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.     

清营汤加减联合寿胎灌肠汤对特发性畸形精子症患者的临床疗效

目的研究清营汤加减联合寿胎灌肠汤对特发性畸形精子症患者的临床疗效。方法 120例患者随机分为对照组和观察组,每组60例,对照组给予左卡尼汀,观察组给予清营汤加减联合寿胎灌肠汤,疗程60 d。检测临床疗效、精子形态学、精子活力、血清免疫功能指标(CD^3+、CD^4+、CD^8+、CD^4+/CD^8+)、精浆免疫功能指标(Ig G、Ig M、Ig A)、VEGF、MMP-3、MMP-9、不良反应发生率变化。结果观察组总有效率高于对照组(P<0.05)。治疗后,观察组精子形态学较对照组改善(P<0.05),精子活力、CD^3+、CD^4+、CD^4+/CD^8+、精浆免疫功能指标、MMP-3、MMP-9升高(P<0.05),CD^8+、VEGF、不良反应发生率降低(P<0.05)。结论清营汤加减联合寿胎灌肠汤可有效改善特发性畸形精子症患者临床症状,安全性较高。     

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。     

Cryptococcus neoformans in the Seminal Fluid of an AIDS Patient. A Contribution to the Clinical Course of Cryptococcosis: Cryptococcus neofomans im Sperma eines AIDS-Patienten. Ein Beitrag zum Minischen Verlauf der Cryptococcose

In a 33-year-old HIV-positive homosexual male suffering from unexplained headache, cryptococcosis was diagnosed in a progressive secondary stage. After treatment with the standard combination therapy of amphotericin B + flucytosine for 34 d, the patient was clinically symptom-free and discharged, upon his own request, from the hospital. He remained under ambulatory mycological control. After an interval of 65 d during which the urine had been free from Cryptococcus neoformans (Cr.n.), the fungus could not be isolated from urine but 3 X 10(5) CFUs/ml were found in the seminal fluid. Andrologically, teratospermia and hyposemia were present. There were no clinical signs in the genitourinary tract including the prostate. The significance of ecological niches for Cr.n. colonization of the genitourinary tract after antimycotic therapy is discussed. In such cases, in addition to cultural examination of urine for Cr.n. by the membrane filtration technique (MFT) and Staib agar, an additional cultural examination of seminal fluid is recommended. It is also proposed to pay more attention to Cr.n. in andrological examinations. Special regard should be given to a possible occurrence of Cr.n. in the seminal fluid of AIDS patients. In cytology of the seminal fluid, use of the Giemsa stain is unsuitable for the purpose of Cr.n. detection. For this reason, it should be supplemented by PAS staining.     

艾叶油对小鼠的遗传毒理学研究

目的:探讨艾叶油对成年小鼠及胚胎鼠的遗传毒性。方法:采用一次性小鼠灌胃急性毒性试验、小鼠骨髓嗜多染红细胞微核试验、小鼠胚胎肝转移微核试验、小鼠精子畸形试验。结果:艾叶油经小鼠口灌胃给药LD50为4.11ml/kg;艾叶油灌胃剂量2ml/kg时,孕鼠和雄鼠诱发的胚胎肝微核率、骨髓微核率和精子畸形率均较对照组显著升高(P<0.05)。艾叶油灌胃剂量为1ml/kg时,诱发的胚胎肝微核率较对照组显著升高(P<0.05),骨髓微核率与精子畸形率与对照组相比无显著性差异。艾叶油灌胃剂量为0.5ml/kg时,诱发的胚胎肝微核率、骨髓微核率、精子畸形率与对照组相比均无显著性差异。结论:一定剂量的艾叶挥发油对小鼠具有潜在的遗传毒性,并呈剂量-反应关系。     

精子畸形率对卵胞浆内单精子注射(ICSI)临床结局的影响

目的:分析畸形精子行卵胞浆内单精子注射(ICSI)的临床结局。方法:回顾性分析因男性因素行ICSI治疗的239个新鲜取卵周期。根据精子形态学分析结果将研究对象分为:精子形态正常组(A组)、非极重度畸形精子症组(B组)和极重度畸形精子症组(C组),比较3组的受精率、卵裂率、优质胚胎率、胚胎种植率及临床妊娠率、流产率、异位妊娠率和多胎妊娠率。结果:A、B组在受精率、卵裂率、优质胚胎率与C组有统计学差异(分别为80.20%、81.40%和67.60%;94.91%、93.42%和79.91%;63.87%、59.30%和54.29%)(P<0.05);3组的胚胎种植率、临床妊娠率、流产率、异位妊娠率、多胎妊娠率均无统计学差异(分别为26.3%、25.6%和24.2%;42.28%、45.00%和42.86%;7.94%、7.40%和25.00%;4.76%、3.70%和8.33%;31.75%、18.52%和25.00%)(P>0.05);而C组内手术取精(PESA/TESA)亚组的卵裂率低于体外排精亚组,差异有统计学意义(86.72%vs 76.11%,P<0.05)。结论:采用畸形精子行ICSI的不育患者同样可获得理想的临床结局。     

常规体外受精后完全不受精患者的病因及精子参数分析

目的通过回顾性分析常规体外受精(IVF)后出现完全不受精的病因及精子参数,探讨体外不受精的相关原因。方法自2005年4月至2007年8月期间选择原发性不孕3年以上、在我中心接受2次宫腔内人工授精未孕、具有体外受精-胚胎移植(IVF-ET)适应证者,首次接受助孕的35个周期。为避免常规IVF失败导致无胚胎移植,对取出的卵子同时行常规IVF和卵浆内单精子显微注射(ICSI),结果发现有18个周期常规IVF后完全不受精(称不受精组),17个周期常规IVF和ICSI后均有受精(称受精组)。结果两组相比,在不受精组,精子畸形率显著高于受精组,分别为(72.59±19.76)%,(54.06±20.92)%;男方不育因素显著多于受精组(分别为44.44%,17.65%)。进一步分析两组男方不育病因发现,不受精组畸形精子症伴少或弱精子症因素显著高于其它男方因素(分别为81.25%,16.67%)。结论在原发性不育症中,畸形精子症是完全不受精的主要原因。因此建议原发性不育3年以上、男方两次以上精液常规分析及形态学检查均为畸形精子症同时伴少或弱精子症时,应直接采用ICSI助孕。     

金萆地黄汤治疗男性不育症合并畸形精子症患者81例疗效观察

目的观察金萆地黄汤治疗男性不育症合并畸形精子症的临床疗效。方法 100例男性不育症合并畸形精子症患者采用金萆地黄汤治疗,每日1剂,治疗12周。观察治疗前后患者畸形精子指数、精子畸形指数、正常形态精子总数、正常形态精子率、正常形态前向运动精子总数的变化,并评价临床疗效、观察精子畸形不同程度患者治疗后精子形态正常率。结果 81例患者完成研究,治疗12周后临床痊愈34例(42.0%),有效26例(32.1%),无效31例(38.3%)。治疗后正常形态精子率升高,畸形精子指数、精子畸形指数降低(P<0.01)。治疗后正常形态精子总数、正常形态前向运动精子总数均多于治疗前(P<0.05)。治疗后精子畸形不同程度患者正常形态精子率比较,差异有统计学意义(P<0.05),畸形程度轻者治疗后正常率高。治疗过程中患者均未出现不良事件。结论金萆地黄汤能改善男性不育症合并畸形精子症患者畸形精子和精子多重缺陷指标,且精子畸形程度越轻,疗效越佳。     

Study of sperm characteristics in persons occupationally exposed to lead.

The sperm characteristics of 38 male workers exposed to lead in a battery factory were studied. Sperm analysis was performed after 4 days of sexual abstinence. Parameters analyzed were: volume, sperm count, motility, and morphology. Exposure levels were estimated by measuring the concentration of lead and delta-aminolevulinic acid in the serum. Based on blood lead levels, the tested individuals were divided in three groups: A (12), B (11), and C (15). Significant levels of asthenospermia and teratospermia were found in exposed workers when compared with unexposed controls. Long-term exposure to lead may lead to changes in sperm characteristics and function.     

上泳法与人工授精治疗少、弱、畸形精子不育症的价值

为提高少、弱、畸形精子症不育患者的治愈率，从1990年开始对50例药物未能治愈的少、弱、畸形精子症不有患者采用上泳法处理精子并行宫腔内人工授精治疗153个周期，结果妊娠16例，总妊娠率为32．0％，周期妊娠率为10．4％。认为尽管总妊娠率还比较抵，但对药物治疗无效的患者，此法无疑是重要的治疗方法之一。