应用供精冷冻精液出生子代的安全性分析

目的:调查使用供精者精液行辅助生殖技术(ART)后的妊娠结局,探讨应用供精冷冻精液出生子代的安全性。方法:2006年1月至2012年12月我院人类精子库向全国31家生殖中心提供冷冻精液,共治疗50 247个周期。统计使用供精精液行宫颈内人工授精(ICI)、宫腔内人工授精(IUI)、体外受精(IVF)及卵细胞胞质内单精子注射(ICSI)的子代出生缺陷发生率及自然流产率,对比不同授精方式的出生缺陷率与自然流产率的差异。结果:使用供精者冷冻精液行人工授精39 047个周期,其中ICI周期数36 674个,临床妊娠8 612例,自然流产917例,自然流产率(28孕周)10.6%(917/8 612);活胎数6 133例,发生出生缺陷者43例,出生缺陷发生率0.70%(43/6 133)。IUI周期数2 373个,共获得临床妊娠547例,自然流产41例,自然流产率为7.5%(41/547);活胎数426例,发生出生缺陷2例,出生缺陷率0.47%(2/426)。使用供精者冷冻精液行IVF、ICSI治疗共计11 200个周期,其中IVF临床妊娠5 860例,自然流产456例,自然流产率7.8%(456/5 860),活胎数5 089例,出生缺陷发生率1.08%(55/5 089);ICSI临床妊娠350例,自然流产30例,自然流产率8.6%(30/350),活胎数229例,出生缺陷发生率1.31%(3/229)。使用供精冷冻精液出生的后代缺陷发生率显著低于我国卫生部发布的监测数据(0.86%vs 1.53%,P0.01)。结论:供精冷冻精液出生子代的安全性仍在可控的范围。     

不同授精方式的选择性单囊胚移植的妊娠结局分析

目的探讨不同的授精方式[体外受精(IVF)和卵胞浆内单精子注射(ICSI)]的D5选择性单囊胚移植妊娠结局分析。方法回顾性分析2012年4月至2013年10月在陕西省妇幼保健院生殖中心助孕的第1周期D5新鲜移植单囊胚的IVF/ICSI患者,其中IVF单囊胚移植组移植288个周期、ICSI单囊胚移植组移植85个周期。分析两组间临床特征、超促排卵情况、胚胎质量、妊娠率、着床率、多胎率、流产率、异位妊娠率。结果两组间的超排卵情况、临床妊娠率、种植率、流产率、异位妊娠率差异均无统计学意义(P0.05)。IVF组的囊胚形成率高于ICSI组(分别为62.24%和56.14%),差异有统计学意义(P0.05)。结论无论授精方式如何,只要囊胚质量好,就可以单囊胚移植;授精方式可能只影响囊胚形成率,对妊娠率等没有明显的影响。     

精子DNA完整性对冻融胚胎移植周期妊娠结局的影响

目的探讨男性精子DNA完整性对行ART助孕患者冻融胚胎移植(FET)周期妊娠结局的影响。方法回顾性分析2016年8月至2017年12月在江苏省苏北人民医院生殖中心接受IVF/ICSI助孕的667对不孕夫妇FET周期的临床资料。男性患者进入周期前均采用精子染色质结构分析法(SCSA)染色后通过流式细胞仪来检测男性精子DNA完整性,并观察精子DNA碎片率(DFI)对妊娠结局的影响。根据不同精子DFI水平将研究对象分为两组:低DFI水平组(低DFI组:DFI≤30%,439个周期)和高DFI水平组(高DFI组:DFI30%,228个周期);再根据不同受精方式分为两个亚组:常规IVF组及ICSI组,比较不同水平的精子DFI及不同受精方式对FET周期妊娠结局的影响。结果纳入研究的667对不孕夫妇中临床妊娠334例,总妊娠率50.07%。低DFI组、高DFI组患者的一般资料比较均无统计学差异(P0.05),但低DFI组的受精率显著高于高DFI组(P0.05)。低DFI组的临床妊娠率显著高于高DFI组(54.21%vs.42.11%)(P0.05),流产率则显著低于高DFI组(16.81%vs.27.08%)(P0.05)。低DFI组中IVF组和ICSI组的临床妊娠率(52.63%vs.58.62%)、流产率(15.88%vs.19.12%)比较均无显著性差异(P0.05);高DFI组中IVF组的临床妊娠率显著低于ICSI组(33.33%vs.48.48%),流产率则显著高于ICSI组(40.63%vs.20.31%)(P均0.05)。结论精子DFI水平影响不孕患者的受精率;随着精子DFI水平增高,其整体临床妊娠率下降,流产率增加。低DFI水平的不孕夫妇可选择常规IVF或ICSI助孕;但对于高DFI水平的不孕夫妇,选择ICSI助孕方式可能对改善妊娠结局有益。     

不同受精方式对畸形精子症患者体外受精结局的影响

目的依据畸形精子症患者精子浓度来选择采用IVF或ICSI受精方式,探讨其对IVF-ET助孕结局的影响。方法回顾性分析2014年1月至2017年1月于徐州市妇幼保健院生殖医学中心行IVF/ICSI-ET治疗周期的畸形精子症患者,共计82个周期。根据畸形精子症患者精子浓度选择不同的受精方式,分为IVF畸形精子症组和ICSI畸形精子症组,其中精子浓度≥5×106/ml患者行常规IVF治疗(IVF畸形精子症组,44个周期),精子浓度5×106/ml的患者行ICSI治疗(ICSI畸形精子症组,38个周期),对照组为同期行IVF/ICSI-ET助孕治疗精子形态正常的患者,共605个周期(其中IVF对照组494个周期,ICSI对照组111个周期)。分别比较IVF组内、ICSI组内和畸形精子症组内在年龄、不孕年限、子宫内膜厚度及妊娠结局(临床妊娠率、种植率和流产率)等方面的差异。结果 IVF对照组与IVF畸形精子症组,ICSI对照组与ICSI畸形精子症组分别在年龄、不孕年限和移植日子宫内膜厚度均差异不显著(P均0.05);IVF对照组的种植率略高于IVF畸形精子症组,临床妊娠率和流产率均略低于IVF畸形精子症组,但均无统计学差异(P均0.05);ICSI畸形精子症组的临床妊娠率、种植率和流产率高于ICSI对照组(57.9%vs.48.6%;33.8%vs.29.5%;9.1%vs.1.9%),但均无统计学差异(P均0.05);ICSI畸形精子症组的临床妊娠率、种植率高于IVF畸形精子症组(57.9%vs.52.3%;33.8%vs.27.3%),流产率低于IVF畸形精子症组(9.1%vs.13.0%)但均无统计学差异(P均0.05)。结论畸形精子症患者精子浓度≥5×106/ml时,选择常规IVF是可行的。     

间苯三酚对IVF/ICSI鲜胚移植患者妊娠结局的影响

目的探讨间苯三酚对IVF/ICSI鲜胚移植周期临床妊娠结局的影响。方法回顾性分析2016年1月至2019年6月期间在我院生殖中心初次接受IVF/ICSI助孕治疗的2110周期患者的临床资料,根据鲜胚移植后是否使用间苯三酚,分为间苯三酚组(n=474)和对照组(n=1636);各入组患者再根据鲜胚移植的胚胎类型不同,分为卵裂期胚胎移植组和囊胚期移植组2个亚组。比较各组患者IVF/ICSI鲜胚移植周期的临床妊娠率、胚胎种植率、多胎妊娠率、流产率、异位妊娠率、活产率及胎儿畸形率等。结果间苯三酚组多胎妊娠率及活产率显著高于对照组(P<0.05),而早期流产率及晚期流产率均显著低于对照组(P<0.05),两组间临床妊娠率、生化妊娠率、种植率以及异位妊娠率无显著性差异(P>0.05);卵裂期胚胎移植间苯三酚组多胎妊娠率及活产率显著高于对照组(P<0.05),而其他指标无显著性差异(P>0.05);囊胚移植间苯三酚组的种植率及活产率显著高于对照组(P<0.05),而其他指标无显著性差异(P>0.05);卵裂胚胎移植中正常对照组新生儿畸形率为0.31%(2/637),而间苯三酚组中未发现新生儿畸形(P<0.05)。结论IVF/ICSI鲜胚移植周期使用间苯三酚能显著降低流产率、增加活产率,且未发现胎儿致畸作用,能明显改善临床妊娠结局。     

供精人工授精妊娠结局的影响因素及子代安全性分析

目的:分析影响供精人工授精(AID)妊娠结局的相关因素,以提高妊娠率,并评价其子代安全性。方法:回顾性分析沈阳二〇四医院生殖医学研中心2005年7月1日至2013年6月30日行AID助孕的5 109例患者,共计7 761周期的妊娠结局及子代出生缺陷发生率情况。结果:AID临床妊娠2 252例,周期妊娠率29.02%,累积妊娠率44.08%。女方年龄≤35岁组临床妊娠率明显高于35岁以上组(30.31%vs 20.18%,P0.01),不孕年限5年以下组高于5年以上组(30.83%vs 28.16%,P0.01),使用促排卵组临床妊娠率明显高于自然周期组(33.22%vs 28.68%,P0.01);治疗第1周期组的临床妊娠率最高(29.87%),与治疗第4周期组妊娠率(23.61%)差异有统计学意义(P0.05),其余各治疗周期组间的临床妊娠率差异无统计学意义(P0.05)。AID发生子代出生缺陷28例(1.40%),以心血管畸形发生率最高(6例,21.43%),其次是骨骼肌肉系统畸形4例(14.29%),泌尿系统和神经系统畸形各3例(10.71%),还包括唇腭裂、呼吸系统、消化系统畸形各2例(7.14%)及其它系统畸形。结论:女方年龄、不孕年限及促排卵治疗是影响AID临床妊娠率的重要因素;冷冻精液行AID并未增加子代出生缺陷发生率,是一项相对安全的辅助生殖技术。     

IVF与IUI助孕成本效益比较的初步探讨

目的回顾性分析本中心宫腔内人工授精(IUI)或体外受精(IVF)助孕周期的临床资料,初步探讨IVF与IUI助孕的成本效益,以期为临床诊治提供参考。方法回顾性分析2016年期间在本中心行IUI助孕的113个周期(IUI组)以及进行IVF助孕治疗的121个取卵周期(IVF组)的临床资料。观察两组的临床妊娠率、多胎妊娠率、早期流产率、异位妊娠率及卵巢过激刺激综合征(OHSS)发生情况,记录两组的药物使用费用、手术费用等,计算患者的临床妊娠成本;同时对IUI组中连续进行3次IUI的患者亦进行相关成本计算和比较。结果IUI组和IVF组的患者年龄、体重指数(BMI)、不育年限、原发不孕比例、男方精液浓度比较,差异均无统计学意义(P0.05);不育原因构成比中,两组患者存在一定差异(P0.05)。IVF组的临床妊娠率(63.64%)及多胎妊娠率(25.97%)显著高于IUI组(分别为7.08%、12.50%)(P0.05);两组间中重度OHSS发生率、早期流产率、异位妊娠率比较无显著性差异(P0.05)。IVF组的Gn费用、手术费用及总费用均显著高于IUI组(P0.05)。IUI组中,每1名患者成功妊娠所花费的成本是46 595.60元,高于IVF组中每例患者成功妊娠所花费的34 163.40元,但尚无显著性差异(P0.05);3次IUI组中,每1名患者成功妊娠所花费的成本为33 341.00元,低于IVF组和IUI组,但亦无显著性差异(P0.05)。结论对于有IVF指征、拟行IUI助孕的患者来说,进行一个完整周期的IVF助孕比单次行IUI助孕的妊娠成本更低、更划算;对已经进行IUI助孕的患者,连续3次行IUI助孕能有效降低妊娠成本。但由于本次纳入的样本量相对较小且研究设计存在一定局限性,仍需更多的大样本前瞻性研究进一步探索。     

Y染色体长臂异染色质区延长对辅助生殖妊娠结局和新生儿健康情况的影响

目的探讨Y染色体长臂异染色质区延长(Yqh+)对体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)妊娠结局和新生儿健康情况的影响。方法采用单中心回顾性研究,收集2014年1月至2017年12月期间在西北妇女儿童医院辅助生殖中心行IVF/ICSI-ET助孕的不育症患者为研究对象,根据Y染色体核型分析结果分为Yqh+组和对照组。又根据男方精液分析结果分别行IVF或ICSI人工授精,比较IVF周期和ICSI周期中Yqh+组和对照组的妊娠结局和新生儿健康情况。结果研究共纳入1 705对不育夫妇,其中Yqh+组67例,对照组1 638例。(1)在IVF治疗周期中,Yqh+组和对照组患者一般资料比较无显著性差异(P>0.05)。新鲜移植周期中,Yqh+组的临床妊娠率、活产率略低于对照组,但均无显著性差异(P>0.05);Yqh+组的异位妊娠率显著高于对照组(11.11%vs. 1.63%,P=0.04);两组的新生儿Apgar评分、出生缺陷率和男婴出生率比较亦均无显著性差异(P>0.05)。(2)在ICSI治疗周期中,两组患者的一般资料比较无显著性差异(P>0.05);新鲜移植周期的妊娠结局(包括临床妊娠率和活产率)和新生儿出生情况各观察指标比较均无显著性差异(P>0.05)。结论 Yqh+可能对IVF/ICSI-ET妊娠结局和新生儿健康情况无明显影响。Yqh+是否增加IVF新鲜移植周期中异位妊娠的风险,尚需要更大样本量的研究加以探讨。     

特发性少、弱精子症患者精液质量指标及辅助生殖妊娠结局相关性研究

目的通过分析特发性少、弱精子症患者精液质量及其精子功能、体外受精/胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)妊娠结局以及后代情况,探讨其对精液质量、精子功能、辅助生殖妊娠结局以及出生后代的影响。方法 132例特发性少、弱精子症患者作为实验组,50例正常生育男性纳入对照组。对比两组精子质量、精子功能指标以及妊娠结局和出生后代指标差别有无统计学意义。结果实验组与对照组一般资料的比较,男、女方患者的平均年龄、不育年限、窦卵泡数、女方激素水平比较,差异均无统计学意义(P0.05)。实验组患者精液质量、顶体酶活性、精子-透明质酸结合率小于对照组,DNA碎片、核蛋白组型大于对照组,差异具有统计学意义(P0.05)。与对照组相比,实验组IVF治疗者的受精率、着床率,优质胚胎率和临床妊娠率降低,流产率升高,差异有统计学意义(P0.05)。ICSI治疗者,两组患者的受精率、着床率、优质胚胎率、临床妊娠率和流产率无明显差异。实验组对子代影响指标(诸如早产率、出生体质量、双胎妊娠率、男婴比例、出生缺陷率等)与对照组相比,差异亦无统计学意义(P0.05)。结论在IVF/ICSI助孕的患者中,特发性少、弱精子症患者可伴有精子受精能力降低。对于IVF治疗结局不良的特发性少、弱精子症患者,ICSI受精可能会改善其助孕治疗结局。     

供精精液行辅助生殖技术出生子代安全性评估

目的:本研究调查应用供精者精液实施辅助生殖技术(ART),包括供精人工授精(AID)、供精体外受精(IVF-D、ICSI-D)与应用丈夫精液经ART(AIH、IVF、ICSI)出生子代缺陷的发生率,从而评价应用供精者精子实施ART出生子代的安全性。方法:2005年1月至2009年10月,上海市人类精子库向全国11家医疗机构供精,实施供精ART出生子代904例。对照组为4家生殖医学中心,同期对不育夫妇实施丈夫精液ART出生子代4 195例。统计两类精液实施ART出生子代的数量与出生缺陷的例数及病种分类,比较两种精液来源获得子代出生缺陷的发生率。结果:应用供精者精液实施ART获得子代出生缺陷7例(0.77%),使用丈夫精液出生缺陷42例(1.00%),其差异无显著性(P>0.05)。结论:应用供精者精子实施ART出生子代同夫精ICSI出生的子代相比,出生缺陷的种类没有明显差异,但前者的出生缺陷率明显低于后者,就目前结果而言,供精辅助生殖技术更具安全性。     

精子计数池深度对精子活力影响的实验研究

目的:调查精子计数池深度对精子活力检测结果的影响。方法:利用Filmetrics间隙测量仪精确测量4种不同深度的Geoffrey精子计数池,然后按照WHO手册第5版的要求利用瑞祺CFT-9201型精子质量检测分析系统分析36例精液标本的前向运动精子百分率(PR)、非前向运动精子百分率(NP)和总活动率(PR+NP),并进行比较分析。结果:4种精子计数池的深度分别为9.8、12.7、15.7和19.9μm,测得的PR分别为(44.00±11.63)%、(41.96±12.62)%、(40.86±11.71)%和(37.78±11.38)%,NP分别为(13.54±3.01)%、(14.13±2.94)%、(14.91±3.02)%和(16.53±2.77)%,总活动率分别为(57.53±11.06)%、(56.08±11.97)%、(55.78±11.55)%和(54.31±12.11)%。精子计数板深度与PR呈显著负相关(r=-0.993,P<0.05),与NP呈显著正相关(r=0.989,P<0.05),与活动率呈显著负相关(r=-0.978,P<0.05)。尽管精子总活动率在4种不同深度的计数池之间没有显著差异,但PR和NP在9.8μm深的计数池和19.9μm深的计数池之间均有显著性差异(P<0.05)。结论:精子计数池的深度对精子活力的影响不容忽视,不同深度计数池获得的结果差异将会给临床医生对患者做出正确的诊断(如弱精子症)和采取合适的治疗措施带来一定的负面影响。不同深度的精子计数池应有相应的精子活力正常参考值范围。     

Relationship between the sperm penetration assay and other tests of sperm function

Semen from 88 men of infertile couples and 33 fertile donors differed in seminal fluid analysis (sperm density and motility) (SFA) as well as in the penetration of hamster ova (SPA) and bovine cervical mucus (MPT). In the fertile group, significantly more subjects had adequate SFA, SPA, or MPT results than in the infertile group. When the two groups were subdivided into those with normal or those with abnormal SFA, no differences were noted in SPA, MPT, or postcoital test (PCT) scores. The SFA parameter most consistently reflected in the results of the SPA, MPT, and PCT was sperm density. This was most evident when the SFA was poor. The worst prognosticator of fertility was the SFA, with 30% of the fertile donors having an abnormal SFA. The worst prognosticator of infertility was the MPT, with 79% of the patients penetrating in the fertile range. The SPA was a significantly better predictor than either the SFA or MPT. SPA and MPT results were positively correlated only in the overall infertile group. The SPA, MPT, and PCT measure sperm qualities distinct from those revealed by the SFA, and from each other, and in combination provide the best assessment of fertility.     

精子库捐精志愿者特征与筛查合格率的分析

目的:探讨捐精志愿者年龄、学历、职业、婚育特征与筛查结果的关系,为精子库捐精宣传招募工作提供参考。方法:对广东精子库2003年1月至2017年6月期间12 362例捐精志愿者的筛查资料进行汇总统计,分析捐精志愿者年龄、学历、职业、婚育特征与筛查合格率的关系。结果:12 362例志愿者中,3 968例(32.1%)精液质量达到合格标准;全部检查结果达到精子库捐精标准即筛查合格的志愿者3 127例(25.3%)。志愿者达到精子库捐精标准合格率20~24岁组为27.7%,25~29岁组24.3%,30~34岁组23.8%,≥35岁组17.5%,不同年龄组筛查合格率差异有统计学意义(P0.01)。高中、专科、本科、研究生的志愿者筛查合格率分别为23.5%、24.0%、25.9%和30.3%,差异有统计学意义(P=0.000)。学生和社会人员的筛查合格率分别为29.3%和22.9%,差异有统计学意义(P0.01)。已婚和未婚志愿者的筛查合格率分别为41.5%和20.7%,差异有统计学意义(P0.01)。已生育和未生育志愿者的筛查合格率分别为45.6%和20.9%,差异有统计学意义(P0.01)。结论:人类精子库尽量招募年龄低于35岁、学历大学本科或以上并以学生为主的志愿者,并面向此类人群进行精准宣传,提高他们捐精的积极性和意愿,从而提高精子库筛查合格率。     

Analysis of the outcome of intracytoplasmic sperm injection using fresh or frozen sperm

Study Type – Diagnostic (retrospective cohort)
Level of Evidence 2b What’s known on the subject? and What does the study add? The results of ICSI using fresh or frozen sperm on the site of sperm retrieval remains controversial with respect to outcome. The results of this study showed no difference in outcome using ICSI either with respect to the site of retrieval or whether the sperm used was fresh or frozen. It also showed that the outcome of ICSI is not related to the underlying cause of the azoospermia.

OBJECTIVES

? To compare the outcome of first‐attempt intracytoplasmic sperm injection (ICSI) ICSI–embryo transfer (ET) cycles using frozen‐thawed testicular sperm (FTTS), fresh testicular sperm (FTS), frozen‐thawed epididymal sperm (FTES) and fresh epididymal sperm (FES) so as to determine which of these has the most successful ICSI outcome with respect to fertilization rate (FR), pregnancy rate (PR) and birth rate. ? To assess the outcomes according to the underlying aetiology of azoospermia.

PATIENTS AND METHODS

? The records of 493 patients undergoing first‐attempt ICSI between 1993 and 2008 were reviewed retrospectively. FTS was used in 112 cycles, FTTS in 43 cycles, FES in 279 cycles, and FTES in 59 cycles. ? Within each group, the aetiology of the azoospermia was recorded according to history, clinical examination and histological analysis (n= 316). ? The FR, clinical PR and delivery rate were calculated for each group with respect to the type of sperm retrieval used.

RESULTS

? Analysis of the data showed no significant differences between any of the four groups in the FR, PR or delivery rate (P > 0.05). ? There were no significant differences seen between fresh sperm (FTS and FES) and frozen sperm (FTTS and FTES) or between epididymal sperm (FES and FTES) and testicular sperm (FTS and FTTS) in any of the outcomes measured (P > 0.05). However, sub‐set analysis showed a statistically higher FR and PR for FTTS over fresh sperm. ? When comparing aetiologies, there was no significant difference in the FR, clinical PR and delivery rate between obstructive azoospermia (OA) and non‐obstructive azoospermia (NOA) groups. However, sub‐set analysis showed a higher PR and birth rate for FTTS over fresh sperm in both OA and NOA groups.

CONCLUSIONS

? The results of the present study suggest that using frozen sperm in ICSI cycles is a reliable and favourable method with the same outcome as fresh sperm. ? Testicular and epididymal sperm have similar ICSI outcomes for both fresh and frozen samples. However, results suggest a tendency for higher PRs and birth rates for frozen than for fresh testicular sperm in both OA and NOA aetiologies. ? The aetiology of azoospermia does not significantly affect the outcome of first‐attempt ICSI. The higher rates in the frozen groups suggest that these patients have had better quality semen when they were initially harvested and frozen.     

Influence of sperm pretreatment on the efficiency of intracytoplasmic sperm injection in pigs

The purpose of this study was to determine the influence of sperm pretreatment on the efficiency of intracytoplasmic sperm injection (ICSI) in pigs. This was done by examining the effect of 1) the conservation method (fresh vs frozen); 2) the sperm treatment preinjection (resuspension in Dulbecco phosphate-buffered saline (DPBS) vs selection by a Percoll gradient); and 3) the acrosomal and live or dead status of the spermatozoa (by incubation with or without calcium ionophore, 1 muM and 5 muM). In vitro matured porcine oocytes were injected with treated spermatozoa according to each experiment. All the experiments were done with non-artificially activated oocytes. The percentages of activation and cleavage were higher (68% vs 43% and 63% vs 43%, respectively, P < .05) in oocytes injected with fresh vs frozen spermatozoa. The DPBS treatment allowed higher cleavage proportions than the Percoll treatment (P < .05). Moreover, a boar effect was observed in the percentage of developing blastocysts. None of the studied parameters was affected by the acrosomal or the live or dead status of the spermatozoa injected. In conclusion, the use of fresh semen is recommended for porcine ICSI, as well as careful selection of the boar; Percoll treatment is only recommended for poor-quality samples or for removing toxic agents, and no exogenous form of activation or induction of the acrosome reaction is necessary for porcine oocytes to develop a male pronucleus and cleave up to the 2-cell stage after ICSI, although experimental conditions to reach the blastocyst stage need to be investigated further.     

Computerized sperm motility and application of sperm cryopreservation

An objective method for measuring sperm motion characteristics was developed on an Intellect 100 Quantel Image Analysis System suitable for various image cytometric applications. It provided overall analysis of percent motility (% MS) as well as individual and mean measurements of motion characteristics, including vigor characteristics such as curvilinear velocity (Vc), straight line velocity (Vsl), and trajectory pattern characteristics, that is, progressiveness ratio (PR) and amplitude of lateral head displacement (Alh). Evaluation of the method for reproducibility and accuracy showed reliable measurements of these parameters measured on a minimum of 70 motile sperm, sufficient to describe adequately the sperm population. A study was performed comparing motion characteristics of 30 semen samples falling in a normal range before and after cryopreservation in cryoprotector medium (CM). A mean motility rate of recovery (MRR) of 45% was obtained. Only sperm count and concentration in motile forms among initial semen variables correlated weakly with MRR. Velocity recovery rate (VRR) approached 1 with a marked variability among ejaculates. Distribution profile of Vc was highly modified by freezing in CM: spermatozoa that were initially fast and progressive were the most resistant to cryoaggression. PR and Alh values were little affected by freezing in CM. The tolerance of various samples from a given patient was highly variable for % MS and Alh and less variable for Vc and PR. This illustrates the difficulty in predicting the effect of freezing on motility characteristics and, therefore, of extrapolating from semen variables the ability of frozen-thawed samples to fertilize.     

北京地区精子库自精保存现状分析

目的:综合分析北京地区精子库的自精保存现状,更好利用精子库的资源保存男性生育力。方法:对2006年7月至2016年12月在精子库进行自精保存者的基本资料和精液质量进行回顾性分析。结果:251例自精保存者成功保存,2011～2013年自精保存的平均年增长率为119%。自精保存者以本科和硕士学历为主(n=175,69.72%),年龄以20～39岁人群为主(n=204,81.27%),未育者占88.84%(n=223)。有27.49%(n=69)患者冷冻精液数量少于10支,有10.36%(n=26)患者仅冻存1次。最终冻存后精液使用仅为5.58%(n=14)。保存原因中以患肿瘤原因最多(n=140,55.78%),并以血液肿瘤最多(n=66,22.31%),其次为睾丸肿瘤(n=33,13.15%)和其他肿瘤(n=41,16.33%)。肿瘤患者与非肿瘤患者平均精子浓度(60.53×10~6/ml vs 90.45×10~6/ml)、精子总数(175.8×10~6vs 311.3×10~6)、前向运动精子百分率(43.55%vs 49.21%)和前向运动精子的复苏率(52.17%vs 68.13%)有显著性差异(P0.05)。睾丸肿瘤、血液肿瘤及其他肿瘤平均精子浓度分别为37.68×10~6/ml、57.98×10~6/ml、90.69×10~6/ml,精液体积分别为2.73、2.82、3.41 ml,精子总数分别为93.29×10~6、158.41×10~6、349.49×10~6,前向运动精子百分率分别为45.32%、43.47%、44.49%,前向运动精子百分率的复苏率分别为48.32、50.07%、61.09%,睾丸肿瘤患者的精子浓度和总数显著低于另外两组(P0.05)。结论:北京地区自精保存人数呈现逐年增加的趋势,以肿瘤患者最多;多数肿瘤患者错过了最佳保存时期,应提高患者和医务工作者对自精保存的知晓度。     

Cryopreservation of ram semen facilitates sperm DNA damage: relationship between sperm andrological parameters and the sperm chromatin structure assay

We hypothesized that cryopreservation and incubation in conditions that mimic the female genital tract following insemination increases the susceptibility of ram sperm DNA to denaturation. Ram sperm samples (n = 12) underwent the sperm chromatin structure assay (SCSA) and semen quality tests, including motility parameters, viability, and chlortetracycline fluorescence (CTC) patterns. We also assessed correlations between SCSA variables and semen quality parameters. Analyses were performed for both fresh and cryopreserved samples at 0, 3, and 20 hours of incubation in synthetic oviductal fluid (SOF; 39 degrees C, 5% CO(2)). The SCSA variables, mean alpha t (X alpha(t)) and standard deviation of alpha t (SD alpha(t)), were higher because of cryopreservation (P <.05, P <.001, respectively) after 20 hours in SOF. For both fresh and frozen spermatozoa, SCSA values (X alpha(t), SD alpha(t), and the percentage of cells outside the main population of alpha(t) [%COMP alpha(t)]) increased during incubation in SOF. Motility was negatively correlated with both SD alpha(t) and %COMP alpha(t), ranging from -0.39 (P <.01) to -0.59 (P <.001) for both fresh and cryopreserved semen; viability also was negatively correlated with X alpha(t), SD alpha(t), or %COMP alpha(t) (-0.36; P <.05, -.40 and -.46; P <.01, respectively) in fresh semen. The %COMP alpha(t) was positively correlated to the percentage of CTC pattern AR (P <.001) and negatively correlated to the percentages of patterns F and B (-0.33 to -0.60, P <.05 to P <.001). Variation among ejaculates within ram was observed (P <.01). Cryopreservation clearly facilitates DNA damage in physiological conditions. The low to moderate correlations between SCSA variables and classical semen quality parameters indicate that the SCSA provides additional information to standard tests for evaluating ram sperm quality.     

不同来源精子对卵胞浆内单精子注射治疗结局的影响

目的:分析不同来源精子对卵胞浆内单精子注射(ICSI)临床结局的影响.方法:接受ICSI治疗的不育夫妇共进行了286个周期,分为3组,A组(射出精子组):射出精液少弱畸(包括严重少弱畸)精子症186个周期;B组(PESA组):经皮附睾抽吸术(PESA)80个周期;C组(TESE组):睾丸精子获取术(TESE)20个周期,比较其妊娠结局.结果:PESA组受精率明显高于射出精子组和TESE组(88%VS 84%,77%,P<0.01),PESA组的临床妊娠率显著高于射出精子组(47%,33%,P<0.05),射出精子组临床妊娠率高于TESE组,但差异无统计学意义;3组的种植率差异极显著(20.7%,31.4%,13.2%,P<0.01);卵裂率(99%,98%,98%)、流产率(7%,15%,0%)均没有显著差异.结论:PESA来源精子比射出精子组及TESE组的受精率及临床妊娠率有所增高,但TESE和PESA来源精子对临床妊娠率没有影响,射出精子组和TESE组来源精子对临床妊娠率没有影响.对于重度少弱精子症患者和梗阻性无精子症患者,进行ICSI治疗,均有机会获得妊娠.