中国男性十一酸睾酮酯注射避孕有效性多中心研究

目的评估十一酸睾酮酯（TU）注射避孕的安全性、有效性、可复性和可接受性。方法1,045名健康的有生育力的中国男性,每月一次TU500mg肌注共30个月,统计分析其配偶的妊娠率、精液参数、睾丸体积、生殖激素水平及安全性评估。结果在6个月的抑制期内有43名对象（4．8％）未达到无精子或严重少精子症;855名对象进入起效期,其中733名完成每月一次TU注射和恢复阶段。在避孕有效期的24个月,暴露1,554／人年中有9次妊娠,累计避孕失败率为1．1／100人;综合失败率6．1％,其中包括1．3％抑制不充分和4．8％短暂抑制后的精子反跳。本研究无严重不良事件报告。除了2名对象以外全部恢复生精功能,达到正常有生育力参考值范围。结论每月一次TU500mg肌注可以为健康有生育力的中国男性提供安全、有效、可逆的避孕。     

多重聚合酶链反应技术检测严重少精及无精子症患者无精子因子的研究

遗传缺陷引起男性精子发生障碍是男性无精子症、严重少精子症的原因之一。业已证明 ,位于 Y染色体长臂的无精子因子 (azoospermiafactor,AZF)的基因缺失或突变引起精子发生异常 ,为调控精子发生的候选基因之一。本研究采用多重聚合酶链反应技术检测 5 0名正常男性及 36例严重少精及无精子症患者 AZF因子。一、材料与方法1 .对象 :5 0名正常生育男性 ,36例不明原因的严重少精、无精子症患者 (按照 WHO的标准 )。所有患者染色体核型分析正常 ,并排除克氏征及其他因素引起的无精、少精症 ,以及先天性输精管缺如、炎症性输精管梗阻及病毒性…     

伴及不伴精索静脉曲张的无精子、严重少精子症患者Y染色体微缺失对比研究

目的:比较精索静脉曲张(VC)无精子症和严重少精子症与不伴VC无精子症和严重少精子症患者Y染色体微缺失发生率,探讨他们不育的内在原因。方法:A组为VC无精子症和严重少精子症的患者137例,其中无精子症70例(A1组),严重少精子症67例(A2组);B组为不伴有VC的特发性无精子症和严重少精子症患者135例,其中无精子症69例(B1组),严重少精子症66例(B2组)。C组(对照组)为30例正常生育男性。采用多重PCR技术对受试者进行Y染色体微缺失检测。结果:1 A组137例中有23例检测到Y染色体微缺失,缺失率16.8%。B组135例中有23例检测到Y染色体微缺失,缺失率17.0%;C组未检测到Y染色体微缺失;2 A1组、A2组、B1组和B2组Y染色体微缺失率分别为为22.9%、10.4%、20.3%和13.6%;3严重少精子症A2组和B2组共133例中16例检测出Y染色体微缺失,发生率为12.0%;4A组与B组比较,差异无统计学意义(P0.05)。结论:Y染色体微缺失发生率在伴有及不伴有精索静脉曲张的无精子、严重少精子症患者中无显著差异,Y染色体微缺失是精索静脉曲张伴有的无精子、严重少精子症病因之一。     

特发性无精子症和严重少精子症患者无精子因子检测的临床意义

20 0 1年10月至2 0 0 3年1月,我们采用PCR方法对5 0例正常生育男性和5 0例特发性无精子症和严重少精子症患者进行无精子因子(AZF)检测,现报告如下。材料与方法　5 0例正常生育男性。年龄2 8～38岁,平均33岁。精液常规检查精子数均>4 0×10 6/ml。5 0例特发性不育男性患者年龄2 8～4 2岁,平均34岁。临床检查排除相关的泌尿生殖系疾患。精子计数(2～5×10 6/ml) ,符合WHO诊断标准。患者均有正常4 6XY核型,外周血性激素指标正常。38例无精子症患者睾丸病理检查符合精子发生不完全的诊断。取抗凝血1ml,加入5倍体积重蒸馏水溶解红细胞,离心…     

严重少精子、无精子症患者外周血雄激素受体mRNA的表达研究

目的研究严重少精子或无精子症患者外周血中雄激素受体mRNA的表达。方法采用PT-PCR方法分别检测12例正常男性和31例严重少精子或无精子症患者外周血雄激素受体mRNA的表达。结果 所有正常男性和20例严重少精子或无精子症患者外周血雄激素受体mRNA的表达阳性，11例严重少精子或无精子症患者表达阴性。结论 雄激素受体异常可能是部分严重少精子或无精子症患者的病因。     

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。     

男性FASL-844基因多态性与特发性无精子症及严重少精子症发病风险的研究

目的:研究FASL-844位点基因多态性在中国南方汉族男性人群中的分布,探讨其与特发性无精子症及严重少精子症发病风险的关系。方法:采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法,分析184例特发性无精子症及严重少精子症患者与236例正常生育男性FASL-844位点的基因型及等位基因频率,分析该基因多态性与特发性无精子症及严重少精子症之间的关系。结果:不育组与正常生育组FASL-844CT和TT基因型分布差异有显著性(P=0.024;P=0.008)。携带FASL-844TT基因型个体罹患特发性无精子症或严重少精子症的风险是CC基因型个体的2.76倍(95%CI:1.20~6.35);将携带CC和CT基因型的个体合并,携带TT基因型的个体罹患特发性无精子症或严重少精子症的风险是(CC+CT)基因型个体的2.90倍(95%CI:1.28~6.58)。结论:FASL-844基因多态性可能是中国南方汉族男性特发性无精子症及严重少精子症的遗传易感因素之一。     

无精子症和严重少精子症患者Y染色体微缺失、染色体核型和性激素结果分析

目的:研究男性无精子和严重少精子症患者Y染色体微缺失、染色体核型和性激素的相关性。方法:收集无精子症患者63例、严重少精子症患者49例和精液参数正常生育男性60例,抽取外周血分别检测Y染色体微缺失、染色体核型和性激素水平。结果:63例无精子症患者中,7例Y染色体微缺失,微缺失的发生率为11.11%(7/63);49例严重少精子症患者中,4例Y染色体微缺失,微缺失的发生率为8.16%(4/49),与正常精液组(未发现Y染色体微缺失)比较均有统计学差异(P<0.05)。无精子症患者中,染色体核型异常率为9.52%(6/63),而正常生育男性精液组和严重少精子症患者中均未发现异常染色体核型。与正常生育男性精液组[FSH(3.88±2.21)IU/L;LH(4.63±1.51)IU/L]比较,无精子症[FSH(20.41±19.34)IU/L;LH(11.44±9.48)IU/L]和严重少精子症[FSH(8.88±7.04)IU/L;LH(6.78±3.85)IU/L]不育患者FSH和LH水平显著升高(P<0.05)。结论:无精子症和严重少精子症不育患者有必要进行遗传学和性激素检查,便于早期诊断和治疗。     

特发性无、少精子症病人精浆中性激素水平的测定及意义

目的 :通过测定特发性无、少精子症病人精浆中的性激素水平 ,比较分析精浆性激素与无、少精子症的关系。　方法 :特发性无、少精子症男性各 5 0例 ,正常对照 5 0例。精液常规分析判断精子密度 ,化学发光技术测定精浆性激素水平。　结果 :特发性无、少精子症组黄体生成素 (LH)分别为 (5 .19± 0 .6 7)IU/L和 (4.77± 0 .6 8)IU/L ,与正常组 (2 .19± 0 .2 2 )IU/L相比 ,特发性无精子症组差异有极显著性 (P <0 .0 1) ,特发性少精子症组与正常组相比差异有显著性 (P <0 .0 5 ) ;卵泡刺激素 (FSH)分别为 (1.90± 0 .79)IU/L和 (2 .2 7± 0 .2 5 )IU/L ,与正常组 (1.6 1± 0 .14)IU/L相比 ,差异均有显著性 (P <0 .0 5 ) ;泌乳素 (PRL)分别为 (6 .2 5± 0 .34 )ng/ml和 (6 .33±0 .5 1)ng/ml,与正常组 (6 .36± 0 .32 )ng/ml相比差异均无显著性 (P >0 .0 5 ) ;睾酮 (T)分别为 (1.5 1± 0 .12 )ng/ml和 (1.6 8± 0 .71)ng/ml,与正常组 (1.83± 0 .0 9)ng/ml相比 ,特发性无精子症组差异有显著性 (P <0 .0 5 ) ,特发性少精子症组差异无显著性 (P >0 .0 5 ) ;T/LH的比值分别为 0 .2 9± 0 .0 4和 0 .35± 0 .0 9,与对照组 0 .84± 0 .2 0相比 ,差异均有显著性 (P <0 .0 5 )。　结论 :特发性无、少精子症病人 ,精浆     

精液中白细胞含量不同的少弱精子症患者分类治疗观察

目的观察精液中白细胞含量不同的少、弱精子症患者的分类治疗效果。方法60例正常白细胞含量的少、弱精子症患者双盲分成治疗1组与治疗2组;68例白细胞精液症的少、弱精子症患者双盲分成对照1组和对照2组。分别比较4组治疗前后精液白细胞含量、精液常规及临床妊娠率。结果正常白细胞含量的少、弱精子症患者分别采用助育1号和五子衍宗丸治疗,治疗前后两组患者精液密度、活力、临床妊娠率均有提高,助育1号提高更显著。白细胞精液症的少、弱精子症患者分别采用助育2号和五子衍宗丸治疗,治疗前、后对照1组精液白细胞含量显著下降,对照2组治疗前、后精液白细胞含量无显著改变,对照1组治疗后精液常规有显著提高,与治疗前比较均有显著性差异(P<0．01);与对照2组比较,有显著性意义(P<0．01);配偶妊娠率对照1组与对照2组比较,有显著性意义(P<0．01)。结论少、弱精子症患者治疗前检测精液白细胞含量,根据不同精液白细胞含量分类、结合中医辨证治疗可收到显著疗效。     

十一酸睾酮和长效醋酸甲孕酮联合应用对精子发生抑制效果的临床研究

目的 :观察正常中国男性每 2个月注射一次长效醋酸甲孕酮 /十一酸睾酮 (DMPA/TU)抑制精子发生的效果。　方法 :30例年龄在 2 5～ 4 0岁已婚的健康中国男性在体检及化验筛查合格后参加本试验 ,并被随机分成 3组 :1个TU单用组 (1 0 0 0mgTU)和 2个DMPA/TU合用组 (1 0 0 0mgTU +1 5 0mgDMPA ,1 0 0 0mgTU +30 0mgDMPA) ,每组各 1 0例 ,以 8周间隔进行注射。试验共计 5 6周 :对照期 8周、抑制期 2 4周和恢复期 2 4周。　结果 :在抑制期 ,除了TU单用组有 2例精子密度出现反跳 ,其余所有受试者均达到无精子状态。所有志愿者都能耐受试验 ,没有发生严重不良反应。　结论 :在本试验条件下 ,TU单用能抑制精子发生但抑制效果不恒定 ,而DMPA/TU合用能恒定地抑制精子发生 ,1 0 0 0mgTU +1 5 0mgDMPA是最佳剂量组合 ,可用于进一步的临床扩大试验或避孕有效性试验。     

Male hormonal contraception: suppression of spermatogenesis by injectable testosterone undecanoate alone or with levonorgestrel implants in chinese men

Monthly injections of testosterone undecanoate (TU) act as a male contraceptive by reversibly suppressing spermatogenesis to azoospermia or severe oligoazoospermia in 95% of Chinese men. In 5% of Chinese men, however, monthly TU administered alone fails to suppress spermatogenesis into contraceptive ranges, or sperm "rebound," leading to occurrences of pregnancy during treatment. Since combinations of progestins and androgens are associated with greater degrees of sperm suppression in white men, we hypothesized that the combination of TU and the progestin levonorgestrel (LNG) would result in improved spermatogenic suppression in Chinese men. Sixty-two healthy Chinese men were randomly assigned to one of the following 3 regimens: group I (n = 21) received 4 LNG rods (75 mg each), which were followed 4 weeks later by 500 mg of TU by intra-muscular (IM) injection every 8 weeks for 24 weeks; group II (n = 20) received 4 LNG implants, which were followed 4 weeks later by 1000 mg of TU by IM injection every 8 weeks for 24 weeks; and group III (n = 21) received TU 1000 mg by IM injection every 8 weeks for 24 weeks. Sperm counts, serum testosterone (T), luteinizing hormone, follicle-stimulating hormone, and LNG were measured every 2 weeks before, during, and after treatment. During treatment, group II demonstrated a trend toward a greater attainment of azoospermia than groups I and III (90% vs 62% [group I] vs 67% [group III]; P =.09). Attainments of either azoospermia or oligozoospermia (sperm density, <3 x 10(6)/mL) were 95%, 100%, and 86% for groups I, II, and III, respectively (P >.05 for comparisons between groups). Spermatogenesis in all subjects returned to the normal range after the implants were removed. No serious adverse events and no significant changes in serum chemistry occurred during the study. These results demonstrate that the combination of IM injections of high-dose TU every 2 months and LNG implants is associated with marked suppression of spermatogenesis in Chinese men. The combination of high-dose TU every 2 months and LNG implants is a promising candidate for future large-scale efficacy studies of hormonal male contraception in Chinese men.     

Natural course of idiopathic oligozoospermia: Comparison of mild,moderate and severe forms

Objectives: To investigate the natural courses of mild, moderate and severe idiopathic oligozoospermia, and which factors or semen variables were of utmost importance in predicting the courses. Methods: A total of 208 men (age 29–47 years) who were diagnosed with mild, moderate and severe idiopathic oligozoospermia in a 9‐year‐period between January 2000 and December 2008 were followed up for more than 6 months. Results: Overall, 16 (24.6%) of 65 patients with severe oligozoospermia developed azoospermia, whereas two (3.1%) patients with moderate oligozoospermia developed azoospermia and none of the patients with mild oligozoospermia developed azoospermia. Initial follicle stimulating hormone level and testicular volume between the subgroups were significantly different (P = 0.0071 and 0.0039, respectively). The subgroup of patients who became azoospermic (n = 18) showed statistically significant differences in terms of body mass index and the level of prolactin (PRL) from the subgroup that maintained the initial lingering sperm count (n = 190; P = 0.0086 and 0.0154, respectively). As the vitality of semen variables increased 1%, the risk of progression to azoospermia diminished by 0.892‐fold, according to Cox's proportional hazards model analysis. A receiver operating characteristic curve analysis showed that the area under the curve was 0.755 and the sperm concentration value with the highest sensitivity and specificity was the reference value of 3–5 million/mL, with a sensitivity of 0.746 and specificity of 0.711 (P = 0.01). Conclusions: Patients with severe oligozoospermia should be warned of the possibility of becoming azoospermic and hence sperm freezing should be encouraged as early as possible.     

Predictors for partial suppression of spermatogenesis of hormonal male contraception

Aim： To analyze factors influencing the efficacy of hormonal suppression of spermatogenesis for male contraception. Methods： A nested case-control study was conducted, involving 43 subjects, who did not achieve azoospermia or severe oligozoospermia when given monthly injections of 500 mg testosterone undecanoate （TU）, defined as partial suppressors compared with 855 subjects who had suppressed spermatogenesis （complete suppressors）. Sperm density, serum testosterone, luteinizing hormone （LH） and follicle stimulating hormone （FSH） concentrations at the baseline and the suppression phase were compared between partial and complete suppressors. Polymorphisms of androgen receptor （AR） and three single nucleotide variants and their haplotypes of FSH receptor （FSHR） genes determined by polymerase chain reaction （PCR） and DNA sequencing technique were compared between 29 partial and 34 complete suppressors. Results： Baseline serum LH level was higher and serum LH as well as FSH level during the suppression phase was less suppressed in partial suppressors. Additionally, in a logistic regression analysis larger testis volume, higher serum FSH concentrations alone, or interaction of serum LH, FSH, testosterone and sperm concentrations were associated with degree of suppression. The distribution of polymorphisms of AR or FSH receptor genes did not differ between partial and complete suppressors. In cases with incomplete FSH suppression （FSH 〉 0.2 IU/L）, the chances of reaching azoospermia were 1.5 times higher in the subjects with more than 22 CAG triplet repeats. Conclusion： Partial suppression of spermatogenesis induced by 500 mg TU monthly injections is weakly influenced by hormonal and clinical features but not polymorphism in AR and FSHR genes.     

Evaluation of trend in semen analysis for 11 years in subjects attending a fertility clinic in India

Aim: The data on semen analysis of subjects attending the Fertility Clinic at NIHFW (National Institute of Health and Family Welfare) Munirka, New Delhi for the last 11 years were analyzed to verify the claims and speculations on declining sperm counts in men. Methods: Approximately 10 % of the records every year starting from 1990 to 2000 (numbering 1176 in total) were randomly selected for analysis. Subjects with azoospermia or severe oligozoospermia were excluded from analysis. Results: The average age of the men attending the infertility clinic was 31.2 years. The average semen volume and sperm count were found to be (2.6 ±0.1) mL and (60.6 ± 0.9) × 106/mL, respectively. No significant decline in sperm counts was observed in any year during the entire study period. Only 1.8 % of the total number of sperm counts in the random sampling were less then 20 × 106/mL. On the basis of WHO criteria on motility, the total percentage of non-progressive and non-motile sperm in the ejaculate was higher (63 %)     

Stimulation of sperm production by human chorionic gonadotropin after prolonged gonadotropin suppression in normal men

The precise hormonal milieu required for quantitatively normal spermatogenesis in man is unclear. The authors previously have shown that both supraphysiologic dosages of human chorionic gonadotropin (hCG) and physiologic dosages of human luteinizing hormone (hLH) can reinitiate sperm production in short-term (four months) gonadotropin-suppressed normal men who have prepubertal FSH levels. To determine whether normal FSH levels were necessary to stimulate sperm production after a prolonged period of gonadotropin and testicular suppression, the authors administered hCG to four normal men whose endogenous gonadotropin levels and sperm production were suppressed by prolonged exogenous testosterone (T) administration. After a 3-month control period, all subjects received 200 mg of T enanthate intramuscularly (im) each week to suppress LH and FSH for a total of 9 months and until successive sperm concentrations (performed twice monthly) revealed azoospermia or severe oligozoospermia (mean sperm concentration less than 3 X 10(6) spermatozoa/ml) for 6 months. Then, while continuing the same dosage of T enanthate, all four men simultaneously received 5000 IU of hCG im three times weekly for 6 months, replacing LH-like activity and leaving FSH activity suppressed. The effect on sperm production of the selective FSH deficiency produced by hCG plus T administration after the period of prolonged gonadotropin suppression was determined. Exogenous T administration resulted in severe suppression of sperm concentrations from 79 +/- 7 X 10(6) spermatozoa/ml (mean +/- SEM) during the control period to 0.8 +/- 0.5 X 10(6)/ml after 12 weeks of T treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hormonal contraception in Chinese men：variations in suppression of spermatogenesis with injectable testosterone undecanoate and levonorgestrel implants

Aim: To explore the causes of the difference in spermatogenic suppression between responders and non-responders in Chinese men treated with levonorgestrel (LNG) implants plus testosterone undecanoate (TU) injectable. Methods: The 16 Chinese volunteers treated were divided into two groups in regard to the sperm count during the treatment period, 7 men in the responder group (Group R), including 6 azoospermia and one severe oligozoospermia, and the remaining 9 in the non-responder group (Group N), including 4 oligozoospermia and 5 with sperm counts greater than 20×106/mL. The differences in serum profiles of FSH, LH, T, LNG and T/LH ratio were compared between the two groups and the correlation between the seminal fluid parameters and serum reproductive hormones was analyzed. Results: The serum FSH level was lower in Group R than that in Group N (P<0.05), while the serum LH and LNG levels were higher in Group R than those in Group N (P<0.05). The sperm density (P<0.01, r=0.235), motility (P<0.01, r=0.326)     

Isotretinoin for the treatment of nonobstructive azoospermia:a pilot study

T he treatment of men with infertility from azoospermia is challenging.As some men with severe oligozoospermia improve sperm output during treatment with isotre...     

不同来源的精子ICSI治疗周期妊娠结局分析

目的:比较不同来源的精子进行ICSI治疗后受精率、胚胎种植率、临床妊娠率等临床指标有无差异。方法:回顾性分析2006年1月~2008年12月本院生殖中心进行的431个ICSI治疗周期,按精子来源分为A组(重度少弱精子症组)287个周期、B组(梗阻性无精子症附睾穿刺组)109个周期、C组(梗阻性无精子症睾丸穿刺组)35个周期,比较各组女方平均年龄、男方平均年龄、不孕病史、平均MII卵数、受精率、卵裂率、胚胎利用率、平均移植胚胎数量、种植率、妊娠率、流产率等指标的差异。结果:A组与B、C两组在种植率、妊娠率方面差异有统计学意义(18.46%vs25.23%、28.76%;31.23%vs42.16%、39.39%,P<0.05);B、C两组之间各数据差异无统计学意义(P>0.05),受精率、卵裂率、流产率3组之间差异无统计学意义。结论:重度少弱精子症患者射出精子进行ICSI治疗后胚胎种植率、临床妊娠率低于梗阻性无精子症患者。