Outcome of conventional IVF and ICSI on sibling oocytes in the case of isolated teratozoospermia

Purpose

To reevaluate the effect of isolated teratozoospermia on IVF and determine if there was any therapeutic benefit to isolated teratozoospermia by ICSI, since there are no widely accepted criteria for the treatment technique about isolated teratozoospermia.

Methods

A total of 441 couples with >20 million and progressive motility >30 % sperm undergoing their first IVF/ICSI cycle were included in the study between 2008 and 2010, for whom at least 8 oocytes were retrived. Isolated teratozoospermia was diagnosed in 183 of the included couples, and the rest couples (normal sperm morphology) were studied as control. Sibling oocytes were randomized to be inseminated either by ICSI or IVF. Fertilization rate, embryo quality, pregnancy rate, implantation rate and spontaneous abortion rate were assessed.

Results

There was no difference in the percentage of eggs fertilized, implantation rate, pregnancy rate and spontaneous abortion rate between conventional IVF and ICSI regardless of the percentage of normal morphology. The day 3 embryonic morphology and rate of development were not different despite the insemination method and percentage of normal morphology.

Conclusion

Because isolated teratozoospermia did not influence the major indices of IVF and the unnecessary use of ICSI is time-consuming, costly and potential risks, couples with isolated teratozoospermia need not be subjected to ICSI.     

常德贵教授运用补肾活血法治疗男科疾病验案举隅

目的:介绍常德贵教授运用补肾活血法治疗男科常见疾病相关经验。方法:通过中医辨证论治运用补肾活血法治疗男科常见疾病如畸形精子增多症、勃起功能障碍(erectile dysfunction,ED)、遗精等。结果:补肾活血法对男科常见疾病治疗有效。结论:补肾活血法在男性疾病中的应用前景广泛。     

不同类型精子缺陷与印记基因H19甲基化水平关联性研究

目的:探讨不同类型精子缺陷与印记基因H19印记控制区域甲基化水平的相关性。方法:以2014年4月至2014年9月间入院诊治的男性不育患者为研究对象,排除患有精索静脉曲张、隐睾症、核型异常和Y染色体微缺失的病例,依据临床精液常规检查结果,分别筛选出特发性少精子症患者(浓度20×10~6/m L,其余指标均正常)、特发性弱精子症患者(前向运动精子百分率50%,其余指标均正常)、特发性畸形精子症患者(正常精子形态比率15%,其余指标均正常)各25例;25例正常精液样本作为对照组。采用焦磷酸测序法定量分析各组精子DNA中H19基因印记控制区域的甲基化水平。结果:少精子症组[(75.04±15.35)%]和弱精子症组[(79.48±11.64)%]印记基因H19甲基化水平显著低于正常对照组[(89.10±11.23)%],差异均有统计学意义(P=0.006,P=0.024);畸形精子症组[(87.82±12.10)%]与正常对照组H19基因甲基化水平的差异无统计学意义(P=0.758)。结论:印记基因H19印记控制区域的DNA甲基化程度的降低与少精子症和弱精子症有关联,可能与畸形精子症无关。     

GLUTATHIONE-RELATED ENZYMES IN CELL CULTURES FROM DIFFERENT REGIONS OF HUMAN EPIDIDYMIS

Protection of maturing sperm from potential endogenous or exogenous harmful substances during their transit throughout the epididymis is a critical event. The authors studied the activity of gamma-glutamyl transpeptidase (GGT) and glutathione S-transferase (GST), and glutathione (GSH) levels in epithelial cell cultures from human caput, corpus, and cauda epididymides. Tissue was obtained from patients undergoing therapeutic orchidectomy for prostatic cancer. Enzymatic activity was measured in conditioned media and cellular fractions. Androgen influence was also evaluated. Both enzymatic activities were found in cellular homogenates and conditioned media from cultures of all epididymal regions. GGT activity was highest in cultures from cauda epididymis, both in conditioned media and cell fractions, while GST activity did not show regional differences in conditioned media, but exhibited higher activity in cell homogenates from cauda cultures than those obtained from corpus and caput epididymis. GSH level showed no regional difference in cell homogenates and it could not be detected in conditioned media by the method used. Presence of different concentrations of dihydrotestosterone (DHT) had no influence neither on the enzymatic activities nor GSH concentration. The results indicate that GGT and GST are present along the human epididymis and a fraction or isoform of these enzymes might be secreted to the luminal fluid to play a detoxificative role in sperm maturation.     

单纯畸形精子症对宫腔内人工授精结局的影响

目的:研究单纯畸形精子症对宫腔内人工授精(IUI)结局的相关性。方法:回顾性分析2012年1月至2015年12月本院生殖医学中心行夫精IUI治疗的不孕不育患者189例,共行323个IUI周期,按照WHO第5版精子形态学分析方法分为(1)正常对照组,146个周期,(2)轻中度畸形精子症组,121个周期,(3)重度畸形精子症组,56个周期,以临床妊娠率与早期流产率等为指标,以评估畸形精子症对IUI结局的影响。结果:三组间临床妊娠率、早期流产率、早产率及活产率等均无显著性差异(P0.05)。结论:不论轻中度或重度畸形精子症对IUI后临床妊娠率、早期流产率、早产率及活产率等均无明显影响。     

Teratozoospermia and its effect on male fertility potential

Teratozoospermia and its significance for male fertility problems is discussed. Different points of view and available information concerning the phenomenon of teratozoospermia have been presented. Ongoing debate about the influence of sperm morphology on male infertility and IVF results emphasizes the fact that when sperm morphology is evaluated using strict criteria, this parameter is thought to have an excellent predictive value and shows a significant positive correlation with successful fertilization. Selective abilities of zona pellucida to differentiate between morphologically normal and abnormal spermatozoa, the superior role of acrosomal morphology assessment in the prediction of IVF outcome, and the involvement of cell surface molecules in the adhesion of spermatozoa to oocytes are described. The usefulness of the hamster oocyte penetration assay (HOPA), which is important not only because of its predictive value of sperm function, but also because of its role as a tool for visualizing sperm chromosomes, was found to be questionable in cases of teratozoospermia. Cytogenetic findings related to teratozoospermia are controversial as classical methodology of visualizing sperm chromosomes (through HOPA) may cause selection of sperm metaphases which can be obtained only from good-penetrating spermatozoa. There are few reports presenting chromosome complements of abnormal sperm visualized with the help of micromanipulation. There is clear evidence that a variety of genetic defects can affect spermatogenesis. The possible genetic background of teratozoospermia is discussed.     

精子畸形率对体外受精-胚胎移植治疗结局的影响

目的回顾性分析我中心接受常规体外受精（IVF）及卵胞浆内单精子注射（ICSI）治疗中,男方精子畸形率对受精率、胚胎质量及临床结局的影响。方法选取本中心2008年9月至2010年5月接受IVF的344对及ICSI的178对夫妇,分为常规IVF组和ICSI组,组内按照男方精子畸形率分为正常形态组（IVF266／ICSI76）和畸精子症组（IVF78／ICSI102）。受精后分别统计IVF及ICSI两组内畸精子症组和正常形态组正常受精率、优质胚胎率、种植率、临床妊娠率及流产率的差别。结果在IVF中,畸精子症组和正常形态组的正常受精率、种植率、临床妊娠率及流产率分别为64．32％／60．09％、33．78％／37．02％、42．03％／54．62％及12．5％／4．23％。两组间受精率无显著性差别,畸精子症组的临床妊娠率显著性低于正常形态组,而早期流产率显著高于正常形态组（P〈0．05）;ICSI组中,畸精子症组和正常形态组的正常受精率、种植率、临床妊娠率及流产率分别为68．01％／64．59％、32．26％／33．78％、43．75％／52．63％及4．76％／5％。畸精子症患者的临床妊娠率较正常组显著性降低（P〈0．05）。将两种受精方式的畸精子症组间比较,IVF的患者早孕流产率显著高于ICSI者（P〈0.05）。结论常规IVF中畸精子症不影响正常受精。对于畸精症子患者,其临床妊娠率均较精子形态正常组低,但是采用ICSI治疗可以显著降低早孕流产率。‘     

Semen Characteristics in Pubertal Boys. II. Semen Quality in Relation to Bone Age

Semen specimens from 134 pubertal boys were examined and compared to bone age. Normal figures for semen volume, liquefaction, sperm concentration, and morphology were observed between 15 0/12 and 16 0/12 years of bone age. The number of normally motile spermatozoa became standard at 17 0/12 years of bone age. Azoospermia was noted from 13 0/12 to 14 0/12 years of bone age, oligozoospermia from 14 0/12 to 15 0/12, asthenozoospermia from 16 0/12 to 17 0/12, and normospermia from 17 0/12 on.