精子形态变化对体外受精率的影响

目的:通过对ICSI和IVF受精率的统计,比较精子形态中的精子正常形态率、头部畸形率、畸形精子指数(TZI)和精子畸形指数(SDI)对受精结果的影响。方法:用Krger's严格标准法分别计算每组样本的精子正常形态率、头部畸形率、TZI和SDI值,与受精率进行比较。结果:①IVF组和ICSI组的受精率,与精子正常形态率、头部畸形率、TZI、SDI均无相关性。②IVF组和ICSI组中SDI>1.6和SDI<1.6的受精率、优质胚胎率和临床妊娠率差异均无统计学意义(P>0.05)。③IVF组和ICSI组中精子正常形态率≤15%与精子正常形态率>15%的二组间受精率、优质胚胎率和临床妊娠率的差异均无统计学意义(P>0.05)。结论:精子形态在体外受精时对受精率无影响,不能用精子形态来直接评价体外受精的结果。     

Comparison of conventional in vitro fertilisation and intracytoplasmic sperm injection outcomes in patients with moderate oligoasthenozoospermia

The method of choice for assisted reproductive technology treatment in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) is usually based on the evaluation of male infertility factors. Decisions for couples with moderate oligoasthenozoospermia (OA) are often empirical because uniform treatment criteria are lacking. This study aimed to evaluate the effect of patients with moderate OA treated with conventional IVF and ICSI. A total of 199 couples with moderate OA undergoing their first IVF/ICSI cycle were included in the study. The patients were divided into two groups according to the type of insemination: conventional IVF group (n = 97) and ICSI group (n = 102). All patients were randomised to be inseminated either by conventional IVF or ICSI. The fertilisation rate, embryo quality, implantation rate and clinical pregnancy rate were examined. No differences in the fertilisation, implantation and pregnancy rates were observed between conventional IVF and ICSI groups (P > 0.05). However, the number of good‐quality embryos was significantly higher in the ICSI group than in the IVF group (P < 0.05). Couples with moderate OA did not influence on the overall clinical outcomes between IVF and ICSI treatments, and a negative influence by ICSI on blastocyst development was not confirmed.     

Influence of male hyperinsulinaemia on IVF outcome

The IVF outcome of a group of hyperinsulinaemic men (group B) was compared with a group of IVF males with normal insulin levels (group A). The participating females in the study groups were younger than 38 years old, had blocked Fallopian tubes and/or endometriosis, had normal insulin levels and produced five or more ova on stimulation. The male participants in both groups were normozoospermic with motility above 50% and sperm morphology between 5 and 13% normal forms (G‐pattern according to Tygerberg strict criteria). The two groups did not differ statistically in terms of age or semen parameters (P = 0.39; P < 0.05).The group of men that presented with normal insulin levels had a higher fertilisation rate (79.15% versus 74.57%) and superior embryo quality on day 3 (55.77% versus 50.39%) than the group that presented with hyperinsulinaemia, but these differences were not statistically significant (P = 0.28, P = 0.40; P < 0.05). The clinical pregnancy rate of the group with normal insulin was significantly higher than that of the hyperinsulinaemic group, 57.9% versus 31.8% respectively (P = 0.03). The results suggest that hyperinsulinaemia had a negative impact on IVF outcome and patients should be advised accordingly.     

中国乙型肝炎和非肝炎男性间的精液质量和辅助生殖技术治疗结果的比较

本研究旨在确定乙型肝炎病毒（HBV）感染对精子质量和辅助生殖技术治疗结局的影响。分析2008年1月至2009年12月于浙江大学附属妇产科医院寻求辅助生育治疗的916例男性（457例乙型肝炎病毒携带者和459例阴性对照男性）的精液参数;将2004年1月至2009年12月期间的男性乙肝病毒携带的587个常规体外受精（In vitro fertilisation,IVF）周期和325个单精子卵细胞浆内注射（Intracytoplasmic sperm injection,ICSI）周期作为阳性观察组,根据取卵日期、女方年龄及ART受精方式通过统计软件以1：1比例匹配,设立夫妇双方均为HBsAg阴性的对照组（587个IVF周期,324个ICSI周期）,分析两组间的辅助生殖治疗结局。与对照组相比,乙肝携带者表现有较低的精液体积、精子总数以及较差的精子活动力和形态学表现（P〈0．05）;乙肝男性夫妇接受ICSI治疗后,双原核（2PN）受精率、优质胚胎率、胚胎着床率以及临床妊娠率均显著性降低俨〈0．05）;而两组病人间的IVF治疗结局差异无显著性（P〉0．05）。通过Logistic回归分析发现乙肝病毒感染作为一个独立的因素增加少弱精子症的发生以及降低ICSI治疗周期的胚胎着床率和临床妊娠率（P〈0．05）。我们的研究结果提示了男性乙型肝炎病毒感染与较差的精子质量和ICSI治疗结局有关,而对IVF治疗结局没有明显的影响。     

Relationship between hyaluronic acid binding assay and outcome in ART: a pilot study

The sperm–hyaluronan binding assay (HBA) is a diagnostic kit for assessing sperm maturity, function and fertility. The aim of this prospective cohort pilot study was to evaluate the relationship between HBA and WHO sperm parameters (motility, concentration and detailed morphology) and possible influence of sperm processing on hyaluronic acid binding. A cohort of 68 patients undergoing a first combo in vitro fertilisation/intracytoplasmic sperm injection treatment after failure of three or more intrauterine insemination cycles were included in the study. Outcome measures studied were fertilisation rate, embryo quality, ongoing pregnancy rate and cumulative pregnancy rate. HBA outcome improved after sperm preparation and culture, but was not correlated to detailed sperm morphology, concentration or motility. HBA did not provide additional information for identifying patients with poor or absent fertilisation, although the latter had more immature sperm cells and cells with cytoplasmic retention present in their semen. HBA outcome in the neat sample was significantly correlated with embryo quality, with miscarriage rates and ongoing pregnancy rates in the fresh cycles, but not with the cumulative ongoing pregnancy rate. No threshold value for HBA and outcome in combo IVF/ICSI treatment could be established. The clinical value for HBA in addition to routine semen analysis for this patient population seems limited.     

Assessment of sperm hyperactivated motility and acrosome reaction can discriminate the use of spermatozoa for conventional in vitro fertilisation or intracytoplasmic sperm injection: Preliminary results

Basic semen analysis is insufficient for determining the fertility potential. The aim of this study was to determine if hyperactivated motility (HAM) and acrosome reaction (AR) can be useful tests for evaluating semen quality during male infertility evaluations and to help the clinician decide whether regular insemination or intracytoplasmic sperm injection (ICSI) is preferable during in vitro fertilisation. A prospective study was conducted. Patients with normal sperm according to World Health Organization guidelines who underwent IVF treatment and planned regular insemination were asked to participate. A portion of sperm sample was evaluated for HAM and AR on day of ovum pick up. In HAM assessment, 93.3% of patients with increased HAM had a high fertilisation rate compared with 64% in the group without increased HAM (P = 0.059). For the AR evaluation, 91.7% of samples with a low rate of spontaneous AR had a high fertilisation rate compared with 39.3% in the group with a high rate of spontaneous AR (P = 0.004).     

Alterations in semen parameters of toll collectors working at motorways: does diesel exposure induce detrimental effects on semen?

Air pollution is contemporarily considered to be a significant cause in impairing semen parameters. The aim of this study was to investigate possible effects of traffic pollutants, mainly the diesel exposure, on semen analysis. A total of 38 men working as toll collectors at motorways formed the study group. Simultaneously, 35 men working as office personnel constituted the control group. Factors including varicocele, chronic diseases that can affect sperm production were the exclusion criteria. No difference regarding smoking was present between the groups. Usual semen analysis according to WHO guidelines was performed. The results of semen analysis revealed decreased motility and low sperm counts in eight and seven men from the study group respectively. Besides, a man from the same group had combined abnormality of decreased motility and low sperm count. However, two men from the control group had slight motility defect and one had low sperm count. The differences regarding the abnormal sperm count and motility were significant between the groups (P = 0.002 and P = 0.003, respectively). Similarly, the ratio of sperm cells with normal morphology was significantly lower in the study group than that in the control group (P = 0.001). This observation proposes that air pollution particularly diesel exposure may have detrimental effects on sperm parameters.     

Effect of mild α-chymotrypsin treatment of highly viscous semen samples on fertilization rates

BackgroundHighly viscous semen reduces sperm motility significantly and can contribute to infertility. When processing semen samples, few techniques exist to induce liquefaction in case of seminal hyperviscosity such as different washing steps and mechanical treatment. The use of α-chymotrypsin seems controversial due to possible negative effects on fertilisation rates after in vitro fertilization (IVF). The main objective of this study was to examine the influence of mild α-chymotrypsin treatment of semen samples on the fertilisation rate after artificial reproductive treatment (ART).MethodsThe fertilization rate of 52 ART cycles was examined following IVF using a low dose of α-chymotrypsin to induce liquefaction of highly viscous semen and was compared to a control group of 88 ART cycles.ResultsThere was no significant difference in the fertilization rates of α-chymotrypsin treated semen samples compared to the control group; pregnancy rates were unaffected.ConclusionsThe use of mild α-chymotrypsin treatment of semen samples in case of hyperviscosity does not appear to impact negatively on the fertilization rates after ART and could be regarded as an additional method to induce liquefaction of highly viscous semen samples in IVF.     

In vitro effects of clomiphene citrate on sperm parameters and fertilisation rate in male NMRI mice

Clomiphene citrate (CC), as a medication in male infertility, improves the sperm parameters in oral consumption but various detrimental side effects have been reported including testicular tumours, gynaecomastia, skin allergic reactions and ocular symptoms. Therefore, this study was designed to evaluate the in vitro effects of CC on sperm parameters and fertilisation rate in IVF protocol. Sperm samples of NMRI adult mice were divided into six groups: group 1 received no treatment (control group), while groups of 2, 3, 4, 5 and 6 (experimental groups) were incubated with the doses of 0.001, 0.01, 0.1, 1 and 10 µg/ml of CC in culture medium respectively. Sperm parameters (viability, morphology and motility), DNA fragmentation levels and fertilisation rate in IVF were evaluated. The results demonstrated that the doses of 0.1 µg/ml (p = .000007 for viability and p = .00006 for fertilisation rate) and 1 µg/ml (p = .032 for viability and p = .005 for fertilisation rate) CC cause a significant improvements; also, the dose of 0.1 µg/ml CC found effective on sperm motility (p = .0003). In the field of IVF, the application of 0.1 and 1 µg/ml of CC in the culture medium may improve the sperm parameters in IVF protocol with no side effects.     

Effect of increasing paternal body mass index on pregnancy and live birth rates in couples undergoing intracytoplasmic sperm injection

In this study, our purpose was to investigate the possible effect of paternal obesity on intracytoplasmic sperm injection (ICSI) outcomes on the basis of clinical pregnancy outcome. Antropometric measurements of 155 couples, referred to our infertility clinic and who underwent an ICSI cycle, have been evaluated. The study sample were divided into three groups with respect to paternal body mass index (BMI), as normal weight (BMI: 20–24.9), overweight (BMI: 25–29.9) and obese (BMI ≥ 30). Results of conventional semen analysis were also analysed. Clinical pregnancy data, including fertilisation rate, implantation rate, clinical pregnancy rate and live birth rate, were evaluated. Paternal obesity was a significant negative factor for sperm concentration and sperm motility (P = 0.03 and P = 0.01 respectively). A significant decrease of clinical pregnancy rate and live birth rate was associated with increased paternal BMI (P = 0.04 and P = 0.03 respectively). We have not determined a significant difference among groups in terms of fertilisation rate and implantation rate. This study demonstrates that increasing paternal BMI has a negative influence on ICSI success, including clinical pregnancy rate and live birth rate. There is a need for further studies to point the importance of lifestyle changes in order to overcome the negative influence of paternal obesity on couple's fertility.     

Relationship between age and semen parameters in men with normal sperm concentration: analysis of 6022 semen samples

This study evaluates retrospectively the relationship between age and semen parameters among men with normal sperm concentration. It was based on computerized data and performed in an Academic Fertility and IVF Unit. Six thousand and twenty-two semen samples with sperm concentrations of >or=20 x 10(6) ml(-1) were examined according to WHO criteria and analysed in relation to patients' age. For each age group, mean values +/- SD of semen volume, sperm concentration, percentage of motile spermatozoa, normal morphology, acrosome index, total sperm count/ejaculate, total motile sperm count/ejaculate and sexual abstinence duration were examined. A peak semen volume of 3.51 +/- 1.76 ml(-1) was observed at age >or=30 to <35 years and a lowest volume of 2.21 +/- 1.23 ml(-1) was observed at age >or=55 years (P<0.05). Sperm motility was found to be inversely related to age with peak motility of 44.39 +/- 20.69% at age <25 years and lowest motility of 24.76 +/- 18.27% at age >or=55 years (P<0.05). A reduction of 54% was observed for total motile sperm, between values of 103.34 +/- 107 x 10(6) at age >or=30 to <35 years and 46.68 +/- 53.73 x 10(6) (P<0.05) at age >55 years. A statistically significant and inverse relationship was observed between semen volume, sperm quality and patient age, in spite of prolonged sexual abstinence duration. Top sperm parameters were observed at age >or=30 to <35 years, while the most significant reduction in sperm parameters occurred after the age of 55 years.     

Predictors of pregnancy outcome for infertile couples attending IVF and ICSI programmes

The purpose of this study was to evaluate the predictors of pregnancy outcome for infertile couples attending in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) programmes. Infertile couples attending IVF or ICSI procedures were included in this study. Related data including semen parameters and male and female age and body mass index were collected and analysed. The main outcome was clinical pregnancy, defined as an ultrasound detection of foetal heartbeat 6 weeks after embryo transfer. A total of 1316 couples who underwent IVF and 266 who underwent ICSI were recruited for this study. A multivariate logistic regression with likelihood ratio test revealed the following predictors of pregnancy outcome: female age and sperm DNA fragmentation index (DFI) and acrosomal activity in IVF procedures (chi‐square of likelihood ratio = 26.42, d.f. = 3, P < 0.005) and female age and DFI in ICSI procedures (chi‐square of likelihood ratio = 18.88, d.f. = 2, P < 0.005). In conclusion, our study indicated that sperm DFI, female age and acrosomal levels have a significant effect on ART pregnancy outcome.     

Association between obesity and alteration of sperm DNA integrity and mitochondrial activity

Study Type – Prognosis (cohort) Level of Evidence 3a What's known on the subject? and What does the study add? The relationship between high levels of BMI and changes in altered standard semen analysis parameters are described in the literature. However, the functional characteristics of the sperm are essential to complete the evaluation of male infertility. Thus, this study provides important information about the functionality of the sperm of men with different levels of BMI.

OBJECTIVE

• ? To assess the effect of obesity on semen analysis, sperm mitochondrial activity and DNA fragmentation.

MATERIALS AND METHODS

• ? A transversal study of 305 male patients, presenting for clinical evaluation, was carried out. The patients were divided into three groups according to body mass index (BMI) as follows: eutrophic (BMI < 25 kg/m², n= 82), overweight (BMI ≥ 25 kg/m² and <30, n= 187) and obese (BMI ≥ 30 kg/m², n= 36).
• ? The variables analysed were semen analysis, rate of sperm DNA fragmentation and sperm mitochondrial activity.
• ? Groups were compared using one‐way analysis of variance followed by a least significant difference post‐hoc test. A P‐value of <0.05 was considered to indicate statistical significance.

RESULTS

• ? No differences were observed in age, ejaculatory abstinence, ejaculate volume, sperm vitality, morphology or round cell and neutrophil count among the groups.
• ? The eutrophic group had a higher percentage of sperm with progressive motility (P= 0.001). Mitochondrial activity was lower in the obese group (P= 0.037) when compared to the eutrophic, and the percentage of sperm with DNA damage was higher in the obese group (P= 0.004) than the other two groups.

CONCLUSION

• ? Increased BMI values are associated with decreased mitochondrial activity and progressive motility and increased DNA fragmentation.

     

正常生育力和精子活力低下不育者精子运动计算机辅助分析

用精子活力分析仪对７３名正常生育力男性射出精子进行了精子动力学指标分析；用上述指标分析了２００例精子活力低下不育男性射出精子动力学指标及各项运动参数间相互关系；用己酮可可碱作用精子活力低下不育男性射出精子，观察精子各项运动参数改变。结果：（１）正常生育力组，前向运动精子在总运动精子中比例与精子活动率间不呈相关性；随精子活动率提高，快速相和慢速相精子分布分别逐渐增加和减少，精子ＶＡＰ、ＶＣＬ、ＶＳＬ、ＢＣＦ、ＡＬＨ增加，ＬＩＮ和ＳＴＲ降低。（２）精子活力低下不育组，随精子活动率下降，主要表现在运动速度下降，与正常组比较，精子前向运动能力和运动速度均有明显下降（Ｐ＜０．０５），但ＬＩＮ和ＳＴＲ不管在组内还是与正常组相比均无明显差别（Ｐ＞０．０５），反映出这种前向运动能力的减低是由速度下降引起，速度分布变化以中速相明显。（３）己酮可可碱能明显提高精子活力低下不育者精子的活动率，前向运动率和精子运动快速相的分布；对精子ＬＩＮ，ＳＴＲ影响不明显。     

异常形态精子对植入前胚胎发育和妊娠结局的影响

目的探讨异常形态精子(畸形率≥98%)对植入前胚胎发育及妊娠结局的影响。方法采用回顾性队列研究,分析2017年1～12月在唐都医院妇产科生殖医学中心行ART助孕的2 419例患者临床资料,根据异常形态精子分为3组,即IVF对照组(畸形率≤96%,n=2 129)、IVF实验组(畸形率≥98%,n=90)和ICSI实验组(畸形率≥98%,n=200)。比较3组间植入前受精失败率(受精率<30%)、正常受精率、可用胚胎率等胚胎发育参数和着床率、临床妊娠率、流产率及活产率等妊娠结局的差异。结果 (1)胚胎发育结果:组间比较,IVF实验组受精失败率显著高于IVF对照组(P<0.05),ICSI实验组的受精失败率为0;ICSI实验组正常受精率显著高于IVF对照组和IVF实验组(P<0.05);IVF实验组可用胚胎率显著低于IVF对照组和ICSI实验组(P<0.05)。(2)妊娠结局:单因素分析结果显示,与IVF对照组、ICSI实验组相比,IVF实验组的着床率、临床妊娠率、流产发生率和活产率差异均有统计学意义(P<0.05);IVF对照组和ICSI实验组组间妊娠结局指...     

Effect of You Gui Wan on mouse sperm fertilising ability in vivo and in vitro

This study is to explore whether YGW has an impact on sperm fertilising ability in mice. Twenty male mice were randomly divided into two groups. In vivo experiments, one group of animals were orally administrated with YGW decoction and another group administered with saline for 14 days. Afterwards, the animals were mated with their female partners. Percentages of retrieved zygotes were then compared. In vitro experiments, in vitro fertilisation (IVF) assay, sperm acrosome reaction and acrosin activity were used to compare sperm fertilising ability between the two groups. The YGW‐treated group had a significantly higher percentage of zygotes than the saline controls (P = 0.005). The IVF rates induced by spermatozoa from the herb‐treated mice were also significantly higher than those from the control animals (P = 0.015). The sperm acrosin activity of the herb‐treated group was significantly higher than that of the saline‐treated group (P = 0.048), although there was no significant difference in testicular weight, sperm count and sperm motility. These data suggest that YGW decoction has a significant effect on normal sperm fertilising ability both in vivo and in vitro, which may be due to, at least in part, increments in the sperm acrosin activity.     

精子DNA完整性与体外受精-胚胎移植临床结局的相关性研究

目的 探讨精子DNA完整性与精液参数及体外受精-胚胎移植（IVF-ET）/卵胞浆内单精子注射（ICSI）临床结局的关系.方法 选择2008年6月～2009年6月在解放军105医院生殖医学中心接受IVF/ICSI治疗的179对不育夫妇作为研究对象,采用吖啶橙试验（AOT）对116例实施IVF和63例实施ICSI治疗的男性患者进行精子DNA完整性分析,根据精子DNA碎片指数（DFI）将患者分为DFI≤30%组和DFI＞30%组,比较两组间精液参数、受精率、卵裂率、优胚率、胚胎冷冻率、着床率和临床妊娠率.结果 DFI ＞30%组精子畸形率显著高于≤30%组（P＜0.01）,但两组间精子密度、活动率、前向运动精子（a＋b）均无显著性差异（P＞0.05）;DFI＞30%组IVF和ICSI的优胚率、ICSI的胚胎着床率和临床妊娠率均显著低于DFI≤30%组（P＜0.01,P＜0.05）.结论 精子DNA完整性与精子形态密切相关,精子DNA损伤在IVF/ICSI过程中对胚胎质量有负面影响,并显著影响ICSI的胚胎着床率和妊娠率,建议行ICSI前应对精子DNA完整性进行评估.     

Randomised clinical trial of comparing effects of acupuncture and varicocelectomy on sperm parameters in infertile varicocele patients

The aim of the study was to evaluate the effect of the acupuncture treatment on sperm parameters and pregnancy rates in patients with primary infertility. Between January 2008 and May 2010, 30 men with the primary infertility (one year of unprotected intercourse, healthy wife) and varicocele with normal hormone levels and abnormal semen analysis were randomised into two groups. Group 1 underwent subinguinal microscopic varicocelectomy, and Group 2 underwent acupuncture treatment twice a week for 2 months. Both groups were evaluated with semen analysis at 6 months after the treatment. Patients in both groups evaluated with telephone calls and e‐mail in terms of pregnancy. The mean age of the patients was 27.2, and groups were comparable regarding the age (P = 0.542). The pre‐treatment sperm concentration, motility and morphological characteristics were similar in both groups. Sperm concentration and motility improved significantly in both groups after the treatment. Increase in sperm concentration was higher in the acupuncture group compared to the varicocelectomy group (P = 0.039). The average follow‐up was 42 months, and pregnancy rates were emphasised 33% in both groups. Acupuncture treatment in primary infertile varicocele patients with semen abnormalities seems to be effective and has comparable results with the varicocelectomy treatment.     

Difference in the seminal plasma protein expression in unexplained infertile men with successful and unsuccessful in vitro fertilisation outcome

Unexplained male infertility (UMI) is a condition in which routine semen analysis fails to detect subcellular sperm dysfunctions. In the present research, a comparative proteomics study of seminal plasma (SP) was conducted in men with unexplained infertility whose female partners had undergone in vitro fertilisation (IVF) treatment to find differences in the SP protein profile. Five UMI men with successful and eight with unsuccessful IVF outcome enrolled in this study. Two‐dimensional polyacrylamide gel electrophoresis (2D‐PAGE) technique was used for protein separation. The differentially expressed proteins were identified using mass spectrometry. Results indicated that at least two different protein spots, including clusterin and epididymal secretory protein E1, were over‐expressed (1.5‐ and 2‐fold change, respectively, p < 0.05) while prostate‐specific antigen was downregulated (0.3‐fold change, p < 0.05) in the successful group as compared with the unsuccessful group. Considering the role of all three identified proteins in the sperm quality, the results of the present study introduced these proteins as new candidate biomarkers for success of IVF in UMI couples.     

Prognostic value of an automated sperm analysis in IVF or insemination therapy

Summary. During the course of sterility treatment semenograms of 271 IVF and 316 insemination patients were carried out by two automated semen analysers. The parameters of these analyses were correlated to pregnancies resulting from the treatment. Semen samples were analysed in the ejaculate and after swim-up preparation. In addition, the swim-up suspension of IVF patients was measured again 18 h after sperm preparation. Patients were divided into three groups: (1) couples who achieved a pregnancy, (2) couples who did not achieve a pregnancy, and (3) IVF patients with no fertilization of the oocytes. Because of large standard deviations in the quality of ejaculates, the results in the IVF group show no significant differences in the semen parameters of husbands of pregnant and non-pregnant women. In contrast husbands of women with no fertilization have a significantly lower sperm motility. After swim-up preparation these differences no longer occur. A further measurement, taken 18 h later, reveals that there are no differences in the sperm parameters between the pregnant and non-pregnant group. However, the semen quality in the group with no fertilization is significantly reduced. The results of the insemination patients are similar to those of the IVF group. Thus, the results from automated sperm analysers cannot replace either the microscopic or biochemical analysis of an ejaculate and, moreover, cannot be used as prognosis for the fertilization capacity of sperms or a following pregnancy.