冷冻精液行供精人工授精685例临床观察

目的比较ICI和IUI的成功率,评价人类精子库的冻精质量。方法对用我库的冷冻精液行供精人工授精(AID)治疗有适应证妇女685例的临床资料进行回顾性分析。精液冻后平均活率为(62.23±26.78)%,平均密度为(38.17±13.62)×106/ml。结果供精人工授精685例,共有1385个周期中214例获临床妊娠,周期妊娠率15.5%,受孕率31.2%,二种AID方法的成功率无显著性差异(P>0.05)。结论我院人类精子库的冷冻精液各项指标均达到并超过部颁标准,可用作供精人工授精。     

体外受精-胚胎移植术中使用冷冻供精及夫精的临床效果观察

目的 观察比较IVF-ET中使用冷冻供精及夫精的临床效果,了解正常精液经冷冻保存后使用是否影响IVF-ET的效果。方法 回顾本院常规IVF-ET中使用新鲜夫精172周期(夫精组)及采用冷冻供精47个周期(供精组)资料,对两组的精液情况、受精率、卵裂率以及临床妊娠率进行分析比较。结果 冷冻供精组在精子密度、精子总活动率、前向运动精子率3项指标均低于新鲜夫精组(P<0.01),而受精率、卵裂率、临床妊娠率两组比较无显著性差异(P>0.05)。结论 正常精液经冷冻保存后,尽管精液各项参数有一定改变,但对IVF-ET中受精率、卵裂率及临床妊娠率无明显影响。     

精液不液化对精子回收率及人工授精妊娠率的影响

目的分析不同液化状态的精液行夫精人工授精(AIH)精浆优化后的精液质量、精子回收率、不达标率及妊娠率,探讨精液不液化对人工授精的影响以及人工授精前纠正精液不液化的必要性。方法回顾性分析2014年1月至2016年12月1553例共2525周期AIH资料,根据精液检查结果,分为液化组及不液化组,其中液化组2350周期,不液化组175周期,比较两组处理后精子回收率、不达标率及妊娠结局有无差别。结果液化组不达标率(7.1%)显著低于不液化组(12.0%),差异具统计学意义(P0.05),两组精液处理后精液量、存活率无显著性差异;但不液化组处理后的前向运动精子总数(24.92±15.38×10~6/一次射精)低于液化组(29.59±17.66×10~6/一次射精,差异具统计学意义(P 0.05),液化组的处理后活动精子回收率(38.54±12.64%)高于不液化组(31.87±15.21%),差异具统计学意义(P0.05);不液化组AIH周期妊娠率(9.14%)、累积妊娠率(14.55%)均低于正常组(12.60%、20.51%),差异具统计学意义(P0.05)。结论精液不液化与AIH精浆优化的精子低回收率、精液不达标率相关。相对于液化组,不液化精液行密度梯度离心法优化精浆后前向运动精子总数较低,AIH妊娠率较低。行AIH前纠正精液不液化可能有助于提高精浆优化后精液质量,提高AIH妊娠率。     

深圳地区与其他地区男科就诊患者精液质量比较分析

目的 了解深圳地区就诊男科患者的精液质量特征.方法 对北京大学深圳医院泌尿男科及辅助生育科室就诊病人的6 964份精液标本检测结果进行统计分析,并将结果与成都、遵义及西班牙男科门诊就诊病人精液质量进行比较.分析指标包括精液量、密度、活动率、活力(A+B)精子百分比等.结果 在6964份精液中,正常的精液占19.74%,弱精子症占50.72%,少精子症占24.11%,无精子症占2.77%,其他指标异常占2.66%.各项指标均数:精液量(3.04±1.05)ml,精子密度(50.73±42.11)×106/ml,精子总数(148.03±127.05)×106/ml,精子活动率(50.06±17.90)%,a级精子(17.98±11.75)%,(a+b)级精子(32.80±15.14)%.对比成都、遵义地区的相关数据,精子密度下降、精子活动率下降、精子活力下降等精液异常的百分比较高,差异有统计学意义,而无精子症百分比差异有统计学意义.对比西班牙相关数据,(a+b)级精子百分比差异无统计学意义(P>0.05);精子密度、(a+b)级精子数目高于西班牙(P<0.01);精液量、禁欲时间、精子总数低于西班牙指标,差异有统计学意义(P<0.01).结论 深圳地区就诊男科患者精液质量低于成都地区及遵义地区水平,与西班牙比较精液质量无明显下降.     

少弱精子冷冻保存在宫腔内人工授精中的应用

目的:探讨精液冷冻保存在少弱精子症患者行宫腔内人工授精(IUI)周期中的应用效果。方法:2008年3月至2009年6月103对原发性不孕夫妇,共计152个IUI治疗周期,其中精液正常者53个周期(组1),少弱精子者52个周期(组2),少弱精子经精液冷冻保存后结合新鲜精液者47个周期(组3)。检测治疗前后精液常规、精液处理后前向活动精子总数,随访3组患者治疗期间配偶妊娠结局。结果:精液处理前组3精液体积、精子活率、a级精子均低于组2,差异极显著(P<0.01);组3处理后前向活动精子总数高于组2,但差异无显著性(P>0.05)。3组间生化妊娠率和临床妊娠率均无显著性差异。结论:精液冷冻保存可以增加少弱精子症患者前向活动精子总数,精液冷冻保存技术可以在一定程度上提高其IUI妊娠率。精液冷冻保存与IUI相结合,可能是治疗少弱精子症一种较为理想的方法。     

乙肝病毒携带者不育男性精液质量分析

目的:分析携带乙肝病毒(HBV)的不育男性的精液质量,探讨HBV感染对男性精液质量的影响。方法:选择2018年门诊初诊的782例不育男性,年龄25~35岁,根据HBV感染情况分为小三阳组(血清学检查乙肝表面抗原、e抗体、核心抗体阳性,n=286)和大三阳组(血清学检查乙肝表面抗原、e抗原、核心抗体阳性,n=230),以未感染者作为对照组(n=266),对上述3组进行精液常规、精子顶体酶活性及精子染色质结构分析,比较3组结果是否有差异。结果:①小三阳组精子浓度[(71.49±60.03)×10^6/ml]、前向运动精子百分率[(30.70±14.79)%]、精子活率[(42.67±17.23)%]、精子存活率[(81.07±10.19)%]、正常形态精子百分率[(5.72±3.47)%]均低于大三阳组[(88.20±82.62)×10^6/ml、(34.88±15.60)%、(45.77±16.58)%、(82.55±7.55)%、(6.93±4.45)%]和对照组[(89.29±53.80)×10^6/ml、(37.82±13.63)%、(48.16±14.03)%、(85.26±6.39)%、(7.27±4.43)%],除精子存活率以外差异均有统计学意义(P<0.05);大三阳组精子浓度、前向运动精子百分率、精子活率、精子存活率、正常形态精子百分率均低于对照组,其中前向运动精子百分率、精子存活率的差异有统计学意义(P<0.05);②小三阳组的精子顶体酶活性[(57.07±26.38)μIU/10^6精子]显著低于大三阳组[(63.03±28.75)μIU/10^6精子,P<0.05]和对照组[(78.00±33.49)μIU/10^6精子,P<0.01];大三阳组的精子顶体酶活性显著低于对照组(P<0.01);③小三阳组精子DNA碎片指数[DFI,(14.79±9.46)%]和高可染性[HDS,(9.62±6.20)%]均高于大三阳组[(12.95±7.29)%、(8.43±4.72)%]和对照组[(11.60±5.98)%、(8.41±4.59)%],差异有统计学意义(P<0.05);大三阳组的DFI和HDS均高于对照组,仅DFI的差异有统计学意义(P<0.05)。结论:HBV携带者的男性精液质量显著低于未感染者,HBV感染可能是引起男性生育力降低的原因之一。     

夫精人工授精导致的精神心理压力对精液标本质量及临床妊娠率的影响

目的研究夫精人工授精(AIH)本身导致的精神心理压力对AIH手术日男方采集到的精液标本质量以及配偶临床妊娠率的影响。方法回顾性分析近1年来在我中心行AIH的243例患者术前精液检查结果、首次及第二次AIH手术当日所采集精液标本检查结果、不同周期配偶临床妊娠率。通过分析和对比患者不同时间采集精液标本的体积、精子浓度、精子总数、精子活动率等参数及配偶妊娠率有无差异,得出相应的结论。结果与术前检查相比,患者首次AIH采集到的精液标本体积及精子总数均减少(p0.05);首次及第二次AIH采集到的精液标本精子活动率均降低(P0.05)。与首次AIH相比,患者第二次AIH采集到的精液标本体积及精子总数均增加(P0.05);临床妊娠率改善(P0.05);精子活动率差异无统计学意义(P0.05)。三组精子浓度差异均无统计学意义(P0.05)。结论患者在首次AIH时容易受到AIH本身所带来的精神心理压力的影响,从而导致所采集到的精液标本的体积、精子总数、精子活动率下降;第二次AIH时患者精液标本体积、精子总数及配偶临床妊娠率较首次AIH时均有改善,而精子活动率无显著性变化;首次及第二次AIH时精子浓度与术前检查相比均无显著性降低。     

男性肿瘤患者精液冷冻保存后常规参数分析

目的:了解男性肿瘤患者精液质量现状,探索保存男性肿瘤患者生育能力的方法。方法:对来源于2005~2013年浙江省人类精子库43例肿瘤自精保存患者的精液质量进行回顾性分析,检测项目包括精液体积、精子浓度、精子活力、精子冷冻复苏率等指标。比较肿瘤患者与供精志愿者(248例)之间精液质量的差异;并将肿瘤患者分为睾丸肿瘤组(22例)和非睾丸肿瘤组(21例),比较两组之间精液质量的差异。结果:43例肿瘤患者精液的平均精子浓度(60.90×106/ml)、前向运动精子百分率(41.07%)及精子冷冻复苏率(49.98%)均显著低于供精志愿者(分别为74.27×106/ml、51.79%和57.33%),P均<0.05;睾丸肿瘤组的冻后平均前向运动精子百分率(15.68%)与冷冻复苏率(42.81%)均显著低于非睾丸肿瘤组(分别为28.36%和57.53%),P均<0.05。结论:肿瘤患者精液质量普遍下降,进行自精保存的时机非常重要,应该加强自精保存的宣传力度。另外,睾丸肿瘤患者精液冷冻保存效果较差,精子库应对其冷冻复苏率低下的原因进行深入研究,优化冷冻保存技术,为患者提供更好的生育力保护。     

海南不同民族不育男性精液质量分析

目的 分析海南地区少数民族和汉族不育男性精液质量状况,为海南地区不育男性患者在诊断与治疗方面提供科学依据。方法 回顾性分析2020年1月至2021年12月男性不育患者1 682例的临床资料。按民族分为少数民族组(367例)和汉族组(1 315例)。比较两组间患者年龄、精液质量指标(精液量、精液液化时间异常率、精子浓度、精子活动率、前向运动精子百分率、精子正常形态百分率)、精子异常类型发生率。结果 两组中患者年龄、精液量、少精子症、弱精子症、无精子症的发生率比较,均无统计学意义(P>0.05);但少数民族组精液液化时间异常率(10.40%)、畸形精子症的发生率(29.70%)均高于汉族组(6.60%、27.00%),差异均具有统计学意义(P<0.05);少数民族组精子浓度66×10⁶/mL、精子活动率(49.38±15.85)%、前向运动精子百分率(44.54±15.67)%、精子正常形态百分率(3.86±2.02)%均显著低于汉族组的73×10⁶/mL、(55.16±12.67)%、(48.85±12.73)%和(4.90±2.5...     

密度梯度离心方式对人工授精结局的影响

目的探讨精液经密度梯度离心时经水平转子和角转子处理后对精液质量及其对人工授精结局的影响。方法回顾性分析352个人工授精周期,根据梯度离心时转子的不同,分成水平转子组和角转子组两组,精液经密度梯度离心法处理,形态学分析严格按照WHO(World Health Organization)人类精液检验与处理实验手册第五版标准,比较处理后精液质量及两组对妊娠结局的影响。结果(1)精液质量比较:水平转子组前向运动精子为(89.2±8.5)%、精子浓度为(47.8±14.3)×10~6/mL、前向运动精子总数为(13.6±6.3)×10~6;角转子组前向运动精子为(90.1±8.8)%、精子浓度为(43.4±15.1)×10~6/mL、前向运动精子总数为(12.9±6.1)×10~6,无统计学差异(P0.05)。水平转子组和角转子组正常精子比率分别为(18.5±8.2)%和(14.2±5.7)%,两者存在显著性差异(P0.05);(2)妊娠结局比较:水平转子组的临床妊娠率为16.5%(30/182)、流产率为3.3%(1/30)、活产率为96.7%(29/30);角转子组生化妊娠率为临床妊娠率为12.4%(21/170)、流产率为9.5%(2/21)、活产率为90.5%(19/21),无统计学差异(P0.05),生化妊娠率:两组分别为0%(0/30),19.2%(5/26),有统计学意义(P0.05)。结论密度梯度离心应用水平转子可以降低对处理后精液的精子形态的影响,减少生化妊娠率。     

Ultrastructural parameters of fertile cryopreserved human sperm.

Two hundred and forty-four cryopreserved semen samples were used for artificial insemination by donor (AID). All samples were examined for motility and concentration. Thirty of the samples resulted in pregnancies. These samples were further examined ultrastructurally. There was no difference in sperm motility or concentration between the samples that did or did not result in a pregnancy. The ultrastructural characteristics of the samples that resulted in pregnancies revealed that only 15% of sperm (SD = 7.67) possessed normal morphology and had undamaged acrosomes after cryopreservation.     

两种精子优选方法效果比较

目的　探讨精子经王氏管和密度梯度离心法处理后精子参数的变化 ,比较两者在宫内人工授精 (IUI)的临床效果。　方法　选择不育男性精液 15 7份 ,采用两种方法进行配对处理 ,比较两种分离方法前后精子活力、正常形态率、精子顶体形态和精子染色质等变化 ;分离后的精子用于IUI的临床妊娠率。　结果　两种方法处理后的精子活力 (a +b级 )、正常精子形态率、精子顶体完整率、正常染色质率与处理前比较有显著差异 (P <0 .0 1) ;但两种方法分离的精子用于IUI的临床妊娠率无显著差异 (P >0 .0 5 )。　结论　王氏管法和密度梯度离心法处理精子后均获得质量较好的精子 ,但用于IUI后临床妊娠率无明显差异     

Transmission of sexually transmitted diseases by donor semen

Therapeutic insemination by donor (TID) is being used with increasing frequency. Because many diseases, some of which are lethal, can be transmitted through semen, the American Fertility Society established guidelines for use of donor sperm. They limit TID to cases of male infertility or hereditary/genetic disorders. Donor selection requires good health and absence of genetic abnormalities; criteria for semen including normal sperm motility, concentration, and normal morphology, and blood screening for infectious agents. Human immunodeficiency virus (HIV) testing should be performed initially in donors for fresh semen inseminations. If positive, the assay is verified with a Western blot test; if negative, the donor should be screened at 6-month intervals. Frozen samples should not be used until the 180 day reevaluation of the donor. Many studies show higher pregnancy rates using fresh rather than frozen semen samples for insemination. New methods of cryopreservation minimize the deleterious effects of freezing. If these effects, namely decreased sperm motility and impaired penetration ability, are eliminated, pregnancy rates can be expected to rise. Frozen semen is preferable because it allows time for sexually transmitted diseases to manifest themselves and for specimens from those donors to be rejected prior to use.     

Cryopreservation of human semen

A review is given of the techniques for the cryopreservation of human semen, including the preparation of cryoprotective media, the use of ampoules, straws, and pellets, and freezing and thawing techniques. The use of cryopreserved semen for therapeutic artificial insemination by donor is described. The advantages of cryopreserved semen over fresh donor semen mostly lie in the ability to exclude infections before use and the extra convenience, in spite of the lower success rate and increased cost. The recovery of sperm motility on thawing is described, as are other methods for assessing the degree of damage to the spermatozoa by the freezing procedure. The success rates reported by large semen banks are summarized.     

The cryopreservation of donor semen by a simplified method: use in an IVF and GIFT programme

The cryopreservation of semen used in assisted reproduction procedures was carried out exclusively by a simplified method in which a mixture of semen and cryoprotectant was contained in 1-ml tuberculin syringes and plunged directly into liquid nitrogen. Donor semen samples halved and frozen in syringes and in straws in a controlled-rate freezer showed no significant difference in post-thaw motility (P = 0.217) or survival (P = 0.217) after 30 min. However, after 180 min the survival rate showed a significant reduction in syringes (P = 0.045). A significant difference (P less than 0.00008) in the rate of fertilization of oocytes was seen in IVF cycles using frozen-thawed donor sperm (58/142, 42%) when compared to fresh sperm from husbands (2315/3926, 59%). A significant reduction (P less than 0.00005) in fertilization rate was also observed in the case of supernumerary oocytes in GIFT cycles with the cryopreserved donor sperm (29/132, 22%) compared to the husbands' sperm (239/514, 46%). However, the pregnancy rate following IVF and embryo replacement was the same after fertilization with fresh sperm (75/351, 21%) as opposed to frozen sperm (3/14, 21%). Furthermore, a higher pregnancy rate was observed in GIFT with frozen donor sperm (9/19, 47%) than with fresh sperm from husbands (28/103, 27%), though this was not statistically significant (P = 0.079). These results show this simplified methods of semen cryopreservation to be effective when used in an IVF and GIFT programme, giving pregnancy rates comparable to fresh normospermic semen samples. The method is simple, quick and inexpensive.     

Pregnancy following in vitro fertilization using cryopreserved semen from a man with testicular teratoma

Semen for cryopreservation was collected in a man with a testicular teratoma after unilateral orchidectomy but before chemotherapy which rendered him azoospermic. After two years artificial insemination using this semen in his wife failed repeatedly. The semen quality on thawing was extremely poor in terms of sperm motility. A pre-freeze motility of 90 per cent was reduced to 2 per cent, and the movement was graded as sluggish. Using the techniques of semen and oocyte preparation and in vitro fertilization, a number of cleaving embryos was produced. A pregnancy was established after four of these embryos were replaced in the wife. The pregnancy aborted spontaneously, but a subsequent course of treatment resulted in an on-going twin pregnancy. The potential of in vitro fertilization for overcoming the poor quality of semen after storage by cryopreservation from men with testicular neoplasms is discussed.     

The mean of sperm parameters in semen donations from the same donor. An important prognostic factor in insemination

We analysed 12,100 consecutive cycles of artificial insemination by donor spermatozoa in 1901 infertile couples. In our analysis, particular attention was given to finding an appropriate way of taking into account the respective effects of female and male factors on the pregnancy success rate and the level at which these factors act (cycle vs. woman and donation vs. donor). A total of 1213 pregnancies occurred. The pregnancy rate per cycle was lower as the age of the woman increased (p < 0.0001) and varied with the type of infertility: fecundity was higher (p = 0.03) in the case of azoospermia than of severe oligozoospermia. After taking into account these factors, significant unexplained variation in likelihood to conceive remained. A part of this heterogeneity was shown to be due to variation in fecundability between semen donors. In order to explain this heterogeneity between donors, compositional covariates were used, particularly the mean of results of the semen analysis performed for donations from the same donor. For each semen characteristic, the overall mean of the different donations of a donor was an important predictive factor of successful insemination: after taking into account all of the other factors, the odds ratios for an increase of 50 x 10(6)/mL spermatozoa, of a 20% increase in sperm motility and of a 2 point increase in the post-thaw quality index, were, respectively, 1.13, 1.37 and 1.56. After adjustment for these factors, the specific characteristics of each semen donation were no longer significantly predictive of successful insemination. This observation has a biological interpretation: sperm with low parameters but produced by a normally fertile man can have a satisfactory success rate.     

Improvement in sperm functional competence through modified low‐dose packaging in French mini straws of bull semen

To achieve the targeted artificial insemination coverage with the current rate of semen production, without affecting the conception rate, it needs to reduce the number of spermatozoa per insemination dose in India as per international practice. Therefore, this study was planned to perform different levels of semen dilution, compare in vitro post‐thaw semen quality and develop a modified low‐dose semen packaging method in French mini straw to minimise semen dilution effect. Sixteen ejaculates were collected from Karan Fries bulls (n = 4). The mean percentage post‐thaw motility, viability, membrane integrity, acrosome integrity, lipid peroxidation and capacitation status were estimated as post‐thaw sperm function assays in semen sample diluted to 20, 15, 10 and 5 million spermatozoa per 0.25 ml and filled in the French mini straw by conventional packaging. No significant (p > .05) difference in post‐thaw sperm quality was observed between 15 and 20 million doses; however, below 15 million sperm quality get reduced. There was no significant difference in post‐thaw semen quality traits between 20 million conventional packaging and 5 million spermatozoa/dose in modified packaging. In conclusions, the modified packaging is a very effective method for low‐dose cryopreservation with acceptable post‐thaw semen quality.     

Evaluation of donor semen quality provided by six sperm banks: a retrospective study of 1877 artificial insemination cycles

This study aimed at evaluating the impacts of sperm quality of six national sperm banks on pregnancy rates (PRs) of artificial insemination with donor sperm (AID) in China. A large retrospective analysis was performed on 1877 insemination cycles in 1209 women in a unique setting during a 3.5-year period. Global PRs of 22.1% per cycle and 34.2% per patient were achieved. The PRs of the six banks varied from 15.5% to 29.0% (P = 0.011). Significant differences were observed in the quality of donor semen provided by the six sperm banks. Moreover, in some banks, the poor sperm quality was related to the suboptimal PRs. However, in certain banks, high values of sperm parameters did not result in satisfactory PRs accordingly. These data demonstrated that variability of donor semen quality existed in the different banks. But, sperm parameters after thawing may not be detrimental factors affecting the success rate of AID treatment. Further studies are needed to seek potential molecular markers for predicting fertility potency of donor sperm.