精子DNA损伤在男性不育症中的研究进展

男性不育症是现今困扰我国不孕不育夫妇的一个严重问题。目前临床上对于男性不育的筛查主要取决于精液常规的检查。但由于精液本身的易干扰性,导致其已不能对精子的受精能力及男性的生育能力进行准确的评价。近年来,精子DNA损伤作为一项新的评价精子功能的指标,逐渐成为男性不育症的研究热点。本文就精子DNA损伤的原因、机制及在男性不育症中的研究进展作一综述,为男性不育症的诊断和治疗研究提供依据。     

生精胶囊治疗少弱精子症疗效观察

据世界卫生组织估计,目前全世界共有6 000～8 000万对夫妇患有不育症,其中一半为男性不育患者,而且有逐年增多的趋势。除了造成沉重的经济负担以外,不育症还严重地影响了患者夫妇的家庭生活,为不育夫妇提供良好的治疗方法是非常重要的。本文主要是探讨生精胶囊治疗男性不育症的疗效和安全性。     

男性不育症和男性生育调节问题的进展

男性不育症和男性生育调节问题的进展周性明关键词男性不育，生育能力，性功能障碍，生育调节１男性不育症国内外统计资料表明，１００对夫妇中约有１５对不能生育，世界卫生组织统计全球有６０００万～８０００万对夫妇不育，其中原因在男方者占５０％，所以，男性不育症...     

石萆汤对肾虚夹湿型男性不育患者精子DNA完整性的影响

<正>近些年来,随着国家计划生育政策的调整,门诊中就诊的男性不育症比例大幅增加,据统计有15%的夫妇在1年内不能受孕而寻求药物治疗,不育的夫妇中至少50%存在男性精子异常的因素[1]。另外,有较多男性不育症病因不明确,精液常规检查无异常,给临床医生的诊断和治疗带来了困惑。随着人们对男性不育相关因素深入研究,精子DNA损伤作为一项新的评价精子功能的指标,逐渐受到临床的重视。传统的精液常规检查,易受时间和外界环境的干扰,易于波动,已不能对精子的受     

生精胶囊与左旋卡尼汀并用治疗少弱精子症100例临床观察

近年来,随着环境的污染、工作压力的增加、生活节奏的加快,男性不育发病率呈上升趋势,目前全世界约有6000万～8000万对夫妇患有各种原因引起的不育症,其中50%为男性因素,而影响最明显的是男性精子数量及质量在逐年下降.     

精子优选的临床应用

本文报告一种用于收集高活动力精子的改良上游技术。用本方法获得的精子悬液平均精子活动率＞８０％,精子前向运动力比处理前明显提高。３５对不育夫妇用上游法获得的精子悬液做夫妇间人工授精。结果１１例妇女受孕,受孕率３１．４％,周期受孕率２５．０％。现已有１０例婴儿出生（７男,３女）。婴儿生长发育良好。讨论了本方法对不育症的治疗效果,成功率受精子处理、授精技术、授精时间、受精妇女生育功能等因素影响。     

精子低温保存与精子功能

自５０年代美国和日本相继用低温保存的精液复温后作人工受精,并获得成功以来［１～３］,目前精液低温保存在不育症的治疗、生殖保险、计划生育和优生等领域得到广泛开展。精子功能是影响人工受精成功率的关键因素之一,而低温冻存及复温过程中均会对精子的功能造成一定...     

辅助生育技术中精液处理的重要性

辅助生育，顾名思义就是利用医学手段辅助不育症夫妇获得妊娠。目前，应用于临床的辅助生育技术有人工授精、体外受精及在传统体外受精技术基础上发展起来的卵子胞浆内单精子显微注射等。无论哪一种辅助生育技术，都需要对精子进行实验室处理，优选成熟的具有受精潜能的活动精子。但体外是精子的非正常生存环境，在离体环境中，     

计算机辅助精子运动参数分析在男性不育症诊断中的价值

精液分析在男性不育症诊断中占有重要的地位,是确定男性生育能力的重要检查方法。近年来,随着计算机辅助精子分析(CASA)系统的应用,精子的运动参数在男性不育症诊断中的价值受到普遍关注。为了探讨精子运动参数的变化对男性生育能力诊断的临床价值,我们应用CASA对307例男性的精液进行了相关参数的分析,报告如下。     

改良精子冷冻贮存复温法

人类精子库供精为不可治愈的男性不育症夫妇的人工授精提供了有利条件。因精子库具有长期保存精子的优点临床上可广泛应用。但精子在冷冻复温过程中如果条件不得当将会影响精子的活动率、运动速度。为寻求保证冷冻复温后精子功能正常的可行方法，提高人工受精的成功率，我们对３８例精液进行了冷冻自然复温与快速复温，及冷冻精子保护剂每１分钟加入１滴与２分钟加入１滴的对比实验观察，结果报告如下：材料与方法一、材料来源１９９７年８月至１９９８年６月，在我院不育门诊中选择３８例男性不育精液进行研究。不育年限２～１０年，年龄２…     

Embryo development, pregnancy and twin delivery after microinjection of 'stump' spermatozoa

Intracytoplasmic sperm injection was performed with immotile spermatozoa affected by tail 'stump' defect, and resulted in normal fertilization, embryo transfer and pregnancy in a 35-year-old female. The husband had a consanguineous ancestry. Two healthy babies, a male and a female, were born and this confirms that male infertility due to certain genetic sperm defects can be overcome by the intracytoplasmic sperm injection-assisted reproduction technique. The likely genetic origin of this sperm defect and the probability of the male offspring inheriting this sperm defect should be considered. The fertilization ability of stump spermatozoa, microinjected into the oocyte, is explained on the basis of experience from our previous research.     

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.     

RhoGDIα在人睾丸、精子中表达及其与体外受精成功率相关性的初步分析

目的:观察Rho特异性的GDP解离抑制因子α(RhoGDIα)在人睾丸、精子中的表达及定位并比较RhoGDIα在正常生育男性和体外受精(IVF)不育患者精子中的表达差异。方法:通过免疫组化方法观察RhoGDIα在人睾丸中的定位;通过免疫荧光方法观察RhoGDIα在人精子获能前、获能后、顶体反应后的定位;收集正常男性精液标本(10例),高受精率(≥60%,12例)和低受精率(<60%,13例)的IVF不育患者的精液标本,Percoll细胞分离液分离精液标本,排除生精细胞和白细胞,分别通过免疫荧光和Western印迹方法,检测RhoGDIα的表达。结果:免疫组化结果显示RhoGDIα存在于人睾丸各级生精细胞中,并在长形精子细胞高表达。免疫荧光结果显示RhoGDIα在人精子的顶体和尾部有较强表达,并且随着获能的发生,在顶体上的表达减弱,当顶体反应发生后,顶体上的表达完全消失。Western印迹结果显示不易受精的IVF患者精子中RhoGDIα的表达(0.66±0.18)显著低于正常组(1.13±0.21)和易受精的IVF患者组(0.97±0.17)。结论:RhoGDIα定位于人精子的顶体和尾部,可能参与了精子运动,获能及顶体反应过程。RhoGDIα在受精率低下患者精子中表达显著降低,提示RhoGDIα可能成为一个新的男性不育的诊断指标,并且可能成为IVF供精选择的一个指标。     

Sperm morphology training in India

Sperm morphology is regarded as possibly the most consistent sperm variable that is related to in vitro and in vivo fertilisation success or failure. There is also a re‐emerging awareness of andrology, particularly in developing countries where healthcare resources are often limited. This study aimed to record the importance of hands‐on training on the sperm morphology reading skills among 174 Indian infertility workers. During a series of five workshops presented by the Indian Academy of Clinical Embryologists, delegates were requested to record the percentage normal spermatozoa on pre‐stained Diff Quick slides. A total of four slides each containing different percentages normal spermatozoa were used during the workshops. The delegates were requested to record the percentage normal spermatozoa prior and after training. The results were expressed as the percentage difference between the reference value and the pre‐training and post‐training values reported by the workshop delegates. The percentage difference indicated a significant improvement in the reading skills, for example from 253 ± 244% to 20 ± 93% for slide 1. Similar values were recorded for slide 2, 3 and 4. If we consider the present findings as representative of medical laboratory scientist's sperm morphology reading skills, clinicians should be concerned about the diagnostic quality as far as male infertility is concerned.     

Hormonal treatment of male infertility: promises and pitfalls

Approximately 50% of infertility issues are attributable to male factors. A number of different factors may result in similar reductions of sperm count or motility and affect sperm morphology. Not only is the etiology of male infertility difficult to understand, but it is equally challenging to treat male infertility because of its etiological heterogeneity. Because of complex and incomplete knowledge of the underlying causes, most infertile men are described as idiopathically oligozoospermic and/or asthenozoospermic. Different hormonal treatments have been attempted, aiming to improve mainly endogenous follicle-stimulating hormone and/or androgen levels and subsequent spermatogenesis. Various studies have tried to treat infertility through natural pregnancies or increased sperm retrieval for in vitro fertilization techniques, or by treating spermatozoa in vitro to improve its fertilizing potential. The present review focuses on all of the aspects of male infertility treatment by hormone supplementation.     

Tales of the tail and sperm head aches: changing concepts on the prognostic significance of sperm pathologies affecting the head, neck and tail

This article presents an update on the variable prognostic significance of different sperm pathologies in patients with severe male factor infertility due to morphology and motility disorders. Severe asthenozoospermia is one of the leading causes of male infertility as spermatozoa cannot reach the oocyte and/or penetrate normally. Identifying structural causes of sperm immotility was of great concern before the advent of intracytoplasmic sperm injection (ICSI), because immotility was the limiting factor in the treatment of these patients. In these cases, in vitro methods are used to identify live spermatozoa or stimulate sperm motility to avoid selection of non-viable cells. With these advances, fertilization and pregnancy results have improved dramatically. The identification of genetic phenotypes in asthenozoospermia is important to adequately inform patients of treatment outcomes and risks. The one sperm characteristic that seriously affects fertility prognosis is teratozoospermia, primarily sperm head and neck anomalies. Defects of chromatin condensation and acrosomal hypoplasia are the two most common abnormalities in severe teratozoospermia. The introduction of microscopic methods to select spermatozoa and the development of new ones to evaluate sperm quality before ICSI will assure that ultrastructural identification of sperm pathologies will not only be of academic interest, but will also be an essential tool to inform treatment choice. Herein, we review the differential roles played by sperm components in normal fertilization and early embryo development and explore how assisted reproductive technologies have modified our concepts on the prognostic significance of sperm pathologies affecting the head, neck, mid-piece and tail.     

Review article: Structure and function of the epididymis

Summary Testicular spermatozoa are functionally immature in that they cannot fertilize ova. It was first demonstrated by Young [171, 172] that spermatozoa undergo certain changes as they migrate through the epididymis. He proposed that spermatozoa ripen during epididymal transit. It is now known that specific maturational changes occur in spermatozoa during epididymal transit which result in their developing the ability to fertilize ova. Concomitant with this functional maturity are changes in spermatozoal morphology, motility, chemistry, permeability, density and metabolism. It is apparent that in some way not understood these changes are necessary for sperm to achieve the ability to complete the fertilization process. When these mechanisms are understood, we may be able to effectively treat conditions such as necrospermia or abnormally low sperm motility. Furthermore, with the development of the hamster-egg penetration test a new type of male infertility has become evident in recent years; the inability of otherwise normal sperm to penetrate an ovum. It is during epididymal transit that this ability is normally acquired. Thus, any insight into how sperm attain the capacity to penetrate an ovum could lead to an effective treatment of patients whose sperm do not have this ability. In addition, the epididymis holds significant promise as the site of action for a male contraceptive. Thus, it is the purpose of this review to describe the structure and function of the mammalian epididymis with particular emphasis on the factors regulating sperm maturation.     

IVF过程受精失败的预测

在发明和常规应用卵胞浆内单精子注射（ICSI）之前,十多年的临床体外受精（IVF）治疗实践中,受精率低下很常见,大约有20％～35％的IVF患者受精率很低（〈35％的卵子受精）和受精完全失败（所有卵子都不受精）。虽然受精失败与精子或卵子的质量有关,但相当一部分患者受精失败与精液质量或精子功能低下有很密切相关性。最常见的是严重的少精,弱精和畸形精子症患者。     

纤毛不动综合征伴男性不育的诊断和治疗探讨（附6例报告）

目的探讨纤毛不动综合征（ICS）伴男性不育的临床特点、诊断和治疗方法。方法回顾性分析6例ICS伴男性不育患者的临床资料。结果患者临床特点均表现为反复上下呼吸道感染和男性不育。6例均患有鼻窦炎、支气管炎或支气管扩张,2例有全内脏反位。患者性激素水平、染色体核型和无精子症因子（AZF）均正常。6例均为严重弱精子症,5例精液无活动精子,1例精液偶见活动精子。电镜检查发现6例精子尾部鞭毛轴丝“9＋2”结构排列紊乱或缺失、内外动力蛋白臂缺失,1例支气管纤毛内动力臂缺失。5例患者共行6个周期卵胞浆内单精子注射（ICSI）治疗,受精率、卵裂率和优质胚胎率分别为50．0、69．2和55．6％,2例获得临床妊娠,1例生化妊娠,其中1例已分娩1健康男婴。结论纤毛的超微结构缺陷是ICS的重要诊断依据,而ICSI是治疗ICS伴男性不育的有效方法。     

Morphology of seminal and swim-up spermatozoa and the outcome of in vitro fertilization and embryo transfer

Tubal infertility was treated by in vitro fertilization-embryo transfer (IVF-ET) in 112 couples. Twenty-eight pregnancies were obtained in 140 treatment cycles. Couples are accepted for treatment in our IVF-ET programme if previous semen samples fulfil the inclusion criteria: ejaculate volume greater than 1.5 ml, concentration of spermatozoa greater than 15 x 10(6) ml-1, greater than 40% motile spermatozoa, and greater than 25% spermatozoa with normal morphology. In order to determine to which extent IVF-ET treatment results are influenced by sperm morphology, within this selected group of patients, we have retrospectively analysed the data from both original semen samples and swim-up preparations. The sperm morphology was not related to the outcome of treatment in terms of fertilization (ovum cleavage rate), early embryo development, or pregnancy. Nor was any relationship detected between early embryo development or pregnancy and the degree of improvement in morphology resulting from the swim-up procedure. However, if improvement in morphology by swim-up was high, ovum cleavage rate was low. Sperm morphology within the limits set by our inclusion criteria could not predict the outcome of IVF-ET treatment. It is further concluded that the presence of abnormal spermatozoa at the site of fertilization may be without harm if only the number of normal sperms is high enough.