运动对男性生殖影响的研究进展

运动对男性生殖的作用具有双重性,即合理运动有益于生殖内分泌,超负荷运动却常会损害男性的生育力。合理运动量的体能锻炼,卵泡刺激素(FSH)水平相比锻炼前上升,黄体生成激素(LH)和睾酮(T)水平显著上升;改善睾丸局部微环境,还改变生殖细胞的表观遗传修饰,有利于后代健康。超负荷运动则使睾丸微环境的温度显著上升,热应激可损伤精子的结构和功能并最终导致男性生育力下降;超负荷运动还抑制促性腺激素释放激素(GnRH)神经元和垂体功能,干扰生殖激素分泌。此外,运动还使精子DNA CpG岛相关基因发生明显的去甲基化,影响微小RNA(miRNA)表达水平,影响表观遗传。综述运动对男性生殖的影响及其机制。     

氧化应激对男性（雄性）生殖系统的影响

氧化应激可产生活性氧簇（ROS）。正常状况下，低水平ROS具有调节细胞生理功能的作用，而异常高水平的ROS对组织和细胞产生相应的危害，如信号通路异常、能量代谢失调、基因突变和蛋白质结构改变等，进而影响细胞、组织、器官乃至系统的功能。男性（雄性）生殖系统中，高水平的ROS对生殖器官和生殖细胞同样产生严重的危害，如对睾丸的危害可影响其形态学结构及类固醇激素的合成；对生殖细胞可直接损伤精子的DNA、膜脂质和蛋白的结构，使精子的畸形率大幅度上升，最终导致男性（雄性）不育。综述男性（雄性）生殖系统ROS的产生及其对生殖的影响，对了解临床男性不育症的发病机制及治疗具有重要的意义。     

先天性肾上腺皮质增生伴男性不育诊治一例及相关文献复习

先天性肾上腺皮质增生症（congenital adrenal hyperplasia，CAH）患者肾上腺皮质类固醇激素合成障碍，是一种常染色体隐性遗传病，最常见为21-羟化酶缺陷型，可影响男性生育力。男性CAH患者不育主要是由于肾上腺残余瘤和促性腺激素水平的改变。CAH罕见发病，症状常不典型，临床容易漏诊，早期发现并治疗可改善男性患儿成年后的生殖功能。CAH主要使用糖皮质激素治疗，部分成年患者可恢复生育能力；不能恢复自然生育能力的可通过辅助生殖技术生育；明确诊断后尽早进行精子冷冻保存。报道我院2018年诊治的1例CAH男性不育患者的辅助生殖助孕治疗过程，对其临床资料进行整理和分析，通过文献复习该疾病的发病机制和对男性生育力的影响。     

抗苗勒管激素在辅助生殖领域的临床研究进展

抗苗勒管激素（anti-Mullerian hormone，AMH）又称苗勒管抑制物（Mullerian inhibiting substance, MIS），是由女性卵泡颗粒细胞和男性睾丸支持细胞所分泌的二聚体糖蛋白激素。AMH最初被发现参与胚胎期的生殖系统的分化。越来越多的研究表明，AMH在辅助生殖领域中，可作为卵巢储备功能、促排卵治疗过程中卵巢反应性的预测指标，同时可作为体外受精（in-vitro fertilization, IVF）受精率及临床妊娠率的预测指标。此外，AMH还可用于评估精子质量及精子冷冻保存后的活力恢复情况。AMH还可辅助诊断女性卵巢功能早衰（premature ovarian failure, POF）及多囊卵巢综合征（polycystic ovary syndrome, PCOS），辅助鉴别男性严重少、弱精子症及无精子症，指导生育期肿瘤患者选择治疗方案等。     

抗苗勒氏管激素与男性生殖相关疾病的研究进展

抗苗勒氏管激素( anti Mullerian hormone , AMH) 又名苗勒氏管抑制素( Mulleri-an inhibiting substance , MIS),最早发现于男性胎儿,因抑制其苗勒氏管的发育而被确定并命名,对男性性分化具有重要作用。目前研究发现AMH在男性生殖相关疾病的诊治中有广泛的临床应用,主要体现在以下五方面：①诊断两性畸形患者是否存在男性性腺,血清AMH比Y染色体灵敏度更高,且是青春期评估睾丸功能较好的标志物。②与血清AMH水平比较,精浆AMH与睾丸生精功能显著相关,与精液质量呈正相关,是鉴别梗阻性、非梗阻性无精子症特异性较高的标志物。③精浆AMH是目前严重少、弱精子症患者,精子冷冻、复苏后精子活力的预测指标。④精浆AMH水平可预测促性腺激素（rh-FSH）治疗特发性少、弱精子症的疗效。⑤对男性生殖腺肿瘤患者放化疗后生育力的评估,精浆AMH是目前特异性最高的生物标志物。     

我国工业铅中毒研究48年（下）

6铅对男性生殖功能的影响近年来,我们分析了精液质量及其某些生化改变,以评定铅对男性生殖功能的危害,见表12,结果显示接触组精液液化时间明显长于对照组（P＜0．05）。接触组的精子活力明显受到影响,精子活力百分率和计数特别是直线向前运动的精子活力明显下降,不运动的精子百分率增多。两组间的精子密度、精液果糖和柠檬酸未见差别[13]。为了评定铅经血液-睾丸屏障及其对血液和精液中的其它微量元素代谢的影响,用放射免疫法测定上述铅接触组和对照组的血清FSH（促卵泡成熟激素）和LH（促间质细胞激素）的效应。分析血液和精液中…     

全氟类化合物在人体与动物体内的生殖毒性

全氟类化合物（polyfluorinated chemicals，PFCs）是一类来自工业生产，存在于人们日常生活环境中内分泌干扰物（endocrine disruptors，EDCs）。研究表明，PFCs可以聚集在生物体内，并通过影响甾体激素合成、诱导生殖系统细胞凋亡、拮抗激素受体等机制，在生殖系统表现出毒性作用。在男性中，这类物质被证明与精子的质量与数量的下降及异常精子比率的上调有关，干扰男性性激素水平（如睾酮）；而在女性中也发现血液或卵泡液中PFCs水平的升高，往往伴随着性激素及促性腺激素（如雌孕激素，卵泡刺激素等）水平的异常以及生育力的下降，这类物质在孕期的暴露甚至有影响至下一代的可能。此外，已有动物实验从分子层面对这类物质的毒性机制进行了证实，因此PFCs的生殖毒性值得关注。     

线粒体功能与精子活力

精子活力是衡量精液质量和男性生育力的一个重要指标,在男性不育患者中约19％为精子活力低下所致。精子运动所需能量来自线粒体呼吸链的氧化磷酸化,各种原因导致的线粒体结构和功能改变,如膜电位的降低,酶活性或表达量异常以及线粒体DNA（mtDNA）的突变或缺失等均可导致线粒体能量合成障碍,精子活力降低。对近年有关线粒体功能与精子活力相关性研究进展综述,旨在探讨精子活力低下的发病机制以及临床治疗弱精子症的可能途径。     

限制热能摄入对大鼠生殖功能的影响

本文报道了２０％、３５％两个水平的限制热能摄入对大鼠生殖功能的影响。６个月的试验表明：３５％限食推迟了雌鼠初情期日龄；２０％、３５％限食组雄鼠两个月龄时血清睾酮、促黄体生成素含量降低（Ｐ＜０．０５）；６个月限食使雄鼠附睾精子计数、活动精子百分数减少（Ｐ＜０．０５），精子畸形率升高（Ｐ＜０．０５）；限食对雄鼠睾丸重量无影响。上述结果提示：限食对大鼠生殖功能有不利的影响。     

男子如何看待遗精

男子如何看待遗精遗精是进入青春期发育后的男子常见的正常生理现象。男性进入青春期，随着睾丸的发育，精子产生，睾丸同时分泌较多的男性激素（睾酮），这种激素能刺激生殖器官的发育，使附性腺（主要指精囊和前列腺）分泌精浆，精液就是睾丸产生的精子和附性腺分泌的精...     

Sirtuins在生殖领域的新兴作用和治疗潜力

Sirtuins家族在生殖方面的调控作用近几年成为研究热点，Sirtuins可调节卵母细胞减数分裂进程中纺锤体的组装及染色体的排列，改善卵母细胞减数分裂；促进线粒体生物合成，调节能量稳态，提高卵母细胞及早期胚胎质量；通过上调抗氧化酶，保护体外培养卵母细胞免受氧化应激的影响；通过参与卡路里限制延缓女性生殖寿命。Sirtuins还可抑制人颗粒细胞的凋亡，调节生殖激素的分泌，为卵母细胞的发育提供良好的微环境；且对雄性精子的质量和数量有积极作用。总结当前国内外关于Sirtuins参与生殖调控的相关研究及作用机制，为未来Sirtuins激动剂的应用可能推动人类生殖朝着更加有益方向发展的作用提供理论依据。     

硒对氟致雄性大鼠生殖内分泌干扰的拮抗研究

目的　探讨硒对高氟所致雄性大鼠生殖损害的拮抗作用。方法　通过饮水加氟、加硒的方法 ,观察氟、硒对大鼠精子和睾丸、附睾的组织结构 ,生化标志酶及性激素的影响。结果　氟可使大鼠精子计数、活动率下降 ,畸形率升高 ,生化标志酶、性激素水平下降 ,并导致组织病理学改变。给氟的同时给予硒可使上述指标变化减小 ,差异有统计学意义 (P <0 .0 5 )。结论　硒可以拮抗高氟的雄性生殖毒性 ,尤以中等剂量硒效果最好     

Causes of azoospermia and their management

Azoospermia may occur because of reproductive tract obstruction (obstructive azoospermia) or inadequate production of spermatozoa, such that spermatozoa do not appear in the ejaculate (non-obstructive azoospermia). Azoospermia is diagnosed based on the absence of spermatozoa after centrifugation of complete semen specimens using microscopic analysis. History and physical examination and hormonal analysis (FSH, testosterone) are undertaken to define the cause of azoospermia. Together, these factors provide a >90% prediction of the type of azoospermia (obstructive v. non-obstructive). Full definition of the type of azoospermia is provided based on diagnostic testicular biopsy. Obstructive azoospermia may be congenital (congenital absence of the vas deferens, idiopathic epididymal obstruction) or acquired (from infections, vasectomy, or other iatrogenic injuries to the male reproductive tract). Couples in whom the man has congenital reproductive tract obstruction should have cystic fibrosis (CF) gene mutation analysis for the female partner because of the high risk of the male being a CF carrier. Patients with acquired obstruction of the male reproductive tract may be treated using microsurgical reconstruction or transurethral resection of the ejaculatory ducts, depending on the level of obstruction. Alternatively, sperm retrieval with assisted reproduction may be used to effect pregnancies, with success rates of 25-65% reported by different centres. Non-obstructive azoospermia may be treated by defining the cause of low sperm production and initiating treatment. Genetic evaluation with Y-chromosome microdeletion analysis and karyotype testing provides prognostic information in these men. For men who have had any factors potentially affecting sperm production treated and remain azoospermic, sperm retrieval from the testis may be effective in 30-70% of cases. Once sperm are found, pregnancy rates of 20-50% may be obtained at different centres with in vitro fertilisation and intracytoplasmic sperm injection.     

The effects of smoking on fertility from gametogenesis to implantation

The literature concerning the effects of cigarette smoking, treatment with nicotine, cigarette smoke condensates, or cigarette smoke constituents on reproductive events from gametogenesis to implanatation is reviewed. Epidemiologic evidence, although scanty, suggests that cigarette smoking decreases fertility in women. Cigarette smoking is also associated with an increased frequency of menstrual abnormalities and a cigarette dose-related decrease in the age of spontaneous menopause. Similar epidemiologic studies assessing reproductive function have not been conducted among men who smoke. Several small studies have demonstrated decreased sperm counts and an increased frequency of abnormal sperm morphology among male smokers. Cessation of smoking in several of these studies has been associated with an increase in sperm number and a decrease in the frequency of sperm shape abnormalities. Treatment of rodents with cigarette smoke or cigarette smoke constituents produces similar effects on sperm number and morphology. Experimental evidence from humans and rodents suggests that cigarette smoke or nicotine can alter hypothalamic-pituitary interrelationships, stimulating growth hormone, cortisol, vasopressin, and oxytocin release and inhibiting luteinizing hormone and prolactin release. These changes may alter hormonal interrelationships necessary for successful reproduction. Studies in rodents and human and nonhuman primates also suggest that cigarette smoke or nicotine alters the motility of the female reproductive tract, and may impair implantation of the embryo. Analysis of the experimental data available concerning the effects of smoking on reproductive processes suggests an adverse influence on reproduction at several sites from gametogenesis to implantation. The literature on smoking and fertility, however, is surprisingly small. Additional experimentation, as well as epidemiological surveys of human populations, are necessary before it will be possible to make unequivocal statements concerning reproductive interference by cigarette smoke or its components.     

淫羊藿（苷）对男性生殖系统的作用和机制

淫羊藿是一种常用的中药材,淫羊藿苷是从淫羊藿中提取的一种黄酮类化合物,也是淫羊藿中最主要的活性物质。研究发现,淫羊藿苷具有促进成骨细胞的生成和活化、调节免疫、抗衰老和抗炎等多种功能。临床上淫羊藿（苷）用于治疗生殖系统、骨关节系统、呼吸系统、神经系统、心血管系统和免疫系统等多种疾病。淫羊藿（苷）对男性生殖系统的作用及机制主要包括具有雄性激素样作用,促进睾内睾酮的合成和分泌。淫羊藿（苷）通过改善精子发生的微环境、增强睾丸抗氧化作用促进精子生成,增加精子密度,改善精子活力,减缓生殖衰退。此外,淫羊藿（苷）可促进阴茎勃起,治疗勃起功能障碍及早泄。     

A hormonal,physical, and proteomic view of obesity-induced effects on male infertility and possible lifestyle modifications

The increasing incidence of obesity worldwide combined with the parallel trend of declining sperm quality has given rise to the notion that obesity and infertility are linked. While investigations of sperm quality in obese individuals have yielded inconclusive results, studies of the adverse hormonal, physical, and proteomic changes induced by obesity are more definitive. Unfavorable hormonal abnormalities reported in obese males that affect reproduction are decreased levels of testosterone, inhibin B, and ghrelin and increased levels of estrogen, leptin, and resistin. Moreover, erectile dysfunction and elevated scrotal temperatures have been associated with obesity and are important physical barriers to successful male reproduction. Recently, important advances have been made in proteomics and factors have been identified in obese individuals that may impair spermatogenesis and sperm quality. Although obesity contributes to a host of adverse effects on the reproductive system, certain lifestyle modifications can be made to alleviate such effects. Natural weight loss and surgical weight loss have demonstrated favorable results in obese patients by restoring normal hormone levels and reversing the effects of both erectile dysfunction and testicular heat stress. Pharmacological interventions have also proven to be promising in combating the effects of obesity. Particularly, aromatase inhibitors such as anastrozole, letrozole, and testolactone, have been reported to decrease the aromatase over-activity and increased estrogen levels present in obese males. An understanding of abnormalities associated with obesity and possible lifestyle modifications may help clinicians effectively guide their infertile obese male patients and increase fertility rates.     

Relationship between reproductive success and male plasma vitellogenin concentrations in cunner,Tautogolabrus adspersus

The gene for vitellogenin, an egg yolk protein precursor, is usually silent in male fish but can be induced by estrogen exposure. For this reason, vitellogenin production in male fish has become a widely used indicator of exposure to exogenous estrogens or estrogen mimics in the aquatic environment. The utility of this indicator to predict impacts on fish reproductive success is unclear because information on the relationship between male plasma vitellogenin and reproductive end points in male and female fish is limited. In the research reported in this article, we investigated whether the presence of male plasma vitellogenin is a reliable indicator of decreased reproductive success in mature fish. Adult and sexually mature male and female cunner (Tautogolabrus adspersus) were exposed to 17ss-estradiol, ethynylestradiol, or estrone, three steroidal estrogens that elicit the vitellogenic response. Data were gathered and pooled on egg production, egg viability, egg fertility, sperm motility, and male plasma vitellogenin concentrations. All males, including two with plasma vitellogenin levels exceeding 300 mg/mL, produced motile sperm. Neither percent fertile eggs nor percent viable eggs produced by reproductively active fish demonstrated a significant correlation with male plasma vitellogenin concentrations. Male gonadosomatic index and average daily egg production by females showed significant, but weak, negative correlation with male plasma vitellogenin concentrations. Results suggest that male plasma vitellogenin expression is not a reliable indicator of male reproductive dysfunction in adult cunner exposed to estrogens for 2-8 weeks during their reproductive season, at least in relation to capacity to produce motile sperm or fertilize eggs. Male plasma vitellogenin expression may serve as an indicator of reduced female reproductive function caused by estrogen exposure.     

A review of the effect of pesticide formulations on male fertility

Experimental studies suggest that large numbers of chemicals, environmental and industrial pollutants affect the male reproductive system. At present, almost no information is available on the effects of these adverse agents on human reproduction. Recent reports, however, suggest that in the past 50 years male fertility has declined based on qualitative and quantitative measurements of normal sperm. This study identifies‐among the active ingredients and solvents included in pesticide formulations registered in Italy‐the chemical agents with experimental evidence of male reproductive toxicity. Documents produced by international agencies and organizations such as IARC, EPA, WHO, and original papers from the international literature were systematically reviewed. The results indicate that several pesticide products notified in the Italian Registry contain active ingredients and/or solvents severely affecting testicular function and sperm morphology in laboratory animals. Therefore, exposure to reproductive toxicants occurring among manufacturers and users of pesticide formulations registered in Italy suggest further epidemiologic surveys should be conducted in this area.     

Carboxylesterase overexpression in the male reproductive tract: a universal safeguarding mechanism?

Data on expression patterns of carboxylesterases in the male reproductive tract of different animal groups (i.e. bivalve mollusks, fruitflies and rodents) are summarized to highlight some particularly interesting questions in the context of sperm differentiation, maturation and function. The male reproductive system, in spite of extreme variation in the anatomical/morphological organization in different species, is characterized by similar patterns of male-dependent carboxylesterase overexpression. The phenomenon of conserved carboxylesterase overexpression indicates similar male sex-associated functions of the enzymes. There is possible evidence of carboxylesterase recruitment by male reproductive-tract tissues indicating that it could be adaptive for spermatogenesis, sperm maturation and sperm use. Moreover, this idea can be extended to include a sperm cell lineage protection. This issue is discussed in the light of recent data on environmental reproductive xenobiotics that can provide a basis for a hypothetical explanation of carboxylesterase overexpression in the male reproductive tract. Based on a well-known role of carboxylesterases in detoxification of environmental chemicals such as organophosphate pesticides, it is proposed that various male genital tract carboxylesterases may be characterized by a similar physiological function to protect the male reproductive system against xenobiotic influences that could provoke its dysfunction, thus altering sperm differentiation and maturation.     

氟对雄性大鼠生殖系统的内分泌干扰作用研究

目的　探讨高氟对雄性大鼠生殖系统的内分泌干扰作用。方法　给予雄性Wister大鼠含氟化钠 15 0mg/l的水 10周后 ,检测其精子计数、活动率、畸形率 ,测定睾丸、附睾生化标志酶和性激素 ,观察睾丸组织病理改变。结果　染毒组精子计数、活动率下降 ,畸形率升高 ,血清睾酮、促黄体生成激素下降 ,较对照组差异有统计学意义 (P <0 .0 5 ) ,睾丸组织有明显的病理学改变。结论　长期接触高浓度的氟对雄性生殖系统有明显的内分泌干扰作用