长三角地区重度少弱精子症与卵泡刺激素受体基因单核苷酸多态性相关性研究

目的:研究卵泡刺激素受体(FSHR)基因Thr307Ala(rs6165)和Asn680Ser(rs6166)单核苷酸多态性(SNP)基因型分布情况及其与中国长三角地区重度少弱精子症的关联性。方法:外周血提纯DNA,PCR扩增后直接测序分析200名已育男性(已生育组)和150名重度少弱精子症不育男性(不育组)FSHR基因Thr307Ala和Asn680Ser位点的SNP,并用χ2检验进行相关性分析。结果:FSHR基因Thr307Ala和Asn680Ser多态性位点的基因型分布在已生育组和不育组间无统计学差异(P>0.05)。Thr-Asn/Ala-Asn和Thr-Ser/Thr-Ser双倍型在已育男性与重度少弱精子症患者间分布差异有统计学意义(P<0.05),组间FSHR的单倍型Thr-Asn和Ala-Asn之间亦有统计学差异(P<0.05)。结论:FSHR基因Thr307Ala和Asn680Ser的2个多态性位点特定的单倍型和双倍型与男性不育有一定的相关性。     

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。     

A Prospective Comparative Trial of a Gonadotropin-Releasing Hormone Analogue with Clomiphene Citrate for the Treatment of Oligoasthenozoospermia

Background: We undertook a prospective trial to compare the efficacy and adverse effects of a gonadotropin releasing-hormone analogue (CnRHa) and clomiphene therapy for idiopathic normogonadotropic oligoasthenozoospermia (INOA).
Methods: Between January and December 1995, 44 newly-diagnosed INOA patients were randomly allocated to treatment with GnRHa or clomiphene citrate. Efficacy was assessed by measuring changes in semen parameters prior to and after 3 months of treatment. Twenty-three INOA patients underwent GnRHa therapy with 15 μg of diluted buserelin acetate given once a day intranasally, and 21 INOA patients were treated with 50 μg of clomiphene citrate daily by oral administration.
Results: The mean sperm density in the GnRHa group increased from 1 6.1 times 10⁶/mL to 26.9 times 10⁶/ml(P < 0.05), while the mean sperm density did not change significantly in the group treated with clomiphene. Similarly, the mean sperm motility increased from 35.9% to 43.9% in the GnRHa group (P < 0.05), but did not significantly change in the clomiphene group. No adverse effects were observed in either group.
Conclusion: This GnRHa treatment protocol can be administered as an outpatient and is hoped to benefit INOA patients.     

D-Tryptophan-6-luteinizing hormone-releasing hormone in the treatment of normogonadotropic oligoasthenozoospermia

D-Tryptophan-6-LH-RH was assessed in the treatment of patients with normogonadotropic oligoasthenozoospermia in 18 subjects selected on the basis of at least 3 spermiograms, long standing infertility, normal LH, FSH, prolactin and testosterone serum levels and lack of evidence of any other pathologic involvement. Testicular biopsies performed on these patients showed hypospermatogenesis with foci of alteration at the spermatid stage in some of them. D-Trp-6-LH-RH was administered im for 90 days at a dose of 5 micrograms every 2 days, 10 micrograms daily or 10 micrograms every 2 days. There was no significant improvement in the concentration of spermatozoa or in the motility and vitality parameters. Moreover, in 5 patients who received 10 micrograms daily, basal levels of LH and FSH and the response to LH-RH, decreased significantly during treatment. D-Trp-6-LH-RH at the dose used in this study does not seem useful for the treatment of oligoasthenozoospermia normogonadotropic patients.     

Meiotic abnormalities and spermatogenic parameters in severe oligoasthenozoospermia

The incidence of meiotic abnormalities and their relationship with different spermatogenic parameters was assessed in 103 male patients with presumably idiopathic severe oligoasthenozoospermia (motile sperm concentration < or = 1.5 x 10(6)/ml). Meiosis on testicular biopsies was independently evaluated by two observers. Meiotic patterns included normal meiosis and two meiotic abnormalities, i.e. severe arrest and synaptic anomalies. A normal pattern was found in 64 (62.1%), severe arrest in 21 (20.4%) and synaptic anomalies in 18 (17.5%). The overall rate of meiotic abnormalities was 37.9%. Most (66.7%) meiotic abnormalities occurred in patients with a sperm concentration < or = 1 x 10(6)/ml. In this group, total meiotic abnormalities were found in 57.8% of the patients; of these, 26.7% had synaptic anomalies. When the sperm concentration was < or = 0.5 x 10(6)/ml, synaptic anomalies were detected in 40% of the patients. In patients with increased follicle stimulating hormone (FSH) concentrations, total meiotic abnormalities occurred in 54.8% (synaptic anomalies in 22.6%). There were statistically significant differences among the three meiotic patterns in relation to sperm concentration (P < 0.001) and serum FSH concentration (P < 0.05). In the multivariate analysis, sperm concentration < or = 1 x 10(6)/ml and/or FSH concentration > 10 IU/l were the only predictors of meiotic abnormalities.     

不同参数精子对卵胞质内单精子注射术结局的影响

目的 分析不同精子参数对卵胞质内单精子注射术（ICSI）临床结局的影响.方法 选取在我院接受ICSI治疗的不孕夫妇235对（共299个ICSI周期）,根据男方精液的来源和参数不同,我们将299个ICSI周期分为4组：精液正常组（A组,70例、96个周期）,严重少弱精子症组（B组,33例、44个周期）,附睾精子组（C组,23例、28个周期）和睾丸精子组（D组,109例、131周期）.比较4组的受精率、优质胚胎率、种植率和临床妊娠率等.结果 A组年龄明显大于其他3组（P〈0.01）.A、B、C、D组患者行ICSI卵数分别为937、476、344、1543,单周期移植胚胎数分别为2.74±0.49、2.22±0.47、2.07±0.26、2.12±0.43,A组单周期移植胚胎数显著多于其他各组（P〈0.01）.D组受精率（62.80%）显著低于其他3组（75.03%、72.06%、78.02%）（P〈0.01）.C组优质胚胎率（35.31%）显著低于其他3组{47.65%、48.40%、45.71%）（P〈0.01）,4组间临床妊娠率和种植率并无明显差异（P〉0.05）.结论 不同参数的精子虽然可以影响ICSI后胚胎早期的发育,但对临床妊娠率并无明显影响.     

基于肠道菌群探讨补肾益精法治疗少弱精子症的作用机制

少弱精子症是引起男性不育的主要原因,其病因复杂多样,目前临床上仍有部分少弱精子症的病因未明,称为特发性少弱精子症。随着高通量测序技术的发展,发现肠道菌群紊乱可能是少弱精子症发病的一个重要促进因素。中医学认为“肾精亏虚”为少弱精子症的核心病机,临床上采用补肾益精法治疗少弱精子症疗效显著,但其作用机制尚未完全阐明。结合中医基础理论及分子生物学研究发现,“肾精”与肠道菌群具有相似性,在少弱精子症发病过程中,肠道菌群紊乱与中医“肾精亏虚”病机有共通之处,且补肾益精类中药可调节肠道菌群紊乱,这或许是补肾益精法有效治疗少弱精子症的机制之一。基于此,该文从肠道菌群角度探讨中医补肾益精法治疗少弱精子症的作用机制,以期为中医药治疗少弱精子症提供新的思路。     

基于“肾主生殖”理论探讨少弱精子症的病机及龟鹿育麟汤组方思路

少弱精子症是导致男性不育的主要原因,目前临床上治疗少弱精子症多以经验性药物为主。中医治疗少弱精子症经验丰富,中医药在改善男性生殖功能方面效果显著,是临床上治疗本病的重要手段之一。北京中医药大学东直门医院男科团队基于“肾主生殖”理论,结合现代相关研究,在传统补肾治疗的基础上,创新性提出“以肾精亏虚为本,补肾益精为法,微调阴阳为则”的理念治疗少弱精子症。龟鹿育麟汤是基于这一理念而创立治疗少弱精子症的协定方,为经典方剂龟鹿二仙胶和五子衍宗丸的组合化裁而成,具有补肾益精、温阳不燥、滋阴不寒、微调阴阳等特点,并取得了良好的临床疗效,以期为中医药治疗少弱精子症提供更为直观的参考。     

麒麟丸联合左卡尼汀治疗特发性少弱精子症临床疗效观察

目的:探讨麒麟丸联合左卡尼汀治疗特发性少弱精子症的效果。方法:将特发性少弱精子症患者按照数学表法随机分为研究组与对照组各50例。对照组给予左卡尼汀口服溶液;研究组给予麒麟丸联合左卡尼汀,观察治疗前、后患者的精子质量。结果:治疗前对照组与研究组精子浓度[(13.12±3.58)×10~6/mL vs(12.34±3.59)×10~6/mL]、a级精子活动率(12.03%±5.21%vs 12.31%±5.43%)、a+b级精子比例(21.11%±5.32%vs 22.56%±4.69%)相比较,组间无统计学差异(P0.05);治疗后对照组与研究组精子浓度[(14.06±3.61)×10~6/mL vs(19.18±6.19)×10~6/mL]、精子活动率(68.13%±11.35%vs 78.62%±18.37%)、a级精子活动率(16.24%±7.98%vs 24.67%±8.36%)、a+b级精子比例(29.69%±8.15%vs 45.27%±12.53%)相比较,治疗组显著优于对照组(P0.05)。结论:麒麟丸联合左卡尼汀对改善精子浓度、a级精子活动率、a+b级精子比例有更好的临床疗效。     

Evidence for a stimulatory role of high doses of recombinant human follicle‐stimulating hormone in the treatment of male‐factor infertility

The efficacy of recombinant human follicle‐stimulating hormone (rhFSH) in the treatment of normogonadotropic patients with male‐factor infertility was assessed. Forty‐five infertile men with moderate/severe oligoasthenozoospermia and normal FSH, luteinizing hormone (LH) and testosterone (T) levels were treated with high rhFSH dose (300 IU) on alternate days for ≥4 months. In all, the seminal parameters, endocrine profile (FSH, LH, prolactin (PRL), total and free T and estradiol) and pregnancy rate were evaluated before, during and after rhFSH treatment. Fifteen infertile men were treated with placebo and studied in the same way, as control group. rhFSH treatment induced a marked increase in sperm count and no change in sperm motility, morphology and viability. No changes in seminal parameters were observed in the placebo group. FSH levels increased during treatment with rhFSH and not with placebo. No variations in LH, PRL, free and total T and estradiol were evidenced during treatment. A significant pregnancy rate in rhFSH versus placebo patients was also highlighted. Prolonged treatment with high rhFSH doses leads to increase sperm count and improve the spontaneous pregnancy rate in normogonadotropic infertile patients with oligoasthenozoospermia. rhFSH may represent a rational and useful tool in the treatment of male‐factor infertility.