EFFECTS OF SEMEN CHARACTERISTICS ON IUI COMBINED WITH MILD OVARIAN STIMULATION

To determine the influence of sperm parameters inseminated on the outcome of intrauterine insemination (IUI) in patients undergoing ovarian stimulation with clomiphen citrat (CC) or human menopausal gonadotropin (HMG) therapy, a retrospective review was performed for 2 years on data from the IUI program. 190 couples underwent a total of 268 IUI cycles in which CC or HMG was used for ovulation induction. The initial sperm concentration (mil/ml), motility (percent), preprocessing total motile sperm (TMS) count (million), fast motile sperm (percent) and postprocessing sperm concentration (mil/ml), motility (percent), TMS count, fast motile sperm (percent), sperm morphology, hypoosmotic swelling (HOS) scores, semen leuocytes, and bacteria were analyzed. 268 inseminations were followed by a pregnancy rate of 12% and couple pregnancy rate of 17%. On multivariable logistic regression analysis, total motile sperm (TMS) count, percent motility, and percent of fast motile sperm were independent prognostic factors of fertility. The impact of the preprocessing and postprocessing sperm parameters on pregnancy outcome after IUI was evaluated. There was a trend toward an increasing percent of conception with increasing TMS count, motility, and percent of fast motile sperm. The TMS count, motility and percent of fast motile sperm independently predict success with IUI. Patients with original sperm motility ≥30% had a higher cumulative pregnancy rate (74%) than patient with motility <30% (p < 0.005). Pregnancy rate increased 4 times with motility of ≥30%.     

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。     

EFFECT OF BODY WEIGHT ON SPERM CONCENTRATION IN NORMOZOOSPERMIC MALES

A total of 274 men (aged: 26 ± 4.9 years) with normozoospermia were enrolled into this study. Their body mass index (BMI: kg/m²) varied between 17 and 39. According to BMI, the patients were divided into four groups: Group 1: 17–20, Group 2: 20.1–25, Group 3: 25.1–30 and Group 4: 30.1–39. Twenty-nine subjects were found in the first, 96 in the second, 91 in the third and 58 men in the fourth group. Sperm concentration was significantly lower in the obese group (29 × 10⁶/ml, p < 0.05) than in the group of BMI 17–20, 20–25 and 25–30. In advance, in the obese group, sperm count continuously decreased with aging. We conclude that obesity is associated with a lower sperm count in case of normozoospermia.     

LESS NO PRODUCTION AND BETTER MOTION PARAMETER IN HUMAN SPERM BY SWIM-UP PROCESSING

Fifteen semen specimens were obtained from men for semen analysis; each was divided into two aliquots for prepararation. The motile sperm recovery rate, percentage motility, and motion parameters were measured for each semen specimen (n?=?15) before and after preparation with the use of the two methods, and cultured with different time courses (1?hr, 3?hr, and 6?hr). Nitric oxide (NO) was measured using the chemiluminscence method after centrifugation. Recovery rate of motile cell was significantly higher in direct swim-up method (69.5?±?42.4% versus 49.3?±?29.3%, p?<?0.05). In motility, direct swim-up method in the different time courses was significantly better than IxaPrep method. (1?hr: 91.1?±?5.2% vs 65.6?±?16.4%, 3?hr: 87.2?±?7.9% vs 65.2?±?16.5%, 6?hr: 86.1?±?7.5% vs 60.8?±?17.6% and prewash: 61.6?±?16.2%, p?<?0.05). In VAP and VSL, the sperm prepared by the above two methods all improved compared to pre-wash sperm (p?<?0.05), but there was no statistical significance between the two methods. NO production in the direct swim-up group was significantly lower than IxaPrep group in the first hour of culture (0.09?±?0.09?uM vs 0.15?±?0.09?uM, p?<?0.05). NO production increased as the culture time increased in swim-up group, but conversed in IxaPrep group. The lower level of NO produced in the swim-up group may suggest that better sperm quality achieved is due to the decreased NO production.     

Effect of Sample Collection Site on Semen Parameters of Healthy Young Volunteers

The effect of sample collection site on semen parameters in ten men aged between 22 and 24 years was investigated. Sperm was collected at two sites: in a university hospital restroom for general use and in a one-person hospital room. Samples were collected from the same individual twice, with an interval of two weeks between collections. Semen parameters for the two sites were compared. Samples were collected after a minimum of three days and not longer than seven days of sexual abstinence. Sperm concentration did not differ significantly between the university hospital restroom location (86.8 ± 25.4 × 10⁶/ml; mean ± standard deviation) and the private hospital room (97.1 ± 72.0 × 10⁶/ml). There was no difference in the total motile sperm count or daily sperm production between the collection sites. These results suggest that the collection site has little effect on semen parameters.     

Urinary trichloroacetic acid levels and semen quality: A hospital-based cross-sectional study in Wuhan, China

Toxicological studies indicate an association between exposure to disinfection by-products (DBPs) and impaired male reproductive health in animals. However, epidemiological evidence in humans is still limited. We conducted a hospital-based cross-sectional study to investigate the effect of exposure to DBPs on semen quality in humans. Between May 2008 and July 2008, we recruited 418 male partners in sub-fertile couples seeking infertility medical instruction or assisted reproduction services from the Tongji Hospital in Wuhan, China. Major semen parameters analyzed included sperm concentration, motility, and morphology. Exposure to DBPs was estimated by their urinary creatinine-adjusted trichloroacetic (TCAA) concentrations that were measured with the gas chromatography/electron capture detection method. We used linear regression to assess the relationship between exposure to DBPs and semen quality. According to the World Health Organization criteria (<20 million/mL for sperm concentration and <50% motile for sperm motility) and threshold value recommended by Guzick (<9% for sperm morphology), there were 265 men with all parameters at or above the reference values, 33 men below the reference sperm concentration, 151 men below the reference sperm motility, and 6 men below the reference sperm morphology. The mean (median) urinary creatinine-adjusted TCAA concentration was 9.2 (5.1) μg/g creatinine. Linear regression analyses indicated no significant association of sperm concentration, sperm count, and sperm morphology with urinary TCAA levels. Compared with those in the lowest quartile of creatinine-adjusted urinary TCAA concentrations, subjects in the second and third quartiles had a decrease of 5.1% (95% CI: 0.6%, 9.7%) and 4.7% (95% CI: 0.2%, 9.2%) in percent motility, respectively. However, these associations were not significant after adjustment for age, abstinence time, and smoking status. The present study provides suggestive but inconclusive evidence of the relationship between decreased sperm motility and increased urinary TCAA levels. The effect of exposure to DBPs on human male reproductive health in Chinese populations still warrants further investigations.     

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.     

CORRELATION OF SPERM PARAMETERS WITH APOPTOSIS ASSESSED BY DUAL FLUORESCENCE DNA INTEGRITY ASSAY

Failed fertilization after intracytoplasmic sperm injection or miscarriages occurs in cases involving apoptotic and necrotic sperm. Identifying normal sperm is important for successful assisted reproductive technologies (ART) procedures. The study was conducted to correlate sperm parameters with intact sperm with normal DNA assessed by the dual stain assay in 118 separate individuals. The results showed differences in percent DNA intact sperm in individuals with normal W.H.O. sperm features (62 ± 1.1; mean ± S.E.M.) compared with oligoasthenoteratozoospermia patients (38 ± 5.3). Individuals whose sperm had fertilizing capacity had higher percentages of intact DNA (60 ± 1.3 versus 47 ± 2.4). The percentages of intact DNA sperm were significantly correlated to total motility in semen (R = 0.7), post-wash motility (R = 0.6), rapid progression (R = 0.6), intact acrosome (R = 0.5), and strict morphology (R = 0.5). There were no correlations with the remaining parameters. The dual stain assay identified sperm with normal physiology and fertilizing capacity. The dual stain assay measures DNA integrity and is a promising method to select normal sperm for ART.     

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。     

Dioxin exposure, from infancy through puberty, produces endocrine disruption and affects human semen quality

BACKGROUND: Environmental toxicants are allegedly involved in decreasing semen quality in recent decades; however, definitive proof is not yet available. In 1976 an accident exposed residents in Seveso, Italy, to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). OBJECTIVE: The purpose of this study was to investigate reproductive hormones and sperm quality in exposed males. METHODS: We studied 135 males exposed to TCDD at three age groups, infancy/prepuberty (1-9 years), puberty (10-17 years), and adulthood (18-26 years), and 184 healthy male comparisons using 1976 serum TCDD levels and semen quality and reproductive hormones from samples collected 22 years later. RESULTS: Relative to comparisons, 71 men (mean age at exposure, 6.2 years; median serum TCDD, 210 ppt) at 22-31 years of age showed reductions in sperm concentration (53.6 vs. 72.5 million/mL; p = 0.025); percent progressive motility (33.2% vs. 40.8%; p < 0.001); total motile sperm count (44.2 vs. 77.5 x 10(6); p = 0.018); estradiol (76.2 vs. 95.9 pmol/L; p = 0.001); and an increase in follicle-stimulating hormone (FSH; 3.58 vs. 2.98 IU/L; p = 0.055). Forty-four men (mean age at exposure, 13.2 years; median serum TCDD, 164 ppt) at 32-39 years of age showed increased total sperm count (272 vs. 191.9 x 10(6); p = 0.042), total motile sperm count (105 vs. 64.9 x10(6); p = 0.036), FSH (4.1 vs. 3.2 UI/L; p = 0.038), and reduced estradiol (74.4 vs. 92.9 pmol/L; p < 0.001). No effects were observed in 20 men, 40-47 years of age, who were exposed to TCDD (median, 123 ppt) as adults (mean age at exposure, 21.5 years). CONCLUSIONS: Exposure to TCDD in infancy reduces sperm concentration and motility, and an opposite effect is seen with exposure during puberty. Exposure in either period leads to permanent reduction of estradiol and increased FSH. These effects are permanent and occur at TCDD concentrations < 68 ppt, which is within one order of magnitude of those in the industrialized world in the 1970s and 1980s and may be responsible at least in part for the reported decrease in sperm quality, especially in younger men.     

IgA ANTIBODIES TO CHLAMYDIA TRACHOMATIS AND SEMINAL PARAMETERS IN ASYMPTOMATIC INFERTILE MALES

Prevalence of IgA antibodies to Chlamydia trachomatis in semen samples from infertile men was estimated and its clinical meaning is discussed. The ejaculate of 102 infertile men without any symptom of genital infection was studied, and seminal alterations were classified according to WHO criteria. Antichlamydial IgA antibodies were detected using a solid-phase, enzyme-linked immunoassay (ImmunoComb II Chlamydia trachomatis monovalent IgA) and related to sperm count, motility and membrane integrity, seminal leucocyte count, and past history of sexually transmitted disease (STD). Prevalence of IgA antibodies to C. trachomatis was 23%. There was no relationship between IgA antibodies and the sperm variables or leucocyte count in semen. However, a strong association between antichlamydial IgA antibodies and the antecedent of STD was found (p &lt;. 005; OR = 6). IgA antibodies to C. trachomatis did not cause alterations in sperm function and they were not associated with inflammatory response. However, these antibodies in semen of asymptomatic infertile men would indicate a risk of C. trachomatis infection for the couples of those patients.     

丙种反应性蛋白与血小板输注疗效的关系

目的探讨恶性血液病及实体瘤化疗后血小板减少并出血病人输注浓缩血小板的疗效与丙种反应性蛋白之间的关系。方法观察46例恶性血液病及13例实体瘤化疗后血小板减少并出血病人,共输注浓缩血小板113次,在输注前、输注后12~16h外周血小板计数、临床出血情况,分析丙种反应性蛋白(C-reactiveprotein,CRP)指标改变对输血小板效果的影响,全部59例被分为CRP正常组和CRP增高组。结果输注浓缩血小板后,外周血小板计数升高值:CRP增高组(12.16±8.27)×109/L较CRP正常组(28.65±10.34)×109/L低(P<0.01)。实体瘤组输血小板前后差值(29.44±11.07)×109/L较恶性血液病组(17.32±11.33)×109/L高(P<0.05),治疗3天后临床出血改善率79%。结论输注浓缩血小板,能提高外周血小板计数,临床止血效果明显,可防止或减少脑出血等严重事件的发生。CRP可能是影响血小板输注效果的又一因素。     

Improvement in human semen quality after oral supplementation of vitamin C

This study was carried out to monitor the effect of oral supplementation of vitamin C on various semen parameters in oligospermic, infertile, otherwise healthy individuals. Various semen parameters, including sperm motility, sperm count, and sperm morphology, were studied before and after the vitamin C treatment. A total of 13 infertile patients were included. Their ages ranged between 25 and 35 years. They had no genital infection or varicocele. Physical examination and other routine laboratory investigations were normal. General semen analysis revealed oligozoospermia (mean sperm count was 14.3 +/- 7.38 x 10(6) sperms/mL, mean sperm with normal morphology was 43 +/- 7.87%, and mean sperm motility was 31.2 +/- 9.61%). Testicular biopsy was not done. These patients received in an open trial of 1,000 mg of vitamin C twice daily for a maximum of 2 months. Results showed that the mean sperm count was increased to 32.8 +/- 10.3 x 10(6) sperms/mL (P < .001) after 2 months of vitamin C intake. The mean sperm motility was increased significantly to 60.1 +/- 8.47% (P < .001), and mean sperms with normal morphology increased significantly to 66.7 +/- 4.77% (P < .001). This study showed that vitamin C supplementation in infertile men might improve sperm count, sperm motility, and sperm morphology and might have a place as an additional supplement to improve the semen quality towards conception.     

不育门诊男性精液质量及影响因素研究

目的：了解浙江南部地区不育门诊男性精液质量及危险因素。方法对浙南地区不育门诊的3017名男性精液进行检测,分析影响精液质量的因素。按精液质量分组,用全模型计算方程进行统计分析。结果精液质量参数的中位数：体积2.5 mL,密度76＆#215;106/mL,精子总数160＆#215;106,前向运动精子50.0％,总活率62.0％,正常形态6.9％。精液常规参数全部符合WHO标准的仅占32.90％。禁欲时间与精液体积、精子密度及总数呈正相关（P＜0.01）。单因素分析提示吸烟、接触环境污染物及肥胖对精液质量可能造成不良影响,但多因素分析差异均无统计学意义（P＞0.05）。结论浙南地区不育门诊部分男性精液质量低于WHO标准。地区差别、生活方式及环境因素可能造成精液质量的变化有待进一步研究。     

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Varicocele is currently the most common irregularity identified in males that is associated with impaired spermatogenesis. It primarily presents in the form of decreased sperm count and motility, abnormal morphology, and significantly increased sperm DNA fragmentation. Several studies have shown that surgical repair improves semen parameters and increases the odds of spontaneous pregnancy. However the exact effect of surgical repair treatment remains controversial. Therefore, the aim of our study was to evaluate the effectiveness of microsurgical repair by comparing common semen parameters and sperm DNA fragmentation index (DFI). We evaluated infertile men (n?=?19) who underwent microsurgical subinguinal varicocelectomy for treatment of clinical varicocele before and 3 months after surgery. Normozoospermic men (n?=?19) were considered as the normal control group. Semen parameters improved significantly after surgery when compared with that before surgery, but still significant differences with the normal control group were observed. In comparison, sperm DNA integrity improved significantly after surgery (percentage DFI decreased from 28.4?±?15.6% before surgery to 22.4?±?12.9%, at 3 months post surgery) to similar levels as the normal control group. These results suggest that microsurgical repair may be considered as a treatment option in infertile men with palpable varicocele.     

REVISION OF HYPO-OSMOTIC SWELLING (HOS) TEST WITH A PROPOSITION OF CLASSIFIED GRADING SYSTEM: iTS COMPARISONS WITH FOUR DIFFERENT TYPES OF HUMAN SPERM SEPARATION TECHNIQUE

In this study, we arbitrarily classified the morphological changes of sperm under hypo-osmotic condition and compared the results with four different sperm separation techniques. The morphology of classification ranged from a good swelling (SG 3 > SG 2 > SG 1), to non-swelling but reactive (SG 0-R), and completely non-swelling (SG 0). Thirty fresh semen from patients were divided into 4 groups and each processed by washing, swim up, 2-layer column and real time micro-separation system. The prevalent patterns of the swollen sperm in sequence after treatment was SG 0 > SG 1 > SG 3 > SG2 > SG 0-R in fresh semen, and the proportion of SG 0 was almost half of the total % HOS test results. However, SG 3 became the most common swollen form with a significant increase in number with any method of sperm preparation after treatment. The real time technique yielded the highest % rate of SG 3 type of swollen spermatozoa and was the richest in concentration (53±3.9%, P < 0.05) as compared with that of swim up (26±4.6%), 2-layer (20±4.4%), sperm washing (23±3.9%), and fresh semen (17± 2.8%), respectively. By contrast, 2-layer collected more number of SG0-R (5.3±1.2%, P < 0.05) pattern of spermatozoa when compared to real time and swim up. A positive correlation (r = 0.81, P < 0.002) was shown between the % total HOS spermatozoa and total motility of fresh semen but not with morphology. Collectively, an abnormally functional sperm may exist in almost half of a total sperm count from men. It would appear that a better potential fertilization capacity may reside in the more swollen sperm from HOS test than the less swollen sperm and that may be more related with the motility rather than the morphology. The HOS classification and grading system appears valuable in further evaluating sperm quality.     

急性心肌梗死溶栓再通与血小板计数关系的研究

目的观察急性心肌梗死(AMI)冠状动脉再通与否和血小板的关系。方法将89例AMI患者溶栓治疗后分为冠脉再通组和冠脉未通组,观察两组PLT变化。结果51例冠脉再通组PLT为119·9±54·0×109/L,而38例冠脉未通组PLT为(205·5±74·7)×109/L,冠脉未通组PLT显著高于冠脉再通组(p<0·01)。PLT≤180×109/L者,再通率高达91·6%,PLT>180×109/L者,再通率仅20·0%(p<0·01)。结论PLT高者冠脉再通率低。     

HYALURONIC ACID INCREASES MOTILITY/INTRACELLULAR CA 2+ CONCENTRATION IN HUMAN SPERM IN VITRO

This study investigated the mechanisms of the stimulatory effect of hyaluronic acid on motility in human sperm in vitro. A method, involving the measurement of forward progression through an agarose gel, was used to measure sperm motility quantitatively. Changes in intracellular Ca 2+ concentrations in sperm were detected using the fluorescent dye Fluo-3. The effects of hyaluronic acid (6.5, 65, 650 ng/mL) and nifedipine (32 nM) on sperm motility were investigated. The effects of hyaluronic acid, nifedipine (32 nM), A23187 (32 µM), and a monoclonal antibody to human CD44 (1 µg/mL) on changes in intracellular CA 2+ concentrations were investigated. Hyaluronic acid significantly ( p <. 008) stimulated sperm motility and this was partially inhibited by nifedipine.A23187 significantly ( p <. 005) increased intracellular CA 2+ concentrations. Hyaluronic acid significantly ( p <. 04) increased intracellular Ca 2+ concentrations and this was inhibited by nifedipine and a monoclonal antibody to human CD44. Hyaluronic acid stimulated human sperm motility by increasing intracellular Ca 2+ concentration, partially via an influx of extracellular Ca 2+.     

Seminal Biochemistry and Sperm Characteristics in Infertile Men with Bacteria in Ejaculate

Sperm examination, quantitative sperm culture, citric acid, acid phosphatase, and fructose were assayed in three groups of men: fertile controls without significant bacteriospermia (group I), infertile men with significant bacteriospermia; idiopathic infertile men (group II), and infertile men with varicocele (group III). Level of significance of bacteriospermia was 10⁴ germs/ml of ejaculate. In group II, motility and typical morphology percentages were lower, independently of the degree and the nature of bacteriospermia. Incidence of pathogenic bacteria was higher than in group III and linked to the degree of bacteriospermia. Fructose was unaltered in the two groups of infected men. No modification of prostatic markers was observed in any groups, except in group II, where they decreased when bacteriospermia was lower than 10⁵ germs/ml and when biological pattern of semen evoked chronic prostatitis. Thus, the presence of germs in ejaculate alters the motility and the typical morphology percentages but does not result in any obvious modifications of biochemical markers of prostate and seminal vesicles. For idiopathic infertile men, it is suggested that the quantitative criterion of pathogenic bacteriospermia is a germ count ± 10⁵/ml.