精子形态对体外受精胚胎移植妊娠结局的影响

目的：分析男性精液参数与卵裂率、优质胚胎率及妊娠率的相关性,探讨体外受精-胚胎移植（IVF-ET）周期中精子形态对精子功能的影响。方法：分析82个受精率100%的IVF-ET周期。以Diff-Quickstain方法染色,密度梯度离心法处理精液,WHO精子形态学标准评估精子形态,精子正常形态率≥14%为正常组,〈14%者为异常组。观察精液处理前后精子参数变化,比较妊娠组与未妊娠组的年龄、移植日子宫内膜厚度和精液各参数的情况。比较精液处理前后精子正常形态率与两组的正常受精率、卵裂率、优质胚胎率和妊娠率。结果：①密度梯度离心法处理后82例精液密度明显降低,活动力明显提高,差别有统计学意义。②精液处理前精子正常形态率：正常组11例（13.41%）,异常组71例（86.59%）;处理后正常组34例（41.46%）,异常组48例（58.53%）。异常组精液处理后正常精子形态的比例提高,中位数（P25,P75）分别为8.15%（6.38%,10.50%）vs.12.41%（9.98%,18.58%）,差别有统计学意义（P〈0.01）。③精液处理前精子正常形态率正常组和异常组的密度和活动力差别无统计学意义（P〉0.05）。④精液处理前后精子正常形态率正常组和异常组的妊娠率和优质胚胎率差异均无统计学意义（P〉0.05）;精子正常形态率正常组的卵裂率高于异常组（P〈0.05）。⑤妊娠组和未妊娠组除男女双方年龄差异有统计学意义外,移植日子宫内膜厚度和各精液参数差异均无统计学意义。结论：精子形态对妊娠结局无预测,密度梯度离心法能提高正常精子形态百分数,需根据精液处理后的结果选择受精方式。     

有机磷农药接触对精液质量影响的研究

目的:探讨有机磷农药接触对精液质量的可能影响因素。 方法:对161例有机磷农药暴露组的对象和161例非暴露组对象进行流行病学问卷调查、外生殖器检查和精液质量测定。结果:多因素结果显示:受教育程度和饮酒对精液量有影响,受教育程度为初中的对象精液量正常率高(OR=1.961);随饮酒年数的增加,精液量正常率降低(OR=0.962)。有机磷农药接触使快速前向运动精子百分比(OR=0.528)、精子密度(OR=0.266)、精子存活率(OR=0.398)和正常精子形态率(OR=0.281)这4个指标的正常率下降。精液收集的季节对快速前向运动精子百分比、精子存活率和正常精子形态率均有影响,与夏季相比,冬季采集的精液这3个指标的正常率高(OR分别为2.272、4.060、5.249)。 结论:有机磷农药暴露可导致农民精液质量下降。     

精子核成熟度与精液参数关系研究

目的:研究精子核成熟度与精液参数关系。方法:49例精液标本,其中生育组15例,不育组34例。应用精子质量自动检测系统(CASA)进行精子密度、活力分析,伊红染色进行活率分析,联苯胺染色评价精液白细胞,采用精子形态检测系统下人工修正方法分析精子形态,用苯胺蓝染色评价精子核成熟度。结果:不育组苯胺蓝染色阳性率显著高于生育组(P<0.05)。形态异常精子组中头部异常、颈部异常、尾部异常、无定型、其它畸形精子组苯胺蓝染色阳性率均显著高于形态正常精子组(P<0.05)。苯胺蓝染色阳性精子率与形态正常精子率、活力、活率均呈显著负相关(P<0.05);苯胺蓝染色阳性精子率与精子密度、精液白细胞浓度均无显著相关性。结论:精子核成熟度异常可导致男性生育力下降,精子核成熟度是评价男性生育力重要参考指标。     

精子形态对体外受精-胚胎移植妊娠结局的影响

目的:分析男性精液参数与卵裂率、优质胚胎率及妊娠率的相关性,探讨休外受精一胚胎移植(IVF-ET)周期中精子形态对精子功能的影响.方法:分析82个受精率100%的IVF-ET周期.以Diff-Quickstain方法染色,密度梯度离心法处理精液.WHO精子形态学标准评估精子形态,精子正常形态率≥14%为正常组,<14%...     

近25年中国正常男性精液质量的变化趋势分析

目的:研究近25年来中国正常男性的精液质量变化趋势。方法:通过文献检索,收集1985～2009年间我国正常男性精液质量检测报告文献115篇,涉及69个县市的23 126人。用直线回归法和秩和检验分析精液参数的变化趋势。结果:精子密度、精子非前向运动率(c%)呈显著下降趋势。1985～1989年、1990～1999年、2000～2009年3组的精子密度、精子总数的秩和检验显示组间差异有统计学意义(P<0.05)。结论:近25年来我国正常男性的精子密度可能呈下降趋势。     

不育男性精子DNA碎片化指数与精液解脲脲原体及人型支原体感染关系的研究

目的:探讨解脲脲原体(Uu)和人型支原体(Mh)对不育男性精子浓度、活动力、正常形态率及精子DNA碎片化指数(DNA fragmentation index,DFI)的影响.方法:选取169份精液标本,其中129例特发不育者为不育组,40例正常生育者为对照组,计算机辅助精液分析(CASA)系统分析精子浓度和活动力.精子形态分析采用Shorr染色法,吖啶橙试验(acridine orange test,AOT)检测精子DFI.支原体检测采用培养法.结果:与对照组相比无Uu/Mh、Uu或Uu+Mh感染组精子DFI显著增高(P＜0.05),与无Uu/Mh感染组相比,Uu或Uu+Mh感染组DFI亦显著增高(P＜0.05).与正常生育对照组相比无Uu/Mh、Uu或Uu+Mh感染组正常形态率显著降低(P＜0.05),其余组间无统计学差异(P＞0.05).与正常对照组相比,无Uu/Mh、Uu、Mh和Uu+Mh感染组的精子浓度、a级、a+b级和a+b+c级精子百分比均显著降低(P＜0.05),而除无Uu/Mh感染组外,其余各组间无统计学差异(P＞0.05).结论:特发性不育男性的精子浓度、正常形态率、a级、a+b级和a+b+c级精子百分比较正常男性的均显著下降,Uu/Mh感染并非是最主要原因,可能是其他重要因素或综合因素影响的结果.特发性不育男性精子DFI明显增加,Uu是其中的主要因素之一.Uu可能主要通过对精子DNA,而不是常规参数的影响来造成男性生育力的下降.     

复发性流产及胎儿发育异常与男性畸形精子的相关性探讨

目的:探讨男性畸形精子与不明原因复发性流产及胎儿发育异常发生的相关性。方法:筛选185例配偶不明原因复发性流产及22例配偶因胎儿发育异常终止妊娠的男性的精液,涂片染色后按照严格标准进行精子形态分析,与配偶有过正常妊娠史的继发不育男性精液进行精子形态学比较。结果:复发性流产及胎儿发育异常与对照组精子正常形态百分率间比较差异无统计学意义,且胎儿异常组和复发性流产组组间差异也无统计学意义。结论:发生不明原因复发性流产和胎儿异常的精子畸形率并不显著高于正常妊娠,畸形精子率高低是否作为一个影响自然妊娠和胚胎发育的独立因素,缺乏足够的临床依据。     

精液分析区域性外部质量控制研究

目的:探讨精液分析区域性外部质量控制实践中参评实验室检测结果的准确性和结果的可比性。方法:制作2个水平的精子浓度、活动率和正常形态率的质控品发放给参评实验室进行外部质量控制测试,分析质控结果。评价指标为均值和实验室间变异系数(CV)。结果:精子浓度、前向运动精子百分率(PR)和正常形态精子百分率(NR)CV分别为34.09%、24.96%和62.01%;各实验室精子浓度、PR结果差异均无统计学意义(P0.05),NR差异有统计学意义(P0.05)。结论:外部质控结果CV较大,尤其正常形态精子的检测结果,提示技术人员亟需进行规范培训,开展标准化精液分析质量控制活动,提高分析结果的重复性和准确性。     

精子质量分析仪(SQA)临床评估

243例正常及不正常生育力精液标本用精子质量分析仪（SpermQualityAnalyzer，U－nitdMedicalSystemsInc.SantaAna，CA）测定其精子活力指数SMI，并用常规精液分析方法（按WHO标准）测定主要精液参数，其中包括精子密度、a、b级活动精子百分率及正常形态精子。结果显示SMI与上述各项参数都有好的相关性。由于精子质量分析仪具有简便、客观、快速、可重复性等优点，可应用于不育症检查男性因素的筛选、男性不育治疗和绝育效果的随访、精子浓缩过程的评估及人工授精前的试验等。     

正常育龄男子附睾精子各参数的分析

73例正常育龄男子在输精管结扎术时,分别收集左、右侧附睾液,做了附睾液精子各种参数的分析。结果显示,精子活动率(%)、正常形态精子(%)、精子存活率(%)和精子低渗膨胀试验(HOST,%)等与精液中精子参数相似;但附睾液精子密度(6220.6±5300.8×10~6/ml)高于精液中精子密度,且右侧附睾液精子密度显著高于左侧;左侧附睾液精子中异常的精子-宫颈粘液穿透试验显著高于右侧,用精子-宫颈粘液接触试验(SCMC)和免疫珠试验(IBT)测定,未发现附睾液中精子表面有抗精子抗体存在。     

The impact of pesticides on male fertility

PURPOSE OF REVIEW: Observations in several Western countries point toward a decline in semen quality which may be associated with exposure to environmental endocrine disruptors such as several frequently used pesticides. The scarce literature on the effects of pesticides on male fertility will be reviewed with a focus on semen quality and time-to-pregnancy. RECENT FINDINGS: The majority of studies published since 2000 reported some effects of pesticide exposure on semen quality or time-to-pregnancy. The results are not consistent, however, with some studies showing reduced sperm concentrations and others showing low percentages of morphologically normal and/or motile sperm. In time-to-pregnancy studies, reduced male fertility measured as prolonged time-to-pregnancy related to pesticide exposure was observed for first pregnancies only. Some of the inconsistencies may be explained by heterogeneity in populations, pesticide exposure, and study design. SUMMARY: Despite this heterogeneity, the conclusion can be drawn that pesticide exposure may affect spermatogenesis leading to poor semen quality and reduced male fertility. More research is needed to unravel the pathophysiological mechanisms and the role of endocrine disruption.     

Semen quality of workers occupationally exposed to hydrocarbons

OBJECTIVE: To determine whether occupational exposure of men to hydrocarbons has adverse effects on the quality of their semen. DESIGN: Comparative study. SETTING: The rubber industry in Mexico City. PATIENT(S): Forty-eight workers who were exposed to hydrocarbons for 2-24 years and 42 unexposed workers. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Environmental hydrocarbon concentrations were determined by continuous air monitoring in all areas of the factory. Analyses of semen samples were performed in accordance with World Health Organization criteria. RESULT(S): Hydrocarbon concentrations were as follows: ethylbenzene, 220.7-234 mg/m3; benzene, 31.9-47.8 mg/m3; toluene, 189.7-212.5 mg/m3; and xylene, 47-56.4 mg/m3. The number of subjects with ejaculates that had normal characteristics was greater in the unexposed group (76%) than in the exposed group (17%). More abnormal characteristics were found in the semen of exposed workers than unexposed workers, including alterations in viscosity, liquefaction capacity, sperm count, sperm motility, and the proportion of sperm with normal morphology. Some abnormal characteristics correlated with the number of years of exposure to the hydrocarbons. CONCLUSION(S): Damage to the spermatogenic process resulting from hydrocarbon exposure was demonstrated by an increased rate of abnormalities in the semen of exposed workers compared with unexposed workers. This information may be useful for conducting future analyses of reproductive risks related to exposure to high concentrations of hydrocarbons.     

不同源性及不同参数精子对ICSI结局的影响

目的:研究不同源性精子、不同参数精子及冻融精子对ICSI结局的影响。方法:接受ICSI治疗的510对不育夫妇共进行了517个周期,分为6组。射出精液少弱畸精子症组(A组)82例,共进行85个周期;射出精液严重少弱精子症组(B组)170例,共进行174个周期;附睾细针穿刺抽吸精子组(C组)108例,共进行108个周期;睾丸细针穿刺抽吸精子组(D组)71例,共进行71个周期;冻融射出精子组(E组)34例,共进行34个周期;冻融附睾睾丸精子组(F组)45例,共进行45个周期;比较其妊娠结局。结果:6组患者一般情况比较无统计学差异(P>0.05),6组患者的受精率、优胚率、临床妊娠率、早期流产率无统计学差异(P>0.05)。结论:不同源性精子、不同参数精子及冻融精子对ICSI结局无明显影响。     

Air-conditioned environments do not prevent deterioration of human semen quality during the summer.

OBJECTIVE: To determine if air conditioning might mitigate summer reductions in semen quality. DESIGN: Prospective study of semen quality in summer and winter. SETTING: Normal human volunteers were studied in the setting of a fertility laboratory. PATIENTS, PARTICIPANTS: Two groups of volunteers were selected from the vicinity of New Orleans: 64 men who worked indoors during the summer in air-conditioned environments and 76 others who worked outdoors. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Parameters of manual semen analysis were examined for seasonal and group differences. RESULTS: Remarkably similar reductions in semen quality during summer as compared with winter were observed in both indoor and outdoor workers, respectively, with regard to the following parameters of semen quality: 19% and 19% in sperm concentration, 25% and 27% in total sperm per ejaculate, 17% and 20% in motile sperm concentration, 13% and 15% in percent sperm with normal morphology, and 23% and 23% in concentration of morphologically normal motile sperm. CONCLUSIONS: These findings do not support the hypothesis that the heat of the summer is detrimental to male reproductive capacity. The available evidence suggests instead a possible role of photoperiod in causing the seasonal changes in semen quality.     

Comparison of the ICSI outcome of ejaculated sperm with normal,abnormal parameters and testicular sperm

OBJECTIVE(S): To compare fertilization rates, quality of embryos, pregnancy rates (PRs) and outcome of pregnancies in intracytoplasmic sperm injection (ICSI) using sperm from ejaculates of normal and abnormal semen and testicular sperm of non-obstructive azoospermia. STUDY DESIGN: Four hundred fifty-four patients who underwent 454 ICSI cycles were evaluated retrospectively. Patients were divided into three groups according to the quality and source of sperm. Patients in group 1 underwent 133 cycles of ICSI using ejaculated normal semen, group 2 underwent 235 cycles using ejaculated abnormal semen, and group 3 underwent 86 cycles using testicular sperm. RESULTS: The parameters were compared among the groups with respect to cycles induced by long (n = 160) and short (n = 294) protocol. In group 3, the fertilization and PRs were significantly lower than in all other groups (51.3 and 10.6% in the long protocol cycles, 53.3 and 5.1% in the short protocol cycles, respectively). There was no significant difference in the outcome of pregnancies in respect to abortion rates between different groups. CONCLUSION(S): The fertilizing ability of sperm in ICSI is highest with ejaculated sperm and lowest with sperm extracted by testicular biopsy. Also, the clinical PRs are significantly lower in ICSI with sperm from testicular biopsy. However, the outcomes of pregnancies are not affected by using surgically retrieved sperm from ejaculated semen.     

Comparison of protective media and freezing techniques for cryopreservation of human semen

OBJECTIVE: To evaluate the influence of cryopreservation medium and freezing-thawing techniques on human sperm motility and morphology. STUDY DESIGN: 63 semen samples were obtained from 39 donors to the artificial insemination programme. Possible effects of the sperm dilution with cryomedium on the motility were examined 10 min after exposure of 24 high initial quality semen samples to TEST-yolk ?zwitterion-citrate-egg yolk extender containing TES [N-Tris (hydroxymethyl) methylaminoethane sulfonic acid] and Tris [(hydroxymethyl) aminomethane]? and human sperm preservation medium (HSPM). Post-thaw sperm motility from 24 frozen semen samples was examined comparing the cryoprotective efficacy of TEST-yolk and HSPM following different freezing techniques (vapour freezing, fast programmable freezing and slow programmable freezing). The relationship of sperm morphology to the effects of freezing was investigated on 39 semen samples following different freezing techniques. Post-thaw sperm motility from 39 frozen semen samples was compared among three groups divided according to the percentage of morphologically normal cells (<40, 40-50 and >50%) in fresh semen. RESULTS: Exposure of spermatozoa to cryomedia for 10 min at room temperature significantly reduced motility in TEST-yolk treatment group for 9% and in HSPM treatment group for 18% (P<0.01). The recovery of motile sperms (mean+/-standard deviation) was 49+/-15.7, 43+/-15.2 and 52+/-16.8% when TEST-yolk was used and 34+/-17.8, 32+/-18.2 and 50+/-13.6% when HSPM was used as a cryopreservative following vapour freezing, and fast and slow programmable freezing, respectively. Following vapour freezing and also following fast programmable freezing, the recovery of motile sperm was significantly higher (P<0.05) after addition of TEST-yolk medium than after addition of HSPM. Post-thaw motility of the sperm cryopreserved in HSPM showed significant differences (P<0.05) after three different freezing techniques. The recovery of motile sperms was 57+/-26.4, 38+/-8.6 and 38+/-17.3% in groups with >50, 40-50 and <40% morphologically normal cells, respectively. The percentage of morphologically normal spermatozoa was reduced 8% after vapour freezing and 6 and 3% after fast and slow programmable freezing, respectively. The results were statistically analysed using SAS/STAT software. CONCLUSIONS: Slow programmable freezing was superior to vapour freezing and fast programmable freezing as a method for sperm cryopreservation. However, none of these methods of freezing had discernible effects on sperm morphology. Motility of spermatozoa decreased due to the exposure of semen to cryomedium. TEST-yolk was a superior cryomedium to HSPM. Fresh semen with more than 50% of morphologically normal cells showed the best recovery of motile cells after freezing and thawing.     

Prospective,randomized, blinded evaluation of donor semen quality provided by seven commercial sperm banks

OBJECTIVE: To evaluate variability in donor semen quality between seven commercial donor sperm banks, within sperm banks, and between intracervical insemination and intrauterine insemination. DESIGN: Prospective, randomized, blind evaluation of commercially available donor semen samples. SETTING: An academic andrology laboratory. PATIENT(S): Seventy-five cryopreserved donor semen samples were evaluated. INTERVENTION(S): Samples were coded, then blindly evaluated for semen quality. MAIN OUTCOME MEASURE(S): Standard semen quality parameters, including concentration, motility parameters, World Health Organization criteria morphology, and strict criteria morphology. RESULT(S): Significant differences were observed between donor semen banks for most semen quality parameters analyzed in intracervical insemination samples. In general, the greatest variability observed between banks was in percentage progressive sperm motility (range, 8.8 +/- 5.8 to 42.4 +/- 5.5) and normal sperm morphology (strict criteria; range, 10.1 +/- 3.3 to 26.6 +/- 4.7). Coefficients of variation within sperm banks were generally high. CONCLUSION(S): These data demonstrate the variability of donor semen quality provided by commercial sperm banks, both between banks and within a given bank. No relationship was observed between the size or type of sperm bank and the degree of variability. The data demonstrate the lack of uniformity in the criteria used to screen potential semen donors and emphasize the need for more stringent screening criteria and strict quality control in processing samples.     

Sperm function in workers exposed to N,N-dimethylformamide in the synthetic leather industry

OBJECTIVE: To determine whether occupational exposure to N,N-dimethylformamide (DMF) for men has adverse effects on sperm function. DESIGN: Cross-sectional study. SETTING: A synthetic leather factory in Taiwan. PATIENT(S): Twelve DMF-exposed workers in a synthetic leather factory and 8 socioeconomically matched control workers from another non-DMF-exposed manufacturing plant in the vicinity were recruited. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Breathing-zone monitoring of DMF exposure covering the full work shift was implemented on each participant. Urine specimens were collected from each worker immediately after their work shift in parallel with environmental sampling. Environmental DMF and urinary N-methylformamide (NMF) levels were measured by gas chromatograph. Analysis of semen samples was performed to measure semen volume, sperm concentration, morphology, and motility in accordance with World Health Organization criteria. RESULT(S): Both conventional microscopy and computer-assisted semen analysis showed that sperm motility in DMF-exposed group was significantly reduced from that in controls. Motility parameters were related to urinary NMF in a dose-response manner but were not related to airborne DMF. CONCLUSION(S): Workers occupationally exposed to DMF could be at risk of sperm motility perturbation. The responsible toxicant for the alterations of sperm function could be the active NMF metabolite instead of DMF, but this conclusion warrants a further complete investigation.     

Life styles of men in barren couples and their relationship to sperm quality.

This study is based on a questionnaire which focused on the possible association between life-style factors and male fertility in a group of 252 men attending our laboratory in connection with a fertility investigation. Their answers were correlated to sperm quality. No association could be documented between sperm quality and smoking habits, coffee drinking, a moderate alcohol intake, exposure to heat (sauna, hot baths, type of underwear, sedentary activities), or physical activities in their leisure time. In contrast, the reported average ejaculation frequency was significantly positively correlated to the motility of the sperm (% progressive), and inversely related to the proportion of sperm with abnormal morphology and semen volume. This indicates that the life style of the subject has little if any impact on semen quality, at least within the limits recorded in the present study.