睾丸精子与附睾精子结合单精子注射治疗无精子症妊娠结局比较

目的比较附睾精子和睾丸精子结合单精子注射(ICSI)治疗无精子症的妊娠结局。方法 216例无精子症患者经皮附睾穿刺抽吸术取得附睾精子;74例无精子症患者经皮睾丸精子抽吸术(TESA)获得睾丸精子。女方进行常规超排卵。采用卵胞浆内单精子注射技术获得妊娠,比较两者的受精率、种植率和临床妊娠率。结果附睾精子组和睾丸精子组的受精率分别为75.20%和74.61%,比较其差异无显著性(P0.05);两者的种植率和临床妊娠率分别为29.18%vs 23.89%和52.43%vs 40.21%,差异具有显著性(P0.05)。结论附睾是精子获能、成熟的重要部位,附睾精子优于睾丸精子,对无精子症患者行ICSI之前尽可能首先选取附睾精子。     

经皮附睾或睾丸抽吸取精结合ICSI治疗无精子症

目的评价经皮附睾精子抽吸术（percutaneus epididymal sperm aspiration,PESA）或睾丸精子抽吸术（testicu1ar sperm aspiration,TESA）结合卵胞浆内单精子注射（intracytoplasmic sperm injection,ICSI）治疗无精子症的临床效果。方法对290例因男性梗阻性及非梗阻性无精子症（non-obstructive azoospermia,NOA）采用PESA或TESA穿刺获取精子,女方采用长方案超排卵,然后对处于细胞分裂中期的成熟卵母细胞进行单精予注射。结果梗阻性无精子症组203例,受精率77．5％,临床妊娠率46．1％;非梗阻性无精子症组87例,受精率73．O％,临床妊娠率41．4％,两组比较其受精率及临床妊娠率均无显著性差异（P〉0．05）。结论采用PESA或TESA获取精子结合ICSI是治疗梗阻性及非梗阻性无精子症等严重的男性不育症的一种有效的方法。     

采用抽吸取精法结合单精子注射治疗无精子症结局

目的评价经皮附睾精子抽吸术（percutaneus epididymal sperm aspiration,PESA）或睾丸精子抽吸术（testicular sperm aspiration,TESA）结合卵胞浆内单精子注射（intracytoplasmic sperm injection,ICSI）治疗无精子症的临床效果。方法对290例因男性梗阻性及非梗阻性无精子症（non-obstructive azoospermia,NOA）采用PESA或TESA穿刺获取精子,女方采用长方案超排卵,然后对处于细胞分裂中期的成熟卵母细胞进行单精子注射。结果梗阻性无精子症组203例,受精率77.5%,临床妊娠率46.1%;非梗阻性无精子症组87例,受精率73.0%,临床妊娠率41.4%,两组比较其受精率及临床妊娠率均无显著性差异（P〉0.05）。结论采用PESA或TESA获取精子结合ICSI是治疗梗阻性及非梗阻性无精子症等严重的男性不育症的一种有效的方法。     

新鲜附睾精子与冷冻复苏后的附睾精子临床结局比较

目的探讨经皮附睾穿刺取精术（PESA）获得精子经冷冻复苏后行卵胞浆内单精子注射术（ICSI）的临床效果。方法将采用新鲜附睾精子的94例患者作为新鲜组对照,冷冻复苏后附睾精子的92例患者作为冻精组,比较二组的受精率,可利用胚胎率及妊娠率。结果新鲜组与冻精组相比受精率,可利用胚胎率及妊娠率无显著性差异（75.04%vs78.4%,78.3%vs81.3%,47.87%vs44.44%P〉0.05）。结论PESA精子经冷冻后有很好的复苏率（97.94%）,结合ICSI可得到与使用新鲜PESA精子同样的临床结局,可作为梗阻性无精症的治疗方法。     

经皮睾丸精子抽吸术治疗无精子症的研究

目的探讨经皮睾丸精子抽吸术(PTSA)获取睾丸精子结合卵胞浆内单精子注射术(ICSI)治疗梗阻性和非梗阻性无精子症,使之获得亲生子女.方法对121例因男性梗阻性及非梗阻性无精子症患者进行诊断性穿刺,均证实有精子后进行119个周期PTSA ICSI治疗.结果共获卵子1514个,成熟卵985个,胚胎741个,平均每例6.23个胚胎,总受精率74.4%,卵裂率97.6%;共移植114个周期和冷冻胚胎移植5个周期,平均移植2.86个胚胎,B超证实临床妊娠48例,临床妊娠率40.3%.结论采用PTSA技术获取的睾丸精子进行ICSI是治疗梗阻性及非梗阻性无精子症的一种安全、简单、有效的方法.     

睾丸精子抽吸后行卵细胞单精子显微注射治疗梗阻性无精子症

无精子症约占男性不育患者的7％～14％。目前尚无确切的治疗方法。自Palerm等于1992年首次报道卵细胞浆内单精子注射（ICSI）获得妊娠成功，为男性不育症治疗提供了新方法，同时附睾或睾丸取精术彻底改变了无精子症不可治疗的局面。采用此方法只要在男性生殖道或睾丸内发现并分离到精子，利用ICSI技术就能获得一定的妊娠率，     

无精子症患者附睾穿刺及睾丸活检结果分析

无精子症占男性不育病例的10％左右,其病因多不确定,治疗效果也不好。本文通过对无精子症患者经皮附睾精子抽吸术（PESA）及睾丸活检（TESE）,分析睾丸病变,为其病因分析、临床诊疗、辅助生殖等提供实验室依据。     

睾丸与附睾精子对梗阻性无精子症ICSI助孕结局的影响

目的比较睾丸精子与附睾精子对梗阻性无精子症(obstructive azoospermia,OA)患者行卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)治疗结局的影响。方法收集2014年1月至2016年12月在海南医学院第一附属医院生殖医学中心因梗阻性无精子症行ICSI助孕治疗患者的临床资料,共163个周期。根据精子来源分为两组,TESA组:采用睾丸精子抽吸术(testicular sperm aspiration,TESA)取精,共137个周期;PESA组:采用经皮附睾精子抽吸术(percutaneous epididymal sperm aspiration,PESA)取精,共26个周期。比较两组的正常受精率、2PN卵裂率、优质胚胎率、胚胎利用率、胚胎种植率、临床妊娠率、流产率及活产率之间有无差异。结果 TESA组的胚胎种植率、临床妊娠率及活产率高于PESA组,但差异均无统计学意义(P0.05);TESA组的正常受精率、2PN卵裂率、优质胚胎率、胚胎利用率及流产率均低于PESA组,但差异亦无统计学意义(P0.05)。结论对梗阻性无精子症患者,睾丸精子和附睾精子ICSI后可达到相似的助孕结局。     

附睾穿刺取精行ICSI治疗梗阻性无精子症

目的探讨附睾穿刺取精术(PESA)结合单精子卵胞浆内注射(ICSI)治疗梗阻性无精子症男性不育的可行性,并观察其临床效果。方法 7对夫妇为研究对象,男方均确诊为梗阻性无精子症,女方超促排卵获得卵细胞,男方于取卵日在局麻下通过细针穿刺附睾头部吸取少量精子,行ICSI,受精成功后24-48h,选择优质胚胎移植入子宫腔。因男性少弱精子症行ICSI治疗的20个治疗周期为对照组。结果附睾取精7例共11个治疗周期全部获得活动精子,ICSI后受精率65．9％,卵裂率98．3％,优质胚胎率71．9％,临床妊娠5例,周期临床妊娠率45．5％,与对照组比较,各项指标均无显著差异。结论附睾穿刺取得的精子与排出体外的精子具有相同的受精和获得优质胚胎的能力,PESA是治疗梗阻性无精子症男性不育的安全有效的方法。     

睾丸容积、染色体及血清生殖激素对无精子症睾丸内精子存在的评估作用

无精子症,在男性不育患者中占5%～20%,包括染色体畸变、内分泌激素异常等病因[1]。无精子症病因复杂、临床治疗困难,是导致男性绝对不育的重要原因。临床上常采用经皮附睾精子抽吸术（percutaneous epididymal sperm aspira-tion,PESA）和睾丸精子抽吸术（testicular sperm extraction,TESE）,通过手术获取成熟精子行辅助生殖技术。     

Andrology: The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters

High success rates have been reported for the use of intracytoplasmicsperm injection (ICSI) in alleviating essentially andrologicalinfertility. However, neither the relationship between any ofthe sperm parameters and the result of ICSI nor the minimalsperm requirements for ICSI have been investigated so far. Inthis paper, our objective was therefore to study the relationshipbetween three basic sperm parameters (total sperm count, spermmotility and morphology) and the outcome of ICSI by retrospectiveanalyses of fertilization, embryo development and pregnancyrates in 966 micro-injection cycles, performed with ejaculatedsemen. The results showed that there was no important influencefrom either the type or the extent of sperm impairment on theoutcome of ICSI. Even in the most extreme cases of male-factorinfertility, where cryptozoospermia or total astheno- or totalteratozoospermia was diagnosed in the initial semen sample,high fertilization and pregnancy rates were obtained by ICSI.Only one condition had a strongly negative influence on theresult of ICSI: where an immotile (presumably dead) spermatozoonwas injected into the oocyte. Thus the only ultimate criterionfor successful ICSI is the presence of at least one living spermatozoonper oocyte in the pellet of the treated semen sample used formicro-injection.     

Pharmacological stimulation of sperm motility

The treatment of male factor infertility is a rapidly developingfield. The introduction of microsurgical fertilization techniquesallows assisted conception units to treat couples who previouslywould not have benefited from in–vitro fertilization techniques.However, these techniques are only used for the minority ofsubfertile men in andrological practice. Many subfertile menare still treated pharmacologically or by sperm selection methodsto enhance sperm fertilizing ability. Numerous pharmacologicalcompounds have been described that enhance sperm motility andthus, potentially, sperm fertilizing capacity. This paper attemptsto review these compounds and assess their role in treatmentof the subfertile male.     

Sealed mini-chamber of variable depth for direct observation and extended evaluation of sperm motility under the influence of various gases.

A new chamber for microscopical observation of living cells, e.g. spermatozoa, under hermetically sealed conditions and over an extended period is described. Motile spermatozoa were serially observed for several hours and the effect of various gases on sperm motility has been studied. The chamber could also be used to study the effect of various toxic gases in the fields of microbiology and toxicology.     

Effects of ageing on spermatozoal chromatin and its sensitivity to in vivo and in vitro oxidative challenge in the Brown Norway rat

BACKGROUND: The goals of our study were to examine chromatin packaging and integrity in spermatozoa taken from the caput and cauda epididymides of young (4-month-old) and old (21-month-old) Brown Norway rats and to assess whether spermatozoal sensitivity to oxidative treatments is altered with age. METHODS: Oxidative treatments consisted of (i) in vivo oxidative challenge by systemic administration of the glutathione-depleting drug l-buthionine-[S,R]-sulphoximine (BSO) and (ii) in vitro oxidative challenge by incubating collected spermatozoa with hydrogen peroxide (H(2)O(2)). Chromatin parameters assessed included quantification of thiols, nuclear chromomycin A3 (CMA3) penetration, DNA breaks by TdT (terminal deoxynucleotidyl transferase)-mediated dUDP nick-end labelling (TUNEL) and ease of DNA dissociation by acridine orange (AO) staining. RESULTS: In spermatozoa from older rats, we found decreases in thiols, CMA3 penetration and the percentage of cells that undergo DNA dissociation. Administration of BSO had oxidizing effects on the thiol groups. It also decreased CMA3 penetration and DNA dissociation and increased TUNEL staining. Furthermore, BSO treatment sensitized cauda epididymidis spermatozoa, from older animals, to H(2)O(2). CONCLUSIONS: Overall, we show that spermatozoa from older rats have altered chromatin packaging and integrity and that spermatozoa from the cauda epididymidis are more responsive to combined in vivo and in vitro oxidative challenge than spermatozoa from young rats.     

Mouse Sperm Rosette: Assembling During Epididymal Transit,in vitro Disassemble,and Oligosaccharide Participation in the Linkage Material

In many mammals, sperm associations had been observed, but not in the mouse. In this work, mouse sperm rosettes are morphologically described inside the epididymis and during its dissolution in a culture medium. Also characterized are the saccharides present in the linking material. Sperm association and other epididymal actions are supported by sperm during epididymal transit and are verified at the caudal region, suggesting a relation between epididymal transit and sperm maturation. In drops of epididymal content obtained from distal (cauda), but not from proximal (caput and corpus) regions; dissolved in culture medium, rosettes appear to be 10 to 15 motile sperm joined by their heads. After 3 min, sperm progressively detach, disassembling the rosette. These structures are studied by several techniques, including optic, electronic (scanning electron microscopy and transmission electron microscopy), and video microscopy. At the ultrastructural level, a dense network of electron‐dense material was observed between sperm heads, joining them. Based on previous works in rat, several lectins were used to characterize the type of saccharides present in this linking material. To avoid the contact between sperm and epididymal fluid from distal region—that probably exerts an influence on sperm association—a ligature was placed between caput and corpus. This epididymal content isolated from caput did not display any rosettes after 28 days. Anat Rec, 2007. © 2007 Wiley‐Liss, Inc.     

Enzyme-linked immunosorbent assays for sperm antibody detection and antigenic analysis

Enzyme-linked immunosorbent assays for estimation of antibodies against human sperm and for determination of antigenic reactivity of spermatozoal proteins were established. Sperm immobilized on PHA-coated microtiter plates or solubilized spermatozoal antigens adsorbed on poly(L)-lysine coated microtiter plates were used as the solid phase. Assay of sperm antibodies was performed by incubation of the test samples with the solid phase followed by incubation with anti-Ig conjugated to peroxidase. Sigmoidal antibody dilution curves were obtained with rabbit and mouse anti-sperm sera. The ELISA was effectively used to screen production of anti-sperm antibodies by mouse myeloma x splenocyte hybridomas. The sensitivity of this ELISA for sperm antibodies was more than 1000-fold greater than the classical tray sperm immobilization test, and was comparable in sensitivity to a radioimmunoassay using 125I-labeled protein A as the tracer. Sperm immobilized on PHA-coated plates exhibited significantly greater antigenic reactivity in both the ELISA and RIA compared with methanol fixed sperm. In a competitive inhibition ELISA, linear Logit-log dose-response curves were obtained with detergent solubilized spermatozoal antigens. The assay was used to monitor the purification of the solubilized spermatozoal antigens by chromatofocussing; a more than 60-fold increase of antigenic potency of purified sperm antigen compared with unfractionated sperm extract was evident in the competitive ELISA.     

The Presence of a C1-Inhibitor-Like Molecule (C1-INH-L) On Human Sperm: Its Involvement in Sperm Motility

PROBLEM: An 88–92-kDa C1-inhibitor-like molecule (C1-INH-L) was previously identified to elicit cytotoxic sperm antibody response in infertile men and women. Here, we document that it is present on the human sperm surface and could be detected by an enzyme-labeled immunoglobulin G (IgG) fraction of anti-human C1-INH antibody. METHOD OF STUDY: Western blot analysis, enzyme-lined immunoadsorbent assay (ELISA) and computerized sperm motion analysis. RESULTS: The existence of C1-INH-L on the sperm surface is calcium independent. Phosphatidylinositol-specific phospholipase C (PIPLC), EDTA, and acid (pH 3.0) could not remove the C1-INH-L from sperm, but trypsin did. Activated C1s was able to bind to the sperm surface. Immunofluorescence studies localized the protein to the head and midpiece of the sperm membrane. The C1-INH-L exists on both uncapacitated and capacitated sperm surfaces, which suggests that this protein is a sperm-surface protein. The heat-treated (56°C, 30 min) IgG fraction of anti-C1-INH greatly reduced the percentage of motile spermatozoa and the progressive and path velocities in the absence of complement. CONCLUSION: Our data suggest that C1-INH is a sperm membrane-anchored protein that may have complement and sperm motility regulatory function.     

Complement Regulatory Proteins on the Sperm Surface: Relevance to Sperm Motility

PROBLEM: To determine whether complement regulatory proteins are present on human spermatozoa and whether antibodies to these proteins adversely affect sperm motility. METHOD OF STUDY: Human sperm membrane proteins were solubilized and subjected to Polyacrylamide gel electrophoresis followed by Western blot analysis against antibodies to complement component 1 inhibitor (C1-INH), decay-activating factor (DAF; CD55), membrane cofactor protein (MCP; CD46), and homologous restriction factor (HRF; CD59). Spermatozoa, obtained by a swim-up technique, were incubated in medium (control 1) and medium supplemented with antibodies to human albumin (control 2) and antibodies to these complement regulatory proteins. We used a computerized sperm motion analysis to determine the effect of these antibodies on sperm motion characteristics. RESULTS: Complement regulatory proteins such as C1-INH, CD55, CD46, and CD59 were found in the sperm extracts as shown by Western blot analysis. The heat-treated (56°C, 30 min) IgG fraction of antibodies to these proteins significantly reduced sperm motility in general and other motion parameters. Addition of complement did not affect these results except in the antibodies to CD46 in which the reducing action was further amplified. CONCLUSIONS: Our data suggest that C1-INH, CD55, CD46, and CD59 are present on the sperm surface. These proteins may have biological functions, such as affecting sperm motility, besides the complement regulatory functions. In infertile men and women with antibodies that recognize one or more of these complement regulatory proteins, there may be problems related to poor sperm motility and survival in the reproductive tracts.     

Monoclonal Sperm Antibodies: Their Potential for Investigation of Sperms as Target of Immunological Contraception

ABSTRACT: We generated 149 hybridoma cell lines secreting antibodies against human spermatozoal antigens of which antibodies from 136 hybridoma lines also reacted with seminal plasma constituents. The occurrence of common antigeneic determinants on spermatozoa and seminal plasma was further demonstrated by competitive inhibition ELISA tests. We found that seven hybridoma clones secreted antibodies reactive with spermatozoa but nonreactive with seminal plasma. Antibodies from 5 clones were sperm-agglutinating and from 15 clones sperm-immobilizing. Localization of sperm antigens reactive with the monoclonal antibodies was demonstrated by indirect immunoperoxidase staining. A synthetic decapeptide, earlier shown to be reactive with naturally occurring human iso- and autosperm antibodies, was shown to be reactive with the monoclonal antibody VII-5 in ELISA tests.     

Evolution of the sperm aster after microinjection of isolated human sperm centrosomes into meiotically mature human oocytes

This study examined the feasibility of isolating and transferringthe centrosome-containing region of spermatozoa to mature humanoocytes. The findings demonstrate that individual sperm centrosomescan be transferred and are capable of nucleating maternal tubulinto form a well-developed sperm aster in the recipient oocyte.The results are discussed with respect to centrosome functionin early human development and applications in clinical in-vitrofertilization in the treatment of certain forms of male factorinfertility.