatozoa. Sperm morphology is related to sperm dysfunction such as poor chromatin condensation, acrosome reaction and DNA integrity. Negative and significant correlations existed between normal sperm morphology and chromatin condensation, the percentage of spermatozoa with abnormal DNA and spermatozoa with apoptotic activity. The authors do not regard sperm morphology as the only test for the diagnosis of male fertility, but sperm morphology can serve as a valuable indicator of underlying dysfunction.     

Relationship between sperm telomere length and sperm quality in infertile men

Telomeres, noncoding and repetitive DNA sequences play a significant function in chromatin integrity. Telomere length is age-dependent in somatic cells, while it increases in sperm cell with age. Therefore, we aimed to assess sperm chromatin, leucocyte and sperm telomere length (LTL, STL) in spermatozoon of 38 infertile and 19 fertile men aged between 20 and 50 years. Protamine deficiency (chromomycin A3 test), DNA fragmentation (TUNEL assay), lipid peroxidation (Bodipy probe) and telomere length (quantitative real-time PCR) were assessed. A significant decrease in mean of sperm concentration and motility and a significant increase in means of sperm abnormal morphology, DNA fragmentation, lipid peroxidation and protamine deficiency were observed in infertile compared with fertile men. In addition, the mean of LTL and STL were significantly shorter in infertile men compared with fertile individuals. We observed significant associations between telomere length with sperm concentration, DNA fragmentation and lipid peroxidation. We hypothesised that increased oxidative stress in spermatozoa of infertile men can result in abnormal packaging of chromatin, damage of DNA and shorter sperm telomere length. Together, these anomalies may account for fertility failure in these individuals.     

附睾、睾丸精子卵浆内单精子注射治疗阻塞性无精症引起不育

为评价附睾或睾丸精子卵浆内单精子注射（ＩＣＳＩ）治疗阻塞性无精症引起不育的疗效，对３１例无精子男性不育患者配偶进行超排卵治疗３７个周期，获卵当日从患者附睾取精，其中２４例获得活动精子，７例失败，改用钳取睾丸曲细精管从中分离精子以供ＩＣＳＩ。结果：共获卵４５３个，附睾、睾丸精子ＩＣＳＩ受精率分别为５５７％、６１７％，平均每周期移植胚胎３７个，总妊娠率每周期２９７％。结论：只要获得活动精子ＩＣＳＩ，阻塞性无精症患者也有机会生育     

正常生育力和精子活力低下不育者精子运动计算机辅助分析

用精子活力分析仪对７３名正常生育力男性射出精子进行了精子动力学指标分析；用上述指标分析了２００例精子活力低下不育男性射出精子动力学指标及各项运动参数间相互关系；用己酮可可碱作用精子活力低下不育男性射出精子，观察精子各项运动参数改变。结果：（１）正常生育力组，前向运动精子在总运动精子中比例与精子活动率间不呈相关性；随精子活动率提高，快速相和慢速相精子分布分别逐渐增加和减少，精子ＶＡＰ、ＶＣＬ、ＶＳＬ、ＢＣＦ、ＡＬＨ增加，ＬＩＮ和ＳＴＲ降低。（２）精子活力低下不育组，随精子活动率下降，主要表现在运动速度下降，与正常组比较，精子前向运动能力和运动速度均有明显下降（Ｐ＜０．０５），但ＬＩＮ和ＳＴＲ不管在组内还是与正常组相比均无明显差别（Ｐ＞０．０５），反映出这种前向运动能力的减低是由速度下降引起，速度分布变化以中速相明显。（３）己酮可可碱能明显提高精子活力低下不育者精子的活动率，前向运动率和精子运动快速相的分布；对精子ＬＩＮ，ＳＴＲ影响不明显。     

Efficiency of percutaneous testicular sperm aspiration as a mode of sperm collection for intracytoplasmic sperm injection in nonobstructive azoospermia

PURPOSE: We determined the feasibility of obtaining mature spermatozoa for intracytoplasmic sperm injection (ICSI) by percutaneous testicular sperm aspiration in men with nonobstructive azoospermia. We also compared the results of ICSI using spermatozoa recovered by open excisional biopsy versus percutaneous testicular sperm aspiration. MATERIALS AND METHODS: A total of 84 men with nonobstructive azoospermia underwent percutaneous testicular sperm aspiration to recover testicular spermatozoa for ICSI on the day of ova retrieval from the wife. Percutaneous testicular sperm aspiration was performed with the patient under general anesthesia in the upper and lower poles of each testis. It was followed by immediate microscopic search of the aspirate to confirm the presence of spermatozoa. In the absence of spermatozoa open excisional biopsy was performed in the same setting. RESULTS: Percutaneous testicular sperm aspiration resulted in the recovery of mature spermatozoa in 45 men (53.6%). Of the remaining 39 men (46.4%) requiring open biopsy adequate spermatozoa were recovered in 28 (71.8%). Although the fertilization rate was significantly higher in the sperm aspiration group, the cleavage and pregnancy rates were similar in the 2 groups. CONCLUSIONS: Percutaneous testicular sperm aspiration was a successful initial approach to collect mature spermatozoa in a high proportion of men with nonobstructive azoospermia. It is safe, minimally invasive and well tolerated by all patients.