不育妇女抑郁现症测评

本研究采用ＨＤＳ对１３０例不育妇女和５４例正常生育妇女，进行了现症测量，发现不育妇女抑郁发生率高，程度重，其ＨＤＳ总均分高于对照组。在不育妇女中，女性不育症及男性不育症配偶抑郁较重；尤以接受供精者人工授精（ＡＩＤ）者抑郁突出。不明原因不育妇女抑郁较轻。分析认为不育妇女的抑郁与不育病因及治疗经历有关。其抑郁随不育年限有波动。不育妇女，尤其是接受ＡＩＤ者在躯体治疗的同时，很有必要接受心理支持干预。     

睾丸活检对男性不育的诊断价值

45例男性不育患者共55份睾丸活检标本(有10例患者作了双侧活检)病理切片分析结果显示,睾丸生殖病理分类:正常6例,生精功能低下10例,其余39例分别为生精阻滞、纯支持细胞综合征、生精细胞脱落与管壁透明变性;精子发生障碍程度;正常6例,其余49例切片均见不同程度的生精障碍;用图像分析系统作形态学测量,发现生精障碍严重曲细精管直径变小,而基膜增厚。作者认为睾丸活检是确定无精子症病变环节的重要手段,是指导临床治疗、判断预后的可靠依据。图像分析的应用、实现了对睾丸病变的定量诊断,但在分析中要多点观察,遵循随机化、双盲原则。     

男性不育的遗传咨询及辅助生殖技术治疗策略

遗传异常是导致男性不育的重要原因。常见的导致男性不育的遗传异常有：染色体核型异常、Y染色体微缺失、精子DNA完整性异常等。不同类型染色体核型异常在进行遗传咨询及选择治疗方式上会有所不同：对于染色体多态性,在遗传咨询时可解释为染色体非病理性改变;对于染色体平衡易位,不同个体的遗传风险不一,多数患者精子染色体正常或平衡的比例要远高于理论值,实际出生异常染色体病患儿的概率低于理论值。通过常规体外受精/卵胞浆内单精子注射（IVF/ICSI）技术或植入前遗传学诊断（PGD）技术治疗,可提高染色体平衡易位患者的生育率;对于染色体倒位、臂内倒位患者产生重组精子的比例很低,与染色体正常人群并无明显差异。臂间倒位对生育的影响可依据倒位片段大小不同来判断,或进行精子荧光原位杂交（FISH）分析评估异常重组精子的比例,为患者选择辅助生殖技术（ART）治疗方式提供依据;最常见的性染色体数目异常是克氏综合征,通过激素替代治疗加上睾丸组织切取术（TESE）和ICSI 技术的联合使用,大多数非嵌合型的克氏综合征患者可获得健康的后代。Y染色体微缺失可通过ICSI 生育下一代,其胚胎发育情况及临床结局等指标与非缺失患者一致,但这类患者应行PGD 尽量选择女婴以达到优生目的。精子DNA 完整性对男性不育的临床评估意义还不是很清晰,通过抗氧化治疗可减少精子的氧化损伤,可提高精子DNA的完整性。其他与男性不育相关的遗传病如先天性双侧输精管缺如、先天性促性腺激素释放激素分泌不足、雄激素不敏感综合征、不动纤毛综合征和圆头精子症等均可能与相关基因突变有关,所以患者配偶有必要进行相关基因的诊断,并通过PGD 或产前诊断防止患儿的出生。     

Association of a novel human mtDNA ATPase6 mutation with immature sperm cells

This study reports the first clearly defined heteroplasmic mutation in immature human sperm cells. The human sperm mitochondrial genome from residue 8186-9341 was analysed with the aim of identifying point mutations which may be associated with human male infertility. The semen samples analysed were obtained from 88 fertile men, 19 with oligozoospermia, and 12 with severe oligozoospermia. Using single strand conformation polymorphism analysis a heteroplasmic T to C transition was detected in the ATPase6 gene, at nucleotide position 8821, in semen samples from one out of 12 (8%) severely oligozoospermic men, but not in oligozoospermic men or normospermic men. This mutation changed the amino acid serine to proline at residue 99 of the mitochondrial ATPase6 in a region which is highly conserved in other vertebrates including rat, bovine, chicken, salmonids and Xenopus. The mutation was detected in semen samples collected from the same man 9 months apart and in peripheral blood lymphocytes. Single sperm cell analyses did not find this mutation in the mature sperm, but the mutation was detected in 7% of immature spermatids. Our finding suggests that immature spermatids with this mutation fail to develop fully.     

Significance of simultaneous determination of serum and seminal plasma alpha-tocopherol and retinol in infertile men by high-performance liquid chromatography

High-performance liquid chromatography was used for the simultaneous determination of alpha-tocopherol and retinol in serum and semen of 40 subfertile men. The serum levels of the two vitamins were significantly higher in serum than in semen (3- to 10-fold) (P < 0.001). The mean alpha-tocopherol levels were higher in the serum and semen of men with normal sperm parameters (20 +/- 5 and 5 +/- 4 mumol L-1) than those with oligozoospermia (10 +/- 4 and 3 +/- 2 mumol L-1), azoospermia (8 +/- 3 and 3 +/- 1 mumol L-1) and asthenozoospermia (9 +/- 6 and 3 +/- 2 mumol L-1) (P < 0.002). Mean retinol levels in serum were similar in men with normal sperm parameters (2.4 +/- 2 mumol L-1) as in those with defective sperm parameters such as oligozoospermia (2.5 +/- 2 mumol L-) and asthenozoospermia (2.1 +/- 1.0 mumol L-) (P = 0.15), but significantly lower in men with azoospermia (1.3 +/- 0.3 mumol L-1) (P < 0.05). The alpha-tocopherol:retinol ratio was significantly higher in semen than in serum of men with normal sperm parameters (11.5) and those with asthenozoospermia (10.3) compared with ratios in those with oligozoospermia (8.3) and azoospermia (6.3). This may be related to reduced antioxidant activity in sperm dysfunction as a result of lipid peroxidation, from increased generation of reactive oxygen species.     

Clinical findings in congenital absence of the vasa deferentia

In a clinical study, 105 patients with congenital bilateral absence of the vas deferens (CBAVD) and 18 with congenital unilateral absence of the vas deferens (CUAVD) were investigated. CUAVD was observed on the left side in 66%. Renal agenesis was more frequent in CUAVD (73.7%) than in CBAVD (11.8%). The leading signs of CBAVD are low pH level (average 6.5) and low volume of the ejaculate (average 0.95 ml). Testicular biopsies of 52 patients revealed normal spermatogenesis or hypospermatogenesis (33% in CBAVD; 45% in CUAVD). Genetic probing and counselling concerning cystic fibrosis are necessary if extracorporal micro-fertilization is considered. The absence of the vas deferens was often overlooked by the first investigator, the average time until correct diagnosis being 4.3 years. As artificial reproduction technology becomes more common, detection of vasal agenesis will certainly be made earlier and more frequently in the future. In order to assure compatibility of subsequent prospective studies about CBAVD and CUAVD, the following investigations are considered to be necessary: (i) semen analysis (pH, volume); (ii) renal ultrasonography or excretory urogram (screening for renal agenesis); (iii) genetic cystic fibrosis screening.     

精子形态对体外受精-胚胎移植妊娠结局的影响

目的:分析男性精液参数与卵裂率、优质胚胎率及妊娠率的相关性,探讨休外受精一胚胎移植(IVF-ET)周期中精子形态对精子功能的影响.方法:分析82个受精率100%的IVF-ET周期.以Diff-Quickstain方法染色,密度梯度离心法处理精液.WHO精子形态学标准评估精子形态,精子正常形态率≥14%为正常组,<14%...