40例输精管道梗阻性无精子症诊疗策略分析

目的:探讨输精管道梗阻性无精子症(OA)的诊疗策略。方法:40例输精管道OA患者为研究对象。首先行输精管道探查,根据术中探查情况行输精管-输精管显微吻合术(VV)、输精管-附睾显微吻合术(VE)、交叉输精管-输精管吻合术、交叉输精管-附睾管显微吻合术或睾丸取精冻存术。结果:精道探查后,共行吻合手术26例,取精+冻精手术14例。40例患者中,共有3例患者失访(2例吻合患者,1例冻精患者)。随访到的24例吻合术患者术后复通率为58.3%(14/24),自然受孕率为29.1%(7/24)。随访到的13例取精+冻精患者中已有11例行ICSI/冻精助孕。结论:输精管道OA,可根据术前严格评估和术中探查行显微复通手术或取精术;复通术后可获得自然妊娠的机会,交叉显微吻合为输精管道复通的有效途径之一。     

睾丸活检和病理学检查对梗阻性无精子症患者睾丸精子检出率初探

目的:初步评估国内目前睾丸活检手术和睾丸病理对梗阻性无精子症的诊断价值。方法:对曾接受过睾丸活检经本次临床诊断为梗阻性无精子症的84例梗阻性无精子症患者进行梗阻病因分析,对病理报告无精子者重新进行经皮细针附睾或睾丸穿刺(PESA或TEFNA)检查,并对先前的睾丸病理报告进行分析。结果:84例均诊断出明确的梗阻病因,其中先天性梗阻56例(66.67%);炎症性梗阻26例(30.95%);另2例为双侧疝气术史。对33例递交的病理报告为无精子者中的29例重新进行PESA或TEFNA手术,均获取了附睾或睾丸精子。84例中的57例行ICSI62个周期,周期妊娠率为46.8%。结论:本组患者的病因主要为先天性或炎症性梗阻,目前国内睾丸病理学对梗阻性无精子症睾丸内是否存在精子的诊断欠准确。对梗阻性无精子症患者可应用损伤小的PESA或TEFNA进行诊断,有利于患者的后续治疗。     

输精管绝育术后附睾郁积与精子免疫反应关系的研究

<正> 输精管绝育术后一些人发生附睾郁积现象,个别人伴随局部坠胀等症状,形成附睾郁积症。其发病率虽低,由于手术数量大,发病的绝对数不少。且发病原因不很明确,处理有一定困难。近年一些研究中发现输精管绝育术后部分人血清中出现精子制动抗体和精子凝集抗体。这些抗精子抗体的产生与附睾郁积之间有无关系,过去未见到文献报道。为了探索附睾郁积症的原因和它与精子免疫反     

经皮穿刺精液冷冻保存标本和精子胞浆内注射

对丈夫患有不可逆阻塞性无精症的夫妇 ,采用显微手术抽吸附睾精子 (MESA)联合胞浆内注射精子 (ICSI)的方法使妊娠率提高。经皮抽吸附睾精子 (PESA)比 MESA好 ,手术时间短 ,并发症少 ,方法简便。作者报道采用 PESA和冷冻保存精子 ,经冻融后行 ICSI的 2例妊娠。例 1丈夫 (4 0岁 )于 5年前行输精管切除术 ,4年前再婚后行输精管再通术 ,但术后精液分析为无精。体检睾丸正常大小 ,可触及附睾和输精管。血清 FSH、L H、T、PRL 在正常范围。重复精液检查为无精。妻 30岁 ,月经正常 ,子宫输卵管造影示输卵管通畅、宫腔正常。诊断性 PE…     

输精管吻合术后抗精子抗体的变化

众所周知，输精管结扎术后的自身免疫反应，使血清中会产生抗精子抗体（ＡｓＡｂ）［１～３］，并可存在近睾端输精管中的精子上［４］，这些抗体可持续２０多年，并维持在一定的水平［２］，即使输精管吻合术后，血清和精液中仍有抗精子抗体存在［５，６］。为了探讨输精管吻合术后ＡｓＡｂ水平的情况，尤其与吻合术前相比较所发生的变化，本文对一组要求作输精管吻合术对象，分别对吻合术前和术后１～１８个月的血清和精浆ＡｓＡｂ的情况作了初步的报道。材料与方法３１例要求作输精管吻合术者，年龄３０～４２岁。输精管结扎术后１～５年…     

附睾穿刺取精子行ICSI治疗阻塞性无精子症3例

阻塞性无精子症一直是男性不育症治疗中的难点。我们应用经皮附睾穿刺抽吸术取精子结合单精子卵母细胞注射术 (ICSI)治疗阻塞性无精子症 3例。现报道如下。1　资料与方法1.1　阻塞性无精子症病例的筛选以 2 0 0 1年 4月至 2 0 0 2年 11月在本中心就诊的 175 9例男性不育症为筛选对象。筛选的依据是 2次 (间隔 2周左右 )常规精液涂片镜检未见精子。对筛选出的无精子症患者 ,详细了解有无腮腺炎、结核等病史 ,再作进一步检查 ,在排除生精功能障碍性无精子症的基础上行诊断性经皮附睾精子抽吸术 ,当证实附睾内有形态正常的精子 ,则诊断为阻塞…     

输精管结扎术后抗精子抗体在非射出精子上的存在

４８例正常育龄男子和２４例要求作输精管吻合术者，用免疫珠结合试验（ＩＢＴ）和精子－宫颈粘液接触试验（ＳＣＭＣ）分别检测其近睾端输精管液中的精子（非射出的精子）表面抗精子抗体的情况。结果显示：正常育龄男子非射出的精子上没有抗体存在；而输精管结扎术后非射出的精子上有抗精子抗体存在（ＩｇＧ：７９．４％，ＩｇＡ：３８．２％，ＳＣＭＣ：３５．５％）。这些抗体在输精管结扎术后不到１年就可发现，并保持到结扎术后３年以上。吻合术后１～３个月内，其精液中射出的精子上仍发现抗体存在。结果还提示：输精管结扎术后，不能以非射出的精子上抗体的水平去预测吻合术后射出的精子上抗体的水平；吻合术前血清抗体水平与非射出的精子上抗体水平并不一致。     

梗阻性无精子症患者精子顶体完整性与卵胞质单精子注射治疗结局之间的关系

目的:探讨梗阻性无精子症(OA)患者精子的顶体完整性及其与卵胞质单精子注射(ICSI)治疗临床结局之间的关系。方法:选取梗阻性无精子症患者共37例为试验组,同期进行体外受精治疗且精液常规参数正常的男性33例为对照组,应用荧光标记的豌豆凝集素法(PSA-FITC)检测精子顶体完整性,巴氏染色法分析精子形态,比较试验组与对照组的顶体完整率(AIR)、正常形态率(NFR)、受精率(FR)、卵裂率(CR)及优质胚胎率(OER),并将AIR与FR、NFR与FR进行相关性分析。结果:试验组的AIR、NFR、FR显著低于对照组(P<0.01),CR、OER试验组与对照组相比无统计学差异(P>0.05)。试验组AIR与FR呈显著正相关(r=0.595,P<0.01),NFR与FR显著正相关(r=0.463,P<0.01);对照组AIR与FR显著正相关(r=0.683,P<0.01),NFR与FR呈显著正相关(r=0.205,P<0.01)。结论:梗阻性无精子症患者的精子AIR较低。行皮下附睾抽吸术(PESA)-ICSI的梗阻性无精子症患者精子其AIR高则受精率也会高。     

不同源性及不同参数精子对ICSI结局的影响

目的:研究不同源性精子、不同参数精子及冻融精子对ICSI结局的影响。方法:接受ICSI治疗的510对不育夫妇共进行了517个周期,分为6组。射出精液少弱畸精子症组(A组)82例,共进行85个周期;射出精液严重少弱精子症组(B组)170例,共进行174个周期;附睾细针穿刺抽吸精子组(C组)108例,共进行108个周期;睾丸细针穿刺抽吸精子组(D组)71例,共进行71个周期;冻融射出精子组(E组)34例,共进行34个周期;冻融附睾睾丸精子组(F组)45例,共进行45个周期;比较其妊娠结局。结果:6组患者一般情况比较无统计学差异(P>0.05),6组患者的受精率、优胚率、临床妊娠率、早期流产率无统计学差异(P>0.05)。结论:不同源性精子、不同参数精子及冻融精子对ICSI结局无明显影响。     

微量精子冷冻复苏行卵胞浆内单精子注射的临床结局

目的:探讨经皮睾丸穿刺取精术(TESA)获得的微量精子经冷冻复苏后行卵胞浆内单精子注射(ICSI)治疗非梗阻性无精子症患者的临床效果。方法:回顾性分析2015年10月至2017年8月在我院生殖中心因少、弱、畸形精子症行射出精子常规ICSI及非梗阻性无精子患者TESA获得的微量精子行新鲜或冷冻后ICSI治疗,共238个周期的临床资料,132个周期为常规ICSI精子组,63个周期为冷冻TESA精子组,43个周期为新鲜TESA精子组,比较3组的实验室指标和临床妊娠结局。结果:常规ICSI精子组获卵数(10.58±5.37枚)与冷冻TESA精子组(10.73±4.19枚)和新鲜TESA精子组(10.88±4.67枚)相比差异无统计学意义(P0.05)。3组患者卵子成熟率、正常受精率、优质胚胎率相比差异无统计学意义(P0.05)。冷冻TESA精子组的临床妊娠率、多胎率、流产率(47.62%、26.67%、6.67%)与常规ICSI精子组(48.48%、25.00%、6.25%)及新鲜TESA精子组(51.16%、22.73%、4.55%)相比差异无统计学意义(P0.05)。结论:经皮睾丸穿刺取精术后对有活动精子的睾丸组织进行冷冻复苏行ICSI可以获得较好的治疗效果,也是治疗非梗阻性无精子症不育患者的有效方法。     

Retroperitoneal mobilization of the vas deferens in the complex vasovasostomy

Anatomic distances along retroperitoneal, inguinal, and infrainguinal segments of the vas deferens were measured in 14 formalin fixed cadavers and in 15 recently postmortem males. There were no significant differences in segment lengths between the two groups nor between the right and left vasa. Data from the recent postmortem group reveals a mean length of 5.83 +/- .65 cm to be gained from retroperitoneal mobilization of the vas deferens. This information is important to surgical decisions in cases of microsurgical repair of obstructive azoospermia resulting from damage to the inguinal segment of the vas deferens. Data on other vasal segment lengths is beneficial for planning repair in other complex cases of obstructive azoospermia as well.     

Genetic analysis and intracytoplasmic sperm injection outcomes of Chinese patients with congenital bilateral absence of vas deferens

Journal of Assisted Reproduction and Genetics - Congenital bilateral absence of the vas deferens (CBAVD) is a major cause of obstructive azoospermia and male factor infertility. CBAVD is mainly...     

Clinical experience of epididymovasostomy and vasovasostomy for obstructive azoospermia]

14 patients with obstructive azoospermia were treated with microsurgical vasovasostomy or epididymovasostomy. A total of 11 patients underwent 2-layer vasovasostomy, 6 cases following bilateral vasectomy and 5 cases suffering from bilateral vasal disruption by inguinal herniorrhaphy. 3 patients underwent end-to-end epididymovasostomy with Silber's specific tubule technique following bilateral epididymitis. After the operation, fertility was restored in 6 of 14 cases. The recovered sperm density was greater than 20 x 10 6/ml and sperm motility exceeded 50%. Pregnancy was achieved in 1 case following inguinal herniorrhaphy. Preoperative testicular biopsies carried out in 11 cases disclosed slight deterioration of spermatogenesis. Johnsen's mean score was 8.20 +or- 0.38 (mean +or- S.D.). The mean scores of the biopsies obtained from the cases obstructed for more than 20 years were significantly lower than those with less than a 20-year time period. After inguinal herniorrhaphy, reanastomosis of the vas deferens was difficult in order to restore fertility. This was due to the presence of longterm obstruction, defects in the vas deferens, or the absence of sperm granuloma at the vasectomy site. Epididymovasostomy restored fertility in 67% of the cases. The specific tubule technique was the most effective in the management of such pathological conditions. (author's modified)     

Familial bilateral vas deferens agenesis.

Two brothers with bilateral vas deferens agenesis are described, one of them with a chromosome mosaicism (46,XX/47,XXY). To our knowledge, there are not any previous reports of both conditions existing simultaneously. The patients consulted us because of infertility; they have normal sexual function, normal physical examination, but typical semen analyses with azoospermia, low semen volume, low pH, and negative fructose test. It appears to us that bilateral vas deferens agenesis may be genetic in origin in some patients.     

先天性输精管缺如患者的临床与遗传特点:附41例报道

目的探讨先天性输精管缺如(CAVD)者的临床特点,分析囊性纤维跨膜转运调节因子(CFTR)国内外已知高频突变位点5T剪接变体(IVS8-5T)和F508位点遗传突变特征,旨在建立CAVD的诊治策略。方法收集41例CAVD病例临床资料,总结其分型、诊断和治疗特点,从21例患者血样中提取基因组DNA,利用聚合酶链反应(PCR)扩增5T和F508位点片段,并直接测序。结果 41例患者中20例双侧缺如患者,14例节段性缺如,7例单侧缺如。40例患者通过外科取精方式获取精子,1例取精失败患者睾丸组织病理为生精阻滞,总体取精成功率约97.6%(40/41);4例单侧缺如患者要求行对侧输精管-附睾吻合术或交叉吻合术,术后随访精液1~6个月无精子;12例取精后行卵胞质内单精子注射(ICSI),7例成功生育,2例正常妊娠中(4~8个月)。21例测序显示9例存在5T位点突变(42.9%),未见F508位点突变。结论 CAVD需综合查体、检验和超声等影像资料诊断;取精结合ICSI的辅助生殖技术(ART)是CAVD有效的治疗手段;汉族CAVD患者近半数存在5T剪接变体突变,未见白人高加索人存在的ΔF508del突变。     

The analysis of CFTR mutations in men with azoospermia, oligozoospermia and asthenozoospermia

Mutations in cystic fibrosis transductance regulator gene (CFTR) are known to result in some forms of male infertility. An association between CFTR gene mutations and obstructive azoospermia in cystic fibrosis (CF) and in congenital unilateral and bilateral absence of vas deferens (CUAVD, CBAVD) has been proven. However, the role of CFTR gene mutations in the etiology of non-obstructive azoospermia, as well as in the regulation of spermatogenesis remains unsolved. OBJECTIVES: The aim of the study was to evaluate the frequency of CFTR mutations in patients diagnosed with different forms of spermatogenesis impairment MATERIAL: The molecular analyses were performed in the group of 93 infertile men, diagnosed with either azoospermia, oligospermia or asthenoteratozoospermia. RESULTS: The results of the study revealed the presence of F508del and IVS8-T in 5.4% of analyzed cases. No difference in CFTR gene mutations frequencies among patients with azoospermia, oligospermia and asthenoteratozoospermia has been observed. CONCLUSION: The CFTR gene mutations frequency in men with nonobstructive azoospermia, oligozoospermia and asthenozoospermia is similar to those observed in general population.     

Sperm cryopreservation and in vitro fertilization/intracytoplasmic sperm injection in men with congenital bilateral absence of the vas deferens: a success story

In this study we evaluate the use of cryopreservation of sperm obtained at the time of surgical exploration in men with congenital bilateral absence of the vas deferens. We assess the impact of cryopreservation on pregnancy rates after IVF/intracytoplasmic sperm injection. Intraoperative cryopreservation of sperm at the time of microsurgical epididymal sperm aspiration in men with congenital bilateral absence of the vas deferens resulted in a 100% live delivery rate per couple, providing the highest pregnancy rates of any infertility treatment.     

Molecular screening of CFTR gene in Brazilian men with bilateral agenesis of the vas deferens

Infertility is a common symptom of cystic fibrosis, especially in men (95% become sterile). It is caused by blockage of the vas deferens and the epididymis, which result in degeneration of the tubules. The purpose of this study was to verify the frequency of CFTR gene mutation in patients with bilateral agenesis of the vas deferens using SSCP and sequencing. The study population consisted of 40 white individuals with agenesis of the vas deferens as well as their 12 siblings without agenesis of the vas deferens. CTFR gene mutation was found in 22 of the 40 patients (55%) and it was possible to detect both mutating alleles in these 22 patients. The most frequent genotype found was ?F508/IVS8-5T. There was no genotype concordance in siblings. Our results show the importance of the investigation of CFTR mutation in patients with vas deferens agenesis.