Diagnostic findings from testis fine needle aspiration mapping in obstructed and nonobstructed azoospermic men

PURPOSE: Although helpful for defining extratesticular obstruction, the testis biopsy offers limited information on nonobstructive azoospermic testes. Guided by diagnostic biopsies, testis sperm extraction procedures fail in 25% to 50% of patients with nonobstructive azoospermia, largely because it is clinically difficult to know where sperm are located. To provide a more complete assessment of spermatogenesis in nonobstructive azoospermic patients and to simplify the confirmation of sperm production in men with obstruction, we use a systematic, fine needle aspiration "mapping" procedure. We summarize the diagnostic findings in a series of azoospermic men. MATERIALS AND METHODS: From 118 azoospermic infertile men (22 with obstructed and 96 with nonobstructed azoospermia) fine needle aspiration data were used to generate location specific, sperm frequency maps for obstructed and nonobstructive azoospermic testes to determine if "sperm rich" locations existed. RESULTS: Fine needle aspiration map analysis revealed that all aspiration locations from obstructed cases showed sperm. In men with nonobstructive azoospermia, sperm was identified in the right testis in 134 of 652 (20.5%) and in the left testis in 151 of 716 (21.1%) separate aspirations. Rates of sperm detection among various intratesticular sites were not statistically different. In 27.1% of cases the fine needle aspiration map found sperm in men with sperm negative biopsies. The likelihood of heterogeneity in fine needle aspiration sperm findings was 25% within individual nonobstructive azoospermic testes and 19.2% between testis sides. At post-procedure followup of 88 patients (74%), no clinical or surgical complications were observed. CONCLUSIONS: Testis fine needle aspiration mapping is a simple, reliable and informative diagnostic tool in the evaluation of azoospermic infertile men.     

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。     

男性不育的遗传学评估

无精子症或严重少精子症男性(5×10 6/ml)在接受治疗之前应通过遗传学检测确定其不育的真正原因。正确区分梗阻性无精子症(obstructive azoospermia,OA)与非梗阻性无精子症(non-obstructive azoospermia,NOA)至关重要,因为相比于NOA(睾丸体积小、质地柔软、FSH水平升高),OA(正常的睾丸功能、睾丸体积以及FSH水平)的遗传学检测有所不同。在NOA患者人群中,病史回顾、体格检查和实验室检测对于遗传学检测方法的选择是必须的,尤其针对原发性睾丸衰竭或先天性低促性腺激素型性腺功能低下症的NOA患者。遗传学检测包括由于先天性输精管缺如所致OA的囊性纤维化跨膜传导调节因子的检测,和针对严重少精子症或NOA患者的染色体核型分析、Y染色体微缺失等其他特殊检测方法。这些遗传学检测能够帮助判定哪些患者适合药物和/或手术治疗。最新的遗传学分析技术将有助于男性不育的诊断和掌控。     

宁泌泰胶囊治疗炎性弱精症143例临床观察

运用宁泌泰胶囊结合三磷酸腺苷(ATP)、维生素E治疗炎性弱精症143例,疗程60 d.结果 :治疗后,精子的密度、成活率、活力、精液液化时间均较治疗前明显改善(P＜0.05);前列腺液白细胞和卵磷脂小体改善显著.     

Status of vitamin E and reduced glutathione in semen of oligozoospermic and azoospermic patients

Aim: To investigate the status of seminal plasma reduced glutathione (GSH) and vitamin E in three different conditions of spennatogenesis: azoospennia, oligozoospennia and nonnospennia. Methods: Reduced glutathione was measured in the seminal plasma by the method of Moron et al (1979), and vitamin E estimation was performed by the method of Taylor et al ( 1976). Results. Vitamin E levels in seminal plasma of oligospermic and azoospelxnic sampies were significantly decreased to 65.54% and 66.04% respectively as compared to the nonnospermic group. Levels of reduced glutathione were also significantly decreased in oligospermic and azoospennic group, and the reduction in azoospermic group (76.73 % ) was more pronounced than oligozoospermic group (62.07 % ). Conclusion: The decrease in reduced glutathione, an endogenous antioxidant, levels in azoospermic and oligozoospermic conditions may cause disruption in the membrane integrity of spermatozoa as a consequence of increased oxidative stress.     

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。     

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.     

严重少精子症患者与正常生育男性精浆蛋白质群比较分析

目的:探讨严重少精子症和正常生育男性精浆蛋白质群的差异性。方法:11例正常健康已生育的自愿者(正常组)和6例严重少精子症男性精液标本通过Percoll分离获取精浆。采用SELDI-TOF-MS,经CM10芯片捕获蛋白质并用TOF-MS对蛋白质进行检测,获得各样本的蛋白质指纹图谱,经过归一化处理后进行组间比较。结果:严重少精子症组与正常组比较仅有2种低丰度蛋白质表达存在差异,与非梗阻性无精子症组比较差异蛋白质达15种。蛋白质荷比(m/z)分别为7196.058、7547.610、5780.493、7059.844、7409.589、5379.173、10778.810的7种蛋白质是严重少精子症、正常组与非梗阻性无精子症组的共同差异蛋白质,除后两者在非梗阻性无精子症中含量升高外,其余含量均降低。结论:严重少精子症的精浆蛋白质群与正常组差异较小,即两者的精浆蛋白质组成较为相似,但二者均与非梗阻性无精子症存在显著差异。提示严重少精子症和非梗阻性无精子症的发生机制不同,并非仅是遗传因素量的累加。     

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。