精子核蛋白组型转换对首次宫腔内人工授精临床结局的影响

目的 研究精子核蛋白组型转换对首次宫腔内人工授精(intrauterine insemination, IUI)临床结局的影响。方法 对2017年3月至2021年2月于广东省中医院生殖医学科完成的168个首次IUI周期临床资料及术前3个月内的精子核蛋白组型转换数据进行回顾性分析,根据精子核蛋白组型转换异常率(AB阳性率)分为：AB阳性率<30%组(132例)和AB阳性率≥30%组(36例),比较两组IUI临床妊娠率、自然流产率,分析精子核蛋白组型转换预测IUI临床妊娠的价值。根据妊娠结局,将所有患者分为妊娠组(34例)与未妊娠组(134例),将临床妊娠患者分为自然流产组(8例)与未流产组(26例),比较其精子核蛋白组型转换异常率。结果 AB阳性率<30%组与AB阳性率≥30%组的首次IUI临床妊娠率、自然流产率比较,差异均无统计学意义(P>0.05)。妊娠组与未妊娠组、自然流产组与未流产组精子核蛋白组型转换异常率比较,差异均无统计学意义(P>0.05)。ROC曲线显示,精子核蛋白组型转换异常率不能预测IUI临床妊娠(AUC=0.554,95%CI:0.449-0...     

CHANGES IN SEMEN QUALITY IN JERUSALEM BETWEEN 1990 AND 2000: A CROSS-SECTIONAL AND LONGITUDINAL STUDY

The aim of the present study was to investigate whether sperm quality has changed during the years 1990-1999 among men residing in Jerusalem, Israel, who were involved in treatment by intrauterine insemination (IUI). Both cross-sectional and longitudinal analyses were performed. A total of 2638 male partners in couples that underwent treatment by IUI participated in the cross-sectional investigation. Of them, 417 men (16%) were included in the longitudinal study. Total sperm counts and percent motility were evaluated on an annual basis to assess changes over 10 years from 1990 through 1999. A significant downward trend in sperm count and motility was demonstrated in the cross-sectional study. Sperm count decreased by 5.2×10 6 ±0.9×10 6 ( p <. 0001) each year and percent motility declined by 0.50±0.14% ( p =.0003). Similar changes were found in the longitudinal evaluation, but they were not statistically significant. These data suggest that during the last decade in Jerusalem, sperm count and motility declined significantly among men involved in infertile relationships and treated by IUI.     

宫腔内人工授精成功率的影响因素分析

目的分析影响宫腔内人工授精(intrauterine insemination,IUI)成功率的相关因素。方法回顾性分析2013~2014年北京市海淀区妇幼保健院生殖中心1 659个IUI周期的患者年龄、不孕年限、不孕类型、自然周期或促排卵周期、子宫内膜厚度、排卵数、IUI的时机、洗精前后前向运动精子数、IUI的周期数与妊娠结局的关系。结果 IUI治疗妊娠率与患者年龄、子宫内膜厚度、IUI治疗周期数、排卵数及洗精前前向运动精子数有关(P0.05);与不孕类型、自然周期或促排卵周期、IUI时机、洗涤后前向运动精子数无关(P0.05)。结论影响IUI结局的主要因素是:子宫内膜厚度、患者年龄、IUI治疗周期数、排卵数及洗涤前前向运动精子数。     

男性因素对宫腔内人工授精临床妊娠率的影响

目的：探讨男性因素对宫腔内人工授精（IUI）临床妊娠率的影响。方法：回顾性分析239对不孕夫妇行472个IUI周期的资料,分析男方年龄（＜30岁,30~35岁,≥35岁）、精子正常形态百分率（正常精子形态≥15%,10%~15%,5%~10%,≤4%）及精液处理后前向运动精子总数（PTMS）[＜2×106,（2~15）×106,（5~10）×106,（10~20）×106,≥20×106]对IUI临床妊娠率的影响。结果：472个IUI周期共获得80例临床妊娠,周期妊娠率16.95%,累积妊娠率33.47%。男方年龄≥35岁IUI组临床妊娠率显著下降,仅为10.4%（14/134）;重度畸形精子症组周期临床妊娠率为8.4%（7/83）,低于其他各组,差异有统计学意义（P＜0.05）。结论：IUI治疗过程中要充分考虑男方年龄对治疗结果的影响,当精子正常形态百分率＜5%或PTMS＜2×106时,IUI临床妊娠率显著下降,建议行体外受精-胚胎移植/胞浆内单精子注射-胚胎移植治疗以改善妊娠结局。     

影响宫腔内人工授精治疗结果的因素探讨

目的:探讨影响宫腔内人工授精(IUI)治疗结果的因素,以提高IUI治疗的临床效果。方法:对415个IUI治疗周期的240例患者的年龄、不孕年限、不孕原因、精液处理方法和处理后精子情况、IUI治疗周期数、一个周期内2次IUI以及促排卵方案与治疗结果的关系进行分析。结果:患者的年龄、处理后精子情况、IUI周期数和促排卵药物的使用与治疗结果有关;精液处理方法、一个周期内2次IUI和不同的促排卵方案对治疗结果没有影响。结论:患者的年龄、处理后精子情况、IUI周期数和促排卵药物的使用是影响IUI治疗结果的重要因素;一个周期内2次IUI和增加IUI的治疗周期数无法提高IUI治疗的临床妊娠率。     

SperMagic在自然周期夫精宫腔内人工授精中的临床应用

目的：探讨SperMagic在自然周期夫精宫腔内人工授精中对精子活力及妊娠率的影响。方法：选择2012年3月—2012年6月进行自然周期夫精宫腔内人工授精的患者70例,随机分为2组：30例精子处理后添加SperMagic者为A组;40例精子处理后未添加SperMagic者为B组,比较2组精子活力和妊娠率差异。结果：A、B组年龄、不孕时间、体质量指数（BMI）以及精子处理前后密度、活力差异均无统计学意义（P＞0.05）;2组妊娠率差异亦无统计学意义（P＞0.05）,但A组有增高趋势。添加SperMagic后精子活力比精子处理后活力提高,差异有统计学意义（P＜0.05）。结论：在夫精宫腔内人工授精助孕技术中,精子处理后添加SperMagic可以明显改善精子的活力。     

1136周期宫腔内夫精人工授精临床因素的分析

目的:对影响宫腔内夫精人工授精(Intrauterine insemination,IUI)妊娠率的因素进行分析。方法:对接受夫精宫腔内人工授精治疗的651例不孕患者1 136周期的临床资料进行回顾性分析,主要分析不同的促排卵方案、IUI周期数、子宫内膜形态、内膜厚度等与妊娠率的关系。结果:1 136周期的IUI中妊娠周期93周期,周期妊娠率8.19%;<30岁、30～35岁,和>35岁妊娠率分别是8.80%、7.69%和5.42%;不同的促排卵方案(CC、hMG/hCG、hCG)的妊娠率分别为10.00%、9.00%和7.46%;hCG日内膜厚度为<8 mm、8～14 mm、>14 mm,妊娠率分别为5.61%、8.70%和12.70%;hCG日或出现LH峰当日子宫内膜形态为A型、B型、C型时,妊娠率分别是9.63%、4.55%和8.00%;重复周期IUI对提高妊娠结局差异无统计学意义。结论:施行IUI女方的年龄是影响IUI妊娠率的主要因素;多次重复周期IUI并不能显著改善妊娠结局;不同促排卵方案的妊娠结局差异无统计学意义。     

影响促排卵宫腔内人工授精临床妊娠率相关因素分析

目的探讨影响促排卵周期宫腔内人工授精(intrauterine insemination,IUI)临床妊娠率相关因素。方法回顾性分析广州市妇女儿童医疗中心2011年1月至2015年9月行促排卵IUI治疗的805个周期,对女方年龄、不孕年限、授精周期数、授精次数、促排卵方案、优势卵泡数目、是否行人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)诱导排卵对临床妊娠率的影响进行分析。结果 1年龄30组、31~36岁组、37~40组、40组临床妊娠率分别为17.84%、16.59%、7.77%、0,差异有统计学意义(P0.05)。2不孕年限3年组、3~5年组、5年组临床妊娠率分别为17.88%、14.44%、13.38%,随着不孕年限增加临床妊娠率呈下降趋势,但各组间差异无统计学意义(P0.05)。3授精周期数为1、2、3、3次者临床妊娠率分别为17.07%、15.56%、12.00%、10.34%,授精周期数增加临床妊娠率呈下降趋势,但各组间差异无统计学意义(P0.05);同一周期中授精1次和2次临床妊娠率分别为15.20%、16.06%(P0.05)。4氯米芬、来曲唑、氯米芬+尿促性素、来曲唑+尿促性素、尿促性素5种促排卵方案临床妊娠率分别为12.15%、13.73%、21.74%、19.15%、15.25%,差异无统计学意义(P0.05)。5优势卵泡为1个临床妊娠率为12.17%,低于2个组(19.08%)、3个组(20.88%),(P0.05)。6使用HCG诱导排卵组临床妊娠率为15.59%,略高于未使用HCG诱导排卵组(12.69%),但差异无统计学意义(P0.05)。7 Logistic回归分析显示促排卵IUI妊娠成功率的主要因素是年龄和优势卵泡数目。结论患者年龄、授精周期数、优势卵泡数目是影响促排卵IUI临床妊娠率的主要因素。促排卵方案、授精次数、是否使用HCG诱导排卵等对促排卵IUI临床妊娠无影响。     

Intrauterine insemination with conjoint semen. How to increase the success rate?

BACKGROUND: Intrauterine insemination is usually proposed as the first line therapy for infertility related to cervical hostility, male factor, unexplained infertility or mild endometriosis. The overall succes rate of IUI is about 10-20% clinial pregnancy per cycle. The Aim of this study is to evaluate factors that increase the succes rate of IUI. METHODS: we restrospectively analysed 206 cycles of IUI with partner's semen in 138 infertile couples. The clinical and laboratory factors that may influence the pregnancy rates were analysed: women's age, etiology of infertility, duration of infertility, ovarian stimulation, day of hCG and sperm parametres. RESULTS: The per-cycle clinical pregnancy rate was of 14.56%. Optimal pregnancy rates were observed in less than 38 years old women (18.29% vs 9.52%, p<0.05). The succes rate was statistically depending of the number of IUI cycles until three (p<0.05), the day of hCG (p<0.05) and the sperm count after conventionally prepared semen (p<0.05). Sperm parameters was of no value in predecting the pregnancy rates, and neither seam's to be the total dose of administrated Gonadotrophin or the etiology of infertility, but it seams that, when a cervical factor or PCO were involved, the succes rate is higher. Besides, getting three or more than three follicles may increase the succes rate but expose to a warrying risk of multiple pregnancy. CONCLUSION: According to this study, the only statitically significant factors that are associated with successful IUI were, women partner's age (<38 ans), number of IUI cycles (during the first three IUI cycles), day of hCG (>J13) and sperm count after conventional semen preparation (>1.106/mL).     

VIABILITY AND FECUNDITY OF HUMAN SEMEN SPECIMENS CRYOSTORED AND TRANSPORTED AT 5°C USING THE BIO–TRANZTM SHIPPING

This study was designed to assess the viability and fecundity of semen stored at 5°C for 24 hours using the Bio-Tranz^TM shipping system. Semen specimens were assessed for motility and sperm membrane integrity at the time of collection and 24 hours after storage in the Bio-Tranz^TM. In group 1 (n = 61), specimens were diluted in TYB, processed and used for intrauterine insemination (IUI), leaving an aliquot for storage for 24 hours in the Bio-Tranz^TM. In group 2 (n = 67), specimens were diluted in TYB, stored for 24 hours in the Bio-Tranz^TM and then processed and used for IUI. In both groups, the total motile sperm used for IUI was similar and the women that underwent IUI were standardized for ovulation prediction and time of insemination. The overall sperm characteristics between the two groups were within normal range. Significant decreases were noted in sperm motility and membrane integrity in both groups after storage. Similar pregnancy rates were obtained between the two patient populations. The use of the Bio-Tranz^TM shipper is extremely convenient for patients requiring semen evaluation, cryostorage or IUI and other assisted reproductive technologies.     

Relationship between processed total motile sperm count of husband or donor semen and pregnancy outcome following intrauterine insemination

We retrospectively analyzed 6,360 artificial insemination cycles of husband's semen through intrauterine insemination (AIH-IUI) or artificial insemination with donor semen through intrauterine insemination (AID-IUI) in patients with infertility between August, 1998 and August, 2010. The relationship between processed total motile sperm count (PTMS) and pregnancy outcome was determined. The study was divided into 6 groups according to PTMS. Group 1:?≤?2.0 million, Group 2: 2.1-4.0 million, Group 3: 4.1-6.0 million, Group 4: 6.1-8.0 million, Group 5: 8.1-10.0 million, and Group 6: >10.0 million. There was no statistically significant difference in age, duration of infertility, unilateral tubal patency, induced ovulation, and single IUI or double IUI between the 6 groups in both AIH-IUI and AID-IUI. The total clinical pregnancy rate of AIH-IUI was 10.81 % and AID-IUI was 27.52 %. Among the 6 groups, the clinical pregnancy rate was the lowest in Group 1 (P?相似文献   

经皮穿刺输精管吸取精子行宫腔内人工授精治疗不射精症不育

目的:观察经皮穿刺输精管吸取精子(PVSA)行宫腔内人工授精(IUI)治疗不射精症致不育的临床疗效。方法:对经药物治疗无效的不射精症不育患者23例,采用经PVSA行IUI的方法助孕。结果:23例不射精症不育患者经31个治疗周期,15例妊娠,妊娠率为65.2％(15/23),周期妊娠率为48.4％。PVSA吸出精子活率、动力(a+b级)、精子密度、精子总数及畸形精子分别为(78.6±14.2)％、(60.4±11.2)％、(37.6±13.2)×10_9/L、(35.2±13.2)×10_6及(18.6±7.6)％。结论:PVSA结合IUI治疗难治性不射精症不育,疗效确切,方法简便、创伤小、费用低,可重复操作,便于推广应用。     

Relationship between processed total motile sperm count of husband or donor semen and pregnancy outcome following intrauterine insemination

We retrospectively analyzed 6,360 artificial insemination cycles of husband's semen through intrauterine insemination (AIH-IUI) or artificial insemination with donor semen through intrauterine insemination (AID-IUI) in patients with infertility between August, 1998 and August, 2010. The relationship between processed total motile sperm count (PTMS) and pregnancy outcome was determined. The study was divided into 6 groups according to PTMS. Group 1:?≤?2.0 million, Group 2: 2.1-4.0 million, Group 3: 4.1-6.0 million, Group 4: 6.1-8.0 million, Group 5: 8.1-10.0 million, and Group 6: >10.0 million. There was no statistically significant difference in age, duration of infertility, unilateral tubal patency, induced ovulation, and single IUI or double IUI between the 6 groups in both AIH-IUI and AID-IUI. The total clinical pregnancy rate of AIH-IUI was 10.81 % and AID-IUI was 27.52 %. Among the 6 groups, the clinical pregnancy rate was the lowest in Group 1 (P?<?0.05) in both AIH-IUI and AID-IUI. With the increased PTMS, the clinical pregnancy rate of IUI was improved. However, a statistical difference between groups was only observed for Group 1. When PTMS is?≤?2?×?10⁶ the clinical pregnancy rate of IUI is significantly decreased. In this case in vitro fertilization (IVF) should be adopted.     

影响供精人工授精成功率因素的临床研究

目的:探讨影响供精人工授精(AID)成功率的各种临床因素及治疗对策。方法:121对夫妇行336个AID周期,其中6例行AID联合促排卵治疗3个周期以上未孕,遂改为供精IVF。结果:336个AID周期中共34例妊娠,周期妊娠率为10.1%。自然周期192例,周期妊娠率为7.2%。自然周期行宫颈管内人工授精(ICI)102周期,周期妊娠率为6.8%(7/102);宫腔内人工授精(IUI)82周期,周期妊娠率为7.3%(6/82);输卵管内精液灌注(FSP)8例,周期妊娠率为12.5%(1/8)。促排卵周期中,CC周期76例,HMG周期68例,妊娠率分别为7.8%和20.5%,两组相比较,HMG周期的妊娠率显著高于CC周期(P<0.05);CC周期和自然周期相比较无显著差异(P>0.05)。在CC和HMG促排卵周期中,均以FSP的妊娠率(16.6%和33.3%)最高(P<0.005),而ICl的周期妊娠率(3.1%和12.5%)显著低于IUI(10.5%和20.5%)和FSP(P<0.01)。6对夫妇行8个周期的供精IVF,周期妊娠率为50%(4/8)。结论:手术方式和促排卵方案的选择与AID的成功率密切相关,改变手术方式和促排卵方案可提高AID的成功率。     

Inflammatory bowel disease in subfertile men and the effect of mesalazine on fertility

Abstract

This study aimed to examine the effect of mesalazine on fertility. In this retrospective analysis of 1,225 male subfertile patients, we reviewed the cases of inflammatory bowel disease (IBD) in the medical records and evaluated the prevalence of the disease in our reproduction center. Specifically, we examined IBD patients who ceased mesalazine during male infertility treatment, and compared the seminogram of these patients before and after discontinuation of mesalazine. We also analyzed pregnancy outcome after discontinuation. The prevalence rate of Crohn’s disease and ulcerative colitis in our male infertile patients was 163 per 100,000 men and 490 per 100,000 men, respectively. Seven patients had taken mesalazine and six of them subsequently stopped the medication. The mean values of sperm concentration, sperm motility, percentage of normal formed sperm, semen volume, and total motile sperm count taken before discontinuation increased after discontinuation of mesalazine. Among these parameters, the sperm motility and total motile sperm count were significantly improved (p?<?0.05) after discontinuation. Of the six patients who stopped the drug, four achieved pregnancy with their partners, with two of the four men showing significant improvement not only in the percentage of normal shaped sperm but also sperm motility and total motile sperm count. This study provides further insight into the rarely investigated relationship between male fertility and mesalazine.     

克罗米芬+补佳乐在IUI中的临床应用探讨

目的观察克罗米芬+补佳乐在宫腔内人工授精中的应用,探讨影响克罗米芬的作用因素以提高IUI的成功率;方法回顾性分析了50例病人56周期IUI治疗方案,总结了不同年龄病人用药情况及用药后在注射hCG日病人的子宫内膜厚度、妊娠结局等;结果在57周期克罗米芬+补佳乐/IUI治疗中,妊娠有6例,临床妊娠率为12%,周期妊娠率为10.7%;其中1例为异位妊娠,1例早期流产;结论克罗米芬+补佳乐可改善子宫内膜的厚度,有利于胚胎着床,结合IUI能取得较好的妊娠结局。     

COMPARISON OF FOUR METHODS FOR SPERM PREPARATION FOR IUI

We compared the pregnancy rates and sperm characteristics of semen prepared by the albumin, Percoll, Puresperm, and swim-up methods. Semen analysis was performed by a computer-assisted system (CASA). The overall pregnancy rate was 14% per patient and 11% per cycle. The albumin and Percoll methods had the highest pregnancy rates, up to 12% per cycle. We then compared each method with the albumin method. The swim-up technique yielded the highest percentage of motile sperm. The Percoll method yielded statistically significant changes in average path velocity and straight-line velocity, while the Puresperm method revealed the same statistical changes in total concentration and hyperactive motile sperm percentage. After adjusting for age, methods, and CASA estimates, only straight-line velocity was significantly correlated with pregnancy. Although the Percoll method was associated with the best pregnancy rate, this product has been withdrawn from the market because of toxic contamination. Puresperm had replaced it in our laboratory but showed an unsatisfactory pregnancy rate. The swim-up method is the best choice for IUI.     

同一周期单双次授精对供精人工授精妊娠率的影响

目的：研究同一周期单次授精和双次授精对供精人工授精妊娠率的影响。方法收集2012年8月至2013年7月在郑州大学第三附属医院生殖医学中心进行的供精人工授精（ AID）共568人次864个周期。回顾性分析同一周期单次授精、双次授精及首次注入不同精子数对供精人工授精妊娠率的影响。结果在568人次864个供精人工授精周期中,单次授精、双次授精妊娠率分别为29．77％和36．29％,双次授精妊娠率高于单次授精,差异具有统计学意义（χ^2＝3．438,P＜0．05）。首次注入精子数≥1000万条和＜1000万条的两组患者,前者单双次授精妊娠率分别为19．80％和34．93％,后者单双次授精妊娠率分别为10．00％和31．95％,双次授精妊娠率高于单次授精,差异具有统计学意义（首次注入精子数≥1000万条：χ^2＝8．863,P＜0．05;首次注入精子数＜1000万条：χ^2＝9．759,P＜0．05）。结论围排卵期首次注入精子数≥1000万条或＜1000万条,同一周期行双次人工授精可提高妊娠率。     

影响宫腔内人工授精临床妊娠结局的相关因素

目的:通过对宫腔内人工授精(IUI)临床资料的回顾性分析,探讨男性因素与IUI妊娠结局的关系。方法:回顾性分析2010年1～12月在河南省人民医院生殖医学中心进行的329个IUI治疗周期的临床资料。按照IUI结局分为妊娠组、非妊娠组,比较各组患者在男方年龄、女方年龄、不孕病史、精子参数等方面的差异。分别按照男方年龄、女方年龄、不孕年限、精子参数等指标进行分组,比较各组患者妊娠率的差异。结果:妊娠组和非妊娠组的男女双方年龄、不孕年限等指标差异均无统计学意义(P>0.05);女方年龄>35岁组临床妊娠率低于≤35岁组(P<0.05),处理后前向运动精子数<2×106条组临床妊娠率低于处理后前向运动精子数≥2×106条组(P<0.05),其余各组临床妊娠率差异无统计学意义(P>0.05)。结论:在输卵管通畅的情况下,处理后前向运动精子数≥2×106条男性不育者应尽可能采用IUI进行治疗,处理后前向运动精子数<2×106条或女方年龄偏大时可考虑IVF或ICSI。     

Effect of density gradient centrifugation on reactive oxygen species in human semen

Density gradient centrifugation can separate motile sperm from immotile sperm and other cells for assisted reproduction, but may also remove antioxidants from seminal plasma, resulting in oxidative stress. Therefore, we investigated reactive oxygen species (ROS) concentrations and distribution in semen before and after density gradient centrifugation. We assessed semen volume, sperm concentration, sperm motility, and ROS levels before and after density gradient centrifugation (300 x g for 20 minutes) in 143 semen samples from 118 patients. The ROS removal rate was evaluated in ROS-positive samples and ROS formation rate in ROS-negative samples. Thirty-eight of 143 untreated samples (26.6%) were ROS-positive; sperm motility was significantly lower in these samples than in ROS-negative samples (p < 0.05). After density gradient centrifugation, only seven of the 38 ROS-positive samples (18.42%) exhibited a ROS-positive lower layer (containing motile sperm) with a ROS removal rate of 81.58%, whereas the upper layer was ROS-positive in 24 samples (63.16%). In the ROS-negative group (n = 105), ROS was detected in 19 samples after centrifugation (18.10%, ROS generation rate), of which 18 were ROS-positive only in the upper layer or interface and the other was ROS-positive in both layers. Density gradient centrifugation can separate motile sperm from immotile sperm as well as remove ROS (including newly generated ROS). This data supports the view that density gradient centrifugation can select motile spermatozoa without enhancing oxidative stress.

Abbreviations: ROS: reactive oxygen species; SOD: superoxide dismutase; GPx: glutathione peroxidase; DNA: deoxyribonucleic acid; DGC: density gradient centrifugation; IUI: intrauterine insemination; IVF: in vitro fertilization; HEPES: 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid; EDTA: ethylenediaminetetraacetic acid; HTF: HEPES-buffered human tubal fluid; IMSI: intracytoplasmic morphologically selected sperm injection; SMAS: sperm motility analyzing system; CASA: computer-assisted semen analyzer; WHO: World Health Organization