供精者筛查结果分析

正人类精子库是以治疗不育症以及预防遗传病、性传播疾病等为目的,利用超低温冷冻技术,采集、检测、保存和提供精子~([1])。研究表明,供精者经过严格的筛查后,所提供的冷冻精液是合格的、安全的~([2]),这为供精人工授精或供精试管婴儿的顺利开展提供了有力的保障。然而,近年来,多省人类精子库都出现志愿者招募工作开展艰难、人数减少、合格率下降、精源短缺的现象~([3])。本课题旨在分析我院人类精子库供精者的筛查结果,探讨影响合格率的     

人类精子库供精志愿者筛查结果分析

目的分析供精志愿者筛查结果及被淘汰原因。方法按2003年卫生部修订的《人类精子库基本标准和技术规范》对576例供精志愿者进行筛查。结果82例(14．2%)成为合格的供精者,淘汰494例(85．8%),其中：441例(89．3%)未达到人类精子库有关的精液质量要求,26例(5．3%)主要是体检中支原体阳性(11/108)、乙肝表面抗原阳性(6/108)和常规细菌培养异常(4/108)等,其他原因27例(5．4%)。结论供精志愿者筛查被淘汰的主要原因是精液质量未达到人类精子库标准,另外支原体、乙肝表面抗原阳性及精液常规细菌培养异常等也是淘汰的重要因素。     

精子库供精者筛选评估浅析

众所周知 ,精子的来源和质量是用于精子库和开展非配偶辅助生育技术所必须的基本要求 ,也是获得成功妊娠的保证。但目前国内开展大规模供精者筛选和提供精液服务的单位尚不多 ,国内供精者筛选的情况也尚未见报道。现将我们精子库自1999年 6月成立至 2 0 0 1年 7月底有关供精者筛选作一评估。1　资料和方法1.1　筛选程序　申请→面试→ 3次以上精液筛选→血液检查→签署供精者知情同意书成为供精者→每次精液筛选→冷冻→复苏测试→合格入库。1.2　供精者状况　 15 48名供精者 ,年龄 <4 0周岁 ,身高 >16 5cm。均为大专以上学历 ,职业主要为学…     

精液初筛合格供精者750例染色体分析

目的 探讨染色体检查在精子库筛选供精者中的作用.为预防供精人工受精后染色体病患儿的出生提供依据.方法 采用外周血淋巴细胞培养,常规制备染色体,应用G显带技术进行核型分析.结果 750例精液初筛合格的供精者染色体中,发现5例异常,发生率为0.666%.还发现各种类型的染色体多态55例,发生率为7.334%.结论 供精者即使精液初筛合格,经过染色体检查也能发现染色体异常患者,这对预防供精人工受精后染色体病患儿的出生有着重要意义.     

浙江省人类精子库供精者精液参数及精子耐冻性变化分析

目的 了解供精者捐精过程中精液参数、精子耐冻性变化以及为人类精子库实验室质量控制提供部分依据;方法 13261份精液样本均来自2006年9月至2010年12月浙江省人类精子库的1513例合格的供精者,年龄20～42周岁,职业以学生为主,对所有精液标本进行精液常规分析;达到冷冻标准的精液标本进行冷冻及冷冻复苏后精液常规分析.结果 1513例供精者中,每次捐精均合格的为343例,占22.7%;每次捐精(至少连续3次)均不合格的为68例,占4.5%;捐赠精液至少一次不合格的为1102例,占72.8%.捐赠的13261份精液中,有10158份冷冻复苏后达到外供标准,占76.6%;不合格的捐赠精液为3103份,占23.4%,其中,未达到冷冻标准的为1565份,占所有捐赠精液的11.8%;冷冻复苏后未达到外供标准(不耐冻精液)为1538份,占所有捐赠精液的11.6%.结论 人类精子库供精者每次捐赠的精液不仅精液参数变化较大,其耐冻性变化也很大;所捐赠的精液不合格比例较高.     

上海市人类精子库捐精现状及临床应用回顾性分析

目的 探讨上海市人类精子库捐精现状与临床应用,为中国精子捐献制度的完善提供理论依据.方法 对上海市人类精子库自2003年3月至2010年12月间所有初次捐精者与合格捐精者的信息回顾性分析,研究内容包括:(1)捐精者筛查不合格原因;(2)合格捐精者脱失率及原因;(3)捐精动机;(4)精液标本冷冻前后参数;(5)捐献者精子用于辅助生殖治疗的结果.结果 1.研究期间,共有12 858名志愿者接受捐精筛查,只有2 083名(16.2％)入选.落选的主要原因为:(1)精液参数未达到标准;(2)性传播疾病检测阳性结果.另外,约4.9％的合格捐精者脱失,其主要原因为(1)捐精期间多次精液检测未达到标准,丧失信心;(2)因免费医学检查而加入;(3)迁居外地.2.我库共冻存精液3 1 056份,冷冻前后平均密度为(98.7±25.3)×106和(57.2±26.5)×106,前向运动精子比率为(62.1±15.3)％和(42.6±13.5)％.3.对外供精14 181份,其中AID周期数为7 341,妊娠率为20.13％,新生儿出生数为723人;体外受精-胚胎移植(IVF-ET)周期数为1521,妊娠率为38.66％,新生儿出生数为410人,未出现同一供精者使5名以上妇女受孕的情况.结论 我国精子库已进入成熟发展阶段,遵循国家政策法规的严格管理.目前存在的问题是供精严重不足,这有赖于政策进一步完善.     

供精者捐精的最佳时间研究

目的 了解禁欲时间对供精志愿者精液参数、精了形态及冷冻精液合格率的影响,为供精志愿者捐精最佳时间提供依据.方法 6414份精液样奉均来自2006年9月-2008年6月浙江省计划生育科学技术研究所人类精子库的1135例供精志愿者,年龄22至32周岁.对所有6414份精液标奉进行精液常规分析:其中的483例供精志愿者的精液标本进行精子形态学分析;5425份精液标木进行冷冻及冻后精液常规分析.结果 按禁欲时间分为3d、4d、5d及6～7d四组,各组之间精液量、精子密度及前向运动精子百分率有显著性差异(P＜0.05),精液量、精子密度随禁欲时间的延长而增加,前向运动精子白分率随禁欲时间的延长而下降,各组之间的精液pH值无显著性差异(P＞0.05);四组之间精子正常率、头部异常率、预及中段异常率、尾部异常率、胞质小滴发生率、畸形精子指数(TZI)及精子畸形指数(SDI)均无显著性差异(P＞0.05);各组之间前向运动精子冷冻复苏率无显著性差异(P＞0.05),但禁欲3d、4d、5d三组冷冻精液合格率均高于禁欲6～7d组,有显著性差异(P＜0.05);结论禁欲3～7d,精液量、精子密度随禁欲时间的延长而增加,前向运动精子百分率随禁欲时间的延长而下降;禁欲时间对精子形态参数、前向运动精子冷冻复苏率无影响;禁欲3～5d的冷冻精液合格率明显高于禁欲6～7d,供精者捐精的最佳禁欲时间为3～5d.     

初筛合格供精者核型分析的临床意义探讨

目的:探讨核型分析对于供精者筛选的作用。方法:2004年1月1日至2008年12月31日经过初步筛查合格的供精者2537例,抽取外周血进行常规核型分析。追踪合格供精者进行供精人工授精治疗后的临床妊娠及出生缺陷情况。结果:2537例初筛合格供精者中,发现2362例核型为46,XY,135例染色体核型有多态性,这两类初筛供精者均作为合格供精者。同时发现6例染色体异常,34例有争议的异常核型。结论:核型分析降低了供精人工授精受者妊娠染色体病患儿的风险,对于初筛供精者核型分析中发现的异常核型进行遗传咨询,有助于指导其未来的生育。     

四川地区2754名供精志愿者染色体筛选及结果分析

目的 分析四川地区供精志愿者染色体筛选结果,为精子库排除志愿者遗传缺陷提供依据。方法 选取2013年1月至2022年12月于四川大学华西第二医院生殖男科/人类精子库进行精液筛查的2 754例供精志愿者,分析其染色体核型结果。据染色体结果将供精志愿者分为染色体正常组(2 661例)、染色体核型异常组(7例)及染色体多态性组(86例),比较3组间的人群特征及精液参数。结果 2 754例供精志愿者中,有93例供精志愿者为染色体核型异常或染色体多态性,检出率为3.38%(93/2 754)。染色体正常组、染色体核型异常组及染色体多态性组3组间的年龄、身高、体重及体质量指数(BMI)均无显著差异(P>0.05);3组间冷冻前及复苏后的精液质量也均无显著差异(P>0.05)。93例染色体核型异常或染色体多态性的供精志愿者中,染色体核型异常的志愿者有7例,占比7.53%(7/93);染色体多态性86例,占比92.47%(86/93)。染色体多态性中以D组(13、14、15号)和G组(21、22及Y)染色体随体区变异最多,多态性占比34.88%(30/86);其次为25例1号、9号、16号...     

应用Power Builder进行人类精子库信息系统的开发

随着辅助生殖技术的开展和人类精子库的建立，应用供精人工授精治疗男性不育尤其是无精子症的需求增多，各精子库的精源更是供不应求。面对日趋繁琐的供精者和受精者信息，人类精子库信息系统在精子库的管理中也起着越来越重要的地位。Power Builder是目前公认的最优秀的数据库前端开发工具之一，具有开发速度快、成本低、质量高、功能强等特点。本文介绍利用Power Builder 9．0软件进行人类精子库信息系统的开发。     

Secular and seasonal changes in semen quality among young Danish men: a statistical analysis of semen samples from 1927 donor candidates during 1977-1995

The objective of this study was to investigate whether semen quality has changed during the years 1977-1995 in a group of unselected semen donor candidates, and to determine whether semen quality is subject to seasonal variation, by analysis of time- and season-related changes in semen quality using multiple regression and ANOVA. The study was based on analysis of the first semen sample delivered by 1927 semen donor candidates in Copenhagen during the period 1977-1995, with determination of semen volume, sperm concentration, total sperm count, percentage motile spermatozoa, and a semiquantitative sperm motility score. Multiple linear regression analysis with year, sexual abstinence and season as covariates showed a significant increase in mean sperm concentration from 53.0 x 10(6)/mL in 1977 to 72.7 x 10(6)/mL in 1995 (p < 0.0001) and in mean total sperm count from 166.0 x 10(6) to 227.6 x 10(6) (p < 0.0001). Mean semen volume and percentage motile spermatozoa did not change. Sperm motility deteriorated, as the spermatozoa in 74.2% of the samples were of excellent motility in 1977-1980 compared to only 41.9% in 1993-1995 (chi 2 = 130.0, p < 0.0001). Analysis of variance showed significant variation between seasons regarding sperm concentration (p < 0.0001) and total sperm count (p < 0.0001). Highest sperm counts were found in spring, with a mean concentration (95% C.I.) of 77.6 x 10(6)/mL (71.9-83.7), and lowest in summer, with a mean of 57.5 x 10(6)/mL (50.1-65.4). No other semen parameter varied with season. It is concluded that sperm counts increased, whereas sperm motility decreased, in a group of Danish semen donor candidates, from 1977 to 1995. Due to the retrospective design and the anonymity of the donors, we were unable to control for variation in donor age, and we cannot exclude the possibility that some donor candidates were selected by being accepted as donors by other semen donor services in Copenhagen. With these limitations in mind, we suggest our results should be interpreted cautiously and regarded as a contribution to the ongoing dispute on whether or not there is a continuous decrease in sperm quality. The seasonal variations found in sperm concentration and total sperm count were pronounced and were not attributable to seasonal differences in the length of sexual abstinence. Additionally, the same seasonal pattern was observed in five successive year-intervals. These findings strongly indicate that human testicular function is influenced by season, a phenomenon well known in many lower mammals.     

Comparison between computerized slow-stage and static liquid nitrogen vapour freezing methods with respect to the deleterious effect on chromatin and morphology of spermatozoa from fertile and subfertile men

The purpose of this study was to determine the negative effects (cryodamage) on human spermatozoa after freeze-thawing and to determine whether freeze-thawing of spermatozoa with a programmed slow freezer is better than freezing with liquid nitrogen vapour (rapid freezing) with regard to alterations in sperm chromatin and morphology in semen from fertile (donor) and subfertile, IVF/ICSI, patients. Ninety-five semen samples were obtained either from patients attending our IVF unit for treatment (n=34) or from donors (n=25) with proven fertility and normal sperm quality according to WHO guidelines. Each semen sample was divided into two parts after liquefaction and addition of the cryoprotectant. The first part was frozen using a programmed biological freezer and the second part was frozen by means of liquid nitrogen vapour. Smears were made before the freezing and after the thawing procedure to assess morphology (strict criteria) and chromatin condensation (Acridine Orange test). The mean percentage of chromatin condensed spermatozoa in the samples from donors (control group) was 92.4 +/- 8.4% before freezing and this decreased significantly (p < 0.0001) to 88.7 +/- 11.2% after freeze-thawing with the computerized slow-stage freezer and to 87.2 +/- 12.3% after using static liquid nitrogen vapour (p < 0.001). The corresponding values for semen obtained from patients was 78.9 +/- 10.3% before freezing which decreased to 70.7 +/- 10.8 and 68.5 +/- 14.8%, respectively (p < 0.001). On the other hand, the mean percentage of normal sperm morphology in the control group decreased from 26.3 +/- 7.5% before freezing to 22.1 +/- 6.4% (p < 0.0001) after thawing with the computerized slow-stage freezer and to 22.2 +/- 6.6% (p < 0.0001) after the use of static liquid nitrogen vapour. In the patient group, the mean percentage of normal morphology decreased from 11.7 +/- 6.1% after freezing with the biological freezer to 9.3 +/- 5.6% and to 8.0 +/- 4.9% after freezing with static liquid nitrogen vapour. This study demonstrates that chromatin packaging and morphology of human spermatozoa decrease significantly after the freeze-thawing procedure, not only after the use of static liquid nitrogen vapour but also after the use of a computerized slow-stage freezer. However, the chromatin of semen samples with normal semen parameters (donor sperm) withstand the freeze-thaw injury better than those with low quality semen samples. Therefore, the computerized slow stage freezer could be recommended for freezing of human spermatozoa, especially for subnormal semen samples, for example, ICSI and ICSI/TESE candidates and from patients with testicular tumours or Hodgkin's disease, in order to avoid further damage to the sperm chromatin structure.     

精液冻存时间对精液质量及受孕能力的影响

目的旨在探讨供精精液冻存时间对精液质量及受孕能力的影响。方法回顾性分析广东省人类精子库280对夫妇使用供精冷冻精液成功怀孕在再次生育时使用同一供精者精液用于人工授精技术的临床使用、随访反馈等相关资料。结果已确认妊娠的人工授精周期复苏后供精精液质量如下:精子浓度,首次生育时(67.5±19.8)×10^6/m L,再次生育时(69.3±21.7)×10^6/m L,两组差异无统计学意义(P>0.05);前向运动精子百分比,首次生育时(54.7±8.8)%,再次生育时(51.0±7.0)%,两组差异有统计学意义(P<0.05)。再次生育精液与首次生育精液的冻存时间差与前向运动精子百分比差的相关性无统计学意义(P>0.05)。再次生育时精液周期妊娠率为20.9%,与同期首次生育的周期妊娠率21.49%相比,差异无统计学意义(P>0.05)。结论再次生育时精液质量与首次生育时比较略下降,提示精液冷冻保存时间的延长对精子活力有影响,但冷冻保存时间的长短与对精液质量影响大小的相关性无统计学意义。     

冻储时间对冷冻精子复苏率的影响

目的 :探讨冻储时间对冷冻精子复苏率的影响 ,以期找到最佳复苏时间。　方法 :取 88份正常供精者标本进行精液常规分析 ,精液用程序降温仪通过三步降温法冻存后置 - 196℃液氮中冻储 ,88份冻存标本随机分成 5组 ,分别于冻存后的 1d(Ⅰ组 ,n =14 )、7d(Ⅱ组 ,n =2 4 )、30d(Ⅲ组 ,n =19)、180d(Ⅳ组 ,n =18)、30 0d(Ⅴ组 ,n =12 )取出 ,37℃水浴复苏 ,再次进行精液常规分析。计算冷冻复苏率。　结果 :5组间的复苏率差异均无显著性 (P均 >0 .0 5 ) ,冻储时间与复苏率之间无相关性 (r=- 0 .0 5 ,P >0 .0 5 )。　结论 :程序降温仪冻存精液标本置 - 196℃液氮后 2 4h即可复苏分析 ,便于人类精子库耐冻实验批量筛查     

Sperm donation and its application in China: a 7-year multicenter retrospective study

Sperm donation in China is different from that in other countries due to cultural, social and political factors. This research presents the current status of sperm donation in Mainland China and highlights some problems. Between January 2003 and December 2009, 19 471 sperm donors were screened totally and 6467 donors (33.2%) were recruited. The primary reasons for non-recruitment were either inadequate semen parameters (55.0%) or positive results for sexually transmitted diseases (7.9%). There were 327 (1.7%) qualified donors who withdrew from the program because of frustration related to failed semen parameters, participation merely for free medical tests or job transfer. A questionnaire investigating donor intention, as well as other concerns associated with sperm donation, was distributed to 516 potential donors. All potential donors indicated their primary motivation as altruism, while 90.9% mentioned monetary reward as a second motivating factor. Approximately 93.4% of donors expressed some apprehension about the risk of consanguineous mating and the protection of their identity. Over the past 7 years, 488 389 vials of donors' semen have been cryopreserved. In 36 438 artificial insemination with donor sperm (AID) cycles, the clinical pregnancy rate was 23.9% and the live birth rate was 16.6%. In 7148 in vitro fertilization cycles, the clinical pregnancy rate was 45.8% and the live birth rate was 35.2%. Human sperm banks have been strictly monitored to ensure that each sperm donor can only impregnate five women nationwide. There is still a large gap between the supply and demand for sperm donation which may be solved by updated guidelines.     

Poor semen quality from patients with malignancies does not rule out sperm banking

Cancer therapy can further impair the already poor semen quality in cancer patients. This study evaluated the prefreeze and postthaw semen quality before treatment of patients with malignancies to examine the rationale for sperm banking for these men. Records of nine patients with different malignant tumors, who had been referred for sperm cryopreservation between 1982 and 1997, were reviewed and the results were compared with those of 50 normal healthy donors. Patients did not differ from donors in age, ejaculate volume, or duration of sexual abstinence. The total motile sperm count (median and interquartile range) was significantly different between patients and donors for prefreeze specimens (P=0.026) and postthaw specimens (P=0.008). Also, the percent motility was significantly lower in the patients as compared with the donors in prefreeze (P=0.035) and postthaw specimens (P=0.005). The percentage change in motility after thawing was also larger for patient samples (−54% versus −47%,P=0.39). Other sperm motion characteristics did not significantly differ between the two groups except for postthaw curvilinear velocity (P=0.01). This study concludes that fresh and frozen–thawed semen from patients with malignant tumors is poor in quality but is still adequate for assisted reproductive techniques. As cancer therapy may further impair semen quality, patients should be offered the chance to bank sperm before undergoing cancer therapy. Received: 25 October 1999 / Accepted: 22 May 2000     

Scrotal temperature and semen quality in men with and without varicocele

The exact role of varicocele in human male infertility remains controversial. Fifty-five male partners of infertile couples randomly selected and 17 fertile semen donors were evaluated for semen quality, scrotal temperature, and presence of varicocele using clinical palpation and Doppler ultrasound. The incidence of varicocele was 42% in male partners of infertile couples and 41% in fertile semen donors. Left scrotal temperature was significantly (p less than .001) higher in infertile males with varicocele as compared to all groups. No significant differences were observed in the percentage of morphologically normal sperm in semen of males with and without varicocele. However, the incidence of tapered, elongated, and immature sperm was significantly higher in the infertile patient population with a varicocele. Measurement of scrotal temperature and assessment of sperm morphology may be used as predictors of the presence and deleterious effect of varicocele.     

Assessment of sperm quality, DNA integrity and cryopreservation protocols in men diagnosed with testicular and systemic malignancies

Men diagnosed with malignancy are often referred for semen banking to preserve their fertility prior to cancer treatment. The chances of cancer patients for achieving future fecundity will be determined by the sperm quality including the integrity of the genomic material in the frozen samples. The objectives of this study were to compare the sperm quality and DNA integrity in men diagnosed with testicular and systemic malignancies before receiving treatment and to identify the optimum cryopreservation protocol for their samples including a remote semen collection option. In comparison with fertile donors, patients with testicular malignancies had significantly lower sperm concentration, while both testicular and systemic malignancy patients had significantly lower sperm motility and cryosurvival rates. In addition, the SCSA defined DNA fragmentation index was significantly higher in patients with testicular and systemic malignancies compared with fertile donors. It was noted that the extent of deterioration in sperm quality and DNA integrity seen in cancer patients did not reach the previously defined statistical threshold for impaired fertility. Freezing spermatozoa with the seminal plasma offers the highest protection against cryo-injury. Nevertheless, remote semen collection can still be used as it yields adequate results.     

Cryopreservation of human semen. Comparison of cryopreservatives, sources of variability, and prediction of post-thaw survival.

Human semen was cryopreserved using Human Sperm Preservation Medium, TEST-Yolk buffer, or glycerol alone. Sperm characteristics for each specimen were measured before and after freezing to determine which cryopreservative resulted in better cryosurvival and recovery of motile sperm. Sperm frozen in Human Sperm Preservation Medium had a significantly better recovery of all semen parameters (motility, velocity, and recovery) than either TEST-Yolk or glycerol alone. Statistical analyses also were done to examine the variability between and within donor semen specimens. Differences between donors, between specimens, and measurements within donors all contributed to variability of sperm characteristics. Specimen-to-specimen variability for a given donor represented 12% to 47% of the total variability, whereas processing and measurement variability represented 12% to 41%. Donors also varied in the ability of their sperm to tolerate freezing. There was a relationship between motile count after dilution with cryopreservative and post-thaw motile count. This relationship allows the prediction of poor-thaw survival before freezing a specimen.