新疆地区汉、维吾尔族男性无精子患者与Y染色体微缺失关系的研究

目的探讨检测男性不育症患者Y染色体微缺失的临床意义。方法引用多重聚合酶链反应(PCR)对门诊392例男性不育患者行Y染色体AZFa、AZFb、AZFc、AZFd和SRY20个序列标签位点(STS)设计特异引物进行微缺失检测,同时进行精液常规检查。结果 392例男性不育患者中AZF基因微缺失患者共检出24例,总缺失率为6.12%,其中汉族无精子症组缺失率为6.19%,维吾尔族(以下简称维族)无精子症组缺失率为18.92%,汉、维族不育症患者Y染色体AZF微缺失率比较差异无统计学意义(P0.05);汉、维族无精子症患者Y染色体AZF微缺失率比较差异有统计学意义(χ2=5.333,P=0.021),汉族与维族的Y染色体多位点联合缺失发生率比较差异有统计学意义(χ2=4.168,P=0.041)。结论汉、维族不育症男性患者中Y染色体AZF微缺失发生率存在种族差异,PCR检测AZF基因是诊断Y染色体AZF微缺失的较好的方法。     

多重定量荧光PCR技术在Y染色体AZF微缺失检测中的应用研究

目的建立检测Y染色体无精子症因子（AZF）微缺失的多重定量荧光PCR体系。方法以5’FAM、JOE和TAMRA荧光基团标记PCR引物,建立包含Y染色体AZF4个亚区（AZFa～d）15个序列标签位点（STS）的多重定量荧光PCR体系;并对无精子症组、严重少精子症组及精液正常组进行Y染色体AZF微缺失检测。结果成功建立了检测Y染色体AZF微缺失的多重定量荧光PCR体系;200例男性中检测到Y染色体AZF微缺失16例,其中72例无精子症组7例,缺失率为9．7％,78例严重少精子症组9例,缺失率为15．4％,50例精液正常组未检测到缺失。无精子症组、严重少精子症组缺失率与精液正常组比较差异均有统计学意义（P〈0．05）。结论多重定量荧光PCR技术是一种快速、简便检测Y染色体AZF微缺失的方法,具有重要临床应用价值。     

辅助生殖对妊娠早期自然流产胚胎染色体非整倍体的影响

目的探讨辅助生殖技术(ART)中的不同受精方式对妊娠早期自然流产胚胎染色体非整倍体异常率的影响。方法收集我院辅助生殖妊娠与自然妊娠早期自然流产患者505例,按照不同的受精方式分为人工授精组31例,IVF组158例,ICSI组75例,IMSI组25例,及自然妊娠组216例。应用定量荧光PCR(QF-PCR)联合微阵列比较基因组杂交(array-CGH)的方法对其流产组织进行检测,比较辅助生殖不同受精方式流产胚胎染色体非整倍体的异常率。流产患者按35岁分界,分别比较两个年龄段不同受精组的异常率。分别比较新鲜胚胎和冻融胚胎IVF、ICSI、IMSI三组的异常率。结果人工授精组、IVF组、ICSI组、IMSI组及自然妊娠组的异常率无统计学差异(P0.05)。异常类型中三体、单体、微缺失微重复的异常率均无统计学差异(P0.05),多倍体的异常率有统计学差异(P=0.002)。35岁各组别异常率有统计学差异(P=0.029),≥35岁各组别无统计学差异(P0.05)。新鲜胚胎与冻融胚胎三组异常率均无统计学差异(P0.05)。IVF组的新鲜与冻融胚胎异常率有统计学差异(P=0.047),ICSI组和IMSI组的新鲜与冻融胚胎均无统计学差异(P0.05)。结论辅助生殖的不同受精方式均不会增加自然流产胚胎的染色体非整倍体异常率。对于35岁以下的低龄患者,ART助孕中的各受精方式可能会降低其异常率。胚胎冷冻技术使用过程中,受精方式的改变不会增加自然流产胚胎染色体非整倍体的异常率。     

Y染色体AZF基因微缺失在诊断苏南地区男性不育患者中的研究

目的初步探讨Y染色体无精症基因(AZF)微缺失与苏南地区男性不育症患者之间的相关性。方法纳入274例无精症或严重少精症患者,并入选183例健康人群作为对照组,采用病例对照研究方法,用探针熔解曲线技术对Y染色体无精症基因(AZF)进行分析。结果在实验组中发现30例Y染色体AZF基因微缺失,总缺失率为10.95%,其中无精子症患者缺失率为11.7%,严重少精症患者缺失率为9.5%,AZF a区缺失0例,AZF b区缺失4例,AZF c区缺失15例,AZFb+c缺失10例,AZFa+b+c区缺失1例,AZFc区发生率最高,其次为AZF b+c区,AZF a区发生率最低,对照组183例未发现微缺失,两组微缺失发生率比较,差异具有统计学意义(P0.05)。结论 Y染色体AZF基因微缺失的检测对男性不育患者的诊断有重要的指导价值。     

1736例男性不育患者染色体核型异常情况及细胞和分子遗传学分析

目的了解深圳地区无精子症或严重少精症男性不育患者染色体核型异常和Y染色体无精子症因子(Azoospermia factor,AZF)微缺失情况,为男性不育患者进行辅助生殖技术之前提供遗传筛选依据。方法收集2016年2月～2018年10月来院就诊并确诊为无精子症或严重少精子症男性不育患者1736例,采用淋巴细胞培养G显带法对外周血染色体进行核型分析,采用多重聚合酶链反应(PCR)结合毛细管电泳技术检测Y染色体AZF微缺失。结果 1736例无精子症或严重少精症男性不育患者中检出染色体核型异常的159例,异常率为9.16%,其中染色体数目异常率为59.12%,以47,XXY检出率最高,约32.70%,明显高于其它数目异常类型,差异有统计学意义(χ~2=3.025～11.924,P0.05);结构异常率为36.48%,以46,X,inv(Y)检出率最高,约11.95%,明显高于其它结构异常类型,差异有统计学意义(χ~2=2.174～7.562,P0.05);性反转综合征占总异常的4.40%;Y染色体AZF微缺失检出145例,缺失率为8.35%,其中AZFc缺失为最常见的缺失类型,缺失率为73.10%,明显高于其它缺失类型,差异有统计学意义(χ~2=4.9254～116.3152,P0.05～0.001)。结论染色体核型异常和AZF微缺失在深圳地区无精子症或严重少精症男性不育患者中有一定的检出率,可能是导致男性不育的重要原因。对男性不育患者进行染色体核型和AZF微缺失检测,可为男性不育患者孕前准备提供筛选依据。     

广州地区不育男性Y染色体无精子因子微缺失的筛查

目的探讨Y染色体无精子因子(azoospermia factor,AZF)区域微缺失与原发无精、严重少精症之间的关系。方法采用多重聚合酶链反应技术对广州地区103例原发无精子症、72例原发严重少精症患者及60名正常生育男性进行AZFa、AZFb、AZFc3个区域微缺失分析。结果60名正常生育男性未发现Y染色体AZF区域微缺失,175例生精障碍患者中发现AZF微缺失19例,总缺失率为10.9%。其中11例无精症患者和4例少精症患者的缺失发生在AZFc区域,缺失率为8.6%;1例无精症患者和2例少精症患者发生AZFb、AZFc双重缺失,缺失率为1.7%;1例无精症患者发生AZFa、b、c3个区域同时微缺失,缺失率0.6%。生精障碍组与正常生育男性组比较Y染色体AZF区域微缺失率差异具有统计学意义(P<0.01)。结论Y染色体AZF区域微缺失是引起男性无精、少精子症的重要原因之一,对原发无精、少精子症患者在单精子注射之前进行微缺失筛查是必要的。     

1011例男性不育患者Y染色体无精子症因子微缺失的筛查与临床表型分析

目的 探讨四川地区近6年不育男性Y染色体无精子症因子(azoospermia factor,AZF)微缺失的发生率、缺失类型及其与临床表型的关系.方法 应用多重PCR方法对713例非梗阻性无精症和298例重度少精症的男性进行Y染色体AZF微缺失分析.结果 AZF总体缺失率为10.48％ (106/1011),其中非梗阻性无精症患者缺失率为11.08％ (79/713),重度少精症患者缺失率为9.06％ (27/298).AZFa与AZFb完全缺失者均表现为无精症.AZFc缺失为最常见缺失类型且具有多种表型,占60.38％,其中37.50％的缺失者精液中有成熟精子.2例AZFb和1例AZFb-c部分缺失者精子密度呈轻度下降.结论 AZFc区是Y染色体AZF微缺失的缺失热点,AZFa或AZFb缺失者以及部分AZFc缺失者均表现为无精症.本研究进一步明确了AZF缺失基因型与表型的关系,证实Y染色体AZF微缺失检测对诊断男性不育具有重要的价值.     

新疆地区维吾尔族和汉族男性不育患者Y染色体无精子症因子微缺失分析

目的评估新疆地区汉族、维吾尔族不育男性不明原因无精子症和严重少弱精子症患者Y染色体AZF基因微缺失的频率,探讨不同民族间Y染色体AZF基因微缺失发生率的差异。方法以Y染色体无精子因子(AZF)区20个序列标签位点(STS)设计特异引物,采用多重PCR方法对449例(汉族347例,维吾尔族102例)不育男性患者进行Y染色体无精子因子(AZF)区微缺失检测,并比较不同民族的患者Y染色体无精子因子(AZF)区微缺失发生率的差异。结果 347例汉族患者中有11例(3.17%)存在Y染色体无精子因子(AZF)区微缺失,102例维吾尔族患者检出10例(9.80%)存在Y染色体无精子因子(AZF)区微缺失,在所有被检出有Y染色体无精子因子(AZF)区微缺失的患者中AZF区联合缺失19例(90.47%)。其中AZFb区缺失(100%)最常见,其次为AZFc区缺失(71.4%);AZFa区缺失(23.8%)和SRY基因的缺失(19.05%)。汉族患者与维吾尔族患者Y染色体无精子因子(AZF)区微缺失率(χ2=7.781,P=0.005)及AZF多位点联合缺失发生率差异(χ2=6.867,P=0.009)均有统计学意义(P0.05)。结论无精子症和严重少弱精子症不育男性患者中Y染色体无精子因子(AZF)区微缺失发生率及AZF多位点联合缺失发生率存在民族差异,PCR检测AZF基因是诊断Y染色体无精子因子(AZF)区微缺失的较好的方法。     

不同精子来源及受精方式对胚胎冻融结局的影响

目的探讨常规体外受精(IVF)、精液精子与穿刺后精子卵胞浆内单精子注射(ICSI)对胚胎冻融结局的影响。方法分析我中心2013年1月至2013年12月间行胚胎冻融移植周期的临床妊娠结局,其中IVF周期1479,ICSI周期258,早期补救52例;来源于精液精子组105个周期,行穿刺后精子组33个周期。结果 IVF组、ICSI组与早期补救ICSI组间的复苏胚胎存活率相比无差异(96.5%、95.0%vs 99.0,P0.05);三组之间种植率、妊娠率相比也无统计学差异(27.7%、25.3%vs 35.1%;41.0%、39.5%vs 46.2%,P0.05)。精液精子组与穿刺精子组的复苏胚胎存活率、种植率和妊娠率之间差异不显著(P0.05)。结论 ICSI及穿刺后精子行ICSI胚胎其冻融后的存活率和妊娠率与常规IVF之间无显著差异。     

桂西地区壮族不育患者Y染色体无精子因子筛查

目的探讨桂西地区壮族不育患者Y染色体无精子因子(azoospermia factor,AZF)微缺失与原发无精子、严重少精子症之间的关系。方法采用多重聚合酶链反应技术对桂西地区52例原发无精子症、76例原发严重少精子症患者及40名正常生育男性进行4个区域15个位点微缺失分析。结果 40名正常生育男性未发现Y染色体AZF微缺失,128例生精障碍患者中发现AZF微缺失13例,总缺失率为10.2%。生精障碍组与正常生育男性组比较Y染色体AZF微缺失率差异具有统计学意义(P0.01)。结论 Y染色体AZF微缺失是男性无精子、少精子症的要重原因之一。     

男性不育患者Y染色体AZF基因微缺失检测

目的探讨原发性无精子症、严重少精子症及少精子症患者与Y染色体无精子因子（azoospermia factor,AZF）区微缺失的关系。方法采用多重PCR方法对对照组192例已正常生育男性和实验组448例男性不育患者进行AZF区域内的15个序列标签位点（STS）的检测。结果对照组未发现AZF基因微缺失,实验组448例患者检测出五种AZF微缺失类型共41例,总缺失率为9.2%（41/448）,其中无精子症、严重少精子症和少精子症患者的缺失率分别为12.0%（19/158）、10.8%（17/157）、3.8%（5/133）,无精子症和严重少精子症患者Y染色体AZF微缺失率明显高于少精子症组,差别有统计学意义（P〈0.05）。使用15个STS位点进行检测其检出率较利用欧洲男科学会（European Academy of Andrology,EAA）推荐的6个STS位点提高约14%（5/36）。结论AZF微缺失是引起原发性无精子症、严重少精子症和少精子症的重要原因之一;增加STS位点检测数有利于提高AZF微缺失的检出率。     

Y染色体微缺失及生殖激素水平改变与少精子、无精子症关系的研究

目的探讨Y染色体微缺失及生殖激素水平改变与少精子、无精子症间的关系。方法应用多重聚合酶链反应技术对256例少精子、无精子患者（少精子症92例,无精子症164例）和正常对照组50例进行Y染色体微缺失检测以及生殖激素水平检测。结果发现256例少精子、无精子症患者中无精子因子（azoospermia factor,AZF）微缺失的发生率为12.89%（33/256）,其中164例无精子症患者微缺失24例（24/164,14.63%）,92例少精子症患者微缺失9例（9/92,9.78%）;少精子、无精子症病人中卵泡刺激素（FSH）、黄体生成素（LH）的量明显高于正常对照组（P〈0.05或P〈0.01）;而睾酮（T）的含量明显低于对照组（P〈0.05或P〈0.01）;血清泌乳素（PRL）和雌二醇（E2）的含量与正常组相比差异无明显性（P〉0.05）。结论 Y染色体微缺失及FSH、LH、T水平与少精子、无精子症关系密切,可能是引起少精子、无精子症的原因之一。     

150例无精子和少精子症患者Y染色体AZF区微缺失检测及染色体核型分析

目的分析无精子和少精子症患者Y染色体AZF基因微缺失与染色体核型的关联。方法对无精子、少精子症男性患者Y染色体AZF基因区15个STS位点进行检测和染色体核型分析。结果 150例患者经15个STS位点检测发现AZF区微缺失12例,总缺失率为8.0%。其中AZFa缺失2例,缺失频率为1.3%;AZFb缺失1例,缺失频率为0.6%;AZFc缺失11例,缺失频率为7.3%;AZFd缺失10例,缺失频率为6.7%。AZF区缺失频率为AZFc〉AZFd〉AZFa〉AZFb。12例AZF区微缺失的患者共存在4种缺失类型,其中10例患者为AZF区的联合缺失。所有患者经核型分析共检测出14例异常核型,异常率为9.3%。14例异常核型患者中有1例存在Y染色体微缺失;136例正常核型患者存在11例Y染色体微缺失。结论 Y染色体AZF区有缺失,不一定染色体核型异常,染色体核型异常也不排除有AZF的缺失;Y染色体微缺失与染色体核型异常不呈一一对应关系。     

Conventional in-vitro fertilization versus intracytoplasmic sperm injection in sibling oocytes from couples with tubal infertility and normozoospermic semen.

An auto-controlled study was conducted in couples with tubal infertility and normozoospermic semen. The fertilization rates and embryonic development in sibling oocytes treated, using the same semen sample, either by conventional in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at the same time were compared. Sibling oocyte-cumulus complexes (OCC) of 56 different couples with tubal infertility and normozoospermic semen were randomly divided in order of retrieval into two groups inseminated either by conventional IVF or by ICSI. Of the retrieved OCC in the same cohort, 53.0 +/- 31.2 and 62.0 +/- 26.6% showed two distinct pronuclei after conventional IVF and ICSI respectively (not significant). Complete fertilization failure occurred after conventional IVF in 12.5% (7/56 couples). After ICSI, the comparable figure was 3.6% (2/56). The number of cases was too small to apply a statistical test to this difference. Total cleavage rates were quite similar: 86.7 +/- 28.0 and 90.1 +/- 21% of the zygotes developed into transferable embryos after IVF and ICSI respectively (not significant). Similarly, no difference in embryo quality was observed. Although injection and insemination of the oocytes were performed at the same time in the two groups, at 42 h post-insemination more embryos were at the four-cell stage after ICSI (P < 0.001) than after conventional IVF, where more embryos were still at the two-cell stage (P < 0.02). Embryo transfer was possible in all 56 couples, resulting in 16 positive serum human chorionic gonadotrophin tests (28.6% per embryo transfer), from which a clinical pregnancy resulted in 15 couples. The best embryos were selected for transfer independently of the insemination procedure, but preferably from the same origin. There appeared to be no difference in implantation potency of the embryos obtained with either technique after the non-randomized transfers.     

Potential adverse effect of sperm DNA damage on embryo quality after ICSI

BACKGROUND: Sperm DNA damage is prevalent amongst infertile men and has been shown to strongly impact adversely natural reproduction, intrauterine insemination-assisted reproduction and to a lesser degree IVF/ICSI fertilization. The objective of this study was to examine further the relationship between sperm DNA denaturation (DD) and reproductive outcomes after ICSI. METHODS: We evaluated infertile couples (n = 60) undergoing IVF/ICSI at a single centre. Sperm DD was assessed by flow cytometry analysis of Acridine Orange-treated sperm and expressed as the percentage of sperm with DD. Couples were sub-grouped according to sperm DD results: group 1: 0-15%; group 2: >15-30%; group 3: >30%. RESULTS: There were no differences between the three groups with regard to maternal age, sperm parameters, oocyte maturation, fertilization or pregnancy rates. Group 3 had a significantly higher rate of multinucleation among the embryo cohorts compared to either groups 1 or 2 (20% versus 10% and 8% respectively, P = 0.04). There was a statistically insignificant trend toward an increased spontaneous pregnancy loss rate in group 3 (P =0.50). CONCLUSION: Although we did not observe significant relationships between sperm DNA damage and either fertilization or pregnancy rates, the potential adverse effect of sperm DNA damage on embryo quality and spontaneous pregnancy loss is concerning.     

特发性无精子症及少弱精子症患者Y染色体AZF微缺失筛查分析

目的探讨特发性无精子症及少弱精子症不育男性与Y染色体AZF微缺失的关系.方法用双重PCR技术对63例患者(无精于症41例,少弱精子症14例,严重少精子症8例)进行Y染色体AZFa、AZFb、AZFc、SRY的微缺失筛查.同时对26例无精于症患者行睾丸活检、组织学评估.结果63例中AZF微缺失7例,缺失率为11.1%.其中无精子症5例,严重少精子症2例.AZFc缺失4例,AZFb缺失2例,AZFb AZFc缺失1例,未发现AZFa区缺失.63例及对照组30例SRY基因扩增均阳性.26例无精子症患者行睾丸活检、组织学检查,无1例精子发生正常.结论Y染色体微缺失,特别是AZFc区DAZ基因的微缺失,是引起无精子和严重少弱精子等生精障碍而致男性不育较为重要的遗传学因素.     

Screening for Y chromosome microdeletions in 226 Slovenian subfertile men.

BACKGROUND: The objective of this study was to estimate the frequency of Y chromosome microdeletions in the Slovenian population of infertile men and to analyse the consequences of mutation in respect to clinical severity and prognosis. METHODS: In a controlled clinical study at the university-based medical genetics service and infertility clinic, 226 infertile men undergoing ICSI were tested. The main outcome measures included polymerase chain reaction amplification of 16 genes and gene families and 42 sequence-tagged sites in the non-recombining region of the Y chromosome, semen, testicular volume and testicular histological analysis, serum FSH concentrations, fertilization and respective pregnancy rates. RESULTS: The incidence of deletions was 4.4%: 8.6% in men with azoospermia and 1.5% in men with oligoasthenoteratozoospermia. Isolated gene deletions were not identified. No statistically significant differences in clinical outcome measures were found in patients with mutations versus patients without mutations. High fertilization (49%) and pregnancy (43%) rates with sperm of patients with Y chromosome deletions were obtained. CONCLUSIONS: Testing for gene-specific microdeletions does not contribute significantly to the sensitivity of microdeletion test. Fertilization and pregnancy rates obtained using sperm of patients with Y chromosome deletions were comparable with those achieved in conventional IVF.     

Prognostic value of Y deletion analysis: How reliable is the outcome of Y deletion analysis in providing a sound prognosis?

Y chromosomal microdeletions at the azoospermia factor (AZF) locus have been implicated as one of the major causes of idiopathic male infertility. The availability of intracytoplasmic sperm injection (ICSI) in treating a variety of male infertility has raised the risk of the transmission of Y microdeletions from father to son. In many IVF centres, Y microdeletion analysis has been used as a diagnostic tool for genetic counselling of infertile couples. Presently, the only prognosis that can be derived from Y microdeletion analysis is that the affected male offspring would benefit from proper clinical management of their infertility. Prognoses based on the pattern of Y microdeletions in relation to phenotype are rather subjective and inconclusive because of insufficient data to derive a definitive correlation whose significance can be determined by statistical analysis. Standardization of the number and choice of sequence-tagged sites (STS), whose deletions result in defective spermatogenesis, for the polymerase chain reaction (PCR) analysis of Y microdeletions would enhance its reliability in the interpretation of the results which is crucial for therapeutic decision-making. Furthermore, in-depth understanding of the gene functions in male infertility, especially at the AZF locus, would contribute greatly to the quality of the prognostic value of Y microdeletion analysis.     

Obstetric outcome of pregnancies after the transfer of cryopreserved and fresh embryos obtained by conventional in-vitro fertilization and intracytoplasmic sperm injection.

This study reports the obstetric outcome of pregnancies obtained after the transfer of cryopreserved or fresh embryos where the initial procedure was standard in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Pregnancies obtained after frozen IVF (n = 245) or frozen ICSI (n = 177) were compared with a control group of pregnancies after fresh embryo transfer in standard IVF (n = 245) and ICSI (n = 177) cycles were selected as controls. The controls were matched according to maternal age, parity and date of embryo transfer. In the standard IVF group, the biochemical pregnancy rates in the cryopreserved and fresh groups were 18.8 and 9.8% respectively (P < 0.01). In the ICSI group, the biochemical pregnancy rates in the cryopreserved and fresh groups were 16.4 and 6.8% respectively (P < 0.01). The miscarriage rates were comparable between the cryopreserved and fresh groups. However, in the frozen ICSI group the miscarriage rate (26.0%) was significantly higher than in the frozen conventional IVF group (13.1%) (P = 0.001). The frequencies of preterm deliveries, infants with very low birthweight and intrauterine deaths were similar in the groups. The low birthweight rates in the frozen IVF (16.1%) and ICSI (12.1%) groups were significantly lower than those in the fresh IVF (32.2%) and ICSI (32.7%) groups (P < 0.001). The major malformation rates in the frozen IVF (2.4%) and ICSI (2.9%) groups were not different from the major malformation rates in the fresh IVF (4.5%) and ICSI (2.4%) groups. In conclusion, the cryopreservation process had no negative impact on the outcome of pregnancies over 20 weeks of gestation. Long-term follow-up studies are needed in order to prove the safety of the freezing-thawing process.     

AZF缺失患者Y染色体断裂点定位分析

目的 分析导致无精子因子区域(azoospermia factor,AZF)缺失的Y染色体断裂的特点.方法 在272例无精子症、240例严重少精子症患者进行Y染色体AZF微缺失筛查基础上,对筛查发现大片段缺失的49例患者,选择AZFa、AZFb、AZFc区23个序列标签位点(sequence tagged site,STS),对断裂点进行定位分析.颖有无精子症缺失基因家族(deletedin azoospermia,DAZ)、基因部分拷贝缺失病例进行单核苷酸多态性(single nuecleotide varians,SNV)缺失分析以确定DAZ基因的拷贝数.结果 6例AZFb+C缺失患者,1例为sY98/sY1206缺失,4例为P5/P1远端重组,1例为P4/P1远端重组.3例筛查发现AZFb区缺失患者,1例为P5/P3缺失,2例为P5/P1近端重组,伴有DAZ1、DAZ2拷贝缺失.40例AZFc区全缺失患者,均为b2/b4同源重组.部份AZFb、AZFb+c缺失患者,睾丸穿刺活检发现精子生成减少或精子成熟障碍.结论 对Y染色体AZF大片段缺失断裂点的大致定位有利于判断缺失发生机制,进而分析丢失的生精相关基因拷贝性质与数量,以评价其与生精障碍表型之间的关联.