精浆游离L-肉毒碱水平及其与精子密度、活动率及活力的相关性研究

目的:研究正常生育及不育男性精浆中游离L-肉毒碱水平差异及其与精子密度、活动率(a+b+c级精子百分率)及活力(a+b级精子百分率)之间的相关性,探讨精浆中游离L-肉毒碱水平对男性生育力的影响及其在不育症检查和治疗中的作用。方法:分别采用高效液相色谱法和计算机辅助精液分析系统,测定了230例不育症患者(精子密度正常117例,少精子症81例,无精子症32例)和30例正常生育男性精浆中游离L-肉毒碱水平及精子密度、活动率、活力等参数。根据检查结果对不育症患者分组后,以SPSS12.0软件包进行统计学分析,比较各组间游离L-肉毒碱水平的差异以及游离L-肉毒碱水平与精子密度、活动率、活力之间的相关性。结果:正常生育组精浆游离L-肉毒碱水平明显高于不育组(P<0.01)。精液中精子密度越低、活力越弱,这种差异性越显著。相关性分析结果显示,精浆游离L-肉毒碱水平与精子密度呈显著正相关关系(r=0.521,P<0.01),与精子活动率和活力之间也具有正相关关系(r=0.319,P<0.01;r=0.251,P<0.01)。结论:精浆L-肉毒碱水平与精子密度、活动率和活力之间密切相关,其含量测定作为一项有用的生化指标,可为男性不育症检查及临床诊治和进行有关男性生殖功能机制研究提供参考。     

左旋肉碱体外培养提高睾丸精子活力的实验研究

自1978年第一例试管婴儿出生以来,不育症,尤其是排卵障碍与卵子输送障碍所致不育症的治疗获得突破.自1992年卵胞浆内单精子注射(ICSI)技术问世以来,即使精液中无精子的患者也有望利用睾丸、附睾中的精子进行ICSI获得生育.但是,睾丸中的精子不能运动,难以判断其是否为活精子,需要体外培养一段时间部分活精子才能获得一定运动能力.为了提高睾丸精子的活率,便于选择成活精子用于ICSI中,本文尝试对睾丸精子用含左旋肉碱培养液进行培养,并对其提高精子的活力和活率效果进行评估.     

不育男性精子密度、活动率、活力与顶体酶活性关系的研究

目的探讨不育男性精子密度、活动率、活力、与精子顶体酶活性的关系.方法采用分光光度比色法测定精子顶体酶活性,并将其与精子密度、活动率和活力进行统计分析.结果随着精子密度、活动率、活力降低,精子顶体酶活性均明显降低(各组间比较均P＜0.001).结论不育男性精子顶体酶活性降低可影响精子密度、活动率和a, b级活力精子率,精子顶体酶活性可作为男性不育精子质量检测的指标之一.     

不育男性精浆碳酸氢钠含量与精子活力等参数的关系

本文对80例不育症患者测定精浆N_aHCO_3含量,同时与粘液质量相比较。认为,精浆中N_aHCO_3含量与精子活力有着密切的关系,而与精液的PH值、粘稠度、精子密度无关,并就精浆N_aHCO_3含量测定在男子不育症诊治方面的意义进行探讨。     

左旋肉碱和乙酰左旋肉碱复合制剂对特发性弱精子症精子质量的影响

目的:观察左旋肉碱和乙酰左旋肉碱复合制剂对特发性弱精子症精子质量的影响。方法:采用自身对照实验设计。按WHO的标准诊断为特发性弱精子症的30例患者,经过中西医结合治疗无效后,服用左旋肉碱和乙酰左旋肉碱复合制剂,每次1袋,2次/d,疗程为3个月。应用本复合制剂前后按WHO标准进行精液分析各2次。结果:最终25例完成本观察。和治疗前比较,治疗后的精子存活率从(24.89±12.28)%提高为(49.45±17.40)%,精子活动力(a+b)级从(16.04±8.33)%提高为(24.64±7.09)%,一次射精的精子总数从(76.79±43.14)×106提高为(131.01±94.53)×106,有统计学显著差异(P<0.05)。结论:左旋肉碱和乙酰左旋肉碱对特发性弱精子症有辅助治疗效果,能提高患者的精液质量。     

梗阻性无精子症患者睾丸精子左旋肉碱培养后关键基因表达量的变化研究

目的:探讨肉碱对人精子活力的影响及其对男性不育的治疗作用。方法:以梗阻性无精子症患者睾丸穿刺取得的精子为研究对象,通过普通培养液、培养液中添加100mmol/L及250mmol/L肉碱进行培养,比较培养前后精子活动率的变化,以及用RT-PCR检测男性生殖细胞特异性基因Vasa、Dazl、Acr、Prm1及ATPase6.0表达量的变化,探讨左旋肉碱与有关精子发生和成熟过程的重要功能基因表达的关系。结果:培养24～72h,添加100mmol/L的左旋肉碱培养液运动精子数明显较未添加和添加250mmol/L组高(P<0.01);100mmol/L左旋肉碱培养液组中典型的快速前向运动精子数明显较多,巴氏染色法观察其具有正常的精子结构,RT-PCR检测表明100mmol/L的肉碱可提高精子中Acr、Prm1、Dazl及ATPase6.0基因的表达量,而250mmol/L的肉碱组Dazl、Acr、Prm1基因的表达减少。结论:合适浓度的左旋肉碱可通过上调一些生殖相关基因的表达使得睾丸精子培养后活力增强,有利于对睾丸穿刺患者行单精子注射时精子的选择。如培养液中肉碱浓度过高,可能由于肉碱的毒性作用,反而使得这些基因的表达量减少。     

精浆催乳素浓度与精子计数、活动率的关系

对107例男性进行精液分析并测定其精浆催乳素(PRL)浓度,精子活动率和精子密度正常男性的精浆PRL为11.53±5.36ng/ml,与精子活动率正常而少精子的男性相比(13.06±4.62ng/ml),两组间无显著性差异(t=0.91,t>0.2);而精子密度正常、正常精子活率组和低活率组相比,低活率组的精浆PRL水平(17.24 ±5.86ng/ml)明显增高(t=4.15,P<0.001).相关分析表明精浆PRL与精子活动率呈负相关(r=-0.38,P<0.001);与精子密度亦呈负相关(r=-0.37,P<0.001).49例受试者取精液前抽血测定血清PRL水平,精浆PRL水平与血清PRL无关(r=0.204,P>0.1).     

左旋肉碱和乙酰左旋肉碱联合治疗严重少弱精子症患者成功妊娠1例

在男性不育患者中，由少、弱精子症引起的约占15％。近年，联合应用左旋肉碱和乙酰左旋肉碱治疗男性少弱精子症受到广泛关注，国内外研究表明，左旋肉碱和乙酰左旋肉碱能够提高精子的活力和密度。近来我院对1例严重少弱精子症患者予以左旋肉碱和乙酰左旋肉碱的联合治疗，辅以卵细胞胞质内单精子注射技术，成功获得妊娠，现报告如下。     

Semen analysis and sperm function testing

Despite controversy regarding the clinical value of semen analysis, male fertility investigation still relies on a standardized analysis of the semen parameters. This is especially true for infertility clinics in both developing and developed countries. Other optional tests or sophisticated technologies have not been widely applied. The current review addresses important changes in the analysis of semen as described in the new World Health Organization (WHO) manual for semen analysis. The most important change in the manual is the use of evidence-based publications as references to determine cutoff values for normality. Apart from the above mentioned changes, the initial evaluation and handling methods remain, in most instances, the same as in previous editions. Furthermore, the review evaluates the importance of quality control in andrology with emphasis on the evaluation of sperm morphology. WHO sperm morphology training programmes for Sub-Saharan countries were initiated at Tygerberg Hospital in 1995. The external quality control programme has ensured that the majority of participants have maintained their morphological reading skills acquired during initial training. This review reports on current sperm functional tests, such as the induced acrosome reaction, and sperm-zona pellucida binding assays, as well as the impact of sperm quality in terms of DNA integrity, and the relationship of sperm function tests to sperm morphology.     

Seminal fibronectin in fertile and infertile males

This study aimed to assess seminal plasma fibronectin in fertile and infertile males. Ninety infertile males were investigated; asthenozoospermia (n = 27), asthenoteratozoospermia (n = 30), oligoasthenoteratozoospermia (n = 33) compared with 20 healthy fertile controls. They were subjected to semen analysis, seminal plasma fibronectin estimation by radial immune diffusion, serum testosterone (T) and follicle stimulating hormone (FSH) estimation by ELISA. There was significant increase of seminal plasma fibronectin among different infertile groups compared with the controls. Significant negative correlation was elicited between seminal fibronectin and sperm count, sperm motility grades A, B, A + B, sperm velocity, linear velocity, linearity index, sperm normal forms and serum T. Seminal fibronectin showed significant positive correlation with grade D sperm motility and serum FSH. ROC curve analysis discriminating controls and other infertile groups demonstrated criteria value of < 674 mg l(-1) (sensitivity 100% and specificity 96.4%). It is concluded that increased seminal fibronectin is associated with decreased sperm count and sperm motility.     

精索静脉曲张不育患者的精液质量和精子形态学观察

目的:观察不育伴精索静脉曲张(VC)患者的精液质量和精子形态学变化。方法:98例不育伴VC患者精液按WHO标准常规分析并对精子形态学进行评价。130例正常供精者精液检测结果作为对照。结果:VC患者正常形态精子和前向运动精子明显低于对照组(P<0.001),精子畸形的类型以梨形、锥形和不定型头部畸形为主。结论:VC可导致精子畸形率升高,后者可能是男性生育力受损的重要标志之一,经染色后的精子形态学分析是判定VC患者精子受损的一个敏感指标。     

不育男性精浆总抗氧化能力与精子运动功能的关系

目的:研究不育男性精浆总抗氧化能力(TAC)与精子运动能力和方式之间的关系,探讨精浆TAC水平在男性生育中的临床意义。方法:113例精子密度正常的不育男性,28例正常生育男性作为对照组。精液于37℃液化后采用计算机辅助精液分析(CASA)系统进行精液常规分析,采用比色法进行精浆TAC分析。结果:正常生育组精浆TAC为(19.82±6.33)U,不育男性精子密度正常组精浆TAC为(14.37±8.45)U,不育男性精子密度正常组与正常生育组比较存在显著性差异(P<0.01)。精浆TAC与a级精子百分率(r=0.208,P<0.05)和(a+b)级精子百分率(r=0.231,P<0.05)呈显著正相关,精浆TAC与精子运动参数中的前向性(r=0.200,P<0.05)、直线性(r=0.208,P<0.05)、曲线速度(r=0.189,P<0.05)、直线速度(r=0.210,P<0.05)、平均移动速度(r=0.215,P<0.05)及鞭打频率(r=-0.248,P<0.01)之间有显著的相关性,其中前向性、直线性、直线速度、曲线速度、平均移动速度与TAC呈正相关(P<0.05),而鞭打频率与TAC呈负相关(P<0.01)。精浆TAC与摆动性、侧摆幅度、平均移动角度之间无显著相关。结论:精浆中TAC水平与精子运动能力和运动方式密切相关,适宜的精浆TAC为精子运动提供了良好的外部环境,精浆中过低的TAC水平与精子运动能力下降和运动方式改变有关,可能是引起男性不育的病因之一。精浆中TAC分析可为探讨男性不育的发病机制以及临床用药提供依据。     

Correlation between lead and cadmium concentration and semen quality

There are contrary reports of association of lead and cadmium with the decline in semen quality. This study evaluates whether seminal lead (Pb) and cadmium (Cd) at environmental concentration are associated with altered semen quality. We conducted a study of healthy fertile and infertile men 20–43 years of age attending the Andrology Laboratory of Reproductive Biology Department for semen analysis. The semen analysis was carried out according to the WHO 2010 guidelines. Seminal lead and cadmium were estimated by ICP‐AES. The lead and cadmium values were significantly higher in infertile subjects. A negative association between seminal lead or cadmium concentration and sperm concentration, sperm motility and per cent abnormal spermatozoa was found. This study shows that exposure to Pb (5.29–7.25 μg dl^?1) and cadmium (4.07–5.92 μg dl^?1) might affect semen profile in men. Age, diet, smoking and tobacco chewing habits may have an influence on the increase in exposure to Pb and Cd in the individual subjects.     

Semen banking in patients with cancer: 20-year experience

Modern techniques of banking sperm provide an effective way to preserve the option of future fertility for most teenagers and young men diagnosed with a variety of malignancies that will necessitate treatment with chemotherapy, pelvic surgery, or significant radiation doses to the testes. Results of cumulative data collected at the Cleveland Clinic Foundation from patients with testicular cancer, lymphoma, leukemia, sarcoma, carcinoma and other kinds of malignancy have revealed that: (1) pretreatment semen quality (pre-freeze and post-thaw) in patients with cancer is poorer compared with healthy donors; (2) the percentage decline in semen quality (from pre-freeze to post-thaw) in patients with cancer is similar to that of normal donors. This suggested that the effect of cryodamage on spermatozoa from patients with cancer is similar to that of normal donors. (3) The stage of cancer in patients with testicular cancer and Hodgkin's disease shows no relationship to their semen quality. Based on studies conducted at the Cleveland Clinic Foundation, we recommend that sperm cryopreservation be offered to all men of reproductive age who have malignancies. Cryopreservation is safe and inexpensive, and gives patients a chance to establish pregnancies in the future with an assisted reproductive technique.     

Association of seminal angiotensinogen with sperm motility and morphology in male infertility

Many researchers have shown that renin–angiotensin system (RAS) is involved in various important aspects of male reproduction. In this study, we assessed whether abnormal levels of seminal angiotensinogen (AGT) may be associated with semen parameters in infertile males. A total of 115 male patients were recruited, and semen parameters, seminal AGT and the electrolytes including K⁺, Na⁺, Cl^?, P and Ca were evaluated. According to the World Health Organization (WHO) 2010 criteria, the patients were divided into two groups: G1 group with normal semen parameters (n = 42) and G2 group with subnormal semen parameters (n = 73). The level of seminal AGT was significantly higher in G2 group compared with G1 group. Moreover, the level of AGT was negatively correlated with the percentage of total motility (r = ?.322, p = .000), progressive motility (PR) (r = ?.339, p = .000) and morphologically normal forms (r = ?.263, p = .004). This study suggests that elevated seminal AGT level is associated with increased risk of asthenospermia and teratozoospermia.     

男性不育患者精液质量与精子顶体酶活性关系分析

目的:分析男性不育患者精液参数与精子顶体酶活性变化,探讨精液质量与顶体酶活性的关系。方法:对214例男性不育患者的精液作精子顶体酶活性、弹性蛋白酶、果糖、α葡糖苷酶、锌、酸性磷酸酶、精子尾部低渗肿胀试验检测,同时精子质量检测仪作精液分析。以检出精子顶体酶活性正常的(48.2~218.7μIU/106精子)111例作为对照组,与顶体酶活性异常(<48.2μIU/106精子)的103例精液参数作对比分析。结果:两组精液参数的精子密度、精子活动率、a+b级精子百分率、精子尾部低渗肿胀试验差异均有非常显著性(P<0.001)。弹性蛋白酶差异有显著性(P<0.05)。果糖、α葡糖苷酶差异亦有显著性(P<0.05)。精液量、锌、酸性磷酸酶差异无显著性(P>0.05)。结论:精子顶体酶活性与精液质量关系密切,精子顶体酶活性是反映精液质量的一项可靠指标。