精液白细胞对精子质量及IVF受精率的影响

目的探讨精液中白细胞对精子质量以及对常规体外受精率的影响。方法分析35例门诊白细胞精子症患者及对照组的精子密度、活力、前向运动精子比例及精子畸形率。分析28例常规体外受精(IVF)白细胞精子症及其对照组的受精率。结果白细胞精子症患者精子密度、活力、前向运动精子比例均低于对照组,精子畸形率高于对照组,IVF受精率低于对照组。结论精液白细胞是可能造成精子质量下降,IVF受精率降低的原因之一,纠正白细胞精子症对于治疗男性不育,提高IVF受精率有重要意义。     

精液白细胞对精子功能的影响

白细胞精子症是男性不育的常见病因之一,但该病患者精液白细胞影响精子功能的具有机制目前尚不完全清楚,我室曾报道白细胞介素8(IL-8)和过氧化脂质对精子功能的影响¨卫],现测定精液白细胞(WBC)总数、T细胞亚群、一氧化氮(NO)和抗精子抗体(AsAb)等各项指标在白细胞精子症患者精液中的水平变化,旨在探讨白细胞对精子功能的影响机制,总结如下.     

白细胞精子症不育相关问题探讨

<正>在男性精液中,除精子外还包括生精细胞、白细胞和生殖道上皮细胞等非精子细胞。正常精液中白细胞数不应超过1×10~6/mL,否则可诊断为白细胞精子症。近年许多文献对该病的诊断、机理及治疗都有不同的报道。本文就白细胞精子症男性不育相关问题做一探讨。一、白细胞精子症的诊断标准是否应该重新修订世界卫生组织(WHO)对白细胞精子症的诊断标     

甘肃地区6325例不育男性精液分析

目的研究甘肃地区不育男性患者的精液质量状况。方法采用计算机辅助精液分析技术,参照《人类精液及精子-宫颈粘液相互作用实验室检验手册》5版标准,回顾性分析2009年7月至2014年10月来我院就诊的6325例男性不育患者的精液进行分析。结果 6325份精液标本中,精液量(2.96±1.27)ml, pH值(7.44±0.33),精子浓度(75.01±65.58)×106/m L,精子活力(63.06±27.19)%,前向运动(PR)精子百分率为(46.14±23.07)%。参数正常的精液标本有3971份,约占62.78%;参数异常的精液标本有2354份,约占37.22%。结论甘肃地区男性不育患者精液参数异常主要表现为弱精子症、少精子症和畸精子症,对不育男性进行精液分析,可以为男性不育的病因诊断和治疗提供有力的参考。     

精液离心沉淀分析在无精子症诊断中的应用

世界范围内不育症的发病率高达10％-15％，与男性相关的因素约占50％，其中又有10％的男性不育为无精子症。精液质量分析是诊断和治疗男性不育症的重要依据，而目前临床对无精子症与少精子症的治疗方法多采用辅助生殖技术。因此，无精子症患者精液中是否存在精子不仅决定无精子症诊断成立与否，也关系到患者在采用辅助生殖技术治疗时如何获取精子。在临床工作中常遇到很多医疗单位仅凭常规镜检时未发现精子即作出无精子症的诊断。为此，本研究对经外院检查为无精子而来我院男性不育科就诊的301例患者精液进行离心涂片复检，现将检测结果报告如下。     

精液白细胞含量变化对精子顶体酶活性的影响

目的观察精液白细胞含量变化对精子顶体酶活性的影响。方法在抗炎治疗前后采用正甲苯胺蓝过氧化物酶法对精液中白细胞进行定量测定,并与精子顶体酶活性进行相关性分析。结果383例男性不育就诊者中有106例精液白细胞＞1×10~6个/ml,其精子项体酶活性(12.81±9.23)μIU/10~6精子；经抗炎治疗后75例精液白细胞≤1×10~6个/ml,设为有效组,其精子顶体酶活性(20.65±10.05)μIU/10~6精子,余31例精液白细胞＞1×10~6个/ml,设为无效组,其精子顶体酶活性(13.26±9.81)μIU/10~6精子。治疗后两组精子顶体酶活性有显著性差异(P＜0.01)。结论精液白细胞含量变化可影响精子顶体酶活性,精液白细胞症经抗炎治疗改善后可提高精子顶体酶活性。     

不育患者精子DNA损伤和精液常规参数关系分析

目的探讨男性不育患者的精子DNA碎片率(DFI)与精液参数间相关性及精子DFI评价男性生育力方面的应用价值。方法精液标本均取自不育患者,以WHO精液分析标准行精液检测,根据结果分为精液参数正常组、弱精子症组、少精子症组、少弱精子症组。用染色质扩散实验法(SCD)检测精子DFI。结果精液参数正常组与参数异常组(包括弱精子症组、少精子症组和少弱精子症组)间的DFI有明显的差异(P0.05),不育组间DFI也存在差异(P0.01)。DFI与精子活动率、前向运动精子率存在明显的负相关性(r=-0.575,r=-0.547,P0.01),与精子浓度之间无相关性(r=-0.049,P0.05);精子DFI评价精液参数的ROC曲线下面积(AUC)达0.693,其阈值为19.5%(特异性:89.3%,敏感性:41.8%)。结论随着男性精液质量的下降,精子DFI明显升高,提示精子DNA损伤可能是引起男性不育的重要原因之一。精子DFI19.5%时,精液质量参数有进一步降低的趋势和风险。精子DFI的检测对评估男性生育能力有重要的临床意义。     

西藏拉萨地区育龄男性精子浓度分析

<正>男性不育症是关系人类生殖的重要问题之一,足够数量的精子是生育的必要条件,在引起男性不育的诸多原因中少精子症是一种严重的精液异常。根据世界卫生组织(WHO)2010版《人类精液检查与处理实验室手册》[1],对少精子症给出了明确的判定标准,即液化精液中精子浓度低于15×106/ml。少精子症的发生可能与多种因素有关,如精子营养缺乏、生殖系统感染、中毒、药物滥用以及极端自然环     

生精片加五子衍宗丸改善精液质量和睾酮水平的研究

男性不育症是临床上常见的男性生殖系统疾病,据WHO调查,15%的育龄夫妇存在不育问题,我国育龄夫妇发生率为12.5%[1],男性不育症占不孕夫妇的40%～50%,多为精液异常所致.随着生活方式的改变和环境的日益恶化,男性精子质量逐渐下降,由男性精液质量异常导致的不育症发生率逐渐升高.在男性不育症患者中,少、弱精子症占有相当大的比例[2,3].本临床研究采用口服生精片加五子衍宗丸与单用其中一种药物治疗患有少、弱精子症的不育症患者150例,比较3种方案的疗效.     

男性精液中阴道加德纳菌感染对精液质量参数影响的初步探讨

目的 探讨男性精液中阴道加德纳菌(Gardnerella vaginalis,Gv)感染对男性精液质量的影响,探索男性不育症的病因.方法 收集217例男性精液标本,应用巢式聚合酶链反应(nPCR)技术进行Gv检测,同时行精液常规分析检测、抗精子抗体(混合抗球蛋白反应,MAR法)检测.结果 217例标本中,17例检测到Gv阳性(7.8％),Gv阳性组和阴性组在精液量、精液粘度方面无明显差别(P＞0.05),而两组在精子密度、精子活率、PR、精子畸形率、精液pH值、精液白细胞症检出率、MAR等精液质量参数方面存在明显差别,差异有统计学意义(P＜0.01).结论 男性精液中Gv感染可能是影响精液质量,可能是导致男性不育的原因之一.     

Progress in leukocytospermia research]

Leukocytospermia is a most common cause of male infertility, but the distribution, origin and role of leukocytes in semen are still controversial. Some reports on leukocytospermia have indicated its negative effects on semen parameters and even in vitro fertilization (IVF). Recent literature has made it clear that the most deleterious effect of leukocytospermia is that the increased reactive oxygen species (ROS) may cause sperm damage, leading to significantly increased male infertility. The treatment and prevention of leukocytospermia have been proven of help for improving semen parameters.     

Leukocytospermia in male infertility patients in China

Summary. Recent studies have revealed a high prevalence of leukocytospermia (> 1 × 10⁶ white blood cells ml⁻¹ semen) in male infertility patients in the USA and certain European countries, and have implicated white blood cells as a cause of infertility. Since leukocytospermia may often be attributed to male genital-tract infections, its prevalence could vary widely in different populations depending on factors such as sexual practices and the prevalence of sexually transmitted pathogens. In the study described here the incidence of leukocytospermia was determined in a group of 101 male infertility patients and a small reference group of normal fertile men in Beijing, China. Seminal white blood cells (WBC) and WBC sub-populations were enumerated by peroxidase staining and immunohistological assay. Eight out of 101 (7.9%) samples from infertility patients and 0/10 samples from fertile donors were leukocytospermic. The incidence of leukocytospermia in the Chinese infertility patients was considerably lower than the 23% incidence observed in a recent study of infertility patients in the USA using a similar technique. All but one of the patients with leukocytospermia had a poor sperm count and/or poor sperm motility. However, due to the low incidence of leukocytospermia and the small number of patients in this group, a statistically significant association between leukocytospermia and poor semen quality was not attained. The simple peroxidase test correlated well with the more expensive and technically demanding immunohistological assay for detection of white blood cells in semen.     

Effect of isotypes of antisperm antibodies on semen quality

A direct immunobead test (IBT) was performed on 233 men who attended an immunological centre. Thirty-four (14.6%) of these men were found to be positive (greater than 20% binding) for antisperm antibodies (ASA). IgA, IgG and IgM were the most common sperm-associated immunoglobulins. In 50% of men with ASA asthenozoospermia, teratozoospermia, leukocytospermia or hypofunction of the seminal vesicles was observed. Semen parameters were altered most frequently when IgM was present in association with IgA and/or IgG. This suggests that there is an active inflammatory process in the reproductive tract, as evidenced by leukocytospermia, and this could be responsible for the abnormal semen parameters. ASA generation could be a consequence of this process rather than being the cause of the abnormal semen quality. If ASA do affect fertility, this could take place in the female reproductive tract.     

Are viral infections the cause of leukocytospermia?

Leukocytospermia is defined as a leukocyte count of more than 1 x 106 ml-1 ejaculate. It may be a symptom of male accessory gland infection, but is also observed in up to 10% of asymptomatic patients presenting for infertility work-up. Pathogenic bacteria are not present in all of these semen samples. We attempted to find evidence for infection with cytomegalovirus, Epstein-Barr virus and herpes simplex virus by determining antibodies in serum in 130 patients with, and 80 patients without, leukocytospermia and by polymerase chain reaction in 50 further patients and controls. All semen samples with or without leukocytospermia were free from clinically significant concentrations of pathogenic bacteria. Only IgM antibodies against HSV were found more frequently in patients with leukocytospermia than in the controls (10.8 and 1.25%, respectively). All other virus antibody findings showed an equal frequency in both groups. The determination of HSV DNA in 50 further semen samples with, and 50 samples without, leukocytospermia revealed no positive results. Although our study indicates an association of herpes virus infection and leukocytospermia in 10% of cases, the mechanism of association is to be clarified.     

Methods for the detection of male genital tract inflammation

Summary. Male genital tract inflammation is reflected by increased numbers of white blood cells (WBC) in semen. An ejaculate containing more than 10⁶ WBC ml⁻¹ semen is termed leukocytospermic. Among male infertility patients, the frequency of leukocytospermia is between 10% and 20%. By conventional light microscopy or sperm staining techniques, it is not possible to reliably differentiate WBC from immature germ cells in semen. In contrast, the cytochemical peroxidase method reliably identifies granulocytes, the most prevalent WBC type in semen. The method is cheap, fast and easy to perform. The gold standard for the detection of all WBC populations in semen is immunocytology using monoclonal antibodies. However, it is expensive and time-consuming, thus remaining a research tool at present. The measurement of granulocyte elastase in semen provides information on the number of granulocytes and their inflammatory activation. However, commercial granulocyte elastase enzyme immunoassays are expensive and due to logistical reasons often delay the results for more than 1 week. Leukocyte esterase dipstick tests lack both sensitivity and specificity for the detection of inflammatory changes in semen. For clinical purposes, the peroxidase method is ideally suited to detect inflammatory changes in semen.     

显微外科精索静脉曲张切除术治疗男性不育

精索静脉曲张(VAC)是导致男性不育的常见原因。手术是治疗VAC的主要方法。传统手术方法包括Palo-mo手术、经腹股沟精索内静脉高位结扎术及腹腔镜手术术后睾丸鞘膜积液、睾丸动脉损伤等并发症的发生率及VAC复发率较高。近年来国际上兴起的显微外科精索静脉曲张切除术(MV)可有效的保护精索淋巴管及睾丸动脉,彻底结扎除输精管静脉外的所有精索静脉,使并发症及复发率大为降低。MV可显著改善VAC不育患者的精液质量,提高妊娠率;对严重少弱精子症或非梗阻性无精子症的患者的精液质量也有改善作用,目前已成为治疗VAC的"金标准"。     

Critical appraisal of conventional semen analysis in the context of varicocele

Varicocele is present in approximately 15% of men, and, although it is the most commonly diagnosed cause of male infertility, nearly two-thirds of men with varicoceles remain fertile. It was decided to make use of the current evidence obtained from the previous meta-analyses between 2004 and 2015 as well as available articles covering this field, preferably randomized controlled articles dealing with the topic of semen analysis before and after repair. Two important meta-analyses were discussed as well as other articles dealing with the topic of semen analysis before and after varicocelectomy. The evidence suggests that all semen parameters improve after varicocele repair. Based on the available evidence, it is clear that there is a benefit in treating men with a palpable varicocele. One can expect that all semen parameters will improve within 3 months after repair.     

Comparative analysis of tests used to assess sperm chromatin integrity and DNA fragmentation

Male infertility has a complex etiology, and many times, the cause is unknown. While routine semen analysis provides an overview of basic semen parameters, such as sperm concentration, motility, viability and morphology, a significant overlap of these parameters has been reported in fertile and infertile men. Moreover, conventional semen parameters do not reveal the cellular or molecular mechanisms of sperm dysfunctions leading to infertility. Therefore, sperm functional parameters, including sperm chromatin integrity, are evaluated to provide information on subtle sperm defects that are not routinely identified. Incomplete or defective sperm chromatin condensation increases the susceptibility of the sperm DNA to oxidative damage or other factors. To evaluate sperm chromatin integrity, different methods with varying degrees of diagnostic and prognostic capabilities are available. Among these assays, SCSA, TUNEL and SCD assays are most commonly used. While these assays rather evaluate the DNA directly for damages, the aniline blue and chromomycin A3 stains test for the quality of chromatin condensation. Thus, this review discusses and compares different methods used to evaluate sperm chromatin integrity and condensation, and their inclusion in the routine evaluation of the male infertility.     

Are oxidative stress markers associated with unexplained male infertility?

Male infertility can be responsible for up to 20% of the cases attending fertility consultation facilities; nonetheless, the underlying molecular mechanisms that could explain it are still elusive. Therefore, we aimed to evaluate conventional and functional parameters of semen samples from patients who presented with male infertility of unknown origin. Conventional semen parameters and functional parameters (i.e. intracellular reactive oxygen species production, mitochondrial membrane potential, sperm chromatin structure assay, sperm membrane lipid peroxidation and antioxidant capacity of seminal plasma) were evaluated on semen samples from 54 healthy donors, 23 patients with idiopathic infertility and 34 fertile controls. No significant differences were observed in the conventional seminal parameters between the fertile and infertile men. However, increased intracellular reactive oxygen species (ROS) production and DNA fragmentation were observed in the infertile patients compared to the fertile group. Alterations in intracellular ROS production and DNA fragmentation could be associated with male idiopathic infertility. These parameters could eventually distinguish both groups more accurately than the conventional parameters. Our current results are encouraging, and the efficacy of these parameters in the clinical settings needs to be further assessed to establish their predictive potential as a marker of unexplained male infertility.     

Improvement of sexual activity,pregnancy rate,and low plasma testosterone after bilateral varicocelectomy in impotence and male infertility patients

To evaluate the effects of bilateral varicocelectomy on sexual activity, testicular volumes, semen quality, and serum hormone levels in impotence and male infertility patients, 48 patients were studied from an outpatient clinic from May 1998 to March 2001. The mean age was 37+/-5.9; 16 patients were complaining of erectile dysfunction and 32 patients were complaining of male infertility. The mean duration of impotence was 3.3+/-2.4 years and for male infertility was 3.8+/-3.2 years. Sexual and reproductive history was taken for erectile dysfunction and male infertility patients. General, local examination, and laboratory investigations were done for all patients. Preoperative and postoperative testicular volumes; semen parameters, including semen volume, sperm count, and motility; and morphology and hormonal parameters, including LH and FSH, and testosterone levels were measured. All patients were followed up for 3-36 months after varicocele repair. Left and right testicular volume was improved in impotence and male infertility patients and fertility groups, but this improvement was not statistically significant (p>.25). The semen volume was significantly increased in male infertility patients and fertility group (p<.05), but there was no statistical significant difference in impotent patients (p>.25). The sperm count was improved in male infertility patients and fertility group, but this improvement was not statistically significant (p>.25), and in impotent patients there was no significant difference (p>.40). The sperm motility was very significantly increased in male infertility patients and the fertility group (p<.0005), and highly significantly increased in impotent patients (p<.005). The abnormal forms were not statistically significant in impotence and male infertility patients (p>.40), but significantly decreased in the fertility group (p<.05). Serum testosterone was very significantly increased in impotence and male infertility patients (p<.0005) and was highly significantly increased in fertility groups (p<.005). Serum FSH was improved in impotence and male infertility patients, but this improvement was not statistically significant (p>.10), and in fertility groups of male infertility patients, the results showed a statistically significant increase (p<.05). Serum LH was not statistically significant in impotence and male infertility patients (p>.10), and was significantly increased in fertility groups (p<.05). The improvement of sexual activity was 50-75%, the pregnancy rate for their partners was 37% and increased plasma testosterone levels over a period of 3 years of follow-up after varicocele repair.