经皮附睾精子抽吸术睾丸活检55例分析

目前,无精子症获取精子用于单精子卵细胞胞质内注射(ICSI)的方法主要有以下几种:显微外科附睾精子抽吸术(MESA)、经皮附睾精子抽吸术(PESA)和睾丸细针空刺抽吸术(TFNA).     

梗阻性无精子症患者附睾精子染色体非整倍体和二倍体率均增高

单精子卵胞浆内注射已用来治疗严重的男性不育患者,对于梗阻性无精子症患者可以用附睾和睾丸的精子。为了评估梗阻性无精子症患者睾丸、附睾中非整倍体和二倍体精子率以及其对单精子注射结果的影响,作者对24例梗阻性无精子男性和24     

冻融附睾精子卵浆内显微注射治疗阻塞性无精子症不育二例

附睾取精结合卵浆内单精子注射（ＩＣＳＩ）治疗无精子症不育［１］时,若将ＩＣＳＩ后多余的附睾精子冷冻保存,当患者助孕治疗失败需要再次治疗时,可用冻融附睾精子进行ＩＣＳＩ,避免再次附睾手术。作者用冻融附睾精子ＩＣＳＩ治疗２对阻塞性无精子症的不育夫妇获得妊...     

精氨酸锌作为一种化学绝育剂的研究

本研究采用精氨酸锌及生理盐水,分别经80只正常性成熟Winstar大鼠的附睾尾注射0.1m1,观察48小时、1周、2周,3周及4周以后火鼠睾丸、附睾、输精管、前列腺的病变,结果显示经上述两种物质注射1周以后,睾丸均出现生精功能低下,间质细胞无异常,其精氨酸锌注射两周后,附睾尾管腔内即达到完全无精子,而生理盐水注射后仅导致附睾尾精子数量及活力大大降低,但始终不能达到完全无精子。此结果提示:精氨酸锌附睾尾注射可能成为一种新的男性绝育方法,值得进一步研究。     

经皮附睾精子抽吸术和睾丸精子获取术在无精子症诊断和治疗中的应用

目的 :研究附睾和睾丸精子抽吸术对无精子症患者的诊断和治疗价值。　方法 :应用经皮附睾精子抽吸术(PESA)和睾丸精子获取术 (TESE)两种方法对 385例无精子症患者进行穿刺检查。　结果 :其中 6 4例附睾中存在精子 (1 6 .6 2 %) ;4 5例患者睾丸中存在精子 (1 1 .6 9%) ;对其中 6 4例睾丸或附睾中发现精子的患者采取PESA或TESE取精后行卵细胞胞质内单精子注射 (ICSI)治疗。胚胎移植后妊娠率为 39.0 7%。　结论 :PESA和TESE为部分无精子症患者提供了生育的机会 ,也是针对无精子症的有效的治疗手段。     

无精子症患者的精子获取方法

随着辅助生育技术的极大进展,卵泡浆内精子显微注射已成为当今治疗男性不育中无精子症的首要方法。从附睾或睾丸获取精子是这一技术中的首要步骤。本文概述了目前常用的几种精子获取方法及其临床应用现状。     

附睾和睾丸精子活力对卵胞浆内单精子注射结局的影响

目的比较附睾或睾丸来源及其不同活力精子行卵胞浆内单精子注射（ICSI）的结局。方法回顾性分析2005年1月至2008年5月在本生殖中心经皮附睾精子抽吸术（PESA）、睾丸精子抽吸术（TESA）助孕的218例无精子症患者的资料,比较附睾和睾丸及其不同活力精子的正常受精率、卵裂率、优质胚胎率、临床妊娠率、种植率和早期流产率。结果附睾精子组与睾丸精子组比较,正常受精率、卵裂率、临床妊娠率、种植率和早期流产率无显著性差异（P〉0．05）;优质胚胎率附睾精子组显著高于睾丸精子组（P〈0．05）。附睾活动精子、睾丸活动精子和睾丸不活动精子的正常受精率显著高于附睾不活动精子（P〈0．01）;睾丸活动精子的正常受精率显著高于睾丸不活动精子组（P〈0．05）;以上各组间的优质胚胎率、临床妊娠率、种植率、流产率均无显著性差异（P〉0．05）。结论PESA操作简单且不影响妊娠率,无精子症患者行ICSI治疗时可首选附睾精子;附睾或睾丸不活动精子影响ICSI的受精率,应优先选择活力较好的精子,若无活动精子则选择睾丸不活动精子。     

反复附睾或睾丸取精的无精子症病人妊娠结局

目的 :分析反复附睾或睾丸取精进行卵胞质内单精子注射治疗的妊娠结局。　方法 :收集 2 0 0 1年 1月～2 0 0 2年 12月进行 2周期以上附睾或睾丸取精进行卵胞质内单精子注射治疗的无精子症病人 31例 (共 4 3个周期 ) ,对取精情况及受精、种植和妊娠结局进行总结。　结果 :2 4例病人顺利从附睾取精 ,7例病人从睾丸取精 ,无 1例出现感染、血肿或局部的功能障碍。与第 1周期附睾或睾丸取精 15 4例 (共 15 4个周期 )的受精率、种植率和临床妊娠率比较 ,结果分别是 78.39%与 73.6 4 % ,19.6 8%与 18.38%和 34.88%与 37.91% ,差异无显著性 (P >0 .0 5 )。　结论 :无精子症病人进行反复附睾或睾丸取精 ,是安全和可耐受的 ,其妊娠结局与第 1周期比较无统计学差异。     

经皮穿刺附睾吸精子宫腔内人工授精妊娠成功

目前 ,经皮穿刺附睾吸精子 ( PESA)术正在逐步取代显微外科附睾吸取精子术 ,而PESA大多与卵胞浆内单精子注射 ( ICSI)或输卵管内配子移植 ( GIFT)结合 ,然而 ICSI及GIFT费用昂贵。现将近年我们应用 PESA结合宫腔内人工受精 ( IUI)治疗的 90例阻塞性无精子症不育患者的临床结果报告如下。一、材料及方法1 .临床资料 :1 996年 1月至 2 0 0 1年 6月就诊的无精子症患者 90例 ,年龄 2 5～ 3 8( 3 0 .3± 3 .2 )岁 ,不育年限平均 ( 5.4± 2 .6 )年。男科检查包括男性第二性征、阴茎、阴囊、输精管及睾丸大小等 ;Prader法测量睾丸体积…     

146例炎症梗阻性无精子症的临床评估和ICSI治疗结局分析

目的分析炎症梗阻性无精子症的临床评估和单精子卵胞浆内注射(ICSI)的治疗结局。方法前瞻性研究近5年间接受ICSI治疗的炎症性梗阻性无精子症的临床特征、精液和超声特点,经皮附睾穿刺精子抽吸术(PESA)或经皮睾丸穿刺取精术(TEFNA)结合ICSI治疗后观察受精、临床妊娠等结果。结果146例患者体检附睾均有增粗变硬或伴头尾部结节。82例患者曾有生育史、附睾炎症史或输精管附睾吻合手术史,其中72例PESA找到附睾精子;53例无上述病史者49例PESA找到附睾精子:另有精道远端梗阻11例。ICSI治疗146例167周期炎症性梗阻性无精子症的受精率、每周期临床妊娠率分别为81.1%和42.1%。结论炎症梗阻性无精子症具备典型的临床和超声特征,PESA附睾精子获取率高,ICSI治疗获得较高受精率和临床妊娠率。     

Role of the epididymis in sperm competition

Although it is generally understood that the testes recruited kidney ducts for reproductive function during the evolution of vertebrates, little is understood of the biological significance of the adaptation. In the context of the evolution of the mammalian epididymis, this report provides evidence that a major role of the epididymis is to enhance a male＇s chance of achieving paternity in a competitive mating system. A unique example of sperm cooperation in monotremes is used as evidence that the epididymis produces sperm competition proteins to form groups of 100 sperm into bundles that have a forward motility nearly thrice that of individual spermatozoa. As it required 3-h incubation in vitro under capacitation conditions to release motile sperm from the bundles, it is suggested that the monotremes provide an example of capacitation that is quite different from capacitation in higher mammals. It is suggested that variation between species in the intensity of sperm competition could explain the variation that occurs between species in the amount of post-testicular sperm maturation and storage in the epididymis, an explanation of why the human epididymis does not play as important a role in reproduction as the epididymis of most mammals. （Asian J Androl 2007 July; 9： 493-499）     

Annexin5对雄性SD大鼠生殖相关指标和睾酮分泌的影响

目的 探讨膜联蚩白5(annexin5)对雄性SD大鼠体重、睾丸系数、附睾系数、精子相对计数和睾酮水平的影响.方法 给雄性SD大鼠腹腔注射3个不同剂量(7.5μg/kg、15μg/kg、30μg/kg)的annexin5,对照组腹腔汴射等晕的pH 8.0 Tris-HCI,1次/d,连续20d.分别称重对照组和实验组SD大鼠体重、睾丸、附睾,并对附睾尾进行精子计数.HE染色观察睾丸组织结构.运用化学发光法检测对照组和各实验组SD大鼠血清中睾酮浓度.结果 与对照组相比,15 μg/kg实验组大鼠附睾系数与精子相对计数均显著提高,分别提高了12.5%(131.8±9.6vs 117.2±5.9)(P<0.01)和31.4%(36.8±5.6vs 31.7±5.3)(P<0.05);其它剂量组与对照纰相比差异均无统计学意义(P>0.05).HE染色显示各剂量实验组与对照组相比,睾丸的形态结构没有发牛明显改变.7.5 μg/kg组和15 μg/kg组大鼠血清睾酮含量显著高十对照组,分别提高了35.5%(36.33±3.89vs26.82±3.75)(P<0.01)和82.8%(49.04±5.17vs26.82±3.75)(P<0.01),30 μg/kg组大鼠睾酮含量虽也有升高,但与对照组比较,结果无统计学意义(P>0.05).结论 腹腔注射annexin5能影响大鼠睾丸生精、附睾功能及睾酮水平,并与剂量有关.     

有机阳离子转运子2在人类附睾中的表达及其意义

目的:研究人类附睾有机阳离子转运子2(OCTN2)mRNA的表达,探讨附睾肉碱转运机制,为探索男性避孕节育新技术提供理论依据。方法:应用RT-PCR方法检测人类附睾头、体、尾组织中OCTN2 mRNA的表达。结果:人类附睾头、体、尾组织中都存在OCTN2 mRNA表达。结论:人类附睾可能依赖OCTN2转运肉碱进入附睾管,为精子提供能量,促进精子成熟。对人类附睾OCTN2的进一步研究,将成为男性节育研究中新的分子靶标。     

Serum reproductive hormone levels and sperm production in male adult rats after treatment with arresting, a fraction obtained from seminiferous tubules conditioned medium

This study used seminiferous tubule (ST) segments from adult rats to condition culture medium that had been concentrated, size fractioned and administered 10-84 days to adult rats by subcutaneous or intratesticular injection and the effects on testes weight, testosterone, luteinizing hormone (LH) and FSH levels and (homogenization-resistant) epididymal sperm count were determined. The conditioned medium obtained 2 days after culture of ST was fractionated in a 30-100 kDa component. The fraction was injected subcutaneously or intratesticularly. This factor(s), named arresting, decreases sperm count in the epididymis from 13 days to 84 days of treatment without changes in serum LH or testosterone levels. The results of the present study suggest that arresting acts on spermiogenesis/spermiation and/or the entry of sperm into the epididymis from the efferent ductules.     

附睾相关的抗生育研究及进展

虽然至今尚没有一种直接作用于附睾并可供临床试验用的男性避孕药 ,但对附睾功能和精子在附睾成熟的研究表明 ,附睾极有可能成为男性抗生育最理想的靶器官。相关的动物试验包括直接作用于附睾精子如磺胺水杨嗪类、影响能量代谢与精子活动的氯化甘油和氯化糖苷类化合物、影响附睾环境如雷公藤单体和铜粉等。对附睾特异蛋白研究 ,可望发现免疫学途径的靶抗原 ,用于制备避孕疫苗。近年国内外对附睾特异表达基因的研究取得某些进展 ,如SC342、bin1基因的克隆和功能研究 ,有助于临床附睾炎和不育症的诊治 ,同时有望成为干扰附睾精子成熟达到避孕目的的新靶点。     

Objective evaluation of the morphology of human epididymal sperm heads

Spermatozoa were obtained from nine epididymal regions of six epididymides taken from five men undergoing castration for prostatic carcinoma (53-76 years) and from one man with testicular cancer (38 years). Spermatozoa were obtained by mincing tissue in phosphate-buffered saline, making air dried smears and staining with Hemacolor. The percentage of sperm heads categorised subjectively as normal (of uniform shape) or otherwise was calculated for each region. This confirmed that grossly swollen sperm heads (previously shown to be artefacts) were only present in proximal regions of the duct. A computer-aided sperm morphology analyser (Sperm Class Analyzer(R)) was used to provide objective measurements of sperm head area, perimeter, length and width of the uniform sperm heads and revealed that there was a gradual and statistically significant decline in sperm head size upon maturation, as occurs in other species. There was no significant difference between the morphometric parameters of spermatozoa obtained from the distal cauda epididymis and those obtained from the ejaculates of young normozoospermic patients.     

The maturation of sperm motility in the epididymis and vas deferens of the vervet monkey, Cercopithecus aethiops

Among the diverse facets of sperm maturation, changes in motility are conspicuous and hence studies of sperm kinematics might provide good indices for sperm maturation. Accordingly, the maturation of sperm motility in the epididymis and vas deferens of the vervet monkey, Cercopithecus aethiops, was assessed using a computer-aided sperm motility analysis system. The results revealed clear trends in the development of both sperm motility per se and in the movement characteristics of motile spermatozoa from different regions of the epididymis, the vas deferens and the ejaculate, reflecting maturational changes associated with the attainment of functional motility and fertility. Motion of spermatozoa from the caput epididymis was sluggish and irregular. As the spermatozoa moved through the corpus epididymis, motility increased sharply, and continued to improve through the cauda epididymis and vas deferens. Despite the high proportion of motile cells, full maturation of motion capabilities was not completed in spermatozoa from the corpus epididymis. Only once spermatozoa had reached the cauda epididymis and vas deferens did they attain their full vigour, and swam rapidly (greater VCL, VSL and VAP) with straightline trajectories (greater LIN, WOB and STR; lower ALH, MAD and CURV). After acquiring their maximal percentage motility and progressive velocity in the cauda epididymis and vas deferens, a slight decline in motility and vigour occurred in ejaculated spermatozoa, and was possibly associated with the ageing of stored spermatozoa. The results from this investigation have revealed clear trends in the maturation of the motility of vervet monkey spermatozoa during their transit through the epididymis and vas deferens and final emergence in the ejaculate, and have provided crucial baseline information on the reproductive physiology of this potentially valuable biomedical model to serve as a reference for future studies in reproductive toxicology.     

Sperm membrane modulation by Sapindus mukorossi during sperm maturation

Aim: To observe the alterations in the biochemical and biophysical changes in the sperm membrane during sperm maturation in male rats treated with the water extract of the fruit pericarp of S. mukorossi. Methods: Adult male Sprague-Dawley rats were gavaged the aqueous extract of the fruit pericarp of S. mukorossi at a dose of 50 mg/kg/d for 45 days. On day 46, the sperm parameters were observed in different sections of the epididymis and the sperm superoxide dismutase and the lipid peroxidation was determined and compared with the controls. The testis and epididymis were routinely prepared for histological examination under the light microscope. Results: No significant differences in the sperm number and morphology were observed between the control and treated groups. However, a significant inhibition (P<0.05-0.01) of sperm motility in the caput, corpus and cauda regions of the epididymis was seen in the treated group. No significant histopathological changes were found in the testis and epididymis. The