男性不育症的精液、头发中微量元素关系的研究

本文报告了应用原子吸收分光光度计测定50例男性不育症组与50例健康生育男性组精液、头发中微量元素Zn、Cu、Fe、Mn、Se的结果与精液常规。发现不育症组精液、头发中Zn、Mn、Se含量均低于生育组(P<0.01),而Cu则相反。Zn与精子密度呈正相关,Cu与精子密度、活动度呈负相关,Se与精子活动度呈正相关,其复相关系数R=0.5818.因此在治疗中可适当补充一定量的Zn、Se元素,提高Zn可降低机体Cu的浓度,从而调整精子的形成过程和精子活动的内在环境,提高精液质量。     

上海市某社区中老年男性勃起功能障碍与性激素的关系研究

目的:探索中老年男性勃起功能障碍(erectile dysfunction,ED)与多种性激素之间的关系。方法:对上海市某社区928名40~70岁中老年男性进行问卷调查,采用"勃起功能国际问卷-5(IIEF-5)"量表进行评估,并抽取空腹静脉血,采用免疫学方法测定血清总睾酮(TT)、游离睾酮(FT)、催乳素(PRL)、黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E2)及性激素结合球蛋白(SHBG)水平。按照各激素的四分位数点将对象分为4组(P0~P24组、P25~P49组、P50~P74组和P75~P100组),比较不同水平激素ED的患病风险。结果:40~50岁、51~60岁、61~70岁组的ED患病率分别为52.34%、73.14%、90.18%。调整潜在混杂因素后,FT水平的P0~P24组、P25~P49组、P50~P74组ED的患病危险性,比P75~P100组高,aOR分别为1.54、1.42、1.52,但其95%可信区间(95%CI)下限略小于1。PRL和FSH水平低的对象,患病风险较低;PRL水平在P0~P24组、P25~P49组、P50~P74组的aOR分别为0.61、0.79、0.58,除P25~P49组外,关联均有统计学意义;FSH水平在P0~P24组、P25~P49组、P50~P74组的aOR分别为0.55、0.48、0.60,除P50~P74组95%CI上限稍大于1外,关联均有统计学意义。而ED与TT、SHBG、LH、E2等的关联没有统计学意义。以上各激素与重度ED的关联均无统计学意义。结论:调整年龄及其他混杂因素后,ED与血清PRL、FSH水平存在统计学关联,与FT水平的关联较弱,与TT、LH、SHBG、E2水平的关联没有统计学意义。就现有研究结果,尚不能认为激素水平的变化对中老年人ED的发生起主要作用。     

他达那非治疗勃起功能障碍伴早泄患者的临床研究

目的:探讨他达那非治疗勃起功能障碍(ED)伴有早泄患者的临床疗效和安全性。方法:80例诊断为ED合并早泄患者,按每次服用他达那非20mg,共治疗12周。以阴道内射精潜伏期评价早泄治疗效果,并评估ED的总体疗效和治疗满意度,比较治疗前后的国际勃起功能指数评分5(IIEF-5)。结果:经过12周的治疗,早泄改善者共48例,有效率为60%。勃起功能改善者60例,总改善率为75%。不良反应共有10例(12.5%),均为轻度或中度,未经处理即自行缓解。结论:对ED合并早泄患者,他达那非能安全有效地改善其勃起功能,并能显著改善其早泄症状。     

生育与不育男性生育力指数的比较

目的:评估生育力指数(FI)在判断男性生育能力中的作用。方法:对不育组(n=124)和生育组(n=62)进行精液常规检查,并计算FI[FI=精子密度(106/ml)×精子活动力×精子正常形态率]。结果:生育组FI为13.23(24.16),高于不育组的5.69(10.62)(t=5.657,P=0.001)。生育组FI(P2.5,P97.5)的范围为2.06-56.85。结论:FI较单个精液参数更能客观反映男性生育能力,当FI<2.0时男性生育概率将下降。     

精子质量分析仪(SQA)临床评估

243例正常及不正常生育力精液标本用精子质量分析仪（SpermQualityAnalyzer，U－nitdMedicalSystemsInc.SantaAna，CA）测定其精子活力指数SMI，并用常规精液分析方法（按WHO标准）测定主要精液参数，其中包括精子密度、a、b级活动精子百分率及正常形态精子。结果显示SMI与上述各项参数都有好的相关性。由于精子质量分析仪具有简便、客观、快速、可重复性等优点，可应用于不育症检查男性因素的筛选、男性不育治疗和绝育效果的随访、精子浓缩过程的评估及人工授精前的试验等。     

819对不育夫妇临床分析

<正>不育症是一种涉及夫妇双方的生殖健康问题.据报道人群中约有8～17%夫妇患有不育症.本文收集1985年9月～1996年9月资料较完整的不育症夫妇共869对,其中有病因的819对占94.25%,不明原因的50对占 5.75%.本文就819对有病因的不育夫妇进行临床分析.现报告如下:资料与方法一、一般资料根据《妇产科学》诊断标准诊断为不育症的819对夫妇,年龄:女性最小25岁,最大42岁,平均28.72士3.6岁;男性最小26岁,最大46岁.平均30.5土4.1 岁.病程最短2年,最长14年,平均4.6年.疗程最短3个月,最长3年.平均6～12个月.其中原发不育症425对.占 51.89%,继发不育症394对,占48.11%.在     

糖尿病勃起功能障碍研究进展

阴茎勃起功能障碍是糖尿病常见的并发症,其发生与多种病理生理机制相关,如糖基化终末产物、氧自由基、NO合成障碍、内皮素及其受体、上调的RhoA/Rho激酶途径、神经病变等。治疗较为困难且需要多种模式,如口服药物、阴茎内药物注射、尿道内栓剂、真空勃起装置、阴茎内假体等。     

不明原因的不育男性精子核碱性蛋白组型的电泳分析

本研究从15例正常生育力男性和37例不育男性的射出精子中提取核碱性蛋白,在酸性尿素系统聚丙酰胺凝胶中电泳,经微显像测密仪扫描获得各蛋白区带(组蛋白和HP1～3)的相对含量,并计算各蛋白条带的相对比值.实验结果表明:与正常生育力男性相比,不育组男性精子的TH(total histones)/HP1～3比值增高(P<0.01);而HP2+3/HP1比值降低(P<0.01).基于TH/HP1～3和HP2+3/HP1比值的分折,这些不育男性精子的核碱性蛋白组型可分为四种:1.TH/HP1～3比值较高,同时伴有较低的HP2十3/HP1比值;2.TH/HP1～3比值较高,而HP2+3/HP1比值正常;3,TH/HP1～3比值正常,而HP2十3/HP1比值较低;4.正常的TH/HP1～3和HP2十3/HP1比值.作者认为前三种异常的核蛋白组型可能与不育有关.     

不完全川崎病35例临床特点分析

近年来，小儿不完全川崎病（IKD）逐渐增多，由于其表现多样，与许多疾病有相似之处，易被误诊、漏诊而延误治疗。国内研究发现，19．4％的川崎病（KD）患儿的表现不典型或不完全^[1]。本文对35例IKD患儿的临床资料进行分析，以提高临床医生对不完全IKD的认识。     

夫精人工授精与男性不育治疗的临床应用

９４例不育症夫妇男方患有精索静脉曲张、少精子弱精子症、畸形精子症、精液不液化、免疫不育、阳萎、逆行射精及女方宫颈因素，采取ＡＩＨ或／和药物治疗，提高精液质量等方法，２３例妊娠，妊娠率达２４．６６。研究表明洗涤精子宫腔授精对少精子弱精子症、免疫不育和精液不液化无效。     

The effects of male aging on semen quality,sperm DNA fragmentation and chromosomal abnormalities in an infertile population

Purpose  

To investigate the effects of male aging on semen quality, DNA fragmentation and chromosomal abnormalities in the spermatozoa of infertile patients and fertile men.     

DNA甲基化对男性精液质量影响的研究进展

DNA甲基化是表观遗传学修饰的主要形式之一,对个体发育具有至关重要的作用.近年来,大量研究表明不育男性的精子中存在不同基因异常甲基化.本文主要阐述了印记基因(H19、FAM50B、GNAS、MEST、KCNQ1OT1、SNRPN)和其他相关基因(P16、LINE-1、MTHFR、SLC9B1、DDR1)异常甲基化会对精液质量(包括精子数目、活力和形态)产生不同程度的影响,从而导致男性不育.因此,检测精子特定基因的DNA甲基化程度有可能成为针对男性不育的新型辅助诊断手段.     

Chromosomal translocations and semen quality: A study on 144 male translocation carriers

Research question

Chromosomal translocations are known genetic causes of male infertility. Are certain translocations or chromosomal regions more directly associated with sperm defects? Is there a threshold of sperm impairment that can be relevant for detection of translocations?

Ubiquitin-specific protease (USP26) gene alterations associated with male infertility and recurrent pregnancy loss (RPL) in Iranian infertile patients

Background and purpose

The human X chromosome is enriched with testis-specific genes that may be crucial for male fertility. Mutations in USP26 gene have been proposed to be associated with male infertility. Moreover, the importance of the ubiquitin pathway during different stages of mammalian fertilization and even embryo development has been addressed. Some mutations and haplotypes on this gene have been proposed to be associated with male infertility. In this study, five different mutations on USP26 were investigated: 1737 G > A, 1090 C > T, 370-371ins ACA, 494 T > C and 1423 C > T.

Methods

The study included 166 infertile men with non-obstructive azoospermia, 72 male partners of couples who had previously experienced ≥3 clinical first trimester spontaneous abortions and 60 fertile men. Besides family history of reproduction, hormonal evaluation and semen analysis were performed. DNA was extracted from blood samples. PCR-SSCP, PCR-RFLP and PCR Product Cloning methods were used and resumed by sequencing to insure about the mutations. Moreover, USP26 gene expression was studied by Real-Time PCR after RNA extraction followed by cDNA synthesis from 24 testis biopsies in obstructive and non-obstructive azoospermia patients.

Results

The results indicate that there is a haplotype between three observed mutations in Iranian population include: 370-371insACA, 1423C > T and 494 T > C. This haplotype was seen in control group as well. Surprisingly, total frequency of mutations in men with history of idiopathic RPL and azoospermic cases were significantly higher than that of in control groups (p < 0.05). Serum testosterone concentrations and testicular volume did not differ in the mutation positive group compared with the non-mutation group. About the USP26 gene expression, there is a significant difference between the expression levels of obstructive azoospermia, complete maturation arrest samples and SCO samples (P < 0.05).

Conclusions

According to our results, the USP26 gene may play an important role in male reproduction. The alterations of this gene may be involved in male infertility and RPL in Iranian population and may negatively affect testicular function.     

Protective effects of metformin on reproductive function in obese male rats induced by high-fat diet

PurposeThe study aims to elucidate the changes in testicular spermatogenic function in high-fat diet (HFD)-induced obese rats and to evaluate the protective effects of metformin intervention.MethodsMale Sprague–Dawley rats (n = 18) were randomly divided into a control group (standard diet), an HFD group, and a metformin group (HFD + metformin at 100 mg/kg, once daily by oral gavage). After 8 weeks, rats were euthanized, and the weights of body and testes were measured. Testis and epididymis were dissected and hematoxylin-eosin-stained for histopathological examination and semen parameter analysis. Blood samples were collected for assessment of sex hormones and metabolic parameters (serum glucose, insulin, and leptin). Spermatogenic cell apoptosis was accessed by TUNEL.ResultsCompared with the control group, the final body weight and weight gain were significantly higher in HFD rats, while the testicle weight and coefficients were lower. In HFD rats, metformin treatment induced weight loss and increased testicle weight (P < 0.05). In HFD rats, obvious pathological changes in the testicular tissue were characterized by small, atrophic, and distorted seminiferous tubules and destroyed basement membrane. Metformin treatment protected against the HFD-induced decrease in the number of spermatogonia, Sertoli cells, and Leydig cells (P < 0.05); ameliorated the HFD-induced increases in serum glucose, insulin, leptin, and estrogen; and decreased serum testosterone (P < 0.05) and reduced the rate of testicular cell apoptosis in obese male rats. Finally, metformin significantly improved semen parameters (including concentration, viability, motility, and normal morphology) in HFD rats (P < 0.05).ConclusionsHFD-induced obesity in rats results in detrimental effects on spermatogenesis, semen quality, endogenous hormones, and testicular cell apoptosis. Metformin intervention improved the semen parameters, possibly due to its effects on weight loss, increased testicular weight, reduced testicular cell apoptosis, and resulted in restoration of hormonal homeostasis and correction of metabolic disorder.     

Sperm DNA fragmentation and male fertility: a retrospective study of 5114 men attending a reproductive center

PurposeThe sperm DNA fragmentation index (DFI) was quantitatively measured and its relationship with age, semen quality, and infertility conditions was investigated.MethodsSemen routine test and sperm DFI were performed in 2760 infertile male and 2354 male whose spouse experienced at least one unexplained miscarriage to analyze the correlation between sperm DNA damage, semen routine parameters, and age.ResultsSperm DFI was significantly lower from patients whose wife experienced unexplained miscarriage compared to infertility males (p = 0.000). An inverse correlation between sperm DFI and sperm progressive motility was observed (r_s = − 0.465, p = 0.000) and sperm DFI was positively correlated with age (r_s = 0.255, p = 0.000). However, the correlation between sperm DFI and sperm concentration, semen volume, total sperm count, and motile sperm count were not proved.ConclusionsSperm DFI is an important indicator for evaluating the quality of semen. Sperm DNA integrity testing is preferentially recommended to those who have decreased sperm progressive motility, especially older men. An integrative analysis of sperm DFI, sperm progressive motility, age, and infertility conditions can provide a more comprehensive assessment of male fertility.     

Identification of biochemical differences between different forms of male infertility by nuclear magnetic resonance (NMR) spectroscopy

Purpose

The aim of this study was to analyze the seminal plasma of patients with idiopathic/male factor infertility and healthy controls with proven fertility by NMR spectroscopy, with a hope of establishing difference in biomarker profiles, if any, between the groups.

Methods

A total of 103 subjects visiting the infertility clinic of Manipal University with normozoospermic parameters, oligozoospermia, asthenozoospermia, azoospermia and teratozoospermia were included. Semen characteristics were analysed by standard criteria. Seminal plasma was subjected to NMR spectroscopy at a 700 MHz ¹H frequency. The resultant data was analyzed by appropriate software.

Results

The analysis revealed significant differences between the fertile control group and other forms of male infertility. Interestingly, seminal plasma profile of the idiopathic infertility group showed distinct segregation from the control population as well as other infertile groups. The difference in biomarker profiles between the idiopathic infertility and the rest of the groups combined could originate from either the up-regulation or down regulation of a several compounds, including lysine, arginine, tyrosine, citrate, proline and fructose.

Conclusion

Our data suggests the presence of a metabolic reason behind the origin of idiopathic infertility. ¹H NMR based metabonomic profiling based on concentration of biomarker lysine has the potential to aid in the detection and diagnosis of idiopathic infertility in an efficient manner.

Electronic supplementary material

The online version of this article (doi:10.1007/s10815-014-0282-4) contains supplementary material, which is available to authorized users.     

Y chromosome AZFc microdeletion may not affect the outcomes of ICSI for infertile males with fresh ejaculated sperm

Purpose

To explore whether the presence of a Y chromosome AZFc microdeletion confers any adverse effect on the outcomes of intracytoplasmic sperm injection (ICSI) with fresh ejaculated sperm.

Methods

A total of 143 oligozoospermia patients with Y chromosome AZFc microdeletion in ICSI cycles in a five-year period were studied. Infertile men with normal Y chromosome in ICSI at the same time-frame were used as controls matched to the study group for age of female, female’s body mass index, male’s age, infertility duration and number of oocytes retrieved. Retrospective case–control study was used.

Results

There were no significant differences between groups in clinical outcomes of endometrial thickness, transferred embryos, good embryo rates, implantation rates, biochemical pregnancy rates, clinical pregnancy rates, ectopic pregnancy rates, miscarriage rates, preterm birth rates, the ratio of male and female babies, newborn body height, newborn weight, low birth weight and birth defects (P > 0.05). Patients with Y chromosome AZFc microdeletion had a lower fertilization rate (61.8 % vs. 67.8 %, P < 0.05) and higher cleaved embryo rate (94.0 % vs. 88.1 %, P < 0.05).

Conclusions

ICSI clinical outcomes for oligozoospermic patients with Y chromosome AZFc microdeletion are basically comparable to that of infertile patients with normal Y chromosomes. The results of ICSI were not affected by the AZFc deletion. Preimplantation genetic diagnosis (PGD) before ICSI for Y chromosome AZFc microdeletion may not be a justifiable regular procedure if the couples didn’t care the vertical transmission of Y chromosome deletion.