Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

OBJECTIVE: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. METHODS: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999-November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4-6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P < or = 0.05 was considered significant. RESULTS: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5-7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of > or =20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) CONCLUSION: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy.     

离子通道与弱精子症

弱精子症是引起男性不育的常见病因之一。随着以精子自身为对象的研究深入,发现离子跨膜转运对精子的生理活动起着重要的作用。离子通道病于20世纪90年代提出,现已逐渐发现临床上许多先天性和/或后天获得性疾病与异常的离子通道有关。因此,关于精子的生理和疾病与离子通道的关系研究逐渐成为当前研究的热点之一。现就近年来与精子运动相关的离子通道,包括阳离子通道和阴离子通道的研究进展作一综述。     

The association between trans fatty acids,infertility and fetal life: a review

Trans fatty acids (TFAs) are thought to affect reproductive health by causing adverse effects on sperm morphology and ovum quality as a result of changing membrane lipid composition which, in turn, leads to impairment in metabolic pathways. This literature review examines the evidence for the effects of dietary TFAs on male and female infertility. Studies conducted between 2007 and 2017 on the effect of dietary TFAs on human reproductive health and fetal life have been included. They indicate that TFA intakes are inversely proportional to sperm concentration and total sperm count and exhibit a positive correlation with asthenospermia, as well as an adverse association on sperm concentration and semen quality. In the female TFAs intakes are associated with an increase in the risk of ovulatory infertility, adversely affect the length of gestation leading to fetal developmental defects and fetal loss. The findings suggest that high TFA intake (more than 1% of energy consumption) constitute a risk factor for infertility in both sexes.     

特发性精液质量异常的诊断与治疗

特发性精液质量异常包括特发性少、弱、畸形精子症、特发性无精子症以及特发性精液液化异常。导致特发性精液质量异常的可能原因包括年龄、附属性腺的非炎症性功能改变、感染因素、基因异常、精子线粒体改变、环境污染物的影响和细微的激素改变等。诊断特发性少、弱、畸形精子症和无精子症需要经过全面的病史询问、体格检查、精液分析、生殖激素检查、遗传学检查、免疫学检查等以排除已知的可能病因。特发性少弱畸形精子症的治疗包括使用克罗米芬、他莫西芬、重组FSH、安特尔、锌硒宝、左卡尼汀、重组生长激素、己酮可可碱等西药类、中成药以及中西医结合治疗等;特发性无精子症可在使用促精子生成药的基础上使用辅助生殖技术治疗;特发性精液液化异常主要通过中医药、中西医结合和体外处理技术治疗。随着诊断技术的发展,有望建立更加特异的精液质量异常的治疗措施和降低特发性精液质量异常的发生率。     

Successful use of the sperm motility enhancer 2-deoxyadenosine in previously failed human in vitro fertilization

The outcome of in vitro fertilization treatment in malefactor infertility is generally poor, due mainly to poor fertilization rate and hence fewer available embryos for replacement. This study was carried out to assess the value of asthenospermic sperm exposure to a motility enhancing agent, 2-deoxyadenosine (2-DXA), on our in vitro fertilization program in couples undergoing repeat treatment after previous failed fertilization. Following sperm wash and incubation in 2-DXA-supplemented medium, marked significant improvements were observed in the sperm motility pattern and the number of recoverable sperms as compared to control unexposed samples. There was also a significantly better fertilization rate and higher number of replaceable embryos available following sperm wash in 2-DXA as compared to those washed without it. Following embryo transfer, pregnancy rate was comparable to the generally reported pregnancy rates for routine in vitro fertilization and embryo transfer treatment. Three normal babies were born. Our results indicate that 2-DXA enhances fertilization rate in some asthenospermic patients and that it has no adverse effect on embryonic development.     

48例原发性不育患者染色体核型与AZF基因分析

目的探讨严重少弱精症和无精症的遗传病因。方法采用外周血染色体G显带，PCR技术以及PAGE电泳，对48例严重少弱精症和无精症患者进行外周血染色体核型分析及无精子症因子（AZF）基因的6个位点分析。结果48例中7例染色体异常，5例AZF基因有微缺失。结论严重少弱精症和无精症的发生与遗传密切相关，对男性不育患者进行治疗前有必要进行染色体核型分析及Y染色体AZF微缺失的检测。     

弱精子症患者精子线粒体MTCYB、MTATP6基因的检测

目的:探讨精子线粒体MTCYB、MTATP6基因突变与弱精子症的关系。方法:提取80例成年男性弱精子症和20例活力正常者的精子mtDNA,设计PCR引物并扩增MTCYB、MTATP6基因,PCR产物纯化后进行序列测定和BLAST序列比对。结果:在80例弱精子症样本中有60例同时扩增出MTCYB、MTATP6片段,16例仅扩增出MTATP6片段,4例仅扩增出MTCYB片段。在20例精子活力正常的样本中均同时扩增出MTCYB、MTATP6片段。弱精子症样本中MTCYB和MTATP6基因的缺失率分别为20%和5%。扩增片断的序列分析发现,在弱精子症样本中,MTATP6基因出现G8887A的点突变,突变率为20%,而MTCYB基因未见有规律的突变。精子活力正常的样本中MTCYB、MTATP6基因未检测到明显的点突变。结论:精子线粒体MTCYB和MTATP6的基因缺失以及MTATP6基因的G8887A突变可能影响成年男性的精子活力。     

金冷法治疗少、弱精子症的疗效及安全性临床观察

目的:金冷法可通过低温和中药外用(透皮吸收)两种途径作用于睾丸。本研究目的旨在评价金冷法治疗少、弱精子症的疗效及安全性。方法:将符合纳入标准的39例少、弱精子症的男性不育患者用金冷内裤(金冷法)治疗,每天早、晚各1次,每次30 min,共3个月。观察治疗前后精液参数指标变化以及患者配偶的妊娠结局。结果:按要求完成治疗36例,其中31例精液质量有改善,总有效率为86.1%。少弱精子症组精子密度、前向运动精子百分率、精子活动率、精子总数、活动精子总数等精液参数指标在治疗后均有显著改善(P均<0.05),弱精子症组前向运动精子百分率、精子活动率、活动精子总数等精液参数指标在治疗后均有显著改善(P均<0.05)。治疗期间及治疗后随访2个月有5例配偶怀孕。治疗期间无明显不良反应发生。结论:金冷法治疗少、弱精子症具有疗效确切、使用方便、安全性好的特点,可作为男性少、弱精子症不育患者的一种新的治疗选择推广应用。     

龟龄集胶囊治疗少弱精子症的疗效观察

目的 观察龟龄集胶囊治疗少弱精子症所致男性不育症的疗效和安全性.方法 160例患者随机分为两组,治疗组用龟龄集胶囊口服治疗,一次0.6g,每日1次,对照组服用五子衍宗丸,每次6g,每日2次,疗程均为3个月,并于治疗前后对两组患者进行精液参数及疗效观察.结果 治疗组显效率58.33%,有效率25%,无效率5.56%,总有效率94.44%:女方妊娠率为11.11%:对照组显效率46.05%,有效率22.37%,无效率26.32%,总有效率73.68%;女方妊娠率为5.26%,治疗组临床疗效优于对照组(P<0.01).结论 龟龄集能提高少弱精子症精液质量且安全性良好.     

Clinical Observations on Therapeutic Effects of the Modified Shengjing Zhongzi Tang(生精种子汤) in Patients with Asthenospermia and Oligozoospermia

Objective:To compare the therapeutic effects of Shengjing Zhongzi Tang(生精种子汤Decoction for Generating Sperms) and Wuzi Yanzong Wan(五子衍宗丸Pills for Reproduction) for asthenospermia and oligozoospermia.Methods:Seventy patients with asthenospermia and oligozoospermia were divided into a treatment group of 35 cases treated with Shengjing Zhongzi Tang and a control group of 35 cases treated with Wuzi Yanzong Wan for 3 months respectively.The therapeutic effects were evaluated,the semen parameters were analyzed and...