1426例男性不育患者精液常规结果分析

目的对引起男性不育的各种因素进行分析和探讨。方法用北京中科恒业的精液检测系统对1426例不孕不育中心就诊的男性不育患者及107例正常生育者进行精液常规项目分析及统计。结果（1）不育组与正常组结果比较显示两组精液量、pH值差异无统计学意义（P〉0.05）,而精子密度、a＋b级精子活动率比例、正常精子形态百分率三项指标与正常对照组差异有统计学意义（P〈0.05）;（2）将精液白细胞数〉1×109/L设为阳性组,精液白细胞数≤1×109/L设为阴性组,两组间各类精液异常症状比率的差异有统计学意义（P〈0.05）。结论男性不育症患者的精液精子密度、a＋b级精子活动率比例、正常形态精子百分率三项指标与正常对照组均较正常者低。     

精子DNA碎片指数、精液常规参数与人工授精助孕结局的相关性

分析精子DNA碎片指数、精液常规参数与人工授精助孕结局的相关性。方法 选取鹤壁市某医院2019年5月—2021年4月诊疗的232例男性不育患者为调查对象，对调查对象进行精子DNA碎片指数及精液常规检查（精液体积、精子浓度、精子总数、前向运动精子数、活动精子数、正常形态率），统计调查对象人工授精助孕结局，分析调查对象人工授精助孕结局影响因素，分析调查对象精子DNA碎片指数与精液常规参数的相关性。结果 232例男性不育调查对象中，与其配偶人工授精助孕成功率为48.71%（113/232），失败率为51.29%（119/232）。不同人工授精助孕结局男性不育调查对象前向运动精子数、活动精子数、正常形态率、精子DNA碎片指数比较，差异均有统计学意义（P＜0.05）。Pearson相关分析结果显示：精子DNA碎片指数与前向运动精子数、活动精子数、正常形态率呈负相关关系（P＜0.05）。多因素Logistic多元回归分析结果显示：前向运动精子数、活动精子数、正常形态率是男性不育调查对象配偶人工授精助孕成功的保护因素，精子DNA碎片指数是男性不育调查对象配偶人工授精助孕失败的独立危险因素（P＜0.05）。结论 精子DNA碎片指数、精液常规参数与人工授精助孕结局关系密切，精子DNA碎片指数低、运动精子数及活动精子数多、精子正常形态率高的男性不育患者人工授精助孕成功率较高，此结果对临床人工授精助孕方案的选择具有指导作用。     

宫腔内人工授精助孕患者精子制备方法的选择策略

目的为丈夫精液正常行自然周期宫腔内人工授精（IUI）第一周期患者选择最佳的精子制备方法。方法采用区组随机分组的方法将研究对象分为4组（标准上游组,直接上游组,密度梯度离心组和密度梯度离心和直接上游组）。精子计数应用Makler计数板,形态学分析采用伊红-苏木精染色法,枉娠结果的判定为IUI28d后行超声监测到胎囊及胎心。结果四组患者的岳娠率．活产率及流产率无差异。寥度梯度离心组的精子处理时间最少（13．5分）。密度梯度离组的a＋b级精子回收率（42．5±15．7）％及a＋b级精子总回收数最高（55．3±25．7）百万。密度梯度离心组（26．5±11．6）％和密度梯度离心加上游组的回收精子畸型率低（24．7±12．8）％。结论丈夫精液正常行第一周期IUI自然周期助孕的患者,精子制备方法首选直接上游法。     

长期过量饮酒对精子质量及生精细胞凋亡的影响

目的探讨长期高浓度过量饮酒者精液中一氧化氮（NO）含量其精子质量和生精细胞凋亡与不育的关系。方法116例过量饮酒男性患者精液分为4组,30例不饮酒男性精液为对照,采用硝酸还原酶法特异地将NO代谢产物硝酸盐（NO3^-）测还原成亚硝酸盐（NO2^-）总量代表NO水平。用脱氧核苷酸末端转移酶（TdT）介导的缺口末端标记（TUNEL）法和双目光学显微镜,分别检测和观察生精细胞的凋亡率及形态结构。用SQA—V全自动精子质量分析仪,测定精子质量。结果未饮酒生育组精液中NO的含量为（54．81±11．45）μmol／L,生精细胞的凋亡率（4．52±I．23）％,精子质量活率（80．24±0．17）％、活力a＋b（78．32±0．12）％、畸形率（5．304±0．13）％,与长期高浓度过量饮酒C组[（128．83±22．73）μmol／L,（17．34±2．53）％,（51．18±0．58）％,（21．45±0．26）％,（21．12±3．24）％]相比,差异均有统计学意义（t：10．04,17．38,6．69,15．59,17．02,P〈0．01）。长期高浓度过量饮酒各组NO的含量和生精细胞的凋亡率呈正相关（r=0．93,P〈0．01）。凋亡的生精细胞核染色质浓缩于核周形成新月形,核裂解形成凋亡小体。结论长期高浓度过量饮酒者精液中NO的含量和生精细胞的凋亡率均升高,精子质量低下。提示长期高浓度过量饮酒可致机体NO过度产生而促使生精细胞凋亡致男性不育的因素之一。     

计算机辅助精液质量分析系统参数调校方法

目的：调校精子质量分析系统的体积参数和速度参数。方法：按WHO规定的标准和方法自制精液分析的标准品，分别进行人3-．分析、CASA分析精子的浓度和活力，以人工分析结果来调校精子质量分析系统的体积、速度参数。结果：自制标准品的人工分析精子浓度（×106／mL）、总活力（％）、前向运动精子（％）分别为47．6±3．3、56．6±4．9、36．4±3．8：精子质量分析系统调校前、后的精子浓度（×106／mL）、总活力（％）、前向运动精子（％）分31]为74．8±7．5、53．3±3．6、31．9±2．8和51．3±5．1、55．1±4．5、37．5±3．4。精子质量分析系统体积参数调校前计算出的精子浓度与人工分析结果间存在显著性差异（P〈0．01）。结论：虽然精子质量分析系统经过厂家的定标，但在临床使用前仍有必要进行体积和速度参数设置。     

过频性交,难生宝宝

一些夫妇求子心切，总是频繁性交，甚至一日数次，以期早日受孕，但结果往往适得其反。因为精液及精子的质和量是决定受孕的因素之一，而性交频率又是影响精液和精子质量的重要方面。性交过频可引起每次性交射出的精液量少、精子密度低、精子发育不全、活力不足而影响受孕，甚至可引起女方免疫性不孕。正常情况下，男子一次射精的精液量为２～６毫升，精液中的精子量（精子密度）为６×１０９／升以上，８０％具有正常形态，６０％具有正常活动能力，其中任何一个值低于正常即可导致不孕。如果每日不止一次性交，就会导致精液量减少，精子密…     

显微精索静脉结扎术治疗男性不育56例报告

目的探讨显微精索静脉结扎术治疗精索静脉曲张不育的临床效果。方法采用显微精索静脉结扎技术治疗56例精索静脉曲张不育患者,观察术前及术后1、3、12个月的精液质量并随访观察1年内配偶的妊娠率。结果56例患者术前精子浓度为（16．1±6．3）×10^6个／ml,术后1、3和12个月的精子浓度分别为（32．3±12．3）×10^6个／ml、（38．3±14．7）×10^6个／ml和（39．9±14．2）×10^6个／ml;术前精子总数为（54．2±18．3）×10^6个,术后1、3和12个月的精子总数分别为（112．5±48．8）×10^6、（125．7±47．7）×10^6和（126．7±49．5）×10^6个;术前前向运动精子总数为（7．3±1．5）×10^6个,术后1、3和12个月的前向运动精子总数分别为（53．8±9．0）×10^6、（66．2±10．2）×10^6和（68．3±11．9）×10。个,术后3项指标均有明显提高,与术前比较,差异均有统计学意义。术后随访1年妊娠率为60．7％。结论显微精索静脉结扎术可显著改善精索静脉曲张不育患者的精液质量,提高奸娠率。     

Isolate液优化精子在宫腔内人工授精的应用

宫腔内人工授精（ＩＵＩ）是一种最常用的治疗男女性不孕症的辅助生育方法，首先应对精液进行处理。按严格标准进行精液优化处理，精子质量大大提高。本文对我院４６例ＩＵＩ者采用Ｉｓｏｌａｔｅ液优化精子，并与常用的ｐｅｒｃｏｌｌ液进行比较，报道如下：１　方法１．１　采取精液镜检　受检者手淫法获取精液于消毒容器内，置２０℃～２４℃下３０ｍｉｎ，将标本充分混匀，以简化的男性不孕检查诊断分类的客观标准为依据，进行形态学分析。本文４６例标本精液量１．５～５．５ｍｌ，精子密度≥２０×１０６／Ｌ，活动精子＞３０％。１．…     

男性泌尿生殖道线索细胞的调查及与不育相关性研究

目的探讨精液中线索细胞与男性不育的关系。方法对957例患者精液,直接涂片显微镜下查找线索细胞,阳性者再作革兰染色及细菌培养确证,同时进行精液参数分析。结果精液线索细胞检出率为23．5％（225／957）与细菌培养符合率为95．1％、精子活率、精子a级、a＋b级活力、密度及低渗肿胀率明显低于阴性组及正常对照组,而精子畸形率、精液pH值明显高于阴性组和正常对照组（P〈0．01）。30例不育者配偶依据Amsel诊断标准确诊为细菌性阴道病（Bv）28例（93．3％）。结论Bv病原体可通过性生活侵犯到男性泌尿生殖道各部位,影响精液质量,是不育的重要因素之一,并黏附于鳞状上皮形成线索细胞而对加德纳菌及短小球杆菌感染致不育的判断具有独特价值。     

助孕妊娠后卵巢扭转2例临床诊治分析

本院在行辅助生殖助孕术中，遇卵巢扭转2例，将诊治处理报告如下。 一、临床资料 例1：26岁，因原发不孕3年，男方极重度少弱精子症行卵胞浆内单精子注射（ICSI）助孕。女方月经规律，促性腺激素释放激素激动剂（GnRH—a）长方案超促排卵，共用果纳芬37支，人绝经后促性腺激素（HMG）6支，     

FROM ZERO TO ONE HUNDRED MILLION IN SIX MONTHS: THE TREATMENT OF AZOOSPERMIA IN CONGENITAL ADRENAL HYPERPLASIA

In the majority of the 25% of couples in which a male factor is responsible for their infertility, no identifiable pathology is found. It is unusual to be faced with an etiology that is readily amenable to successful treatment without the eventual dependence on assisted reproductive techniques for pregnancy. The diagnosis of congenital adrenal hyperplasia has variable implications on fertility. A case is presented of azoospermia in a man diagnosed with classical non-salt-losing congenital adrenal hyperplasia. Within 9 months of treatment with dexamethasone, his sperm count had risen to above 100 million per milliliter, enough to overcome very poor morphology and a naturally conceived pregnancy ensued. The pregnancy is ongoing. Although an increase in sperm count has been shown in such cases, the degree of improvement in semen parameters is unique, especially in an azoospermic patient.     

探讨抗精子抗体检验对男性不育症的应用价值

目的评价抗精子抗体检验对男性不育症的应用价值。方法病例选自2012年1月至2013年8月来我院就诊的390例不育症患者,收集所有患者的精液并对精子密度、精子活动百分率、精子活动力、精液中白细胞数量、精液量及精液液化时间进行分析．利用酶联免疫吸附试验检测血清抗精子抗体（Asab）。结果390例患者中,精子密度在0．24亿／mL以上的患者共302倒,其中抗精子抗体阳性患者52例,占17．2％;精子密度在0．2亿／mL以下的患者共88例,其中抗精子抗体阳性患者61例,占69．3％,经比较,差异有统计学意义（P〈0．05）。精子密度越高的患者,血清中抗精子抗体阳性率越低（P〈0．05）,死精与无精患者血清中抗精子抗体阳性率高达75．6％、70％;精子活动力越差,血清中抗精子抗体检出率越高（P〈0．05）,精液中白细胞计数越高,抗精子抗体阳性率越高（P〈0．05）。结论抗精子抗体检验在男性不育症的诊断中有较好的临床价值,值得在临床上推广。     

不育男性精子形态学分析7230例

目的分析不育男性精子形态,探讨精子形态质量与不育的关系。方法按照世界卫生组织(World Health Organization,WHO)精子改良巴氏染色法,对门诊7 230例不育男性开展精子形态学分析,计算不育男性正常形态精子百分率,了解精子畸形情况。结果 7 230例不育男性中,正常形态精子百分率≥4%者5 278例(73.00%);正常形态精子百分率<4%者1 952例(27.00%),其中精子畸形以头部畸形为主的有1 332例(68.24%)。结论精子形态学分析有助于指导助孕方案的确定,应重视开展精子形态学检查。     

精子DNA碎片与精液各参数的相关性分析

目的探讨男性不育患者精子DNA碎片与精液各参数的相关性,研究精子DNA完整性在评估男性生育力方面的应用价值。方法回顾性分析2014年1月至2015年11月就诊于邢台不孕不育专科医院生殖中心男科的不育患者265例,采集精液标本,通过计算机辅助行常规精液分析,采用瑞-吉染色镜检观察精子形态及通过精子染色体扩散试验(SCD法)行精子DNA碎片率检测,对精子DNA碎片率与年龄、精液各参数(精子浓度、前向运动精子、正常精子形态)进行分组比较及相关分析。结果不同年龄段精子DNA碎片组间比较差异有统计学意义(P0.05);不同精子DNA碎片化指数(DNA fragmentation index,DFI)、精子浓度组间比较差异无统计学意义(P0.05),前向活动精子、正常形态精子组间比较差异有统计学意义(P0.05);年龄与精子DNA碎片存在正相关关系,前向运动精子率、正常形态精子率均与精子DNA碎片存在负相关关系。结论年龄是影响精子DNA损伤的因素,精子DNA损伤可能是导致精子活力和正常形态精子的影响因素。     

Present-day management of male infertility

An overview is presented of the management of impaired fertility in men. Laboratory examination of semen, the primary determination of fertility status, is complicated by the lack of criteria of "normal" parameters. Most seminologists agree that fertility is compatible with a count below 20 million/ml, but the quality of motility and morphology is the critical factor. Consecutive semen analyses in the same person can also show great variation, so several specimens should be studied over a period of months. A definite cause for infertility can be found in less than 10% of cases. Half of those with a known cause are azoospermic due to an obstructive lesion of the conducting pathways or to total failure of spermatogenesis. Varicocele and immunolgoic aspects of infertility have attracted recent interest. New investigational methods have identified a substantial retrograde flow down the internal spermatic vein whenever a true varicocele is palpable. Suprainguinal ligation of the internal spermatic vein has been performed in these cases and estimates of improvement in the semen profile range from 30-80% of cases. However, many clinicians have reservations about the overall role of spermatic venous reflex in male infertility. When a significant titer of antibodies is noted, corticosteroids are generally administered. Despite little evident benefit, the trend toward prolonged treatment of infertility with pituitary hormones and stimulants continues. Increasingly, the infertile couple is being treated as a unit. Since specific measures seldom improve the semen profile, attention should be focused on improvement of opportunity for any effective sperm to achieve fertilization. There has been renewed interest in the cervical insemination cap method. About 14% of couples where the man shows seminal impairment conceived by this method, provided some of the sperm are of normal morphology. Artificial insemination with pooled stored sperm has produced disappointing results.     

MOLECULAR BIOLOGY OF MALE INFERTILITY

About 15% of couples have reduced fertility and in approximately one-half of all cases the reason is male infertility, usually of genetic origin. Thus, in the context of research in genes involved in reproduction and sex determination, genetic anomalies in gametogenesis are being extensively studied. The most frequent pathogenic causes of male infertility are Y-chromosomal microdeletions (8-15%) in the long arm of the Y chromosome, which, by loss of specific DNA segments, leads to loss of vital genes for sperm production. Infertile men, who attend infertility clinics, rise to 15% among those with azoospermia or spermatogenesis problem. The new technique of intracytoplasmic sperm injection has allowed many infertile men to achieve their dreams of fatherhood. However, the spermatogenic defect is genetic anomalies, which might be a potential risk of transmitting this defect to future offspring. Therefore, genetic counseling of all couples with the diagnosis of male infertility is recommended before their enrolment in intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. The important role of genetic abnormalities in the causation of human male infertility is increasingly recognized. While much remains to be learned in this fast-moving field, considerable progress has been made in the clinical delineation of genetic forms of male infertility and in the characterization of the responsible genes and their mutations or deletions. This review should provide insight into the understanding of parthenogenesis of male infertility in the human.     

精子DNA完整性与精液常规参数相关性分析

目的探讨精子DNA完整性与精液参数间的相关性,探讨精子DNA完整性检测在评估男性生育力中的应用价值。方法对206例男性不育患者行精液常规分析,并采用精子染色质扩散法(sperm chromatin dispersion,SCD)检测精子DNA完整性情况,计算精子DNA碎片指数(DNA fragmentation index,DFI),对DFI与各项精液常规参数(浓度、活力和形态等)的相关性进行分析。结果将DFI值按DFI≤10%、10%DFI≤30%和DFI30%分为3组,发现3组间禁欲时间、前向运动精子、不动精子、头/颈部缺陷精子和存活率等差异均有统计学意义(P0.05)。双变量相关分析表明精子DFI与不动精子、头/颈部缺陷精子、精子畸形指数(sperm deformity index,SDI)和畸形精子指数(teratozoospermia index,TZI)存在正相关,而与前向运动精子、正常形态精子、精子浓度和存活率存在负相关。结论精子DNA损伤可能会影响精子形态学异常和活力下降,在分析精液常规的同时,检测精子DNA完整性并将二者结合能够更好的评估患者的生育力。     

Estimation of the prevalence and causes of infertility in western Siberia.

The study examined the epidemiology and causes of infertility in Tomsk, Western Siberia, using methodological approaches recommended by WHO and was based on the findings for a randomly selected sample of 2000 married women aged 18-45 years. Among the respondents, 333 couples were considered infertile since they had not conceived after 12 months or more of unprotected intercourse. This group of infertile couples was offered comprehensive clinical investigations but only 186 couples completed them. The infertility rate in Tomsk was 16.7%, being caused by diseases of the female reproduction system in 52.7% of the couples and by male reproductive diseases in 6.4%. In 38.7% of couples, both spouses suffered from infertility, while in 2.2% of cases the cause of infertility was not determined. Among the causes of female infertility, secondary infertility dominated (12.9% of all the women questioned), while primary infertility affected 3.8% of the women. The most frequent causes of female infertility were disturbances to tubal patency (36.5%) and pelvic adhesions (23.6%). Endocrine pathology was found in 32.8% of cases. The most frequent cause of male infertility was inflammatory disease of male accessory glands (12.9%). In 8.6% of cases infection resulted in obstructive azoospermia. Varicocele was registered in 11.3% of cases, and idiopathic pathospermia in 20.9%. Inflammatory complications among females were 4.2 times more frequent than among males.     

男性不育患者2406例染色体异常分析

目的:研究染色体异常和基因突变与男性不育的关系。方法:对2008年3月～2010年3月来本院就诊的男性不育患者2406例,按照WHO精液分析诊断标准分组进行染色体核型分析和无精症因子(AZF)基因缺失分析。结果:非梗阻性无精子症1992例,隐匿精子症216例,严重少弱畸精子症76例,少弱畸精子症122例;各组染色体异常率分别为26.46%、36.57%、27.63%、18.85%,其中常染色体异常率分别为4.17%、20.83%、18.42%、18.85%,性染色体异常率分别为22.29%、15.74%、9.21%和1.64%。核型分析结果显示非梗阻性无精子症组克氏症患者占15.56%。AZF基因缺失检测结果显示非梗阻性无精子症、隐匿精子症和严重少弱畸精子症各组AZF基因缺失异常率分别为4.82%、12.5%、9.21%。结论:男性不育患者染色体异常率高于正常人群,AZF基因缺失异常率高于正常人群,对男性不育诊断时有必要进行常规遗传学检查,尤其对是隐匿精子症和严重少弱畸精子症患者在选择卵细胞浆内单精子注射技术时进行遗传学检查。     

精子质量综合评估指标的建立

目的建立精子质量综合评估指标以辅助男性不育的诊断。方法对273例不育男性和35例已育志愿者用计算机精液分析系统进行常规精液检查,用荧光复染法进行质膜完整性检测,用化学发光法检测精液活性氧水平;对资料进行主成分分析和受试者工作特征曲线分析;用多变量线性组合法建立联合预测因子。用建立的综合指标参考值模拟诊断另外100例不育男性和30例已育志愿者,计算预测的灵敏度和特异度。结果由主成分分析的结果建立精液质量得分(SQ);SQ诊断男性不育的ROC曲线下面积为81.5%,大于单一常规精液参数;用SQ与精液活性氧水平联合预测因子诊断男性不育,ROC曲线下面积为87.1%。在模拟预测中,SQ的灵敏度为72.00%,特异度为83.33%;联合预测因子的灵敏度为93.00%,特异度为73.33%。结论和单独常规精液参数比较,SQ辅助诊断男性不育的价值更高;在有条件检测精液活性氧的实验室,将SQ与活性氧水平用于联合诊断,准确性更高。