上脉法与人工授精治疗少,弱,畸形精子不育症的价值

为提高少、弱、畸形精子症不育患者的治愈率，从１９９０年开始对５０例药物未能治愈的少、弱、畸形精子症不育患者采用上泳法处理精子并行宫腔内人工授精治疗１５３个周期，结果妊娠１６例，总妊娠率为３２．０％，周期妊娠率为１０．４％。认为尽管总妊娠率还比较低，但对药物治疗无效的患者，此法无疑是重要的治疗方法之一。     

精子核成熟性与少、弱、畸形精子症关系初探

目的探讨少、弱、畸形精子症以及精子头部形态缺陷和精子核成熟性的关系。方法2005年3月至2005年7月329例不孕不育患者(其中少精子症患者50例、弱精子症52例、畸形精子症83例)分别采用精液常规检查、精液改良巴氏染色检查以及精液苯胺蓝染色检查。结果①少精子症组患者精液苯胺蓝染色阳性率的中位数为12%(P=0.035),弱精子症组为8%(P=0.947),畸形精子症组为10%(P=0.033)。②少精子症患者精液苯胺蓝染色阳性率与锥形头畸形呈正相关(r=0.635),畸形精子症患者精液苯胺蓝染色阳性率与大头、小头呈正相关(r=0.368、0.304),而和梨形头畸形呈负相关(r=-0.396)。结论少精子症患者和畸形精子症患者中核未成熟精子比例增加,精子头部形态中大头、小头和锥形头畸形与核未成熟精子正相关。     

左卡尼汀治疗男性少、弱精子症临床观察

近年来男性不育发病率呈上升趋势，其中很重要的原因是男性精子数量及质量在逐年下降。目前临床上对于男性少、弱精子症病因研究还不是很深入，在治疗上也没有非常有效的药物和方法。最近，商学军等发现，对于因附睾功能下降而导致的不育患者补充L-肉碱，可取得一定疗效。我科从2003年10月～2004年9月采用含有L-肉碱的制剂[左卡尼汀口服液(Levocarnitine)，商品名：东维力]治疗男性少、弱精子症，取得了一定疗效，现报告如下。     

还少胶囊联合左卡尼汀治疗少、弱、畸精子症的疗效观察

目的:观察还少胶囊及其联合左卡尼汀口服液治疗少、弱、畸精子症的临床疗效及对精子参数的影响。方法:采用随机对照的临床研究,将确诊的186例脾肾虚损型男性不育患者患者随机分为治疗组、对照组和联合治疗组,每组62例。治疗组给予还少胶囊治疗,每日3次,每次3粒;对照组给予左卡尼汀口服液治疗,每日3次,每次1支(10 ml);联合用药组给予还少胶囊联合左卡尼汀口服液治疗,用法同上。3组均用药12周,随访3次,治疗后第4周、第8周、第12周分别检测两组精液质量(精液量、精子浓度、精子活率、前向运动精子百分率)及精子畸形率。结果:180例患者完成了临床研究,治疗12周后,联合用药组精液量提高42.77%,精子浓度提高142.37%,精子活动率增加28.61%,前向运动精子百分率增加24.39%,精子畸形率下降6.27%,与用药前相比都有显著提高,差异有统计学意义(P0.05)。联合用药组在提高精液量、精子浓度、精子活率、前向运动精子百分率上优于对照组(P0.05),在提高精子活率、前向运动精子百分率上优于治疗组(P0.05)。治疗组用药后精液量、精子浓度、精子活率、前向运动精子百分率、精子畸形率与用药前相比都有显著提高,差异有统计学意义(P0.05),治疗组在提高精液量和精子浓度上显著优于对照组(P0.05)。结论:还少胶囊联合左卡尼汀治疗少、弱、畸形精子症安全有效,值得临床推广。     

左卡尼汀治疗特发性少、弱精子症疗效及安全性的系统评价

目的:根据现有临床证据评价左卡尼汀治疗特发性少、弱精子症的疗效及安全性。方法:通过计算机检索建库至2014年4月期间Cochrane图书馆、Pub Med、MEDLINE、EMBASE、CNKI、VIP、CBM、万方数据库,辅以手工检索有关左卡尼汀治疗特发性少、弱精子症的文献,根据纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man5.2软件对数据进行meta分析。结果:纳入7个随机对照试验(RCT),共计751例特发性少、弱精子症患者,排除失访人数后实际纳入678例。meta分析结果显示:左卡尼汀治疗后配偶自然妊娠率高于对照组[RR=3.2,95%CI(1.74,5.87),P=0.000 2];左卡尼汀治疗12~16周和24~26周后精子活动率[WMD=5.21,95%CI(2.78,7.64),P<0.000 1;WMD=9.29,95%CI(1.28,17.29),P=0.02]、前向运动精子百分率[WMD=12.44,95%CI(4.58,20.31),P=0.002;WMD=9.76,95%CI(3.56,15.97),P=0.002]均高于对照组;左卡尼汀治疗12~16周和24~26周后精子浓度与对照组比较差异无统计学意义[WMD=4.91,95%CI(-2.63,12.45),P=0.2;WMD=0.93,95%CI(-3.48,5.34),P=0.68];左卡尼汀治疗12~16周后畸形精子百分率低于对照组[WMD=-2.48,95%CI(-4.35,-0.61),P=0.009],而左卡尼汀治疗24~26周后畸形精子百分率与对照组比较差异无统计学意义[WMD=-4.38,95%CI(-9.66,0.89),P=0.1];左卡尼汀治疗12~16周和24~26周后精液量与对照组比较差异无统计学意义[WMD=-0.13,95%CI(-0.43,0.18),P=0.42;WMD=0.28,95%CI(-0.02,0.58),P=0.07];其中4项研究报告了左卡尼汀治疗期间均无严重不良反应发生。结论:基于当前证据,左卡尼汀可能对特发性少、弱精子症患者配偶的自然妊娠率及患者的精液质量有一定的改善,无明显不良反应。     

少、弱、畸精子症的体外疗法—密度梯度离心法分离高活力精子

为治疗少、弱、畸精子症引致的男性不育,用不连续密度梯度离心技术,从质量较差的精液中将活力好的成熟精子分离出来,用于配偶间人工授精(AIH)并已在临床应用中获得成功。处理后的精液中大部分未成熟生殖细胞和其它细胞成分停留于50～60％等渗Percoll界面,90％等渗Percoll层中回收的精子中几乎不含有其它细胞成分,存活率达95％,形态正常的成熟精子占80％以上,并呈现非常活跃的前向直线运动。本法精子平均总回收率28.4±15.1％,其中活动很好的a级和b级精子平均回收率达59.1±28.1％。非成熟精子细胞成分的清除率则达90％以上。本技术结合利用了活动精子的主动泳动能力和离心力的被动分配作用,优于常用的精子上游法和白蛋白层滤过法。     

新疆地区99例少、弱及无精子症与染色体异常的关系探讨

少、弱及无精子症是造成男性不育的主要原因,而导致男性少、弱及无精子症的原因有内分泌、遗传、免疫等,其中遗传因素是重要的原因之一,染色体引起的男性少、弱及无精子症用药是无法治疗的,染色体检查有重要的临床意义.现对99例少、弱及无精子症患者进行的外周血染色体核型分析结果报告如下.     

夫精宫腔内人工授精135例开展优质护理的效果观察与分析

目的：探讨优质护理示范服务在夫精宫腔内人工授精（IUI）患者中的应用。方法对135例224个周期的夫精IUI患者进行回顾性分析，根据优质护理服务工作质量评价标准制定具体的护理规范，观察IUI成功率及患者的满意度。结果通过有效的护理，使患者积极配合治疗，IUI成功率为14.28%。患者满意度达98.25%。结论对夫精IUI患者全程以“人本原则”的优质护理服务真正做到以患者的最高利益为指导，最大化地满足患者的治疗需求。     

精子综合优选法配合宫腔内联合宫颈管内人工授精疗效分析

目的 探讨运用综合方法 优选精子,并采用宫腔内联合宫颈管内人工授精,对不育患者的临床治疗效果.方法 选取2005年1月至2009年12月期间在本院进行夫精人工授精（AIH）治疗的患者276例,共治疗565周期,随机分为对照组（n=138）和治疗组（n=138）.对照组采用直接或洗涤1次后上游法优选的精子用于宫腔内人工授精280周期;治疗组综合采用直接或洗涤1次后上游法优选的精子,用于宫腔内人工授精,将上游后剩留下的精液,用直接离心法优选得到的精子用于宫颈管内人工授精285周期,观察两组的治疗成功率.结果 对照组妊娠42例,妊娠率30.43 %,治疗周期妊娠率15.00%;治疗组妊娠73例,妊娠率52.89 %,治疗周期妊娠率25.61%,两组的妊娠率及周期妊娠率比较差异有统计学意义（P〈0.01）.结论 本院采用的改良AIH是一种高效、安全的人工授精方法.     

用上游精子行宫腔内授精的临床评估

本文总结了用上游精子行宫腔内授精治疗不孕症的结果。受试对象为４０对不孕夫妇,年龄２６～４０岁,不孕年限２～１０年。不孕原因为宫颈或宫颈粘液异常,男方精子活力低及不明原因的不孕。共进行１２６个周期,平均授精周期为３．５３±１．０６个（ｘ±ｓ）,共１２例妊娠,其中２例流产,妊娠率３０％,流产率１６．７％。无一例感染及其它并发症发生。该技术涉及到多方面因素,需临床与实验室结合以提高妊娠率。     

Treatment of immunological infertility by sperm washing and intrauterine insemination.

The purpose of this study is to review our experience with sperm washing and intrauterine insemination as a method to reduce the presence of sperm antibodies in serum of couples with immunological infertility. Our results support the premise that sperm washing and intrauterine insemination can diminish the level of sperm-bound immunoglobulins and can improve the chance of conception in a selected group of couples with a diagnosis of immunological infertility. Patients with > 50% attachment of IgG, IgA, or both antisperm antibodies in this study had a greater chance of achieving a pregnancy. The high level of antibody attachment seen in our study appears to represent true immunological infertility and therefore is more likely to respond to therapy that reduces antibody attachment and bypasses cervical mucus.     

Successful pregnancy and birth after intrauterine insemination using caput epididymal sperm by percutaneous aspiration

Aim: To manage male infertility with obstructive azoospermia by means of percutaneous epididymal sperm aspiration (PESA) and intrauterine insemination (IUI). Methods: Ninety azoospermic patients with congenital bilateral absence of the vas deferens (BAVD, n=58) or bilateral caudal epididymal obstruction (BCEO, n=32) requesting for fine needle aspiration (FNA), PESA and IUI were recruited. The obstruction was diagnosed by vasography and determination of the fructose, carnitine and alpha-glucosidase levels in the seminal fluid. Results: The mean sperm motility, density, abnormal sperm and total sperm count of the caput epdidymis were 16 %±22 %, (12±31) ×106/mL, 55 %±36 % and (16±14)×106, respectively. In the 90 couples, a total of 74 PESA procedures and 66 cycles of IUI were performed. Three pregnancies resulted, including one twin pregnancy giving birth to two healthy boys, one single pregnancy with a healthy girl and another single pregnancy aborted at week 6 of conception. The pregnancy rate per I     

促排卵与宫腔内人工授精联合治疗不育症

为了比较不同的促排卵方法联合宫腔内人工授精（ＩＵＩ）治疗不育症的疗效。以排卵功能障碍、宫颈因素、免疫因素、原因不明、男方因素等导致不育的１４７对不育夫妇作为观察对象，分为３组。第一组：促性腺激素促排卵加ＩＵＩ，共５６例、６８周期；第二组：克罗米芬促排卵联合ＩＵＩ，共５０例，５６周期；第三组：自然周期加ＩＵＩ共４１例、４１周期。结果：第一组１６例妊娠，妊娠率２９％，周期妊娠率２４％；第二组３例妊娠，妊娠率６％，周期妊娠率５％；第三组妊娠３例，妊娠率与周期妊娠率均为７％。第一组与第二、第三组的妊娠率及周期妊娠率比较，差异均有显著意义，分别为Ｐ＜０．０１及Ｐ＜０．０２。结论：对难治性不育症，如选用ＩＵＩ治疗，则加用促性腺激素促排卵的妊娠率高于克罗米芬刺激排卵或不刺激周期。     

梯度离心前后精子形态对人工授精妊娠结局的影响

目的:探讨精液处理前后精子形态学变化及其对人工授精结局的影响。方法:回顾性分析185对共228个人工授精周期,精液经密度梯度离心法处理,形态学分析严格按照WHO《人类精液检查与处理实验室手册》第5版标准,比较处理前后精子形态4%和≥4%两组对妊娠结局的影响以及其对女性年龄和不孕年限各组的影响。结果:处理前精子形态4%组,周期妊娠率为14.6%(14/96),处理前精子形态≥4%组,周期妊娠率为12.8%(17/132),无统计学差异(P0.05);处理后精子形态4%组,周期妊娠率为8.7%(6/69),处理后精子形态≥4%组,周期妊娠率为15.7%(25/159),无统计学差异(P0.05)。处理前精子形态4%和≥4%两组在不同女性年龄和不孕年限各组间无差异(P0.05);处理后精子形态4%和≥4%两组,当女性年龄35岁时,妊娠率分别为0(0/39)、14.3%(6/42),差异显著(P0.05);当女性不孕年限5年时,妊娠率分别为0(0/38)、14.0%(6/43),差异有显著性(P0.05)。结论:当处理后精子形态4%,女性年龄35岁或女性不孕年限5年时妊娠率明显降低,应及时行IVF或ICSI治疗。     

Treatment of infertile patients by intrauterine insemination of washed spermatozoa

Thirty-five couples with a variety of infertility problems were treated by a sperm-washing and intrauterine-insemination method. The husband's semen was washed with a modified Biggers, Whitten, and Whittingham's medium to obtain a seminal plasma-free, highly concentrated sperm suspension for intrauterine insemination. Couples receiving these inseminations were evaluated by semen analysis, zona-free hamster egg penetration test (EPT), post-coital test (PCT), antisperm antibody test (ASAT), and other appropriate infertility tests to determine the possible cause of infertility. The pregnancy rate as a group was 17%, while the spontaneous rate was found to be only 7%. Patients with a poor PCT result had a good success rate (25%) especially if the male's fertilizing ability appeared normal in the EPT (50% success). This treatment did not help men with poor EPT results or reduced sperm concentration (5% and 0% success). By excluding unsuccessful patients attempting less than three months, the calculated conception rate for this treatment is 33%. No infection or other serious complications were reported. It is concluded that this method is an uncomplicated and effective treatment for certain infertility patients. The patients most likely to be assisted by this method can be identified by using the EPT, PCT, and ASAT, and these patients should be treated for a minimum of three cycles.     

Clinical outcome after insemination with donor sperm in patients with poor results in ICSI cycles

The introduction of intracytoplasmic sperm injection (ICSI) provided an effective treatment for infertile couples whose infertility was attributed to male factors. However, some of them face poor results after ICSI and subsequently use artificial insemination with donor sperm (AID). Only a few studies have reported on the clinical outcome of AID cycles after previous failed ICSI cycles, with contrasting results. The results reported here involve a cohort of 47 couples undertaking 175 AID cycles after 120 failed ICSI cycles for various reasons. Couples were allocated to two groups according to the availability of top quality embryos (TQE) in ICSI cycles. In our series, AID was successful for couples with and without TQE previously transferred in ICSI cycles, the live birth rate (LBR) per cycle being 20.0% and 13.3%, respectively. However, couples with TQE tended to succeed more rapidly than couples with poor quality embryos, with a higher cumulative LBR (68.0% versus 54.5%, respectively). These findings demonstrate that even couples with a history of unsuccessful ICSI cycles because of poor embryo quality are able to achieve high LBR after AID cycles. However, such couples have a lower cumulative LBR and are required to be more patient to achieve parenthood.     

精子形态与宫腔内人工授精妊娠结局的关系

目的回顾性分析宫腔内人工授精（IUI）周期中精子形态与临床妊娠率及子代安全性的关系。方法281个IUI周期按精子形态分为轻、中、重度畸形精子症和正常形态4组,统计临床妊娠率;观察IUI的子代安全性,以1,226例自然妊娠者为对照组,比较两者的多胎率、流产率、早产率、剖官产率、出生缺陷率和围生儿死亡率。结果畸形精子症组的总临床奸娠牢为9．20％,正常形态组临床妊娠率18．69％,两者差异有统计学意义（P〈O．05）;轻、中、重度畸形精子症组的临床妊娠牢分别为12．86％、7．46％、5．4％,组间差异无统计学意义（P〉O．05）;IUI组与自然妊娠组多胎率（11．11％vs．3．75％）、异位妊娠牢（13．89％vs．4．65％）、剖宫产率（76．00％vs．46．63％）,均有显著差异（P〈0．05）,流产率（16．67％vs．10．69％）、早产率（13．33％vs．7．03％）、出生缺陷率（3．57％vs．5．02％）和围生儿死亡率（0％vs．0．74％）,差异无统计学意义（P〉0．05）。结论精子形态影响IUI的临床妊娠率;对于畸形精子症患者,IUI是一种安全的助育方法。