输精管吻合术后精子超微结构观察

目的:观察输精管吻合术后精子超微结构的变化。方法:采用光学显微镜、扫描和透射电子显微镜对20例接受输精管吻合术者和10例正常生育男性精子的形态和超微结构改变进行观察、统计、分析。结果:①光镜和扫描电镜分析显示吻合术后精液中正常形态精子显著减低;②两组精子尾畸在光镜下有明显差异,在扫描电镜下无差异;③两组精子头畸在扫描电镜下有显著性差异;④在透射电镜下吻合术后精子多数均属于复合型精子结构异常,大部分均有多个部位和多个细胞器结构异常。结论:吻合术后精子有多种类型和复合型的异常改变,这些改变与不育男子精子的改变相似。提示:输精管结扎术后精子形态学的改变,是使吻合术后生育能力降低的主要原因之一。     

显微镜下纵向套入式输精管附睾管吻合术治疗梗阻性无精子症

目的 探讨显微镜下纵向套入式输精管附睾管吻合术治疗梗阻性无精子症的疗效.方法 利用手术显微镜对27例梗阻性无精子症患者行纵向两针套入式输精管附睾管吻合术,术后3个月起,开始复查精液常规,两次间隔1个月左右,并随访配偶受孕率.结果 术中发现13例(22侧)梗阻部位在附睾尾部或近睾段输精管,11例(19侧)梗阻部位在附睾体部,13例单侧附睾头部梗阻.双侧吻合12例,单侧吻合15例,所有吻合侧输精管近端均通畅.23例患者随访6个月以上,13例患者随访12个月以上;17例(62.96%)术后3～6个月从精液中检出精子,其中4例(14.81%)配偶受孕成功.精子数为(1.5～65.5)×106/L,精子活率为0～66.0%,精子活动力为3.7%～69.0%.结论 显微镜下纵向两针套入式输精管附睾管吻合术,术式简单,是治疗梗阻性无精子症的有效方法.     

输精管复通术后精液质量改变的研究

为了获得有关大群体输精管吻合术后详细精液参数较长期随访结果,作者对过去15年所作输精管复通术男子的精液质量特征进行了研究。 256例作非显微技术输精管吻合术男子于术后2、4、6和12个月取精液标本。精液质量评价包括量、粘滞度、凝集性、精子活力、定性及定量活动力、精子形态,标本生育力评分和抗精子抗体测定。每份标本作低渗评分(hypo-osmolarity scoyes,HOS)以了解精子膜功能和完整性。检测血清抗体,如可能同时检测精浆抗体。生育力评分标准(最高30分):前向精子活动力、总前向活动精子密度以及精子形态学评分为1～10分。评分相加>25为正常。根据>8 500生育对照(输精管切除术前及有生育供者标本)值的95%概率分布曲线     

用免疫珠抗精子抗体试验确定输精管吻合前后患者的免疫学状况

输精管吻合术成功后妊娠率为12～60%,解剖上成功的吻合不一定使男子生育力恢复,对解剖上成功的吻合术后生育力低下的免疫学作用认识正在逐步提高。本文作者运用直接和间接免疫珠抗精子抗体试验对作输精管吻合术男子的免疫学状况进行了前瞻性研究。 55例作吻合术的男子的平均年龄40岁(30～55岁);输精管阻断时间平均10年(1～19年)。手术当天取血,在-120℃下保存与术后3～6个月取血的31例作间接试验;术后至少4个月后,取31例吻合术者的精液作直接试验。另外,对几种关系到输精管吻合能否顺利成功的因素,如有无精子肉芽肿,从输精管结扎术至吻合术时的间隔和管腔液中有无精子也作了评价。     

钢丝支架输精管复通术18例报道

目的探讨在输精管复通术中采用不锈钢丝作支架,直视下吻合输精管的临床效果。方法回顾性总结1995年1月至2012年1月来安陆市计划生育服务站采用不锈钢丝作支架吻合输精管18例的临床资料。结果 18例手术过程顺利,手术时间80~100 min,无并发症发生。术后3个月第一次行精液检查时,15例查到精子,3例未见精子;该3例6个月复查,2例见到精子,1例仍未见到精子。复通成功率94.4%。随访3年,妻子妊娠13例,妊娠率72.2%。除1例无精外,4对未妊娠的夫妇中,丈夫精液检查3例显示精子数量和质量异常,其中2例精子密度20×106/m L,1例畸形精子30%;2例妻子年龄40岁。结论采用钢丝作支架吻合输精管,可提高复通术效果,且简便、易行,在基层可开展。     

非阻塞性输精管滤过装置节育术远期有效性和安全性的临床研究

本文报告125例输精管滤过装置(IVD)节育术远期(5～8年)有效性和安全性的临床研究。结果:随访率93.60％(117/125);节育有效率97.44％,精液中的精子消失率94.02％(110/117),术后5～8年仍有41.88％(49/117)的受术者精液中可测出中性α-糖苷酶活性(即有附睾液通过);受术者的血清抗精子抗体检出率为9.88％,与近期(术后一年的17.95％)比较有下降的趋势;组织学观察显示IVD与组织相容性好,电镜下可见IVD内尼龙线间隙中破损的精子;附睾膨大率和近睾端输精管代偿性增粗率分别为10.26％(12/117)和11.97％(14/117);所有被访者均未见远期并发症。结果表明IVD置入输精管内不仅远期节育效果可靠,IVD与输精管局部组织相容性良好,而且较好地避免或减轻附睾淤积及其所致并发症的发生。     

输精管绝育术后经皮穿刺吸精子IUI辅助授孕技术临床研究

应用经皮穿刺输精管吸精子(PVSA)及经皮穿刺附睾吸精子(PESA)宫腔内人工授精(IUI)技术,治疗男性绝育术后要求复育或复通复育失败者共28例。其中PVSA 16例,IUI 16个月经周期,6例妊娠,周期妊娠率37.5％;其余12例由于吻合术后输精管与周围组织粘连严重采用PESA,4例从附睾尾吸出精子,IUI后1例妊娠并足月出生一健康男婴;8例从附睾头吸出活精子,IUI 10个月经周期,1例妊娠,现已4个月。结论认为,附睾头部精子进入女性生殖道内具有自然受精能力;PESA或PVSA结合IUI治疗男性绝育术后要求复育者安全、经济、有效,其辅助授孕技术为男性绝育术后复育提供了新的途径。     

亚甲蓝液在疑似梗阻性无精子症探查术中的应用

<正>阴囊探查术是梗阻性无精子症的重要诊疗手段[1],亚甲蓝液的应用减少了探查的盲目性,为快速、准确找到梗阻位置提供了条件。2009年1月～2011年12月,本所对18例疑似梗阻性无精子症患者应用亚甲蓝进行阴囊探查,本文对其效果进行探讨。1对象与方法1.1临床资料18例平均年龄32(25～45)岁。其中13例曾行双侧输精管结扎术;1例为输精管吻合术后1年;4例因原发性不育就诊且无其他特殊病史。13例行双侧输精管结扎术距今平均时间为11(4～20)年,     

显微器械在直视下输精管吻合术中的应用(附132例报告)

目的 探讨显微器械在直视下输精管吻合术中的临床应用.方法 回顾性分析2001年8月～2006年8月,采用显微外科技术,选择显微器械,在直视下施行输精管吻合术132例患者的临床资料.结果 术后132例患者均得到随访,随访率100%.复通效果以射出精液中出现活精子作为依据者有128例,复通率达97.0%(128/132),以配偶妊娠作为判断标准者有81例,且配偶已获妊娠,妊娠率达81.0%(81/100).结论 采用显微器械进行直视下输精管吻合手术,可得到良好的吻合,复通率高,操作简单,费用低,可在基层医院推广应用.     

892例输精管吻合术后之短暂生育能力

1978年,Marshall曾报告过输精管吻合术后之短暂生育力。为了回答对输精管吻合术及术后何时能受孕的询问,作者等人调查了此种吻合术后之生育率,并就此进行了讨论。方法:调查对象均为作者等人采用显微外科技术,亲自吻合的病例。采用输精管粘膜一肌层吻合者(二层吻合)435例,全层吻合455例,一侧作全层吻合而对侧作二层吻合1例,记录遗失不明者1例。除个别人因一侧睾丸萎缩仅做对侧吻合外,其它人均做了两侧输精管吻合术。要求患者于术后一年内,每3～4个月做一次精液分析。在精液分析中,判定生育力的原始参数为精子密度,即每毫升不低于1千5百万(15×10~6/ml)。哪怕术后精子密度只有一次达到这个最低值,也判该例已具有生     

Restoration of fertility in vasectomized men using percutaneous vasal or epididymal sperm aspiration

OBJECTIVE: To restore fertility of vasectomized men using percutaneous epididymal sperm aspiration (PESA) and percutaneous vasal sperm aspiration (PVSA) via intrauterine insemination (IUI). PATIENTS: Twenty-eight vasectomized men who required restoration of their fertility with PESA, PVSA and IUI. RESULTS: Of 28 vasectomy reversal subjects, 16 cycles of IUI using vasal sperm by percutaneous aspiration were performed in 16 subjects and 6 pregnancies were achieved. IUIs with epididymal sperm by percutaneous aspiration were carried out in 12 subjects with epididymal obstruction due to vasovasostomy for vasectomy reversal, and 2 pregnancies were achieved using caudal and epididymal sperm by percutaneous aspiration, respectively. CONCLUSION: The PESA-IUI and PVSA-IUI techniques are attractive, economical and effective for vasectomy reversal. The pregnancy by IUI using PESA and PVSA reveals that the caput epididymal sperm possess fertilization capacity in female reproductive tract and provides a new approach for the restorative fertility of vasectomized men.     

Quantitative Evaluation of the Human Spermatozoal Motility and Acrosome Reaction in Infertile Ollgozoospermic and Fertile Euspermic Men

Idiopathic oligozoospermia is one of the most important problems in Andrology, but up to now it is poorly understood because the often routine conventional semen parameters, unquestionably are not directly related to the evaluation of the morphological and functional integrity that determines the spermatozoan fertilizing capacity. A non complex strategy was designed to determine the presence of alterations in the functional integrity of the spermatozoa from infertile men with idiopathic oligozoospermia and from euspermic fertile men, by the quantitative analysis of the spermatozoan motility and the acrosome reaction. There was a lower percentage of acrosome reacted spermatozoa within the semen of the infertile men, accompanied with a significant decrease in the motility percentage, sperm velocity and motility index in comparison with semen from fertile men. These data strongly support a possible detrimental structural and functional integrity of the spermatozoa from the oligozoospermic men.     

精浆生物大分子氧化损伤与精液参数的相关性研究

目的:探讨精浆中生物大分子氧化损伤与精液参数的相关性。方法:收集96名因不孕不育就诊的男性为研究对象,经过培训的调查员使用结构式调查表对就诊男性进行面对面询问调查。手淫法采集精液样本,用计算机辅助精子分析系统进行精液常规分析。采用酶联免疫吸附试验检测精浆中的羰基衍生物(PC)浓度及8-异前列腺素F2α(8-iso-PGF2α)浓度以反映蛋白质氧化损伤及脂质氧化损伤。根据精子浓度、前向运动精子率和畸形精子率是否正常,将研究对象分为正常组和异常组,研究精液常规指标与氧化损伤指标的关系。结果:异常组8-iso-PGF2α水平高于正常组(P0.05),PC水平差异两组间无统计学意义(P0.05)。前向运动精子率及畸形精子率正常组和异常组间8-iso-PGF2α和PC水平差异均无统计学意义。Pearson相关分析显示,8-iso-PGF2α与精子浓度负相关(r=-0.254,P=0.018),与其他精液参数无统计学相关性;PC水平与各精液参数无统计学相关性。多重线性回归分析显示,8-iso-PGF2α水平每增加1ng/ml,精子浓度平均减少7×10~4/ml。结论:精子浓度低可能与脂质氧化损伤有关。     

男性不育患者精浆锌含量与精液主要参数相关性研究

目的:探讨不育男性精浆的锌含量与精液质量的关系。方法:回顾性分析2011年8月～2012年1月在广西壮族自治区妇幼保健院生殖中心就诊的343例男性不育患者的相关资料,依据精浆锌含量分为正常A组(n=274例)和异常B组(n=69例),比较两组间精液参数的差异;同时根据精液黏稠度分为黏稠C组(n=54例)与非黏稠D组(n=289例),比较两组间精浆锌含量及其他精液参数的差异。结果:A组与B组患者年龄比较差异无统计学意义(P>0.05)。A组的精液量、每次射精精子总数、前向运动精子总数显著高于B组,而黏稠精液的比例明显低于B组,差异均有统计学意义(P<0.05)。其他精液各指标比较差异无统计学意义(P>0.05);C组与D组精液圆细胞浓度、精液量、精子浓度、精子总数比较差异无统计学意义(P>0.05);D组的前向运动精子百分率、前向运动精子总数、活动率、精浆锌明显高于C组,差异有统计学意义(P<0.05)。精浆锌含量与精液量、每次射精精子总数、前向运动精子总数显著正相关,与其他参数无显著相关性。结论:精浆锌含量直接影响精液量、精子总数、前向运动精子总数和精液黏稠度,精浆锌含量是男性生殖力的重要评估指标。     

MEMBRANE STATUS AND IN VITRO CAPACITATION OF PORCINE SPERM PRESERVED IN LONG-TERM EXTENDER AT 16°C

Preservation of porcine semen in long-term extenders at 15-18°C for more than 5 days results in decreased farrowing rates and reduced litter size after artificial insemination, despite the high progressive motility rates of sperm. To improve this preservation system it is necessary to understand sperm physiology under storage conditions. The purpose of this study was to determine the effect of storing diluted porcine semen (during 0, 2, 4, 6, and 8 days) on the sperm membranes status and the ability of sperm to respond to in vitro capacitation treatment. Ten semen samples from 5 adult boars were analyzed. Two aliquots were obtained from the sperm-rich fraction: one was used to assess fresh semen and the other was diluted in Reading extender and stored at 16°C. Both semen samples were stained with chlortetracycline to assess the status of sperm membranes and with Hoechst 33258 to determine viability. Semen storage for 4-8 days increased the proportion of prematurely capacitated sperm. After 4 days of storage, in vitro capacitation treatment did not increase the percentage of capacitated sperm, but increased the percentage of acrosome reacted sperm. This phenomenon could explain the reduced fertilizing ability of porcine semen stored at 16°C for over 4 days, in spite of the acceptable sperm viability and progressive motility.     

PYRIFORM HEAD: A FREQUENT BUT LITTLE-STUDIED MORPHOLOGICAL ABNORMALITY OF SPERM

This study was conducted to investigate the frequency of sperm with a pyriform head in semen samples, to determine the percentage of the occurrence of this abnormal sperm form, and to assess its possible correlation with other semen parameters. The study was designed as a retrospective data analysis in the setting of an andrology laboratory at a tertiary-care academic hospital. Semen quality data were analyzed from 114 subfertile men and 60 fertile men. The Student's t test, the Mann-Whitney nonparametric test, and the Pearson correlation coefficient were used for statistical analysis. Sperm with a pyriform head were present in the semen samples of 98% of the subfertile men and 100% of the fertile men; the percentage of this abnormal sperm form was 22 &#45 14.9% in subfertile and 13% &#45 7.8 in fertile men ( p <.001); 16% of the subfertile men presented a higher percentage of these abnormal sperm than the normal upper limit. In some subfertile men with a high percentage of sperm with a pyriform head, their subfertility could be attributed to the cause that produces this morphological abnormality. Moreover, morphological abnormalities in the neck and the tail, as also a cytoplasmic droplet, are significantly more frequent in sperm with a pyriform head than in sperm with a normal head.     

Improvement in human semen quality after oral supplementation of vitamin C

This study was carried out to monitor the effect of oral supplementation of vitamin C on various semen parameters in oligospermic, infertile, otherwise healthy individuals. Various semen parameters, including sperm motility, sperm count, and sperm morphology, were studied before and after the vitamin C treatment. A total of 13 infertile patients were included. Their ages ranged between 25 and 35 years. They had no genital infection or varicocele. Physical examination and other routine laboratory investigations were normal. General semen analysis revealed oligozoospermia (mean sperm count was 14.3 +/- 7.38 x 10(6) sperms/mL, mean sperm with normal morphology was 43 +/- 7.87%, and mean sperm motility was 31.2 +/- 9.61%). Testicular biopsy was not done. These patients received in an open trial of 1,000 mg of vitamin C twice daily for a maximum of 2 months. Results showed that the mean sperm count was increased to 32.8 +/- 10.3 x 10(6) sperms/mL (P < .001) after 2 months of vitamin C intake. The mean sperm motility was increased significantly to 60.1 +/- 8.47% (P < .001), and mean sperms with normal morphology increased significantly to 66.7 +/- 4.77% (P < .001). This study showed that vitamin C supplementation in infertile men might improve sperm count, sperm motility, and sperm morphology and might have a place as an additional supplement to improve the semen quality towards conception.     

A comprehensive review of the sequelae of male sterilization

This study of the sequelae of vasectomy considers morphological and immunological changes, epidemiological studies, reversibility, and psychological aspects. The data on morphological changes after vasectomy are diverse and contradictory, as a wide range of experimental animals have been studied. The number of studies on men has been limited, but they suggest little histologic change in testicular morphology or spermatogenesis. Hormonal changes after vasectomy are difficult to assess because of the large fluctuations in semen levels of testosterone and gonadotropins. Most of the studies on this topic have been small and have lacked controls, with comparisons consisting of pre-post differences in the same subject group. The only prospective controlled study found no differences between vasectomized and control subjects on any of the hormones investigated. 2 large-scale studies have also produced conflicting results; 1 found no changes in hormone levels, and the other found that only follicle stimulating hormone levels did not change. It is apparent from the studies that any hormonal fluctuations after vasectomy remain within the normal range, and it has not been demonstrated that testicular endocrine function or the relationship of the pituitary to the testis are in any way adversely affected by vasectomy. It has been shown that after vasectomy 50-60% of men develop sperm agglutizating antibodies while 20-30% develop sperm immobilizing antibodies. The implications are 1) that if some of the antibodies are nonspecific or cross-reacting, the incidence of autoimmune disease may be increased in vasectomized men; and 2) the persistence of sperm antibodies may cause failure of reversal attempts despite anatomical patency. Studies of the incidence of atherosclerosis in vasectomized monkeys showed that they developed antisperm antibodies and much more extensive atherosclerosis than controls, causing concern because of the phylogenic closeness of monkeys to man. Epidemiologic studies as yet furnish insufficient evidence to extrapolate findings on postvasectomy atherosclerotic lesions in monkeys to man. There is no clinical evidence after several large studies to show that vasectomy is harmful to the circulatory system in man, but surveillance of men who have undergone vasectomy is indicated. Pregnancy rates after reversal attempts are not as high as success rates in terms of canalization and sperm appearance in the ejaculate, but it is not yet known what causes the difference. No adverse psychological effects of vasectomy have been demonstrated in developed countries, and the high incidence of regret and other psychological effects in developing countries may be due to a lack of truly voluntary consent.     

精液叶酸、维生素B_(12)、活性氧水平与精子质量关系研究

目的 :　检测人精液叶酸、维生素 B12 ( VB12 ) ,及活性氧 ( ROS)的含量 ,探讨三者与精子质量的关系。方法 :　收集经证实配偶已怀孕的新加坡籍健康成年男性 1 76名的精液 ,根据WHO推荐方法检测精子质量各项指标 ,并测定精液叶酸和 VB12 含量及 ROS水平。结果 :　平均精液量、精子浓度和其活力都在正常范围内。而精子存活率 ( 73.0 6% )略低于 WHO标准 (≥ 75% ) ,形态异常的精子 ( 77.0 6% )高于 WHO标准 ( 70 % )。精液的叶酸含量与 ROS水平呈显著负相关 ( r=- 0 .2 5,P=0 .0 0 3) ;VB12 与 ROS呈负相关 ( r=- 0 .2 5,P=0 .0 0 2 ) ,与精子形态异常也呈负相关( r=- 0 .1 5,P=0 .0 4 8) ,但与精子浓度呈正相关 ( r=0 .31 ,P<0 .0 0 1 )。ROS与精子形态异常呈正相关 ( r=0 .2 5,P=0 .0 0 2 ) ,与精子活力也呈正相关 ( r=0 .1 9,P=0 .0 1 9)。结论 :　 VB12 对精子生成和维持精子正常功能是必需的 ,ROS水平与精子功能缺陷有关 ,VB12 和叶酸可能通过降低 ROS以维持精子的正常功能。