Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

OBJECTIVE: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. METHODS: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999-November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4-6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P < or = 0.05 was considered significant. RESULTS: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5-7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of > or =20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) CONCLUSION: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy.     

离子通道与弱精子症

弱精子症是引起男性不育的常见病因之一。随着以精子自身为对象的研究深入,发现离子跨膜转运对精子的生理活动起着重要的作用。离子通道病于20世纪90年代提出,现已逐渐发现临床上许多先天性和/或后天获得性疾病与异常的离子通道有关。因此,关于精子的生理和疾病与离子通道的关系研究逐渐成为当前研究的热点之一。现就近年来与精子运动相关的离子通道,包括阳离子通道和阴离子通道的研究进展作一综述。     

The association between trans fatty acids,infertility and fetal life: a review

Trans fatty acids (TFAs) are thought to affect reproductive health by causing adverse effects on sperm morphology and ovum quality as a result of changing membrane lipid composition which, in turn, leads to impairment in metabolic pathways. This literature review examines the evidence for the effects of dietary TFAs on male and female infertility. Studies conducted between 2007 and 2017 on the effect of dietary TFAs on human reproductive health and fetal life have been included. They indicate that TFA intakes are inversely proportional to sperm concentration and total sperm count and exhibit a positive correlation with asthenospermia, as well as an adverse association on sperm concentration and semen quality. In the female TFAs intakes are associated with an increase in the risk of ovulatory infertility, adversely affect the length of gestation leading to fetal developmental defects and fetal loss. The findings suggest that high TFA intake (more than 1% of energy consumption) constitute a risk factor for infertility in both sexes.     

益肾通络方治疗少弱精子型男性不育症肾虚瘀阻证的临床疗效

目的 观察益肾通络方治疗少弱精子型男性不育症肾虚瘀阻证的临床疗效及对血清性激素和精浆微环境的影响。方法 将104例患者随机按数字表法分为观察组和对照组各52例。对照组口服复方玄驹胶囊,3粒/次,3次/d。观察组内服益肾通络方,1剂/d。两组疗程均为3个月,并随访3个月。记录6个月内配偶受孕情况;进行治疗前后精液参数检查和肾虚瘀阻证评分;检测治疗前后精浆锌、精浆果糖、精浆弹性蛋白酶、精浆酸性磷酸酶,精浆α葡糖苷酶水平及血清促卵泡生成素（FSH）,促黄体生成激素（LH）,泌乳素（PRT）,睾酮（T）水平。结果 在6个月观察期间,观察组配偶受孕率为22.00%高于对照组的10.00%,但差异无统计学意义（χ²=2.678,P>0.05）;观察组临床疗效优于对照组（Z=2.326,P<0.01）;观察组精子浓度、精子活率、精子活力、正常形态精子、直线运动速度均高于对照组（P<0.01）;观察组精浆锌、精浆果糖水平均高于对照组（P<0.01）,肾虚瘀阻证评分低于对照组（P<0.01）;观察组血清FSH,LH,PRT水平均低于对照组（P<0.01）,T水平高于对照组（P<0.01）;观察组精浆弹性蛋白酶低于对照组（P<0.01）,精浆酸性磷酸酶,精浆α葡糖苷酶水平均高于对照组（P<0.01）。结论 益肾通络方用于少弱精子型男性不育症肾虚瘀阻证患者可改善精子参数,调节性激素水平和精浆环境,有提高配偶受孕趋势,临床疗效值得进一步研究。     

Successful use of the sperm motility enhancer 2-deoxyadenosine in previously failed human in vitro fertilization

The outcome of in vitro fertilization treatment in malefactor infertility is generally poor, due mainly to poor fertilization rate and hence fewer available embryos for replacement. This study was carried out to assess the value of asthenospermic sperm exposure to a motility enhancing agent, 2-deoxyadenosine (2-DXA), on our in vitro fertilization program in couples undergoing repeat treatment after previous failed fertilization. Following sperm wash and incubation in 2-DXA-supplemented medium, marked significant improvements were observed in the sperm motility pattern and the number of recoverable sperms as compared to control unexposed samples. There was also a significantly better fertilization rate and higher number of replaceable embryos available following sperm wash in 2-DXA as compared to those washed without it. Following embryo transfer, pregnancy rate was comparable to the generally reported pregnancy rates for routine in vitro fertilization and embryo transfer treatment. Three normal babies were born. Our results indicate that 2-DXA enhances fertilization rate in some asthenospermic patients and that it has no adverse effect on embryonic development.     

48例原发性不育患者染色体核型与AZF基因分析

目的探讨严重少弱精症和无精症的遗传病因。方法采用外周血染色体G显带，PCR技术以及PAGE电泳，对48例严重少弱精症和无精症患者进行外周血染色体核型分析及无精子症因子（AZF）基因的6个位点分析。结果48例中7例染色体异常，5例AZF基因有微缺失。结论严重少弱精症和无精症的发生与遗传密切相关，对男性不育患者进行治疗前有必要进行染色体核型分析及Y染色体AZF微缺失的检测。     

弱精子症患者精子线粒体MTCYB、MTATP6基因的检测

目的:探讨精子线粒体MTCYB、MTATP6基因突变与弱精子症的关系。方法:提取80例成年男性弱精子症和20例活力正常者的精子mtDNA,设计PCR引物并扩增MTCYB、MTATP6基因,PCR产物纯化后进行序列测定和BLAST序列比对。结果:在80例弱精子症样本中有60例同时扩增出MTCYB、MTATP6片段,16例仅扩增出MTATP6片段,4例仅扩增出MTCYB片段。在20例精子活力正常的样本中均同时扩增出MTCYB、MTATP6片段。弱精子症样本中MTCYB和MTATP6基因的缺失率分别为20%和5%。扩增片断的序列分析发现,在弱精子症样本中,MTATP6基因出现G8887A的点突变,突变率为20%,而MTCYB基因未见有规律的突变。精子活力正常的样本中MTCYB、MTATP6基因未检测到明显的点突变。结论:精子线粒体MTCYB和MTATP6的基因缺失以及MTATP6基因的G8887A突变可能影响成年男性的精子活力。     

金冷法治疗少、弱精子症的疗效及安全性临床观察

目的:金冷法可通过低温和中药外用(透皮吸收)两种途径作用于睾丸。本研究目的旨在评价金冷法治疗少、弱精子症的疗效及安全性。方法:将符合纳入标准的39例少、弱精子症的男性不育患者用金冷内裤(金冷法)治疗,每天早、晚各1次,每次30 min,共3个月。观察治疗前后精液参数指标变化以及患者配偶的妊娠结局。结果:按要求完成治疗36例,其中31例精液质量有改善,总有效率为86.1%。少弱精子症组精子密度、前向运动精子百分率、精子活动率、精子总数、活动精子总数等精液参数指标在治疗后均有显著改善(P均<0.05),弱精子症组前向运动精子百分率、精子活动率、活动精子总数等精液参数指标在治疗后均有显著改善(P均<0.05)。治疗期间及治疗后随访2个月有5例配偶怀孕。治疗期间无明显不良反应发生。结论:金冷法治疗少、弱精子症具有疗效确切、使用方便、安全性好的特点,可作为男性少、弱精子症不育患者的一种新的治疗选择推广应用。     

弱精子症动物模型中尿纤溶酶原激活因子的含量及表达情况研究

目的:利用奥硝唑所致弱精子症动物模型,采用免疫组化方法和RT-PCR技术,了解尿纤溶酶原激活因子(uPA)在弱精子症动物模型中的含量及表达情况,初步探讨奥硝唑所致弱精子症动物模型的机制及uPA作为预防或治疗弱精子症药物的可能性。方法:48只雄性SD大鼠随机分为1d用药组,5d用药组,10d用药组,15d用药组,20d用药组和对照组,每组8只,用药组每天给予奥硝唑200mg/kg,对照组给予0.5%羧甲基维素钠连续灌胃,用药组分别在给药第1、5、10、15、20d后24h内,麻醉处死动物取附睾和睾丸。低渗肿胀试验检测精子细胞膜完整性,免疫组化方法动态观察睾丸与附睾组织中uPA蛋白表达情况,RT-PCR检测睾丸组织中uPAmRNA含量。结果:奥硝唑持续给药构建弱精子症时,精子膜完整性下降发生在给药的第10d,并一直维持低值。与建立弱精子症模型同步的uPA在睾丸和附睾组织蛋白表达及mRNA含量下降在用药15d,下降趋势上是平行的,而显效性稍滞后。用药15d组与用药20d组uPA蛋白表达、mRNA水平分别与对照组比较有统计学意义(P<0.05)。结论:精子细胞膜受损、运动能力下降与uPA表达及含量下降平行,奥硝唑所致弱精子症模型形成可能是由于uPA含量及表达下降所致。弱精子症形成原因较复杂,uPA含量及表达的下降可认为是弱精子症形成因素之一,检测uPA含量可能有助于弱精子症的诊断和预防。     

益心康泰胶囊对精浆中活性氧与精子质量影响的临床疗效观察

目的:观察益心康泰胶囊治疗少弱精子症患者的临床疗效。方法:选择确诊的少弱精子症患者72例,分为2组。对照组32例,服用维生素E,每次50mg;葡萄糖酸锌,每次1粒,均每日3次,连续3个月。治疗组40例,在对照组的基础上加服益心康泰胶囊,每次2粒,每日3次,连续3个月。末次给药后,行常规精液分析与精浆中过氧化氢(H2O2)、丙二醛(MDA)含量、超氧化物歧化酶(SOD)活性测定。结果:治疗组在用药后精子密度、精子活力、畸形率与H2O2、MDA、SOD水平均优于对照组(P<0.01或P<0.05)。结论:益心康泰胶囊能通过改善精浆中活性氧的动态平衡,改善精液质量,可用于治疗少弱精子症。