PACTR结构化管理在男性肿瘤患者生育力保存中的实践与效果

目的探讨PACTR结构化管理在男性肿瘤患者生育力保存中的实践与效果。方法将2016年10~12月在四川省肿瘤医院就诊的男性肿瘤患者纳入对照组(31例),采用传统方式管理。2017年1~3月就诊的男性肿瘤患者纳入研究组(28例),采用PACTR结构化管理(包括评估患者接受度和意愿,考虑不育风险和保存生育能力安全性,结合宣教手册告知患者不育风险,提供生育力保存信息,有意愿者及时转诊给生殖专家)。自设问卷调查研究对象的生育力保存及肿瘤治疗生殖毒性认知,以及生育力保存意愿。结果研究组与对照组的生育力保存意愿相比较,差异有统计学意义(P<0.05)。结论PACTR结构化管理是促进男性肿瘤患者保存生育力的有效举措。     

甲氨蝶呤保守治疗与手术开腹治疗异位妊娠疗效对比观察

目的对比观察甲氨蝶呤药物保守治疗和行开腹术治疗异位妊娠的临床效果。方法选取我院收治的102例异位妊娠患者作为研究对象,根据患者有无生育要求的意愿和临床检查结果将所有研究对象分为三组。30例行开腹根治术,37例行开腹保守术,35例选用甲氨蝶呤（MTX）药物保守治疗。对比分析三种方法的临床疗效、住院情况和术后并发症的发生情况。结果三种方法均具有良好的临床效果,在住院情况和并发症发生情况方面发现三者各有优缺点。结论临床上治疗异位妊娠的方法有多种,应根据医院医疗设备条件和患者个人具体情况来选择适合个体的治疗方案。     

SARS-CoV-2对生育的影响

近年严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome corona virus 2,SARS-CoV-2）大流行对人类健康造成了威胁。研究表明,SARS-CoV-2对人类生育能力有潜在影响,对男性生育力的影响远大于女性。目前研究表明接种疫苗可能不会对人类的生育能力存在不利影响。感染SARS-CoV-2会不会发生性传播、垂直传播及母婴传播,从而对下一代产生影响,目前暂不清楚。尚需要从生殖医学科、传染病学科角度探讨SARS-CoV-2及其疫苗对生育的影响,并讨论可能存在的性传播、垂直传播和母婴传播,以提高对SARS-CoV-2及其疫苗的认识。     

先天性肾上腺皮质增生伴男性不育诊治一例及相关文献复习

先天性肾上腺皮质增生症（congenital adrenal hyperplasia，CAH）患者肾上腺皮质类固醇激素合成障碍，是一种常染色体隐性遗传病，最常见为21-羟化酶缺陷型，可影响男性生育力。男性CAH患者不育主要是由于肾上腺残余瘤和促性腺激素水平的改变。CAH罕见发病，症状常不典型，临床容易漏诊，早期发现并治疗可改善男性患儿成年后的生殖功能。CAH主要使用糖皮质激素治疗，部分成年患者可恢复生育能力；不能恢复自然生育能力的可通过辅助生殖技术生育；明确诊断后尽早进行精子冷冻保存。报道我院2018年诊治的1例CAH男性不育患者的辅助生殖助孕治疗过程，对其临床资料进行整理和分析，通过文献复习该疾病的发病机制和对男性生育力的影响。     

Antifertility effects of gossypol and its impurities on male hamsters

Recent papers reporting on the male antifertility effects of gossypol have been criticized due to the possible influence of impurities on efficacy and toxicity. Our laboratory has prepared purified gossypol and a fraction containing the total impurities. The effects of these two substances and impure gossypol on the fertility of male hamsters was evaluated. Only pure gossypol produced a decrease in fertility after six weeks of dosing. No effects on male fertility were observed in the other treatment groups. A full recovery of fertility in the pure gossypol group was observed four weeks after cessation of treatment. These data support the claim that gossypol is indeed an active antifertility agent for males. It is also clear that the impurities may have the ability to block or decrease the efficacy of gosypol.     

IMPROVEMENT OF SEXUAL ACTIVITY,PREGNANCY RATE,AND LOW PLASMA TESTOSTERONE AFTER BILATERAL VARICOCELECTOMY IN IMPOTENCE AND MALE INFERTILITY PATIENTS

To evaluate the effects of bilateral varicocelectomy on sexual activity, testicular volumes, semen quality, and serum hormone levels in impotence and male infertility patients, 48 patients were studied from an outpatient clinic from May 1998 to March 2001. The mean age was 37 &#45 5.9; 16 patients were complaining of erectile dysfunction and 32 patients were complaining of male infertility. The mean duration of impotence was 3.3 &#45 2.4 years and for male infertility was 3.8 &#45 3.2 years. Sexual and reproductive history was taken for erectile dysfunction and male infertility patients. General, local examination, and laboratory investigations were done for all patients. Preoperative and postoperative testicular volumes; semen parameters, including semen volume, sperm count, and motility; and morphology and hormonal parameters, including LH and FSH, and testosterone levels were measured. All patients were followed up for 3-36 months after varicocele repair. Left and right testicular volume was improved in impotence and male infertility patients and fertility groups, but this improvement was not statistically significant ( p >.25). The semen volume was significantly increased in male infertility patients and fertility group ( p <.05), but there was no statistical significant difference in impotent patients ( p >.25). The sperm count was improved in male infertility patients and fertility group, but this improvement was not statistically significant ( p >.25), and in impotent patients there was no significant difference ( p >.40). The sperm motility was very significantly increased in male infertility patients and the fertility group ( p <.0005), and highly significantly increased in impotent patients ( p <.005). The abnormal forms were not statistically significant in impotence and male infertility patients ( p >.40), but significantly decreased in the fertility group ( p <.05). Serum testosterone was very significantly increased in impotence and male infertility patients ( p <.0005) and was highly significantly increased in fertility groups ( p <.005). Serum FSH was improved in impotence and male infertility patients, but this improvement was not statistically significant ( p >.10), and in fertility groups of male infertility patients, the results showed a statistically significant increase ( p <.05). Serum LH was not statistically significant in impotence and male infertility patients ( p >.10), and was significantly increased in fertility groups ( p <.05). The improvement of sexual activity was 50-75%, the pregnancy rate for their partners was 37% and increased plasma testosterone levels over a period of 3 years of follow-up after varicocele repair.     

Normalization of serum calcium restores fertility in vitamin D-deficient male rats.

We performed experiments to determine whether treatment with vitamin D or 1,25-dihydroxycholecalciferol could reverse male infertility caused by vitamin D deficiency. Additionally, an attempt was made to distinguish between a direct and an indirect effect of 1,25-dihydroxycholecalciferol on reproductive tissue. Vitamin D-deficient male rats with impaired fertility were treated with vitamin D and 1,25-dihydroxycholecalciferol for 3 wk, then mated. Secondly, vitamin D-deficient male rats were made normocalcemic by increasing dietary calcium, and their fertility was compared with that of vitamin D-deficient, hypocalcemic rats. The fertility of male rats was restored by treatment with either vitamin D or 1,25-dihydroxycholecalciferol. However, fertility was also restored in vitamin D-deficient animals by feeding them a diet supplemented with high levels of calcium. These results indicate that the influence of vitamin D and its active metabolite, 1,25-dihydroxycholecalciferol, on male fertility is indirect. Vitamin D and 1,25-dihydroxycholecalciferol seemed to influence male fertility by acting on classic target tissues and regulating levels of calcium in reproductive tissues.     

Effect of socioeconomic characteristics on age at marriage and total fertility in Nepal

In societies where childbearing prior to marriage is not socially acceptable, postponement of marriage contributes significantly to a reduction in fertility level by shortening the total reproductive life of women. This, in turn, reduces the number of children a woman is likely to have and has a negative impact on the population growth rate of a country. This paper examined the effect of socioeconomic characteristics on age at marriage and on total fertility rates in Nepal using a household-level dataset. The estimated results showed that an increase in age at marriage significantly reduced total fertility of women. An increase in the number of children who died had a statistically significant effect on total fertility (child replacement effect). The estimation results also emphasized the role of female education in reducing total fertility and increasing age at marriage. Moreover, female educational effect had a strong inter-generational effect on age at marriage, and this effect was stronger than the effect of male educational attainment. One implication of these results is that from the policy point of view, all other things being equal, governments should accord a significant priority to female education and, in particular, a higher priority compared to male schooling.     

超声引导下经腹或经阴道介入治疗输卵管妊娠临床应用

目的:探讨超声引导下经腹或经阴道介入性治疗输卵管妊娠的临床应用价值.方法:经腹或经阴道对17例输卵管妊娠的肿块进行穿刺、抽孕囊液、并注入氨甲喋呤20～50mg.结果:17例病人、3例行二次介入治疗,注药后有胎心的2～72小时胎心消失,治愈率15/17(88%).结论:超声引导下经腹或经阴道介入治疗输卵管妊娠,创伤小、副作用少、治愈率高,并可重复使用,为渴望保留生育机能的患者或已手术过的异位妊娠患者提供了一种新的治疗途径.     

Effect of local epididymal levonorgestrel on the fertilizing ability of male rat, a model for post-testicular contraception

A thin levonorgestrel-silicone layer was applied on the capsule of the cauda epididymis of male rats to study a model for post-testicular male contraception. The effect of different levonorgestrel doses on the fertility of males was tested with fertile females. The time-dependent influence of a standard dose of levonorgestrel on serum LH and on testicular histology was estimated. Among the males tested, there was a group of animals where successful contraception with local application of levonorgestrel-silicone membrane was obtained. Sexual behavior was normal and the spermatogenesis was functioning, but the sperm were infertile. Although further research is needed to estimate adequate dose and strength of levonorgestrel in silicone matrix, this study shows that post-testicular contraception is possible to achieve.     

Environmental risk factors and male fertility and reproduction

Several environmental substances and pesticides exert a direct, cytotoxic effect on male germ cells. However, an increasing concern has been raised by compounds that may act through more subtle mechanisms, for example, specific pesticides that are potentially capable of modulating or disrupting the endocrine system. Overall, exposure to pesticides with endocrine-disrupting potential raise a particular concern for male fertility because of the possible occurrence of both effects at low concentrations and additive interactions with other environmental risk factors. Delayed reproductive problems deserve special attention, since experimental data consistently indicate a high vulnerability in the developing male reproductive system. Epidemiologic studies have confirmed an increased risk of conception delay associated with occupational exposure to pesticides. Moreover, an increased risk of spontaneous abortion has been noted among wives of exposed workers.     

Inflammatory bowel disease in subfertile men and the effect of mesalazine on fertility

Abstract

This study aimed to examine the effect of mesalazine on fertility. In this retrospective analysis of 1,225 male subfertile patients, we reviewed the cases of inflammatory bowel disease (IBD) in the medical records and evaluated the prevalence of the disease in our reproduction center. Specifically, we examined IBD patients who ceased mesalazine during male infertility treatment, and compared the seminogram of these patients before and after discontinuation of mesalazine. We also analyzed pregnancy outcome after discontinuation. The prevalence rate of Crohn’s disease and ulcerative colitis in our male infertile patients was 163 per 100,000 men and 490 per 100,000 men, respectively. Seven patients had taken mesalazine and six of them subsequently stopped the medication. The mean values of sperm concentration, sperm motility, percentage of normal formed sperm, semen volume, and total motile sperm count taken before discontinuation increased after discontinuation of mesalazine. Among these parameters, the sperm motility and total motile sperm count were significantly improved (p?<?0.05) after discontinuation. Of the six patients who stopped the drug, four achieved pregnancy with their partners, with two of the four men showing significant improvement not only in the percentage of normal shaped sperm but also sperm motility and total motile sperm count. This study provides further insight into the rarely investigated relationship between male fertility and mesalazine.     

Indirect fertility analysis in painters exposed to ethylene glycol ethers: sensitivity and specificity

Semen analysis has proven useful in the clinical diagnosis of infertility and is the most widely used method of monitoring the effects of occupational exposure on male fertility. Collection and analysis of semen samples in a field setting, however, require a highly motivated population and excellent technical resources, limiting the widespread application of the method. Techniques of monitoring male worker fertility using questionnaires to avoid some of the difficulties of semen analysis have been developed. These methods compare the rate of observed births for wives of workers with expected birth rates derived either from U.S. fertility tables or from unexposed workers. The present study compares the sensitivity of this questionnaire method with that of semen analysis in an evaluation of reproductive function in men exposed to ethylene glycol ethers. The reproductive function of 74 married painters exposed to ethylene glycol ethers was compared with that of 51 married controls employed at a shipyard. The groups differed in sperm count, but the questionnaire method showed no effect of exposure on fertility. This analysis suggests that the questionnaire assessment of fertility is less sensitive than semen analysis as a screening tool for male reproductive function.     

Chemical methods for male fertility control. Expert consultation of the European Medical Research Council Advisory Subgroup on Human Reproduction

The Advisory Subgroup on Human Reproduction of the European Medical Research Council was founded in 1978 in order to coordinate research efforts and facilitate the exchange of information in the field. A conference held by the Subgroup on chemical methods for male fertility control in 1980 is summarized. The conference reviewed current activity in the field of male chemical fertility control, made recommendations for future research topics, and made further recommendations regarding the allocation of research funds in Europe. The following topics were covered: 1) current research being sponsored by WHO; 2) the Chinese program of research on gossypol, a male steroid pill; 3) the need for more basic research into male reproduction; 4) the advantages and disadvantages of male fertility control thorugh steroids; 5) the possibility of an immunological approach to male fertility control; and 6) the possibility that research into male infertility will provide information useful in male fertility control as well.     

输卵管开窗术联合甲氨喋呤治疗异位妊娠后生育力评价

目的:回顾分析输卵管开窗术联合甲氨喋呤治疗异位妊娠的临床效果,评价腹腔镜下输卵管开窗术联合术中病灶局部注射甲氨喋呤(MTX)对提高异位妊娠后生育力的价值。方法:收集2002年1月～2007年12月在南昌大学第二附属医院住院诊断为异位妊娠的240例患者,按照手术方式及术后MTX的使用方案将其分为A组、B组、C组、D组。随访4组患者治愈后的生育力情况,随访时间为治疗后3年。结果:D组与A组、B组、C组术后1年内、2年内、3年内的宫内妊娠率、不孕率及异位妊娠再发率对照,经χ2检验,差异有统计学意义(P<0.01)。D组术后第1次宫内妊娠时间与A组、B组、C组对照,差异性显著(P<0.01)。结论:腹腔镜下输卵管开窗术联合术中病灶注射MTX治疗异位妊娠在治疗的同时可最大程度的保留患侧输卵管的功能,相对开腹行输卵管开窗术或术后予肌注MTX的治疗方法,对患者生育力的影响小。     

Protective role of caffeic acid on lambda cyhalothrin-induced changes in sperm characteristics and testicular oxidative damage in rats

The synthetic pyrethroids are expected to cause deleterious effects on most of the organs and especially on the male reproductive system. The current study was performed to assess the adverse effect of lambda cyhalothrin (LC) on reproductive organs and fertility in male rats and to evaluate the protective role of caffeic acid phenethyl ester (CAPE) in alleviating the detrimental effect of LC on male fertility. A total of 48 male rats were divided into 4 groups (12 rats each): control group received distilled water ad libitum and 1 ml of vehicle solution given intraperitoneally (i.p.); CAPE-treated group received a single i.p. dose of CAPE (10 μmol kg?1 day?1); LC-treated group received 668 ppm of LC through drinking water; and CAPE + LC-treated group received an i.p. injection of CAPE (10 μmol kg?1 day?1) 12 h before the LC administration. The experiment was conducted for 10 consecutive weeks. LC caused a significant increase in testicular malondialdehyde, catalase, superoxide dismutase, glutathione-S-transferase activities, and sperm abnormalities and a significant reduction in testicular glutathione concentration, sperm count, sperm motility, and a live sperm percentage. Conversely, treatment with CAPE improved the reduction in the sperm characteristics, LC-induced oxidative damage of testes and the testicular histopathological alterations. Results indicate that LC exerts significant harmful effects on the male reproductive system and that CAPE reduced the deleterious effects of LC on male fertility.     

浅谈米非司酮与甲氨蝶呤治疗宫外孕临床有效性

目的：研究对宫外孕采用米非司酮联合甲氨蝶呤药物治疗的临床效果。方法选取我院近年收治的50例宫外孕患者,按照随机原则分为两组,对照组采用米非司酮药物治疗,观察组在对照组基础上加用甲氨蝶呤药物。对比两组患者治疗效果以及恢复情况差异性。结果对照组治疗总有效率为68%,观察组为92%,组间差异显著。在阴道止血时间、腹痛消失时间以及包块消失时间上观察组均明显短于对照组,组间差异显著。结论在米非司酮基础上加用甲氨蝶呤药物可对宫外孕患者起到更明显的治疗作用,且患者恢复较快,具有推广价值。     

Is it an issue before it’s a problem? Investigating men’s talk about fertility

While fatherhood and male involvement in family life have been the focus of much research during the past few decades, we know less about men’s involvement in the stage that precedes fatherhood and reproductive decision-making, their awareness of and sense of responsibility for reproductive health and fertility. This article draws attention to how men talk about fertility and reproductive intentions, focusing on how their perceptions and knowledge of fertility and procreation are structured around social norms and expectations. The study was based on interviews with 25 men in reproductive age with no prior history of infertility, including men with as well as without children and men of different sexual orientations and gender diversity. Our findings indicate a tension between, on the one hand, a general tendency among the men to take their fertility for granted and neither think nor talk about it, and, on the other hand, a latent concern about possible infertility which seemed to be activated in the interview situation. These findings raise questions of how conversations about fertility might impact men’s thinking about their own fertility that call for further exploration and that are of significance in considerations of how to promote fertility awareness and reproductive health.     

育龄期慢性乙肝病毒感染者治疗策略和垂直传播风险探讨

目的探讨育龄期慢性乙肝病毒感染者治疗策略和垂直传播风险。方法回归分析某院门诊乙肝病毒感染者治疗效果及生育情况。结果慢性乙肝病毒携带和非活动性HBsA携带分别占21.6%和45.7%,不进行治疗生育。女性HBVDNA(-)感染者明显多于男性HBVDNA(+)感染者。没有用抗病毒治疗的患者病毒应答率、生化应答率、以及完全应答率明显低于抗病毒治疗患者(P﹤0.05或P﹤0.01),没有用抗病毒治疗的患者治疗失败率高于抗病毒治疗患者(P﹤0.05),停药后没有用抗病毒治疗患者全部复发,用抗病毒治疗患者停药后绝大部分复发(P﹤0.05)。没有用抗病毒治疗的男性和女性感染者预期生育失败率高于抗病毒治疗感染者(P﹤0.01)。女性较男性更担心病毒的垂直传播(P﹤0.01),女性慢性乙肝病毒携带生育子女HBsAg阳性5例(3.2%),男性生育子女无一例HBsAg阳性(P﹤0.01)。结论育龄期慢性乙肝病毒携带者不需要治疗可以正常妊娠,有肝功能异常者,如果通过保肝治疗能够维持肝功能指标正常或大致正常,权衡抗病毒治疗与生育利弊后,可以考虑先生育,感染者后代出生24h内通过预防接种乙肝疫苗和/或乙肝免疫球蛋白,女性垂直传播率非常低,父婴传播风险没有出现。     

Creatine as a Promising Component of Paternal Preconception Diet

Male fertility has been declining globally over the past several decades, advancing from a personal issue to a public health problem. Beyond any doubt, a reduction in fertility (often characterized by low sperm count or motility) can severely threaten reproductive health and lifecourse framework in a long-term fashion. Aside from uncovering the currently unknown etiology of modern-day male infertility, the scientific and medical community faces a double burden: finding an efficient biomarker of impaired fertility and exploring any intervention that can act to enhance fertility. A plethora of nutritional compounds have been recognized as possible modulators of semen quality, and specific dietary patterns and nutrients appear to be accompanied by a lower risk of male infertility. Creatine, a conditionally essential nutrient, has caught attention as a male fertility-promoting candidate due to its role in sperm energy metabolism. This mini-review describes the creatine-related bioenergetics of spermatozoa, explores a connection between creatine levels and sperm quality in men, and critically examines available evidence for interventional studies with creatine to affect sperm viability.