用夫精人工授精法治疗男性不育

９４对不育症夫妇，男方患有精索静脉曲张、少精弱精症、畸形精子症、精液不液化、免疫不育、阳萎、逆行射精以及女方宫颈因素，采取夫精人工授精或药物治疗，提高精液质量等方法，２３例妊娠、妊娠率达２４．６６％。研究表明，洗涤精子、宫腔授精对少精弱精症、免疫不育和精液不液化无效。     

流式细胞计检测人精子顶体及其与精液其他参数的关系

运用流式细胞计及人精子顶体特异性标记物结合异硫氰酸荧光素的花生凝集素检测了３４例精液精子顶体结构的完整性。其中正常生育精液１２例，弱精症精液１２例，畸形弱精症精液１０例。并且进一步检测了２０例精液在体外诱导下精子发生顶体反应的能力，其中正常生育精液１０例，不育精液１０例。结果表明人精子顶体结构的完整性与精于正常形态百分率，存活率，前向运动百分率显著正相关（Ｐ＜０．００１）。不育组精子在体外诱导下发生顶体反应的能力明显低于生育组（Ｐ＜０．０１），说明流式细胞计能用于预测生育力。     

不育男性精浆淀粉酶测定

测定了不育和生育男性糖浆淀粉酶，并对其临床应用进行了探讨。1对象和方法1．互检测对象男性不育病人168例．年龄26～40岁，均为婚后2年以上不育。正常生有男性28例，年龄27～34岁，均为妻子怀孕待产。1．2检测方法用手淫法留取全部精液于干燥洁净的玻璃瓶内，记录液化时间，作常规检查。精浆淀粉酶测定按全国临床检验操作规程，采用碘一淀粉比色法“‘。将不育男性精液分为五组：液化不良组（精液lh不液化或液化不全）；无精子症组；感染组（精液涂片镜检WBC＞IO个／HP）；精子活动率低组（精子活动率＜50％）；少精液组（精液＜1ml）…     

精子体外处理技术

精子体外处理技术辽宁省计划生育科研所李宏军综述少精子、精子活力低下、畸形精子、精液液化不良：精浆中存在抗精子抗体等引起的不育，在经内外科系统治疗都不能使精子质量改善并达到受精目的，而患者又不愿接受供者精液人工授精时，实验室精子体外处理技术是一个重要的...     

Percoll法处理对人精子运动参数的影响

为观察来源于３种不同精液标本精子运动参数的差异及其Ｐｅｒｃｏｌｌ处理后的变化，本文对新收集的正常精液精子（Ｉ组）少精及弱精症精子（Ⅱ组）及正常精液冻融精子（Ⅲ组）各１０份，分别于Ｐｅｒｃｏｌｌ处理前后电子计算机精液分析仪（Ｃｏｍｐｕｔｅｒａｓｓｉｓｔｅｄｓｅｍｅｎａｎａｌｙｓｅｒ）进行运动特性分析，记录ＭＯＴ，ＶＳＬ，ＶＣＬ，ＬＩＮ，ＡＬＨ及ＶＡＰ６项参数，其结果进行统计学分析，Ｐｅｒｃｏｌｌ处理     

强精冲剂治疗少精、弱精症Ⅰ期临床试验

根据浙江省著名中医男性学家鲍严钟主任医师提供的经验方，经省医科院药物所改制成强精冲剂，我们对少精、弱精症等男性不育病人进行了I期临床试验，现小结如下：1对象与方法少精、弱精症的病例选择，按WHO（1992年）《人类精液实验室检验手册》所定标准执行，同时参照卫生部《中药新药治疗男性不育的临床研究指导原则》。精子密度低于20×106／ml为少精子症。活动力为a级精子少于25％或a＋b级精子少于50％为弱精子症。全部试验病例均来自三家医院的门诊男性不育病人，共30例。试验前、后作2~4次精液分析、抗精子抗体测定、精子毛细管穿透…     

精液不液化病因学研究进展

精液不液化是指离体精液在室温下（22～25℃）60min仍不液化或仍含有不液化的凝集块。近年来，因精液不液化导致的男性不育患者逐渐增多，有资料表明：国外报道以精液不液化为惟一异常指标者占男性不育的11．8％，国内报道为9．8％。稠厚和不液化精液影响精子活力和活率，降低精子穿透宫颈粘液能力，导致不育。目前，     

生育与不育男性精液常规、精浆蛋白量和血清FSH水平

本文测定了26例正常生育男性和70例不育男性连续两次精液的常规、精浆总蛋白量和血清FSH浓度。按照精子密度,将不育男性分为少精组、无精组和精子密度>40×10~(?)/ml组。观察到不育男性精液液化时间、pH、体积的均数与正常生育男性间差别无显著性,而Ⅱ级+Ⅲ级活动度精子、活动精子、正常形态精子百分率及精浆总蛋白量低于正常生育组。少精组和无精组的血清FSH浓度明显高于正常生育组。精子密度与血清FSH浓度呈负相关。活动精子百分率与正常形态精子百分率呈正相关。     

不育男性精浆四种肿瘤标志物的检测及其与不育关系的探讨

目的：探讨不育男性精浆四种肿瘤标志物与不育之间关系。方法：用ＥＬＩＳＡ法 ４２例不育男性精浆和血清内的前列腺特异抗原（ＰＳＡ）、卵巢癌抗原（ＣＡ１２５）、乳腺癌抗的（ＣＡ１５－３）、胃肠癌抗的（ＣＡ１９－９）的浓度，并与精子密度、精液液化正常者进行比较。结果：所检测的四种肿瘤标志物精浆明显高于血清浓度，但与精子的运动特必均无明显相关；无精子者精浆内ＣＡ１９－９浓度明显主于精子密度正常者，精液液化不     

精液过滤结合IUI治疗精液不液化不育

探讨体外精液过滤法治疗精液不液化不育症的临床疗效。本文采用双层镜头纸过滤精液结合宫腔内授精或宫颈管内授精（IUI／ICI）,对35例精液不液化不育者进行了48个周期治疗。结果表明过滤后精液全部液化,妻子妊娠率51．4％,周期妊娠率37．5％。结论认为双层镜头纸过滤精液结合IUI治疗精液不液化不育,方法简便、安全、有效、值得临床推广应用。     

bFGF促进特发性少弱精子症生精细胞增殖超微结构改善及临床观察

目的：探讨碱性成纤维细胞生长因子（ｂＦＧＦ）对特发性少弱精子症的作用。方法：应用ｂＦＧＦ对３４例特发性少弱精子症的患者进行治疗,并采用免疫组织化学、放射免疫及电镜技术等观察患者治疗前后睾丸生精细胞增殖情况、超微结构、血生殖激素及精液质量的变化。结果：治疗后所有患者睾丸生精细胞增多（Ｐ〈０．０５）,排列较治疗前规整,细胞超微结构改善。精液质量及血生殖激素（催乳素、卵泡刺激素、黄体生成素、睾酮）水平均     

Beta-endorphin and male infertility

Beta-endorphin (beta-ED) levels were evaluated in blood and seminal plasma of men with infertility due to varicocele, obstructive and nonobstructive azoospermia, and idiopathic oligoasthenospermia. The relation of this opiate to serum levels of gonadotropins, prolactin, testosterone, androstenedione, and dehydroepiandrosterone sulfate has also been investigated. beta-ED levels in seminal plasma were significantly higher than in blood plasma (p less than 0.001) in all persons studied. No statistically significant differences were found for beta-ED concentrations in semen or blood among any of the infertility situations studied. Nor were significant correlations observed between the concentration of this opiate and that of gonadotropins, prolactin, and androgens. The measurement of beta-ED in semen has little value in the differential diagnosis of male infertility. Nonetheless, its presence in high levels in semen must have some unknown function. Possibly, it comes from the various sites of the male reproductive tract, since no significant differences were found between obstructive and nonobstructive azoospermias.     

碱性成纤维细胞生长因子用于治疗特发性少弱精子症的临床意义(附57例疗效观察)

为了探讨碱性成纤维细胞生长因子（ｂＦＧＦ）对特发性少弱精子症患者的作用,本研究对５７例确诊为将发性少弱精子症的患者用ｂＦＧＦ治疗,分别在治疗前后进行血生殖激素测定和精液质量分析。结果发现治疗后血生殖激素（ＰＲＬ、ＦＳＨ、ＬＨ、Ｔ）水平升高,精子密度及顶体酶活性显著提高（Ｐ〈０．０１）,精子活动力和成活率上升、畸形率下降（Ｐ〈０．０５）,生育能力提高。因此认为ｂＦＧＦ是治疗特发性少弱精子症的有效药物。     

Karyotype analysis in large sample cases from Shenyang Women's and Children's hospital: a study of 16,294 male infertility patients

To explore that it is necessary to routinely detect chromosomes in infertile patients, we investigated peripheral blood lymphocyte karyotype in 16,294 male infertile patients in the north‐east of China and analysed the incidence and type of chromosomal anomaly and polymorphism. G‐banding karyotype analysis of peripheral blood lymphocytes was performed in 16,294 cases. Semen analysis was performed three times in all the men. PCR and FISH confirmed the presence of the SRY gene. The rate of chromosomal anomaly in the 16,294 male infertile patients was 4.15% (677/16,294). The rates of chromosomal anomaly were 0.24% in normal semen group, 12.6% in light oligoasthenospermia group, 4.7% in moderate‐to‐severe oligoasthenospermia group and 9.59% in azoospermia group. There are two male infertile patients with 45,X chromosome karyotype. One X male patient had confirmed the presence of the SRY gene and FISH analysis demonstrated its location on the p arm of chromosome 13. The other X male patient had not found SRY gene in its whole‐genome DNA. Meanwhile, sperm motility is slightly oligo‐asthenozoospermic at the age of 35–39 and nearly azoospermic at the age of 40–45. As the rates of chromosomal anomaly are 0.24% and 12.6% even in normal semen group and light oligoasthenospermia group, the rates of chromosomal polymorphism are 5.36% and 25.51% in normal semen group and light oligoasthenospermia group, respectively; it is necessary to explore peripheral blood lymphocyte karyotype in all infertile couples. We mentioned that Y, 1, 2, 9 and 12 chromosomes were quite important about male infertility. These findings demonstrate that autosomal retention of SRY can be submicroscopic and emphasise the importance of PCR and FISH in the genetic workup of the monosomic X male. At the same time, it suggested that male infertility might be related to meiotic disturbances with spermatogenetic arrest in Y‐autosome translocations, which could result in infertility by reduction of sperm production. Last but not least, ageing is one of the factors that could reduce sperm motility and quality.     

Failure of artificial insemination of husband's semen in the treatment of male infertility

In the management of infertility, in case semen quality is found insufficient and could not be improved by medical means, handling the available spermatozoa in the most beneficial way has been aimed. Thus, artificial insemination with low quality semen has become a therapeutic alternative. In this study homologous artificial insemination has been used to treat infertility caused by oligoasthenospermia. Eighteen couples have been treated for 58 cycles by intrauterine or paracervical insemination using cervical cups. During the same period 42 cycles with timed vaginal intercourse have been assessed. Though no pregnancies could be obtained following artificial insemination, one pregnancy occurred during no-treatment cycles.     

The evaluation of Human papilloma virus and human herpes viruses (EBV,CMV, VZV HSV-1 and HSV-2) in semen samples

There are a number of risk factors, especially viral diseases, which can lead to infertility. Among the various viral infections, much attention has been given to the role of the Papillomaviridae and Herpesviridae. After collecting 82 semen samples (37 teratospermia, 2 asthenozoospermia, 2 oligoasthenospermia, 1 oligospermia, 6 asthenoteratospermia and 34 normal semen samples), and washing them, the DNA from both freshly ejaculated spermatozoon and washed spermatozoa was extracted. Subsequently, the prevalence of EBV, CMV, HSV-1, HSV-2, VZV and HPV was evaluated using Multiplex PCR and Nested PCR. In this study, 1 normal and 5 abnormal semen samples were infected with HSV-1 (1 normal, 4 teratospermia and 1 oligoasthenospermia). In addition, there were 2 VZV-positive samples (both were teratozoospermia). Nested PCR indicated that 1 asthenozoospermia, 1 asthenoteratospermia, 3 teratospermia and 4 normal samples were HPV positive (including 8 HPV-18 and 1 HPV-33). Among 9 HPV-positive subjects, 3 samples were negative after washing the infected samples. The prevalence of EBV, CMV, VZV, HSV-1 and HSV-2 remained unchanged prior to and after washing. Maybe sperm washing can be useful to eliminate HPV infection from semen samples, but further investigation is required because of the small number of samples.     

Effects of L-carnitine combined with pancreatic kininogenase on thioredoxin 2, thioredoxin reductase 1, and sperm quality in patients with oligoasthenospermia

BackgroundTo study the effects of L-carnitine (LC) combined with pancreatic kininogenase on thioredoxin 2 (Trx 2), thioredoxin reductase 1 (TrxR 1), and sperm quality in patients with oligoasthenospermia.MethodsA total of 300 male infertility patients with oligoasthenospermia who were treated in the andrology clinic of our hospital from December 2019 to December 2020 were randomly divided into an LC group and combined treatment group, and 50 males with normal semen were selected as a control group. The computer-assisted semen analysis system (CASA) was used to detect the total number, vitality, and forward motility of the sperm before and after treatment, and sperm morphology was detected by the Diff-Quik method of the sperm staining kit. Sperm chromatin dispersion (SCD) method was used to detect sperm DNA fragments, and Western-blot was used to detect the protein expression of Trx 2 and TrxR 1.ResultsThere were no significant differences in sperm density, motility rate, forward motile sperm rate, and DNA fragmentation rate in oligoasthenospermia patients before treatment (P>0.05). However, after 1 month of treatment, the sperm density, motility rate, and forward motile sperm rate were all higher than before treatment (P<0.05), while the DNA fragmentation rate was lower than before treatment. At the same time, each index of semen in the combination group was higher than that in the LC group (P<0.05), and the total effective rate in the combination group was significantly higher than in the LC group (P<0.01). The expression of Trx2 protein in oligoasthenospermia patients was significantly increased (P<0.05), while the expression of TrxR1 protein was significantly decreased (P<0.05). After 3 months of treatment, the expression of Trx2 protein was significantly decreased (P<0.05), while the expression of TrxR1 protein was significantly increased (P<0.05).ConclusionsThe results suggest Trx 2 and TrxR 1 may be candidate protein markers for oligoasthenospermia. LC combined with pancreatic kininogenase in the treatment of male oligoasthenospermia can effectively promote sperm maturation, enhance sperm motility, and improve semen quality, which has high application value.     

显微外科曲张精索静脉结扎术治疗精索静脉曲张(附94例报告)

目的:探讨显微外科曲张精索静脉结扎术治疗精索静脉曲张的临床效果。方法:回顾分析2008年8月至2011年2月显微外科术治疗94例精索静脉曲张患者的临床资料。94例中,主要因睾丸坠胀不适、疼痛等症状就诊者36例;主要因不育或少弱精子症就诊者58例。经腹股沟途径或外环口下途径行显微外科曲张精索静脉结扎术,术后1、3、6个月随访相关并发症及精液参数改善等情况。结果:获得随访6个月至2年的患者88例,失访6例。术前主要以睾丸坠胀不适、疼痛等症状就诊获得随访的32例患者,术后症状消失者21例(65.6%),减轻6例(18.8%),无改善5例(15.6%)。获得随访的56例不育或少弱精子症者术前精子浓度及活力为[(a+b)%]为(8.26±1.68)×106/ml、(5.25±1.09)%,术后3个月及6个月分别为(15.47±3.21)×106/ml、(18.39±4.05)×106/ml和(13.34±5.16)%、(17.23±4.69)%,均较术前显著改善(P均<0.01)。结论:显微外科曲张精索静脉结扎术治疗精索静脉曲张可有效改善睾丸疼痛、坠胀不适等症状,并提高精子浓度和活力。     

显微外科精索静脉曲张切除术治疗男性不育

精索静脉曲张(VAC)是导致男性不育的常见原因。手术是治疗VAC的主要方法。传统手术方法包括Palo-mo手术、经腹股沟精索内静脉高位结扎术及腹腔镜手术术后睾丸鞘膜积液、睾丸动脉损伤等并发症的发生率及VAC复发率较高。近年来国际上兴起的显微外科精索静脉曲张切除术(MV)可有效的保护精索淋巴管及睾丸动脉,彻底结扎除输精管静脉外的所有精索静脉,使并发症及复发率大为降低。MV可显著改善VAC不育患者的精液质量,提高妊娠率;对严重少弱精子症或非梗阻性无精子症的患者的精液质量也有改善作用,目前已成为治疗VAC的"金标准"。     

Sperm processing and intrauterine insemination for oligospermia

The success of IVF has led to the adaptation of IVF sperm processing methods for WIUI. When WIUI is used for treating oligoasthenospermia, there is a theoretical advantage because an isolated population of only the most motile, capacitated sperm are placed directly into the wife's uterus. The cervix and its mucus are bypassed, which may provide a mechanical or biochemical advantage for semen from subfertile males. Removal of seminal plasma (and prostaglandins contained therein) prevents the painful uterine contractions that can occur when raw semen is placed directly into the uterine cavity. The disadvantages of WIUI are related to its expense, problems with precise timing of ovulation, and the frustration that can occur when inseminating personnel are not available whenever ovulation occurs on weekends or holidays. Only truly committed couples who will try WIUI for multiple cycles should be selected for this method of infertility treatment. Although male-factor infertility currently is one of the main indications for WIUI, the widely variable pregnancy rates reported with WIUI leave some doubt regarding its ultimate role in the treatment of this condition. Our own preliminary results with WIUI for treatment of asthenospermia, oligoasthenospermia, and "cervical factor" infertility are encouraging, although the numbers of patients are small. We anticipate that with further refinement of methods of sperm processing and with the newer improved methods of home monitoring of ovulation, these results may improve. Factors that determine pregnancy rates of WIUI for the treatment of oligoasthenospermia are numerous. The degree of oligospermia and/or asthenospermia, the cooperation and persistence of the couple through the required cycles of WIUI (drop-out rate), the method and meticulousness of sperm processing, the accuracy of monitoring ovulation, the availability of insemination personnel whenever ovulation occurs (even on weekends and holidays), and possibly the duration of infertility will all play a role in the ultimate success of WIUI programs. Couples selecting WIUI must be aware that it does not now offer a high pregnancy rate when used for treatment of male-factor infertility. The apparent increased pregnancy rate of WIUI compared with other methods of AIH may have resulted from modern methods of monitoring ovulation. Studies have not yet been performed to show whether comparable pregnancy rates would be obtained if similar methods of monitoring ovulation were used with cervicovaginal methods of AIH. We believe the only clear indication for WIUI now is an abnormal sperm-cervical mucus interaction.(ABSTRACT TRUNCATED AT 400 WORDS)