Studies on pyospermia in male infertility

Among 670 infertile men, 72 were diagnosed as pyospermia according to our criteria. i.e., WBC greater than or equal to 10/hpf semen. The sperm motile efficiency index (SMEI) which indicates the rate of progressively motile sperms, was significantly low in pyospermic group compared with that of non-pyospermic men (WBC less than 5/hpf semen). From the result of split ejaculation, a major cause of pyospermia was supposed to be chronic prostatitis. The SMEI was decreased immediately after addition of the neutrophils and granulocyte elastase to semen. The mean value of granulocyte elastase in pyospermic group was 2859.6 micrograms/L, whereas that of non-pyospermic men was 131.6 micrograms/L. In summary, granulocyte elastase in seminal plasma may be a cause of inhibition of sperm motility in pyospermic state.     

Infection in the male reproductive tract. Impact, diagnosis and treatment in relation to male infertility

The following are the conclusions that can be derived from a review of the literature regarding the role of infection in the aetiology of male infertility. (i) Temporary inflammatory episodes in the male reproductive tract which are self-limiting are probably common. (ii) Caution should be exercised in the use of leukospermia or bacteriospermia as parameters for glandular infection. (iii) There is a need for alternative techniques for detecting non-symptomatic deep pelvic infections in the male; one technique of great promise is rectal ultrasound. (iv) Rectal ultrasound indicates that a large number of men with poor sperm quality have a non-symptomatic, chronic prostatovesiculitis. (v) Increasing evidence implicates Chlamydia trachomatis as being a major cause of chronic non-bacterial prostatitis. (vi) An important aspect of chlamydial infections in men may be that the male accessory sex glands may function as reservoirs for the organism, increasing the probability of infection in the female. (vii) Ureaplasma urealyticum may also play an important aetiological role in male infertility but its significance is confounded by its acknowledged function as a commensal in the reproductive tract. (viii) One of the manifestations of male reproductive tract infectiw is the induction of sperm autoantibodies. (ix) There is a need for more systematic controlled studies of the effects of antibiotic treatment on sperm quality with different preparations for extended periods using patient groups in which a glandular infection has been verified, e.g. by rectal ultrasonography.     

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.     

精索静脉曲张与男性不育

精索静脉曲张(VC)是导致男性不育的最常见原因之一,手术是治疗VC的主要方法。近来,关于VC导致不育的病理机制研究较多,尤其是细胞分子机制的研究进展较快,主要包括生精细胞凋亡异常和氧化应激。同时,对于VC手术指征和各种术式优劣性的认识也渐趋统一。本文介绍VC导致不育的细胞分子机制及临床治疗决策的研究进展。     

Lycopene and male infertility

Excessive amounts of reactive oxygen species （ROS） cause a state of oxidative stress, which result in sperm membrane lipid peroxidation, DNA damage and apoptosis, leading to decreased sperm viability and motility. Elevated levels of ROS are a major cause of idiopathic male factor infertility, which is an increasingly common problem today. Lycopene, the most potent singlet oxygen quencher of all carotenoids, is a possible treatment option for male infertility because of its antioxidant properties. By reacting with and neutralizing free radicals, lycopene could reduce the incidence of oxidative stress and thus, lessen the damage that would otherwise be inflicted on spermatozoa. It is postulated that lycopene may have other beneficial effects via nonoxidative mechanisms in the testis, such as gap junction communication, modulation of gene expression, regulation of the cell cycle and immunoenhancement. Various lycopene supplementation studies conducted on both humans and animals have shown promising results in alleviating male infertility--lipid peroxidation and DNA damage were decreased, while sperm count and viability, and general immunity were increased. Improvement of these parameters indicates a reduction in oxidative stress, and thus the spermatozoa is less vulnerable to oxidative damage, which increases the chances of a normal sperm fertilizing the egg. Human trials have reported improvement in sperm parameters and pregnancy rates with supplementation of 4-8 mg of lycopene daily for 3-12 months. However, further detailed and extensive research is still required to determine the dosage and the usefulness of lycopene as a treatment for male infertility.     

Antioxidant therapy in male infertility

Although reports have suggested the benefit of antioxidant treatment of infertile men, many studies also show no effect. Most studies in the literature are not randomized, placebo controlled, or double blinded in design, which makes it difficult to differentiate regression toward the mean from true positive treatment effects. The small patient sample sizes and varying male populations also add to the difficulty in comparing studies. Pregnancy, the most relevant outcome parameter, is rarely reported. Ideally, patients would be selected based on oxidative stress levels, and improvement in these levels would be correlated to improvement in pregnancy rates. Until those studies are performed, the use of antioxidants for the treatment of male infertility remains empiric.     

Novel concepts in male infertility

Extraordinary advances have been achieved in the field of male infertility in the last decades. There are new concepts in sperm physiology and several modern tools for the assessment of spermatogenesis kinetics in vivo. New tests using molecular biology and DNA damage assays allow the clinician to correctly diagnose men so far classified as having idiopathic male infertility. In the field of treatment, microsurgery has increased success rates either for reconstruction of the reproductive tract or the retrieval of spermatozoa for assisted conception. Emerging evidence suggests that life-style and environmental conditions are of utmost importance in male fertility and subfertility. This review discusses several concepts that have changed over the last years, such as the duration of the spermatogenic cycle in humans, Y-chromosome infertility, the reproductive potential of non-mosaic Klinefelter syndrome men, the impact of paternal age and sperm DNA in male infertility, the role of antioxidants in the treatment of infertile men, the predictive factors and techniques for sperm retrieval in non-obstructive azoospermia, and the microsurgical treatment of clinical varicoceles. Whenever possible, levels of evidence are provided as suggested by the Oxford Center of Evidence-based Medicine.     

Endocrine manipulation in male infertility

Endocrine therapy for male infertility is broadly categorized as specific or nonspecific therapy. Although uncommon, primary endocrine diagnoses in infertile men are amenable to targeted therapy. The efficacy of empiric endocrine therapy for idiopathic male infertility, however, has not been demonstrated conclusively by clinical trials. With better understanding of the underlying pathophysiology of idiopathic male infertility, careful evaluation of endocrine therapy in well-selected treatment groups and well-designed randomized, controlled trials is warranted. Although empiric endocrine therapy for idiopathic male infertility has been largely replaced by assisted reproductive techniques, both treatment modalities could play a role, perhaps as combination therapy.     

Immunology and male infertility.

This article has attempted to review evidence that suggests that immune factors may be operative in a small but significant number of infertile men. Although our current understanding of the possible processes by which autosensitization to previously sequestered reproductive antigens occurs is incomplete, there are laboratory assays presently available that give an indication, but do not prove, that immune factors may be contributing to the infertile state. Continued research is needed to develop new assays and more purified sperm antigens, which might enhance our knowledge of the underlying immunoreproductive changes. Until these are available, the following procedures should be considered when investigating a patient with infertility of suspected immune origin. The patient's history should be taken, and a physical examination should be performed. A complete blood count, urinalysis, and complete semen analysis and culture should be taken. Next, in vivo cervical tests (Sims-Huhner) are performed, followed by sperm antibody assessment (serum, semen) and perhaps in vitro cervical mucus sperm assays (especially the crossed hostility test). After the tests have been completed, the following possibe treatments exist: 1. Treatment of underlying infections 2. Correction of obstructions 3. Corticosteroid (or testosterone?) therapy 4. Washed sperm insemination 5. First portion of fresh ejaculate insemination 6. Artificial insemination with homologous donor 7. Adoption.     

Chlamydial infections and male infertility

Chlamydial infections may be difficult to diagnose due to the silent symptoms and difficulty in culturing. An infectious process may impair fertility by adversely affecting sperm functions, resulting in testicular damage or causing obstruction of the genital tract. In our study, we tried to find Chlamydial antigen by using EIA (Enzyme Immune Assay) and to compare the Ag(+) and Ag(−) groups according to semen parameters. Except for semen volume, we found significant differences in density, morphology, motility and viability (intervolume p>0.05, interdensity p<0.01, intermorphology p<0.001, intermotility p<0.001 and interviability p<0.001).     

阴囊温度升高与男性不育的关系

对２２例生育者、４４例精索静脉曲张（ＶＣ）患者、１７例特发性无精子症（ＩＡ）患者行远红外阴囊测温。并对无精子者行睾丸活检。结果发现：（１）ＶＣ患者阴囊温度显著高于生育者（Ｐ＜０．００１）而低于ＩＡ（Ｐ＜０．００１）。（２）ＶＣ精液正常者阴囊温度与生育者无差异而显著低于ＶＣ精液异常者（Ｐ＜０．０１）。（３）ＩＡ与ＶＣ合并无精子症阴囊温度无显著差异。（４）阴囊温度升高使生精细胞减少，精子成熟障碍，特别是Ｓｅｒｔｏｌｉ细胞变性明显。认为ＶＣ、ＩＡ患者均存在阴囊温度升高，且温度愈高，睾丸生精功能愈差。Ｓｅｒｔｏｌｉ细胞变性是睾丸生精障碍原因之一。阴囊温度调节失调可能是阴囊温度升高的直接原因。     

无精子症因子缺失与男性不育相关性研究进展

Y染色体上含有与男性性腺发育和精子发生及分化密切相关的基因。无精子症因子(AZF)是位于Y染色体长臂远端的精子发生调控基因,它的缺失会导致精子发生障碍进而引发男性不育。目前大多数人将AZF分为AZFa、AZFb、AZFc三个区域,也有人认为AZFb和AZFc之间应该增加一个新的区域并命名为AZFd。不同分区的缺失会引起不同的表型。其中,AZFc缺失作为目前最常见的缺失类型被广泛的研究。AZFc缺失包括了AZFc全缺失和AZFc部分缺失,AZFc部分缺失主要为gr/gr缺失和b2/b3缺失。gr/gr缺失在某些地区或人种中引起男性生精障碍的作用已经被证实,b2/b3缺失对生精障碍的影响目前尚无定论,但是它在单倍群N中的普遍分布这一现象也引发了人们的深入思考。本文对AZF不同区域尤其是AZFc区的基本结构、候选基因、缺失情况以及与精子发生的关系作一综述,旨在为临床产前诊断及男性不育治疗提供理论依据。     

AZF与男性不育研究进展

AZF微缺失的发生率在1%～55%之间不等。AZF基因缺失与严重的生精功能障碍密切相关,是最常见的导致严重少弱精子症和无精子症的分子遗传学因素。对AZF及其相关基因的研究,可从分子水平阐明精子发生障碍的机制,对男性不育症的诊断、治疗及预后判断具有非常重要的意义。本文综述了AZF基因结构和功能特点,及其与男性不育、隐睾、精索静脉曲张、Klinefelter综合征、精原细胞瘤、习惯性流产等之间的关系。     

性染色体与男性不育

男性不育是个全球化的问题,其包括遗传原因在内的影响因素众多。对男性而言,X染色体和Y染色体均为单个拷贝。Y染色体因为包含了许多精子发生和性腺发育的关键基因,因而成为研究的热点。Y染色体微缺失是男性精子发生障碍最常见的原因之一。Y染色体长臂的无精子症因子(AZF)区是Y染色体微缺失的好发区域。目前明确定位于AZF区域与精子发生相关的编码蛋白基因有14个,但由于通常的AZF缺失为多基因的联合缺失,因而AZF区域的特定基因在精子发生中的作用还不是很清楚。哺乳动物X染色体在精子发生中的作用因其富集着许多精子发生过程中生殖细胞特异表达基因而受到重视,如AR、USP26、TAF7L、TEX11、KAL1、AKAP4和NXF2等基因。在男性,由于X染色体为半合子状态,X连锁基因通常承受着特别的进化压力,X染色体连锁的单拷贝基因突变不会象常染色体那样被1个正常的等位基因所掩盖掉。尽管许多关于X染色体与精子发生关系的研究已经进行,但X染色体与男性不育的关系仍然还不清楚,还有待更进一步研究。     

Immunologic infertility in the male

Summary There is increased awareness of the role of immunologic factors in the production of male infertility. It is important to recognize and identify the immunoglobulin class and to attempt to demonstrate the mechanisms by which these immunoglobulins exert their effect on the human spermatozoan. There is most likely a spectrum of effects which are seen at various points in the reproductive tract. The use of high and low dose steroids for immunosuppression as well as sperm washing provide the best forms of therapy currently available, but a more universally effective form of therapy needs to be developed.     

Testicular microlithiasis in male infertility

Testicular microlithiasis was found in a 30-year-old infertile man. The literature is reviewed and the possible influence of testicular microlithiasis on male infertility is discussed.     

Scrotal ultrasound in male infertility

During an 18-month period, 200 male infertility patients had scrotal sonography examination. Fifty-seven percent showed abnormal sonogram; such as epididymitis, epididymo-orchitis, orchitis, varicocele, spermatocele, epididymal cyst and undescended testis. Among all lesions, infection was the commonest finding. There was no obvious relation between oligospermic and azospermic patients with scrotal sonographic findings except for testicular atrophy, which was very common among azospermic patients. This study indicates the role of scrotal sonography in male infertility patients.