人类生殖辅助技术中精子伟哥在无精症中的应用

目的评估在人类生殖辅助技术(ART)中使用精子伟哥治疗无精子症患者的效果。方法选择纳入移植周期的187例无精症患者,在ART当日,按是否添加精子伟哥分组:A组(添加)133周期,其中A1新鲜精子周期73例(附睾精子31例、睾丸精子42例);A2解冻精子周期60例(附睾精子27例、睾丸精子33例);B组(未添加)54周期(附睾精子24例、睾丸精子30例);C组(对照组)55周期,均为男方严重少弱精症患者。结果 1A组在添加精子伟哥后,精子前后质量对比有统计学差异(P0.05)。2B组较A组、C组受精率、优胚率、可利用胚胎率、临床妊娠率、种植率明显降低(P0.05)。3添加精子伟哥后,无论新鲜还是解冻精子,TESA与PESA有相同的妊娠结局,与B组比较有统计学差异(P0.05)。结论无精症患者实施ART技术时,精液中添加精子伟哥能改善精子质量,获得较好的妊娠结局。     

精子染色质完整性检测与辅助生殖技术

随着男科学研究的深入,精子评估已由传统的精液常规分析向细胞、分子水平深入发展。精子染色质完整性是反映男性生育力的新指标,其影响到辅助生殖技术(ART)中的受精率、胚胎质量和妊娠率等,与ART结局密切相关。检测精子染色质完整性,采取适当措施获得染色质无损伤或损伤较小的精子,对改善ART结局十分必要。精子染色质结构分析是目前检测精子染色质完整性最常用的方法之一。现就精子染色质损伤的机制与检测方法、其与ART结局的关系以及ART中染色质损伤的防治做文献综述。     

精子染色质完整性检测与辅助生殖技术

随着男科学研究的深入,精子评估已由传统的精液常规分析向细胞、分子水平深入发展.精子染色质完整性是反映男性生育力的新指标,其影响到辅助生殖技术(ART)中的受精率、胚胎质量和妊娠率等,与ART结局密切相关.检测精子染色质完整性,采取适当措施获得染色质无损伤或损伤较小的精子,对改善ART结局十分必要.精子染色质结构分析是目...     

精子DNA损伤与宫腔内人工授精妊娠率关系

目的 探讨精子DNA损伤与宫腔内人工授精妊娠率的关系. 方法 收集36对夫妇共46个宫腔内人工授精(IUI)周期的男性精液进行分析,每份精液经优化处理后用于IUI,根据妊娠结局将患者分为妊娠组和非妊娠组,比较两组精子浓度、精子活动率、精子正常形态率及精子碎片化指数(DFI),分析精子DFI与IUI妊娠结局的关系. 结果 IUI妊娠组精子DFI为10.0％,比非妊娠组的20.2％低;妊娠组的精子浓度、精子活动率、精子正常形态率比非妊娠组高;精子DFI与精子浓度之间呈负相关,与精子活动率及精子正常形态率呈负相关.结论 精子DFI可能从精子浓度、活动力及形态等方面影响精子质量,是影响IUI妊娠结局的重要因素之一.     

精子DNA损伤与辅助生殖技术结局

精子DNA损伤发生的机制包括染色质包装异常、氧化应激和细胞凋亡等。此外,冷冻保存和体外制备技术均能影响精子DNA的完整性。精子DNA损伤与精液参数、精子的受精能力和受精后的胚胎发育潜能、辅助生殖技术（ART）结局及后代遗传风险密切相关。对近年有关精子DNA损伤的机制、冷冻保存和精子制备、精子DNA损伤与精液参数及其与ART结局关系的相关文献进行综述。     

利用附睾或睾丸精子行卵胞浆内单精子注射治疗阻塞性无精子症

目的回顾性分析38例阻塞性无精子症(OA)患者利用附睾或睾丸精子行卵胞浆内单精子注射(ICSI)的治疗结局。方法OA患者通过经皮附睾精子抽吸术(PESA)或睾丸切开取精术(TESE)获得精子行ICSI,评估受精率及临床妊娠率,以精液精子行ICSI组为对照。结果OA组38例共41个治疗周期,受精率和临床妊娠率分别为73.3%和53.6%,精液精子组31例33个治疗周期受精率和临床妊娠率分别为75.1%和48.4%,两组间比较,受精率和临床妊娠率差异无统计学意义(P>0.05)。OA组共妊娠22例,已分娩13例,流产6例,继续妊娠3例;精液精子组共妊娠16例,已分娩10例,流产1例,继续妊娠5例。结论采用附睾/睾丸精子行ICSI是治疗男性阻塞性无精子症的有效方法。     

梗阻性无精子症患者应用附睾、睾丸精子助孕的结局比较

目的比较梗阻性无精子症患者应用附睾、睾丸精子助孕的结局差异。方法梗阻性无精子症患者54例,其中经皮附睾穿刺抽吸术取精者29例(PESA),睾丸精子抽提术取精者25例(TESE)。辅助生殖采用卵胞浆内单精子注射技术(ICSI),对其正常受精率、胚胎种植率、人绒毛膜促性腺激素(HCG)阳性率及临床妊娠率进行比较。结果不同取精组的正常受精率无统计学差异(P>0.05),而PESA组的胚胎种植率、HCG阳性率及临床妊娠率均高于TESE组(P<0.05)。结论梗阻性无精子症患者附睾、睾丸穿刺取精简单易行,创伤小,并发症少,获精率高,ICSI妊娠结局满意;附睾取精避免了睾丸损伤,且助孕结局可能优于睾丸取精。     

不同来源精子行ICSI妊娠结局分析

目的：比较经皮附睾或睾丸穿刺抽吸术和手淫取精两种方法获得的精子行卵胞浆内单精子注射（ICSI）治疗妊娠结局。方法：回顾性分析进行ICSI治疗的30例36个周期的临床资料,对其中11例15个周期梗阻性无精子症患者行经皮附睾穿刺抽吸术（PESA）或睾丸穿刺抽吸术（TESA）为A组;19例21个周期严重少、弱、畸精子或受精障碍患者采用手淫获得精子为B组,比较两组的受精率、卵裂率、优质胚胎率、种植率和临床妊娠率。结果：两组的受精率、卵裂率、优质胚胎率、种植率和临床妊娠率分别为81.6%vs79.0%、87.9%vs96.9%、57.8%vs39.0%、15.2vs19.2%和26.7%vs33.3%,经统计学分析,两组间以上指标均无显著性（P〉0.05）。结论：两组取得相似的临床结局,经皮附睾穿刺获得的精子不影响ICSI的成功率。     

精子头部空泡及其对体外受精影响的研究进展

将活动精子放大6 000倍以上进行活动精子细胞器官形态学检查(MSOME),可选择形态好的精子进行胞浆内单精子显微注射(ICSI).MSOME对于精子头部空泡的检查十分专业,精子空泡到底是什么？会不会影响辅助生殖技术(ART)结局？回顾近年来有关空泡研究的相关文献,发现精子空泡有如下特征:①空泡十分多发;②空泡主要位于精子的头前中区域;③空泡可能存在异质性;④空泡的来源依然未明;⑤空泡与精液常规参数存在一定的相关性,有研究发现精子空泡与染色质凝聚异常、DNA碎片率及非整倍体率呈正相关,但结果依然存在争议;⑥空泡可能导致受精率、优胚率特别是临床妊娠率的降低.     

精液参数对宫腔内人工授精妊娠结局的影响

目的探讨精液参数对宫腔内人工授精妊娠结局的影响,为需要IUI患者提供参考。方法回顾性分析2010年7月-2016年10月在吉林大学第一医院接受IUI治疗的511对不孕症夫妇,共完成1090个周期。比较分析男女双方年龄、不孕年限、原发性或继发性不孕、处理前精子的活力、浓度、总数、前向精子运动总数(TMS)及处理后前向运动精子活动总数(PTMS)与IUI临床妊娠率间的关系。结果1090个IUI周期共获得130个妊娠周期,周期妊娠率为11.93%,女方年龄、不孕年限在妊娠组与非妊娠组中比较差异有统计学意义(P<0.05)。处理前精子的活力、浓度、总数、TMS、PTMS等参数比较差异无统计学意义(P>0.05),多因素Logistic回归分析结果显示精液常规各项参数与临床妊娠率均无明显相关性(P>0.05)。结论在IUI中女方年龄、不孕年限可影响IUI临床妊娠率;各项精液参数与IUI临床妊娠率无明显相关性,不能有效预测此类型患者IUI的临床妊娠结局。     

Assessing centrosomal function of infertile males using heterologous ICSI

The human spermatozoal centrosome acts as a microtubule organizing center and is essential for male and female pronuclear migration and apposition. In this study, we assess centrosomal function of spermatozoa from infertile patients using heterologus intracytoplasmic sperm injection (ICSI) into bovine eggs. Spermatozoa from 15 infertile patients undergoing assisted reproductive technology (ART) treatment and 3 fertile donors were tested. Microtubules and DNA were imaged by immuocytochemistry and epifluorescence microscopy. Decondensed female chromosomes and sperm nuclei, pronuclear formation and sperm aster formation were examined. The average rate of sperm aster formation using spermatozoa from infertile individuals was lower (47.0%) than that with spermatozoa from fertile individuals (66.1%). We compared the sperm aster formation rates after ART with various clinical parameters, including semen characteristics, pronuclear formation rates, embryonic cleavage rates and pregnancy outcome. Clinical semen characteristics and the rate of pronuclear formation appeared independent of sperm centrosomal function. In contrast, the centrosomal function had a substantial effect on embryonic cleavage rate and pregnancy after ART. These results suggested that centrosomal function is essential for pregnancy and embryonic development. The method described using bovine eggs is suitable to assay human centrosome function and predict pregnancy after ART.     

辅助生殖技术相关并发症的研究进展

辅助生殖技术（ART）已被广泛应用于不孕症的治疗,包括人工授精（AI）和体外受精-胚胎移植（IVF-ET）,及其相关衍生技术如胞浆内单精子注射（ICSI）、胚胎植入前遗传学筛查（PGS）、卵母细胞体外成熟（IVM）、胚胎辅助孵化（AH）等技术。随着ART的普及和妊娠率的逐步提高,其带来的并发症及其安全性也越来越受到重视。能够及时发现和处理并发症,可以最大限度地使不孕症患者获得安全优质的妊娠结局。目前,ART相关并发症发生的原因仍存在争议,有部分研究认为是由于ART导致的多胎妊娠或不孕症病因,也有研究认为是由于ART本身。故对近年来相关文献进行分析,总结ART相关并发症的最新研究进展。     

Clinical outcome of emergency egg vitrification for women when sperm extraction from the testicular tissues of the male partner is not successful

The development of an effective oocyte cryopreservation system will have a significant impact on the clinical practice of reproductive medicine. However, the important option of emergency oocyte cryopreservation has yet to be well documented. In this report, we review the cases of 15 women with male partners who were diagnosed with nonobstructive azoospermia and for whom testicular sperm extraction on the day of oocyte retrieval failed. Emergency oocyte vitrification was performed and after two months, the vitrified oocytes were warmed and the surviving oocytes inseminated with frozen-thawed donor sperm by intracytoplasmic sperm injection (ICSI). A total of 117 mature oocytes from the 15 women were vitrified and warmed. The post-warming survival rate was 84.6% (99/117), and the fertilization rate following ICSI was 83.8% (83/99). We selected 30 embryos for transfer to 15 patients, 8 of whom became pregnant. The clinical pregnancy rate was 53.3% (8/15) and the implantation rate was 30.0% (9/30). Nine healthy live births resulted from 8 pregnancies. These results indicate that emergency oocyte vitrification is an effective rescue technique that can be applied clinically with acceptable pregnancy and live birth rates when testicular sperm extraction from the male partner failed on the day of oocyte retrieval. These results also highlight another important option for oocyte cryopreservation through the use of vitrification technology.     

辅助生殖技术与异位妊娠的风险

辅助生殖技术（ART）妊娠的异位妊娠（EP）风险可能增加2倍,尤其一些罕见的异位妊娠类型（如宫内、宫外同时妊娠）更是显著增加。但最近有报道,ART妊娠的异位妊娠发生率接近自然受孕的异位妊娠发生率。输卵管因素是不孕症患者进行 ART治疗的主要指征,反过来也是ART后发生异位妊娠的重要病因。通过大样本多中心的研究来了解ART妊娠的异位妊娠风险因素,有助于临床上预防ART异位妊娠。     

Clinical outcome of emergency egg vitrification for women when sperm extraction from the testicular tissues of the male partner is not successful

The development of an effective oocyte cryopreservation system will have a significant impact on the clinical practice of reproductive medicine. However, the important option of emergency oocyte cryopreservation has yet to be well documented. In this report, we review the cases of 15 women with male partners who were diagnosed with nonobstructive azoospermia and for whom testicular sperm extraction on the day of oocyte retrieval failed. Emergency oocyte vitrification was performed and after two months, the vitrified oocytes were warmed and the surviving oocytes inseminated with frozen-thawed donor sperm by intracytoplasmic sperm injection (ICSI). A total of 117 mature oocytes from the 15 women were vitrified and warmed. The post-warming survival rate was 84.6% (99/117), and the fertilization rate following ICSI was 83.8% (83/99). We selected 30 embryos for transfer to 15 patients, 8 of whom became pregnant. The clinical pregnancy rate was 53.3% (8/15) and the implantation rate was 30.0% (9/30). Nine healthy live births resulted from 8 pregnancies. These results indicate that emergency oocyte vitrification is an effective rescue technique that can be applied clinically with acceptable pregnancy and live birth rates when testicular sperm extraction from the male partner failed on the day of oocyte retrieval. These results also highlight another important option for oocyte cryopreservation through the use of vitrification technology.     

Ⅲ/Ⅳ期子宫内膜异位症不孕患者预处理对辅助生殖技术结果的影响

目的:分析预处理对子宫内膜异位症(EMs)不孕患者辅助生殖技术(ART)结果的影响。方法:回顾性分析238例行ART的Ⅲ/Ⅳ期EMs不孕患者的妊娠结局,观察未行预处理及两种不同预处理后的ART结局。结果:手术组、GnRHa预处理组及未处理组间行IVF超促排卵周期窦卵泡数目、Gn的剂量、用药时间、HCG日血清E2水平、内膜厚度、获卵数、成熟卵泡数、胚胎数、D1时2PN胚胎数、D3时1级胚胎数、妊娠率、累积妊娠率比较均无统计学差异(P>0.05)。结论:IVF前手术及GnRHa预处理并不能提高IVF成功率,若无明显手术指征,拟行辅助生殖技术之前行腹腔镜手术或者GnRHa治疗(间隔>3月)只会增加患者经济负担。     

睾丸新鲜精子与冷冻复苏精子临床妊娠结局的比较

目的 比较无精子症患者睾丸穿刺取精(testicular aspiration,TESA)与睾丸显微取精(microdissection testicular speron extraction,m-TESE)新鲜与冷冻复苏精子进行卵胞质内单精子注射(intracytoplasmic sperm injection,I...     

Sperm epigenetics in the study of male fertility,offspring health,and potential clinical applications

The mammalian sperm contains a highly unique and specialized epigenetic landscape that offers a great degree of interesting research opportunities. One key discriminating feature of the mature sperm epigenome is that it, in theory, represents both remnant marks used throughout spermatogenesis to generate sperm cells competent to perform their function, but also marks that appear to be useful beyond fertilization. Key questions must be asked about the utility of these marks and the multiple purposes that may be served. It is this unique epigenetic landscape that has driven some labs to begin to study the links between aberrant sperm epigenetic patterns and various forms of infertility, from idiopathic to alterations in sperm motility, morphology, and viability and fertilization capacity. Because of the unique nature of the sperm epigenome and the patterns found in mature sperm that appear to reflect perturbations in spermatogenesis that may ultimately have effect on pregnancy outcomes, some researchers believe that these marks may provide predictive insight that can be exploited. Indeed, there is emerging data suggesting that the predictive power of DNA methylation and RNA signatures in sperm likely exceeds that which can be found with traditional assessments of male infertility. This review will focus on the utilization of the sperm epigenome as a potential diagnostic tool in the context of male infertility, as well as the potential difficulties associated with such an approach.     

在辅助生殖技术中应对双胎妊娠的策略

医学上认为,双胎妊娠是辅助生殖技术(ART)的并发症。最有效、最根本的应对策略就是降低双胎妊娠在ART妊娠者中的比率,预防性地对妊娠率较高、胚胎良好的年轻患者选择性地单胚胎移植,可显著减少双卵双胎的发生,达到预期目的。阻碍中国推广单胚胎移植的主要原因:①ART是自费医疗,且较昂贵。②中国晚婚晚育,高龄不孕女性较多。③患者和医生对双胎妊娠围生期风险的认识和重视不足。ART也增加高风险的单绒毛膜性单卵双胎的发生率,甚至偶可诱发以往未曾发现的单绒毛膜性双卵双胎。对于单绒毛膜性的单卵双胎以及单绒毛膜性的双卵性双胎,还没有很好的应对策略。对双胎膜性予以早期诊断,以及对单绒毛膜性双胎进行早期围生医学干预,是ART中应对单卵双胎增加的唯一策略。     

我国人类辅助生殖技术评估概述

目的：为了了解我国人类辅助生殖技术现状，为制定相关政策提供依据。方法：采用流行病学，社会学调查等方法进行调研。结果：1999年底，实施IVF的机构达70家左右，还有些正在筹建或准备筹建，但有一定的规模的辅助生殖技术中心太少，而IVF的妊娠并发症比自然妊娠要高得多，另外，目前的精子，卵子和孕卵的管理及实施ART技术中还涉及到许多伦理、法规问题没有解决，而过快发展主要受到益驱动所致，结论：加强对ART技术管理非常迫切，特别是对IVF技术的安全性应高度关注，并应尽快加强ART的相关法律法律建设等。