输精管吻合术后精液参数恢复的研究

为探讨输精管吻合术后精液参数恢复情况,我们对46例接受输精管吻合术者进行术后18个月追踪分析,共检查精液85份。结果提示:输精管吻合术后18个月内,精液中射出的精子总数和精子密度(几何均值)减少;正常形态学的精子减少;精子膜完整性的百分率减少;活动良好的精子减少(a级)和活动不良的精子(c级)增高,这6个异常参数在吻合术后18个月时间内较为恒定。精子总活动率和精子低渗膨胀试验有良好的正相关关系,这两个参数在吻合12个月后有逐步恢复至正常水平的趋势。     

The long-term effects of DDT exposure on semen, fertility, and sexual function of malaria vector-control workers in Limpopo Province, South Africa

Hormonally active chemicals in the environment such as DDT have been associated with declining male reproductive health, especially semen quality. A cross-sectional study of 60 workers was performed near the Malaria Control Center (MCC) in Tzaneen, Limpopo Province, South Africa. Tests included a questionnaire (sexual function, fertility, and job history), a physical examination of the reproductive system, and semen analysis (produced via coitus interruptus or masturbation). Sperm count, density, and motility using the World Health Organization criteria and morphology using the strict Tygerberg criteria were determined. Serum o'p' and p'p' isomers of DDE, DDT, and DDD were measured. Forty-eight (81.0%) participants produced a semen sample, while all completed the questionnaires and physical examination. The mean sperm count was 93.8+/-130.3 million, and sperm density was 74.6+/-85.1 million/mL. The mean normal morphology score was 2.5+/-1.8% of subjects. Eighty-four percent of morphology scores were below either the WHO or the Tygerberg criteria, with the highest individual score being 6%. Self-perceived current problems with sexual function ranged between 10% and 20%. The most prevalent genital abnormality was abnormal testis disposition at 71%. There were few significant associations between DDT exposure measures (measured as years worked at MCC and serum DDT) and reproductive outcomes. p'p'-DDT was negatively associated with semen count (beta=-3.7+/-1.7; P=0.04; R2=0.05 adjusted for age, abstinence, physical abnormality, and fever in last 2 months). While the semen quality in the study was less than normal, no strong evidence for a DDT effect was found.     

男性不育患者精液分析和精子形态学分析

目的：回顾性分析助孕门诊男性不育患者精液分析与精子形态学检测，为防止临床对女方过度治疗提供依据。方法：选择2007年10月1日～2008年2月29日在本院助孕门诊就诊的不孕夫妇，男方至少行精液分析2次，在第一次精液分析即进行精子形态学分析。精液分析采用清华同方精液分析系统，精子形态学分析采用改良巴氏法染色，应用Microsoft Excel进行分析。结果：进行精液分析共1206人次，进行精子形态学分析共517人次。精子密度0-180^★10^9／L，平均55．3±32．2^★10^9／L，75．1％的病例精液密度为20-100^★10^9／L，仅13．3％为少精症，无精症占1．5％；a级精子为14．0％±9．9％，b级精子为10．6％±7．8％，a级＋b级〉50％者仅占0．6％，超过半数的为30％-50％（51．1％），精子形态学分析，仅有20．5％病例是正常的（〉14％）。结论：除无精症显然与不育相关外，精液密度可能不是评估男性不育的一个很好的指标，精子活动力低下或精子畸形率过高更能预示不孕因素，精液分析和精子形态学分析可以作为助孕门诊男性不育的首要筛查手段，防止对女方的过度治疗。     

Microbicides--evaluating multiple formulations of C31G

The purpose of the study was to evaluate semen quality in young Chinese men and to establish reference values. Normal healthy young men from seven geographical areas were enrolled. The study showed that the mean sperm volume was 2.61 mL, and mean percent of sperm with forward progression was 59.89, while median of semen viability was 79.0%, and geometric mean of semen density was 55.45 x 10(6)/mL. Proportion of routine semen indexes that met World Health Organization (WHO) criteria were as follows: 81.9% for semen volume, 91.1% for liquefaction time, 93.4% for viscosity, 90.8% for pH, 81.3% for sperm with forward progression, 65.3% for sperm viability, 93.8% for semen density, 98.8% for normal sperm morphology, and 89.1% for total sperm count. Participants whose sperm met all WHO standard parameters accounted for 42.3%. Because the infertility rate in China is about 10-15%, the fifteenth percentile of semen parameters might be used as the lower limit of reference values, which may be more appropriate for young Chinese men. The fifteenth percentiles of parameters in this study were as follows: 1.5 mL for semen volume, 7.2 for pH value, 45% for proportion of sperm with forward progression, 68% for sperm viability, 30 x 10(6)/mL for semen density, 68% for proportion of sperm with normal morphology, and 50 x 10(6) for total sperm count.     

Seasonal variation of human sperm cells among 4,422 semen samples: A retrospective study in Turkey

We aimed to assess the possible presence of a seasonal pattern in three parameters of semen analysis: sperm concentration, morphology, and motility as a function of the time of ejaculation and sperm production (spermatogenesis) in normal and oligozoospermic men. This retrospective study included a consecutive series of 4,422 semen samples that were collected from patients as a part of the basic evaluation of the infertile couples attending the Reproductive Endocrine Outpatient Clinic of a tertiary women’s hospital in Ankara, Turkey, between January 1, 2012 and December 31, 2013. The samples were classified according to sperm concentration: ≥15 x10⁶/mL as normozoospermic samples and 4 -14.99 x10⁶/mL as oligozoospermic samples and seasonal analysis of the semen samples were carried out separately. When the data was analyzed according to the season of semen production, there was no seasonal effect on the sperm concentration. A gradual and consistent decrease in the rate of sperm with fast forward motility was observed from spring to fall with a recovery noticed during the winter. The percentage of sperms with normal morphology was found to be statistically significantly higher in the spring samples compared with the summer samples (p=0.001). Both normozoospermic and oligozoospermic semen samples appeared to have better sperm parameters in spring and winter. The circannual variation of semen parameters may be important in diagnosis and treatment desicions.

Abbreviations: WHO: World Health Organization; mRNA:messenger ribonucleic acid     

不育症木工精液的对照分析

本文对从事木工作业的３６名不育症患者和３３名作为对照的非木工作业的不育症患者的精液进行了分析，结果表明：１．木工不育症患者的精液量、精子密度、精子活率、畸形率与对照组相比有显著性差异（Ｐ＜０．０５）；２．吸烟组精子密度、精液量、精子活率和果糖含量比少吸或不吸烟组低（Ｐ＜０．０５），精子畸形与吸烟无关；３．木工组的精细胞总的核异常率、核碎解率和其它核异常率明显高于对照组（Ｐ＜０．０５），而精细胞微核率、核空泡率及核桥率在两组间无显著性差异。     

CORRELATION OF THE BOVINE CERVICAL MUCUS PENETRATION TEST WITH HUMAN SPERM CHARACTERISTICS IN 1406 EJACULATES

The bovine cervical mucus penetration test (BCMPT) was performed to determine its usefulness in screening the ability of sperm to successfully penetrate mucus in vitro. Ejaculates were obtained by masturbation from patients attending an infertility clinic. Routine semen analysis was performed using a microcomputerized multiple-exposure photography system. The BCMPT was performed. Overall, the average penetration of the mucus was 38+/-0.46 mm. Of the 1406 ejaculates analyzed, 244 (17%) displayed a negative result (0-20 mm), 291 (21%) a questionable result (21-30 mm), and 871 (62%) a positive result (>30 mm). A highly significant (p<.001) correlation between mucus penetration distance and sperm MD (r=0.541), MI (r=0.484), count (r=0.475), motility (r=0.448), velocity (r=0.400) and morphology (r=0.369) was observed. Overall, the finding of an abnormal semen parameter resulted in a 34+/-5% accurate prediction of a negative or questionable BCMPT (<30 mm), while a normal semen parameter resulted in a 90+/-4% accurate prediction of a positive BCMPT (>30 mm). Sperm MD showed the strongest positive predictive value (98%), while morphology showed the greatest negative predictive value (50%). Of the 1406 samples, 25+/-2% of the samples with normal semen parameters displayed a negative BCMPT. Conversely, 6+/-2% of samples with abnormal parameters showed a positive BCMPT. The BCMPT successfully identifies a significant subpopulation of patients as having an inadequate penetration of mucus with otherwise normal semen characteristics.     

PHOSPHOLIPID COMPOSITION OF HUMAN SPERM AND SEMINAL PLASMA IN RELATION TO SPERM FERTILITY

The phospholipid and fatty acid composition of sperm was studied in 8 healthy and 16 infertile men. Infertile men randomly formed from the patients with normal semen parameters according to WHO criterion. Therefore, all semen parameters of infertile patients were similar to the same characteristics of the semen of healthy men, except the abnormal forms. The amount of abnormal forms in infertile men was significantly higher than in healthy men. Sperm from infertile men show a drastic loss of phosphatidyl ethanolamine. At the same time, the significant increase of phosphatidyl serine in the sperm and seminal plasma of sterile patients was found. Lysophosphatidyl serine in the sperm of the infertile men was detected. Fatty acid composition of the semen of infertile men was altered. The levels of stearic and n-3 polyunsaturated fatty acids (eicosopentaenoic and docosahexaenoic acids) was dramatically lowered, but the values of some n-6 polyunsaturated fatty acids (linolenic and docosatetraenoic) acids increased. There was significant positive correlation between docosahexaenoic acid and sperm motility (r =. 82, p <. 001) and negative correlation between linolenic acid and spermatozoa motility (r=-0.58, p<.05). Infertility of men with normal semen quality can originate from the disorder of sperm lipid metabolism. The drastic loss of phosphatidyl ethanolamine and n-3 polyunsaturated fatty acids with simultaneous enhancement of phosphatidyl serine and some n - 6 polyunsaturated fatty acids in sperm could be an important cause of male infertility.     

精液分析中精液质量分析仪的应用

用常规的精液分析方法和精液质量分析仪(Sperm Quality Analyzer, SQA)对110份不同质量及来源的精液样本进行了分析。通过对常规分析的各精液参数与SQA测得的精子活力指数(Sperm Motility Index, SMI)及其对应的精液参数间的相关分析,显示SMI值与常规分析的精子密度、活动精子密度、活动率、活动度指数(Motility Index, MI)显著相关,SQA与常规分析两方法分别得到的精子密度、活动率间有较好的相关性;正常精液与异常精液的SMI值有显著性差异;SMI值用于诊断精子密度异常的敏感性为96.6％,特异性为74.1％。本研究认为精液质量分析仪重复性好,可客观地对精液的活动精子密度和活动力作出综合评价,SMI值在不育症的诊断中有一定的临床意义,但尚有一定的局限性,不能完全替代全面的传统的精液分析。     

精索静脉曲张不育患者8-羟基脱氧鸟苷水平的检测分析

目的:检测人血清及精浆中8-羟基脱氧鸟苷(8-OHdG)水平,探讨男性精索静脉曲张(VC)患者体内氧化损伤情况。方法:对41例VC不育患者、33例正常生育者进行精液分析,用8-OHdG酶联免疫试剂盒检测两组对象血清及精浆中8-OHdG水平,采用Wilcoxon两样本比较法对数据进行统计分析。结果:正常生育组的精子浓度、前向活动率、存活率均高于VC不育组(P<0.05),血清8-OHdG水平(中位数34.83ng/ml)低于VC组(中位数76.87ng/ml,P<0.05),精浆8-OHdG水平(中位数18.51ng/ml)低于VC组(中位数22.19ng/ml,P<0.05)。血清中8-OHdG水平高于精浆(P<0.05)。血清8-OHdG水平与精子存活率、前向活动率呈负相关(γ=-0.293,P<0.05;γ=-0.243,P<0.05);精浆8-OHdG水平与精子存活率、前向活动率呈负相关(γ=-0.327,P<0.05;γ=-0.275,P<0.05);血清及精浆中8-OHdG水平与精子浓度、正常形态率不相关。结论:VC患者血清和精浆中8-OHdG水平高于正常生育组,表明VC患者可能存在DNA氧化损伤,导致精子活力下降。     

精液中硒含量与精子质量和精子DNA 氧化损伤的关系

目的　探讨血清和精液中硒浓度与精子质量和精子DNA氧化损伤的关系。方法　用原子吸收光谱检测血清和精液中硒浓度 ,按WHO规范方法检测精液量、精子数、每次射出精子总数、活力和活动精子百分率及精子畸形率 ,用高压液相色谱 光电检测系统和高压液相色谱 紫外线检测器同时检测人精子DNA 8 羟基脱氧核糖鸟苷 (8 OHdG)和脱氧核糖鸟苷 (dG)水平。结果　已孕组精液硒平均浓度 (0 74μmol/L)明显高于不孕组 (0 5 6 μmol/L) ,而两组间血清硒平均浓度差异无显著性。已孕组精液量、精子数和每次射出精子总数的平均值 (3 91ml、46 4× 10 9/L和 16 8 0× 10 6)明显高于不孕组 (2 79ml、36 5× 10 9/L和 10 2 0× 10 6) ,两组间精子活力、活动精子百分率和精子畸形率的平均值差异无显著性。精液硒浓度与精子数、每次射出精子总数、精子活力、活动精子百分率之间呈明显的正相关 ,而血清硒浓度与精子质量均无明显相关关系。精子DNA 8 OHdG水平与精液硒浓度呈明显负相关 ,而与血清硒浓度无明显相关关系。结论　精液硒浓度与人类精子质量和精子DNA 8 OHdG有关 ,血清硒浓度不影响精子质量和精子DNA氧化损伤程度     

流产患者丈夫精子因素初步分析

目的:探讨流产的精子因素。方法:采用精液常规分析、精子形态分析、吖啶橙荧光染色方法对156例自然流产1～4次患者的丈夫及80例正常生育男性的精子进行分析。结果:对照组与流产组a级精子百分率、a+b级精子百分率、精子密度、精子活率、正常形态精子百分率、异常形态精子百分率、尾部异常精子百分率和精子DNA完整率方面差异均有统计学意义(P<0.05)。结论:精子运动参数、形态参数、精子DNA损伤可能与流产有关。     

Numerical chromosome anomalies in human sperm at low sperm concentration

INTRODUCTION: With the assisted reproduction techniques the natural selection of sperm is bypassed on different levels. AIM: The aim of the present work is to determine the frequencies of sperm numerical chromosome aberrations in infertile men with low sperm count and to examine the relationship between the spermatogram parameters (sperm count and motility) and the aneuploidy and diploidy frequencies. METHODS: 32 men with low sperm count were investigated. Semen analysis was performed according to the WHO criteria. Disomy and diploidy frequencies were detected with fluorescence in situ hibridization using 17, X and Y centromeric probes. 200,969 sperm were scored, with the mean of 6272 cells in each subjects. The rate of numerical chromosome anomalies were also estimated using the detected disomy and the diploidy frequencies. RESULTS: Mean sperm concentration of the 32 men was 18.2 million/ml (SD: +/- 8.43, range: 8.0-45.5), mean motility 49.4% (+/- 9.32, 30-69.2). The X/Y ratio was 1.07. The mean frequencies of sex chromosome disomy, chromosome 17 disomy and diploidy were 0.36%, 0.16% and 0.56%, respectively. The most frequent disomy was XY disomy (0.14). Sex chromosome disomy frequencies were higher in oligospermic samples (0.37% vs. 0.32%, OR = 1.18, 95% CI = 1.01-1.39, p < 0.001). With special regard to XY disomy (0.08% vs. 0.17%, OR = 1.99, 95% CI = 1.48-2.67, p < 0.001). In subjects with oligoasthenozoospermia the diploidy frequency increased (0.96%, OR = 2.39, 95% CI = 2.13-2.69, p < 0.001), mostly due to the elevated rate of diploid sperm of meiosis II. origin (XX or YY diploids). Estimated frequency of the numerical chromosome anomalies was 8.3 +/- 5.3 in the study population. Neither the sperm count, nor the sperm motility showed correlation with the detected frequency of the chromosome aberrations. CONCLUSIONS: In oligospermic patients there is a risk for elevated frequency of sperm with sex chromosome aneuploidy, especially the XY disomy. Furthermore, the diploidy frequency is increased in oligozooastenospermic samples. Nevertheless, classical parameters of semen analysis (sperm count and motility) do not correlate with the frequency of numerical chromosomal anomalies. The risk can be determined using fluorescens in situ hybridization on sperm.     

男性不育精子染色质结构与尿酸和丙二醛含量关系研究

目的:探讨不育精液中活性、精子染色质结构、MDA与尿酸之间的关系。方法:依据WHO诊断标准,选择不育者43例,生育者30例,进行常规精液分析;丙二醛(MDA)测定用TBA显色法;尿酸含量测定采用尿酸酶-过氧化物酶偶联法,将精子标记相应的荧光染料,用流式细胞仪检测精子的染色质状态。结果:生育组精子活率、密度、UA浓度明显高于不育组(P<0.01),精子畸形率、MDA浓度、DNA碎片率明显低于不育组(P<0.01)。且DNA碎片率与精子畸形率呈正相关(r=0.371,P<0.01),与精子活率呈负相关(r=-0.349,P<0.01)。结论:不育患者精液中脂质过氧化(LPO)反应启动,抗氧化物尿酸含量下降,使精子DNA中毒受损,畸形率升高,密度和活率下降;从常规、生化指标说明精子DNA受损的情况,为基层临床诊治男性不育症提供更有力的证据和更好的帮助。     

男性不育患者精浆锌含量与精液主要参数相关性研究

目的:探讨不育男性精浆的锌含量与精液质量的关系。方法:回顾性分析2011年8月～2012年1月在广西壮族自治区妇幼保健院生殖中心就诊的343例男性不育患者的相关资料,依据精浆锌含量分为正常A组(n=274例)和异常B组(n=69例),比较两组间精液参数的差异;同时根据精液黏稠度分为黏稠C组(n=54例)与非黏稠D组(n=289例),比较两组间精浆锌含量及其他精液参数的差异。结果:A组与B组患者年龄比较差异无统计学意义(P>0.05)。A组的精液量、每次射精精子总数、前向运动精子总数显著高于B组,而黏稠精液的比例明显低于B组,差异均有统计学意义(P<0.05)。其他精液各指标比较差异无统计学意义(P>0.05);C组与D组精液圆细胞浓度、精液量、精子浓度、精子总数比较差异无统计学意义(P>0.05);D组的前向运动精子百分率、前向运动精子总数、活动率、精浆锌明显高于C组,差异有统计学意义(P<0.05)。精浆锌含量与精液量、每次射精精子总数、前向运动精子总数显著正相关,与其他参数无显著相关性。结论:精浆锌含量直接影响精液量、精子总数、前向运动精子总数和精液黏稠度,精浆锌含量是男性生殖力的重要评估指标。     

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Varicocele is currently the most common irregularity identified in males that is associated with impaired spermatogenesis. It primarily presents in the form of decreased sperm count and motility, abnormal morphology, and significantly increased sperm DNA fragmentation. Several studies have shown that surgical repair improves semen parameters and increases the odds of spontaneous pregnancy. However the exact effect of surgical repair treatment remains controversial. Therefore, the aim of our study was to evaluate the effectiveness of microsurgical repair by comparing common semen parameters and sperm DNA fragmentation index (DFI). We evaluated infertile men (n?=?19) who underwent microsurgical subinguinal varicocelectomy for treatment of clinical varicocele before and 3 months after surgery. Normozoospermic men (n?=?19) were considered as the normal control group. Semen parameters improved significantly after surgery when compared with that before surgery, but still significant differences with the normal control group were observed. In comparison, sperm DNA integrity improved significantly after surgery (percentage DFI decreased from 28.4?±?15.6% before surgery to 22.4?±?12.9%, at 3 months post surgery) to similar levels as the normal control group. These results suggest that microsurgical repair may be considered as a treatment option in infertile men with palpable varicocele.     

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。     

High incidence of sperm dysfunction in a varicocele infertile man: case report

Studies indicate abnormal semen indicators among varicocele infertile men can be reversed to normal status after surgical repair. While semen indicators and DNA damage of sperms are reported frequently, sperm function tests are rarely performed to assess the functional status of sperms among these individuals. We report a 35-year-old male with 4 years of primary infertility who otherwise has a normal sexual life. Various analyses performed revealed the interplay of multiple abnormalities leading to the observed phenotype. The individual was diagnosed with severe sperm defects, bilateral varicocele (grade II) and endocrinopathy. The percentage of functionally normal sperms were found to be 24% for hypo-osmotic swelling, 28% for acrosome reaction and 21% for nuclear chromatin decondensation test. Cytogenetic analyses showed normal karyotype and sequence-tagged-site markers based PCR showed no deletions involving key candidate genes of the Y chromosome. A thorough investigation of infertile subjects and simple diagnostic tests are essential to detect the treatable defects, in general as well as severe infertile cases, which can improve the chances of normal conception or the success rates of in-vitro fertilization and intracytoplasmic sperm injection.     

精液中HA、LN、PCⅢ、CⅣ含量与精子质量关系的研究

目的:探讨精液中透明质酸(HA),层粘连蛋白(LN),Ⅲ型前胶原(PCⅢ),IV型胶原(CⅣ)与男性精子质量的关系。方法:采用放射免疫分析法分别检测60例男性生育者和不育者精液中的HA、LN、PCⅢ、CⅣ,并进行精子质量分析。结果:精液液化时间正常与异常组精液中HA、PCⅢ、CⅣ及LN含量差异无统计学意义;精子密度正常组精液中HA、PCⅢ及LN含量明显高于异常组,两组比较有统计学意义(P<0.01),而两组中CⅣ含量比较差异无统计学意义(P>0.05);精子活动率异常组精液中HA和LN含量明显高于正常组,两组比较差异有统计学意义(P<0.01),而两组中的PCⅢ和CⅣ含量比较差异无统计学意义(P>0.05)。结论:精液中HA、LN的升高可能是生精功能活跃的表现,且不排除HA、LN是刺激男性生精因素的可能,测定精液中HA、LN的含量可以间接了解生育能力。     

IgA ANTIBODIES TO CHLAMYDIA TRACHOMATIS AND SEMINAL PARAMETERS IN ASYMPTOMATIC INFERTILE MALES

Prevalence of IgA antibodies to Chlamydia trachomatis in semen samples from infertile men was estimated and its clinical meaning is discussed. The ejaculate of 102 infertile men without any symptom of genital infection was studied, and seminal alterations were classified according to WHO criteria. Antichlamydial IgA antibodies were detected using a solid-phase, enzyme-linked immunoassay (ImmunoComb II Chlamydia trachomatis monovalent IgA) and related to sperm count, motility and membrane integrity, seminal leucocyte count, and past history of sexually transmitted disease (STD). Prevalence of IgA antibodies to C. trachomatis was 23%. There was no relationship between IgA antibodies and the sperm variables or leucocyte count in semen. However, a strong association between antichlamydial IgA antibodies and the antecedent of STD was found (p &lt;. 005; OR = 6). IgA antibodies to C. trachomatis did not cause alterations in sperm function and they were not associated with inflammatory response. However, these antibodies in semen of asymptomatic infertile men would indicate a risk of C. trachomatis infection for the couples of those patients.