家兔输精管结扎16月睾丸功能变化及其机制的实验研究

18只日本大耳白雄兔随机分为输精管结扎组(VG)和假手术组(SOG)。术后第16月进行睾丸功能与形态学观察。结果表明:血清睾酮含量两组无明显差异(p>0.05);睾丸环-磷酸腺苷cAMP含量与血管紧张素Ⅰ转换酶(ACE)活力,Na~+,K~+-ATP酶及Mg~(++)-ATP酶比活性呈显著的正相关,两组比较,VG的cAMP含量与酶活力均明显地低于SOG;输精管结扎术后自身免疫性睾丸炎可能是睾丸生精功能抑制的重要原因。     

Superior outcomes of microsurgical vasectomy reversal in men with the same female partners

OBJECTIVE: To evaluate the outcomes of vasectomy reversals in men with the same female partners. DESIGN: Retrospective analysis with comparison with a historical cohort. SETTING: University hospital. PATIENT(S): Among 1,048 patients who underwent microsurgical vasectomy reversal from 1986 to 2002, 27 men (2.6%) were identified who had the same partners as before their vasectomy. INTERVENTION(S): Microsurgical vasovasostomy or vasoepididymostomy. MAIN OUTCOME MEASURE(S): Semen parameters, clinical pregnancy, and live birth rates. RESULT(S): The mean age of the men was 38.5 years, and 37.2 years for their female partners. The reasons for vasectomy reversal were death of a child in 33% of cases and desire for more children in 66% of cases. The overall patency rate was 100% at 1 month postoperatively, with an average sperm concentration of 30 million/mL and 24% motility. Among patients with follow-up beyond 1 year, the natural pregnancy rate was 86%, which was achieved at 8.3 months postoperatively, with a live birth rate of 82%. The live birth rate in couples with the death of a child was 100%. CONCLUSION(S): The outcomes of vasectomy reversal in men with the same female partners are better than for men with new partners. Possible reasons for these superior results are previous proven fecundity as a couple, shorter time interval since vasectomy, and emotional dedication.     

Sterilization-attributable deaths in bangladesh

From January 1, 1979, to March 31, 1980, 20 sterilization-attributable deaths were identified in Dacca and Rajshahi Divisions, Bangladesh. The leading cause of death from tubectomy was anesthesia overdose and from vasectomy, scrotal infection. Overall. The sterilization-attributable death-to-case rate was 21.3 deaths/100,000 procedures. The health impact of contraceptive sterilization is highly favorable: for each 100,000 tubectomies performed, the cost in lives (19) is offset by approximately 1015 maternal deaths averted.     

输精管绝育术对实验性家兔动脉粥样硬化症的影响

报告家兔输精管绝育术后的免疫反应对实验性动脉粥样硬化的影响。日本大耳白兔20只分为4组,每组5只,A、B组作输精管绝育术,B、C组在绝育术后20周用高脂饮食喂养25周,D组为空白对照,整个实验程期共为10月左右(45周)。各组同时结束实验,病理组织学检查,可见绝育组动物睾丸和附睾局部精子淤滞和破入间质引起的反应。在高脂饮食组中:输精管绝育组有3只,未绝育组有2只,肉眼可见主动脉和颈动脉处有粥样化斑形成,镜检10只动物皆有不同程度的类脂沉着,两组比较无明显差异。本动物实验证明输精管绝育术不能促进动脉粥样硬化的发展。     

Do mobile family planning clinics facilitate vasectomy use in Nepal?

Background

Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy.

Study design

A three-level random intercept logistic regression analysis was applied on data from the 2011 Nepal Demographic and Health Survey to investigate the extent of influence of mobile family planning clinics on the odds of a male or a female sterilization, adjusting for relevant characteristics including ecological differences and random effects. The analyses included a sample of 2014 sterilization users, considering responses from currently married women of reproductive ages.

Results

The odds of a male sterilization were significantly higher in a mobile clinic than those in a government hospital (odds ratio, 1.65; 95% confidence interval, 1.21–2.25). The effects remained unaltered and statistically significant after adjusting for sociodemographic and clustering effects. Random effects were highly significant, which suggest the extent of heterogeneity in vasectomy use at the community and district levels. The odds of vasectomy use in mobile clinics were significantly higher among couples residing in hill and mountain regions and among those with three or more sons or those with only daughters.

Conclusion

Mobile clinics significantly increase the uptake of vasectomy in hard-to-reach areas of Nepal. Reproductive health interventions should consider mobile clinics as an effective strategy to improve access to male-based modern methods and enhance gender equity in family planning.

Implications

Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition.     

个性特征与输精管结扎术后性功能状况初探

应用艾森克个性问卷及自编性功能状况问卷,对108例10年以上输精管结扎术受术者及82例非受术者个性特征及性功能状况对比评定。性功能障碍发生率结扎组79.6％,未结扎组57.3％(P<0.01)。两组整体个性特征无显著性差异,但在结扎组中有性功能障碍者EPQ-N分显著性高于无性功能障碍者(P<0.01)。     

大鼠输精管滤过装置节育术的实验研究

本文目的是观察SD大鼠双侧输精管植入滤过装置的节育效果,以及远期局部输精管的组织病理学变化,并对装置内部进行扫描电镜观察。结果装置组8只动物全部失去生育力,交配后雌鼠阴栓内均未见到精子。半年后形态学研究表明装置近端有大量精子,输精管扩张,形成精子肉芽肿。扫描电镜发现装置尼龙丝被蛋白样颗粒物质包绕,装置内尼龙丝之间有一些精子,形态大多完整,少量精子可穿过装置到达装置远端,但形态不完整。本研究表明SD大鼠输精管植入滤过装置有可靠的节育效果,滤过装置能阻止大部分精子通过。附睾液和少量精子可通过装置,但精子形态不完整,失去受精能力。滤过装置的节育机理尚需进一步深入研究。     

全球男性节育方法的应用状况

2010年全球有62.7%的育龄妇女采用了避孕措施,其中79.1%依赖女用方法。全球有39个国家或地区男用避孕方法现用率超过20%(21.9%～64.7%),发达地区男用方法(输精管绝育、避孕套、体外排精)现用率是欠发达地区的3倍。与10年前相比,体外排精和避孕套现用率呈现上升趋势;除英国、韩国、澳大利亚、加拿大和新西兰等国家外,男性节育总体现用率呈下降趋势。我国已婚育龄妇女避孕率高达89%,男用方法现用率仅为12.3%,2000～2009年,避孕套现用率由3.8%上升至7.5%,男性绝育术现用率从8%降至4.9%,男用方法总体现用率年均增长0.4%。我国尚未满足的避孕需求估计为2.3%。鼓励男子承担更多的避孕责任并采用避孕措施,提高男用节育方法的应用比例,不仅是基于性别公平、公正,同时男用节育方法也更安全、简便、经济。男子参与计划生育是社会文明和进步的标志之一,对改善和提高妇女的健康水平,促进社会经济和人的全面发展,以及联合国千年目标的实现具有重要意义。对公众的引导和教育应引起相关政府部门的高度关注和重视。     

输精管结扎家兔血浆睾酮与皮质醇含量的动态变化

利用日本大耳白兔随机分为输精管结扎组（ＶＧ）和假手术组（ＳＯＧ），术后４、８、１２、１８、２２、２５个月分别测定血浆睾酮和皮质醇含量。结果表明，ＶＧ４、１２、１８、２２和２５月组血浆睾酮，皮质醇含量与ＳＯＧ各月比较均无显著差异，（Ｐ＞０．０５）。但是，输精管结扎后８月的血浆皮质酮含量明显低于ＳＯＧ８月（Ｐ＜０．０５），而血浆皮质醇含量则显著地高于ＳＯＧ８月（Ｐ＜０．０５）。血浆睾酮含量和皮质醇含量呈明显负相关（Ｐ＜０．０５）。     

Factors affecting successful outcome from ICSI in men following previous vasectomy

There are conflicting reports as to whether the interval between vasectomy and surgical sperm retrieval (SSR) for intra-cytoplasmic sperm injection (ISCI) is related to clinical pregnancy (CPR), and live birth (LBR), rates. This study aimed to evaluate factors that may influence the outcome of ICSI in males with secondary azoospermia due to previous vasectomy. We analysed the medical records of 198 azoospermic males following vasectomy who underwent percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm extraction (TeSE), between 1997 and 2005 by a single urologist, and whose sperm was subsequently frozen for use in an IVF treatment programme on their partner’s behalf. Hundred and forty-four (73%) males had a positive PESA, and the remaining 54 (27%) had a positive TeSE. Forty-four percent of males with no clinical evidence of epididymal distension still had epididymal sperm retrieved successfully. Hundred and twenty-eight patients proceeded with ICSI, and a total of 237 cycles were performed. The CPR and LBR overall were 29 and 27%, respectively. Using logistic regression there was no association between time since vasectomy and CPR (P = 0.17) or LBR (P = 0.31). A history of an attempted reversal of vasectomy did not negatively affect retrieval rates or CPR and LBR. The success of SSR and the outcome of ICSI, using frozen sperm, are independent of male age and time since vasectomy. Epididymal sperm may be retrieved in over 40% of men in whom there is no clinical evidence of epididymal distension.