辅助生殖技术发展至今,已成为解决人类生育问题的重要手段,其包含和衍生出的各种技术也随着辅助生殖技术本身的进步而日新月异.现在卵胞浆内单精子注射技术(ICSI)日益成熟,对于男性而言配子的问题是最受关注的,也关乎辅助生殖的各个环节[1].ICSI中精子优选技术的应用对ICSI结局的各个指标存在影响,如何合理选择精子优选技术是各生殖中心如何提高胚胎质量的重要课题.

雄激素是与男性性功能及生殖均密切相关的性激素.准确检测雄激素对男科临床工作意义重大.目前国内检测雄激素的方法仍以化学发光法为主,质谱技术尚未普及,而对游离睾酮的检验在临床上也较为少见,这也限制了相关疾病诊疗水平的发展.本文对雄激素的生理基础及临床现有检测方法的进展作一综述.

目的 比较不同精子DNA碎片指数(DNA fragmentation index,DFI)的精子冷冻前后的浓度、活力变化及复苏率,明确DFI对精子冷冻的影响.方法 2017年在上海市第一妇婴保健院生殖中心行体外受精-胚胎移植(in vitrofertilization and embryo transfer,IVF-ET)的患者中,自精冻精患者共55例,男方通过病史询问、生殖系统超声检查、染色体检查排除遗传及其他因素,入组排除因严重少弱精子症和隐匿精子症冻精的患者,入组患者36例,按DFI≥27％和DFI＜27％分为两组.比较两组患者精子冷冻前后的精子浓度、活力差以及复苏率.结果 36例患者分为DFI≥ 27％组1 1例,DFI＜27％组25例.两组间年龄、不育年限和精子形态率等一般情况比较差异无统计学意义(P=0.29;P=0.77;P=0.28).两组间精子冷冻前后的浓度变化、活力变化及前向运动精子(PR)总数变化的差异均无统计学意义(P=0.07;P=0.76;P=0.58),比较两组冷冻复苏率差异无统计学意义(P=0.52).结论 不同DNA碎片率的精子冷冻解冻后的浓度、活力变化以及冷冻复苏率并没有显著差异,DFI异常不是精子冷冻的禁忌证.

睾酮对维持阴茎勃起的生理及解剖基础具有重要作用,性腺功能减退和睾酮水平降低是导致勃起功能障碍(erectile dysfunction,ED)发生的重要因素,通常与肥胖、糖尿病、高脂血症及代谢综合征等代谢性疾病伴发,而代谢疾病则会进一步影响患者的勃起功能.睾酮水平亦与ED的治疗效果息息相关,一线治疗无效的患者中亦存在不同程度的性腺功能减退.本文拟从睾酮在勃起生理机制中的作用入手,阐述睾酮与ED发生及治疗之间的关系,以期为内分泌性ED和难治性ED的诊疗提供参考.

睾酮制剂作为男性雄激素的替代治疗药物,在男性发育的不同年龄阶段具有不同的生理作用.因此,在临床发病不同年龄的男性中具有广泛应用,但效果不一.本文就睾酮替代治疗的临床应用(包括适应证、禁忌证、治疗益处与风险、临床制剂选择和随访)进行了综述,并结合临床最新的研究报道,为临床睾酮替代治疗研究及用药选择提供思路.

Objective To investigate quality control (QC) of Computer-aided Sperm Quality Analysis(CASA) in different laboratories for counting sperm concentration by manual counting, and ensure a standard of sperm concentration counting between different laboratories. Methods Sperm concentrations of 600 semen samples in three different hospitals were determined by manual counting and CASA from January 1, 2016 to March 31, 2016, the CASA parameters wereadjusted based on the results of manual counting. Subsequently, sperm concentrations of other 600 semen samples in three different hospitals were determined by manual counting and CASA from April 1, 2016 to June 30, 2016. The results were comparatively analyzed. Results (1) From January 1, 2016 to March 31, 2016, there was no difference in the results of sperm concentration of 400 semen samples from Shanghai First Maternity and Infant Hospital between manual counting and CASA (P>0.05); the level of sperm concentration in 100 semen samples from Children and Women's Health Care Hospital in Pudong New Area using manual counting was higher than that using CASA (P<0.05); the level of sperm concentration in 100 semen samples from Children and Women's Health Care Hospital in Minhang Area using manual counting was lower than that using CASA (P<0.05). (2) CASA parameters in different laboratories were adjusted based on the above results. from April 1, 2016 to June 30, 2016, there was no difference in the results of sperm concentration of 400 samples from Shanghai First Maternity and Infant Hospital between manual counting and CASA (P>0.05). There was no difference in the results of sperm concentration of 100 samples from Children and Women's Health Care Hospital in Pudong New Area between manual counting and CASA (P>0.05). There was no difference in the results of sperm concentration of 100 samples from Children and Women's Health Care Hospital in Minhang Area between manual counting and CASA (P>0.05). Conclusion The accuracy and consistency of sperm concentration counting between different laboratories can be significantly improved by adjusting the CASA parameters according to the results of sperm concentration by standard manual counting regularly.

Objective To study the incidence of anxiety and depression in patients accepting second cycle of oocyte retrieval and in vitro fertilization-embryo transfer (IVF-ET) and to investigate the effects of psychological nursing on psychological state and pregnancy outcomes in second IVF-ET cycle.Methods Female patients implemented with oocyte retrieval and IVF-ET for second time in reproductive medicine center of First Maternity and Infant Hospital in Tongji University from January 2014 to June 2015 were divided into experimental group (187 cases) and control group (181 cases) randomly.Patients in the experimental group were given additional mental intervention and psychological nursing on basis of routine clinical care, while patients in the control group only received routine clinical care.Anxiety and depression degree in two groups were investigated by Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS).Results Scores of SAS and SDS in the experimental group were obviously lower than those in the control group (t value was-2.084, and-2.239, respectively, both P<0.05).Pregnancy rate of the experimental group was significantly higher than that of the control group (χ2=3.588, P<0.05).There was no significant difference in oocyte retrieval rate, fertilization rate and good quality embryo rate between two groups (χ2 value was 2.149, 1.178 and 2.897, respectively, all P>0.05).Conclusion Patients accepting second oocyte retrieval and IVF-ET cycle are easy to suffer anxiety and depressive disorder.Effective mental intervention and psychological nursing are able to improve psychological status and pregnancy outcomes.

Objectives: To investigate the influence of morphological parameters of sperm on fertility rate of in vitro fertilization and embryo transfer (IVF-ET) and discuss the clinical significance of sperm morphological parameters. Methods: Data form 824 couples underwent IVF-ET in our IVF center during April, 2016 to September, 2016 were analyzed retrospectively. Inclusion criteria were female infertility due to female tubal factors and the method of controlled ovulation induction was short-term long protocol. Number of retrieved oocyte was 6 to 15. Failure of oocyte retrieval, rescue ICSI and short co-incubation of gametes were excluded. Male inclusion criteria were total number of progressive motile sperm more than 5 million in two CASA tests, and patients with genetic and infectious factors were excluded. Altogether 136 couples were enrolled. Sperm morphology test was performed according to WHO 5 th edition manual and acrosome index was calculated by image software. Logistic regression analysis was performed for statistical analysis. Results: The mean age of enrolled male patients was (34.12±4.30) years (ranging from 27-46 years) and female patients was( 32.32±4.14 ) years (ranging from 25-43 years). Their mean infertility time was(2.77±1.34) years (ranging from 1-8 years). The rate of sperm head abnormality was in significant negative correlation with fertility rate (P=0.035), and acrosome index had a significant positive correlation with fertility rate (P=0.046), whereas other CASA and morphological parameters had no correlation with fertility rate. Conclusions: The rate of sperm head abnormality and acrosome index may adversely affect the fertility rate of IVF. Therefore, the morphological tests should not only focus on normal morphology rate, but also should pay attention to the classification of various sperm anomalies for obtaining a better prediction of IVF outcome.

Objective To evaluate the effect of handheld stimulating device assisted behaviour therapy on masturbation ejaculation difficulty of the patients from IVF (in vitro fertilization, IVF) outpatient.Methods Total of 67 cases who complained masturbation ejaculation difficulty during the IVF cycle from August 2013 to May 2014 were selected in the study. The cases who had ejaculation difficulty both in masturbation and sexual life or other determinate factors were ruled out. At last, 53 cases of them were enrolled and divided into two groups according to the treatment method, and the treatment group includes 31 cases. The patients kept regulated ejaculation frequency and living habits. The first 2 weeks these patients use handheld stimulating device and audio-visual stimulation to assist masturbation at home, then the next 2 weeks the patients use the same method to try practice test once or twice a week in hospital. The patients who successfully finished ejaculation after the treatment had a follow-up therapy period for about 1 month. The control group includes 22 cases, 19 cases choose sperm cryopreservation before IVF, 3 cases acquired sperm by testicular puncture. We compare <br> the success rate of ejaculation on operation day of the two groups.Results The patients of the treatment group included 31 cases, in the treatment phase, 25 cases (80.65%) finished ejaculation successfully by masturbation. The control group included 22 cases. 58.49% of the patients preferred handheld stimulating device assisted behavior therapy. On the operation day, 19 cases (61.29%) finished ejaculation successfully in the treatment group, 10 cases (32.26%) used the frozen sperm before operation, and 2 cases (6.45%) were treated by testicular puncture. In the control group, 7 cases (31.82%) finished ejaculation, 12 cases (54.55%) used the frozen sperm, and 3 cases (13.64%) were treated by testicular puncture. There was a significant difference in the success rate of the two groups of patients (P<0.05). There was no significant difference in the success rate of ejaculation on operation day (P>0.05) no matter whether the patient had sperm cryopreservation before the operation.Conclusion Handheld stimulating device assisted behavior therapy has a certain effect on masturbation ejaculation difficulty. The evaluation and mechanism of the effect need further investigation with large sample, multi center.

Objective To investigate the effect of abstinence days on the main parameters. Methods Total of 8686 semen samples according to abstinence time were divided into four groups such as Group A:abstinence time≤2d, Group B: abstinence time 3~5d,Group C: abstinence time 6~7d, Group D: abstinence time >7d; Semen volume, pH, sperm concentration, sperm motility, sperm motility rate, total sperm count of all semen samples were comparatively analyzed. Results (1) Semen volume and semen concentration were increased in group A, group B, group C, group D. There were significant differences between group A and other groups B,C,D (P<0.05);(2) Sperm motility in group A, group B, group C, group D was decreased, and group A was significantly different from other groups B, C and D (P<0.05);(3) Progress sperm count and sperm count were increased in group A, group B, group C, group D. Compared with that of group C , sperm count increased in group D, but progress sperm count was decreased , and group A was significantly different from other goups B, C and D (P<0.05); (4) PH and sperm motility rate were gradually decreased in group A, group B, group C, group D, there were significant differences between group A and other groups (P<0.05). Conclusion When semen analysis, different abstinence day has a certain influence on the CASA parameters. with the prolongation of the duration of abstinence, sperm motility and sperm motility rate were significantly decreased, and prolonged abstinence time did not get high quality of semen samples.

OBJECTIVE:To investigate the influence of Ureaplasma urealyticum (Uu) infection in the male reproductive tract on the outcomes of IVF and the clinical significance of preoperative Uu test by analyzing the correlation between the results of Uu culture before IVF-ET and the outcomes of IVF-ET.METHODS:Among 1,059 couples undergoing IVF-ET, we selected 973 after excluding genetic factors and divided them into a Uu negative and a Uu positive group according to the results of culture of Uu in the semen of the males. We compared the rates of IVF fertilization, oocyte cleavage, clinical pregnancy and abortion between the two groups, and analyzed the influence of Uu infection on IVF outcomes.RESULTS:Among the 973 selected subjects, 836 were Uu negative (group A) and 137 Uu positive (group B), and of the latter, 130 were restored to Uu negative after treatment (group B1) and the other 7 remained unchanged (group B2). No significant differences were found between groups A and B in the rates of IVF fertilization (81.6% vs 79.8%, P = 0.13), abnormal fertilization (11.8% vs 12.4%, P = 0.58) and oocyte cleavage (92.0% vs 92.1%, P = 0.94), nor between groups A and B2 (81.6% vs 89.8%, P = 0.10; 11.8% vs 13.2%, P = 0.75; 92.0% vs 92.5%, P = 0.10). Totally, 747 of the patients underwent embryo transfer, including 643 in group A and 104 in group B. There were no significant differences between groups A and B in the rates of clinical pregnancy (38.6% vs 34.7%, P = 0.44) and abortion (16.5% vs 22.2%, P = 0.39), nor between groups A and B2 (38.6% vs 33.3%, P = 0.79; 16.5% vs 0, P = 0.53).CONCLUSION:Uu infection in the male reproductive tract does not significantly affect the rates of IVF fertilization, oocyte cleavage, clinical pregnancy and abortion. However, more investigations with larger sample sizes of the cases restored from Uu positive to Uu negative are needed to lend further support to our findings.

Objective: To compare the difference in sperm morphology before and after antimicrobial treatment in Ureplasma urealyticum (Uu) infected patients, and analyze the possible effect of Uu infection on sperm morphology. Methods: Two hundred and fifty-eight subjects undergone pre-pregnancy examination at Reproductive Medicine Center of Shanghai First Maternity and Infant Hospital in 2012 were collected. After eliminating cases with influencing factors, 96 eligible cases with Uu infection were enrolled and treated with the same therapeutic regimen. The 96 cases were divided into two groups according to the treatment outcome, Uu turning negative group and Uu remaining positive group. Sperm morphology was analyzed before and after treatment in both these 2 groups. Results: In Un turning negative group, per-centage of morphology normal sperm and percentage of sperm with abnormal head were similar before and after treatment (P=0.90, P=0.08), while percentage of sperm with abnormal tail decreased significantly after treatment (P=0.02). Percent-ages of morphology normal sperm , sperm with abnormal head and sperm with abnormal tail were similar before and after treatment in Uu remaining positive group (P=0.92, P=0.14, P=1.00). The morphology changes before and after treatment were not significantly different between Uu turning negative group and Uu remaining positive group ( P=0.83). Conclu-sions:Uu infection has no evident impact on sperm morphology. However, the percentage of sperm with abnormal tail de-creases significantly after treatment in Uu turning negative patients, which denotes that Uu infection may cause abnormality of sperm tail.

目的 本研究将基于已经建立的三维小鼠体外胚胎着床模型,将整个培养环境的氧浓度调整为2％,从而探究缺氧环境对胚胎着床的作用和影响.方法 将已经建立的小鼠体外着床模型分为两组,其中一组置于氧浓度2％的密封箱内进行培养.另外一组为对照组,直接置于培养箱中,按照原先的大气氧浓度进行培养.观察对比这两组之间胚胎与内膜的黏着率.并对着床胚胎及内膜进行组织切片,观察组织的形态学变化,检测其中细胞凋亡的情况.结果 小鼠囊胚在2％的氧浓度及大气氧浓度下的胚胎黏着率分别为41.4％及53.2％;这两组的胚胎黏着率比较,差异无统计学意义.两种情况下的小鼠胚胎均已经黏附于体外共培养的子宫内膜上皮层表面,未见明显形态学异常.但在2％氧浓度下,子宫内膜组织中很多间质细胞发生了细胞凋亡.结论 2％的氧浓度在三维体外胚胎着床模型的运用中,虽然没有导体外胚胎黏着率的显著降低,但却诱导了体外培养子宫内膜组织中细胞的凋亡.

目的 运用已有的小鼠体外三维着床模型观察LIF抑制状态下对胚胎着床这一过程中的影响以及其转导通路中下游STAT3和pSTAT3蛋白表达水平的变化,从而探究LIF及其转导通路在胚胎着床中的功能.方法 将小鼠内膜组织置于有不同浓度LIF抗体(0.1和1.0μg/ml)及正常IgG对照和阴性对照的培养基中预培养0.5h.然后进行内膜组织和囊胚的共培养,观察比较胚胎与内膜的黏着率的不同,并对抗体处理后的内膜进行STAT3及pSTAT3的免疫组化染色.结果 运用1.0％抗体预处理组的黏着率与正常IgG对照组及阴性对照组之间均有统计学差异.pSTAT3的表达在经LIF抗体预处理的内膜中明显高于对照组.结论 LIF在小鼠胚胎着床中起着非常重要的作用,通过LIF表达的降调节可以显著降低胚胎黏着率.LIF对胚胎黏着的作用可能是通过JAK/STAT通路中STAT3的磷酸化活化而实现的.

目的 分析男性生殖道解脲支原体(Uu)感染治疗后复发的相关因素.方法 对89例男性生殖道Uu感染抗生素治疗转阴患者随访2个星期以上,并进行问卷调查,调查内容包括慢性前列腺炎症状评分,吸烟、饮酒、久坐、食辛辣、骑自行车等生活习惯,性生活满意程度、性生活频率及性伴侣Uu感染情况.结果 89例患者随访(1.62±0.89)个月,治疗转阴后2个星期以上复查发现复发者13例,复发率14.61％.Uu感染治疗后复发情况与久坐时间、食辛辣食物、性伴侣Uu感染呈正相关,与性生活频率呈负相关.结论 在男性生殖道Uu感染治疗中,规避诱发慢性前列腺炎的生活习惯以及关注性伴侣交叉感染情况有利于防止治疗后复发.

Objective To evaluate the value and safety of combined therapy of growth hormone and gonadotropin on male delayed puberty caused by hypogonadotropic hypogonadism.Methods A retrospective analysis was undergoing in Shanghai First Maternity and Infant Hospital from 2010 Jun to 2012 May.28 cases with male delayed puberty caused by hypogonadotropic hypogonadism were enrolled.The average age was(15.25 ± 1.11) years.All the cases were given a combined therapy of human chorionic gonadotrophin,follicle stimulating hormone and growth hormone.After 3 months therapy,the growth condition such as sexual hormone levels, height,and volume of testis were recorded to inspect the treatment effect.Results All 28 cases had a follow-up visit.No short term complications occurred.The height and testosterone level was higher than which before therapy(P0.05).And the volume of testis, follicle stimulating hormone and luteinizing hormone level were significantly higher than before the therapy.Conclusion Combined therapy of human chorionic gonadotrophin,follicle stimulating hormone and growth hormone could be a safe and effective method to treat male delayed puberty caused by hypogonadotropic hypogonadism.

Objective To study the relationship between the level of prostate specific antigen (PSA)and levels of sex hormonessuch asfollicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2)in aging males in the Shanghai. Methods Using multi-stage sampling method, 1 720 cases of 40 to 80-year-old male resident were recruitedfrom the general population of Shanghai The levels of serum prostate-specific antigen (PSA) and levels of four sex hormones (FSH, LH, T, E2) were respectively measured in the sampling population. Results Of 1 720 people, 1 489 were enrolled in the study due to their compliant and comprehensive data.Their average age was 61.88±10 years old, average level of PSA 1.29±1.06, levels of sex hormone FSH(7.97±6.35)mIU/ml, LH(4.39±.73)mIU/ml, T(4.47±2.58)ng/ml, and E2(9.99±16.51)pg/ml, there is no significant correlation between PSA and FSH levels (r = 0.002, P > 0.05); There were no significant correlations between PSA level and LH level (r=-0.008, P >0.05), between PSA level and T level (r =-0.008, P >0.05), between PSA level and E2 level (r =-0.019, P >0.05). Conclusion No relationship between PSA and four sex hormones was found in aging males.

目的:通过研究男性生殖道解脲支原体(Ureaplasma urealyticum,Uu)阳性患者的精液参数水平,比较治疗前后其精液常规参数变化,分析Uu对精液参数可能存在的影响.方法:经排除影响因素后,入组Uu生殖道感染男性患者96例,按Uu治疗结果(转阴或未转阴)分为2组,采用计算机辅助分析精液常规参数,比较2组患者的精子浓度和前向运动率.结果:96例Uu生殖道感染男性患者中,治疗后Uu转阴者86例,未转阴者10例.Uu转阴者治疗前与转阴后的精子浓度及精子前向运动率差异均无统计学意义(P=0.44,P=0.35)；未转阴者治疗前与治疗后的精子浓度及精子前向运动率差异亦无统计学意义(P=0.65,P=0.78).治疗后,Uu未转阴患者的精液参数变化程度与治愈者相比,差异无统计学意义(P=0.39,P=0.44).结论:男性精液Uu培养阳性对常规精液参数无明显影响,Uu阳性对生育力是否存在影响还需要进一步深入探讨.

To observe the relative activity of sperm mitochondria and the proportion of ROS-positive sperm before and after capacitation and progesterone (Pg)-induced hyperactivation, and investigate the functional characteristics of sperm mitochondria.We collected 20 samples of normal human spermatozoa that met the criteria of WHO Laboratory Manual for the Examination and Processing of Human Semen (5th ed) and cultured them with the swim-up method in a CO2 incubator at 37 degrees C for 1 hour. We divided the sperm into a pre-capacitation and a capacitated group, and further incubated the capacitated sperm in an upright tube with (Pg-induced group) or without (control group) slow-releasing Pg at 37 degrees C for another hour. Then we determined the relative activity of mitochondria and the percentage of ROS-positive cells in the sperm samples using JC-1 and DCF staining.The relative activities of mitochondria were significantly increased in the capacitated, control and Pg-induced groups (6.23, 14.36 and 12.33) as compared with the pre-capacitation group (1.42) (P < 0.05), while the percentages of balanced mitochondria (mitochondria with equal amount of high and low electric potentials) remarkably reduced (4.27%, 5.03% and 8.57% vs 21.64%, P < 0.05). The percentages of ROS-positive sperm in the pre-capacitation, capacitated, control and Pg-induced groups were 2.89%, 0.70%, 4.25% and 1.90%, respectively, significantly lower in the capacitated than in the pre-capacitation group (P < 0.01), but dramatically increased in the control group after another hour of swim-up incubation and markedly higher than in the Pg-induced group (P < 0.01).Progesterone induction can hyperactive human sperm motility, inhibit the relative activity of mitochondria, keep mitochondria potential at a more balanced level, and reduce the production of ROS, which may help to raise the rate of in vitro fertilization and improve the quality of embryos.

To investigate the awareness of ethical issues on assisted reproductive technology in medical staffs,a questionnaire investigation was conducted among the medical staffs of Shanghai First Maternity and Infant Hospital which developed assisted reproductive technology for years.The questionnaire included the questions about the management and donation of gametes and embryos,the children from assisted reproductive technology,and the new technology in this field.The results of the investigation showed that medical staffs had a lax attitude on the controversial ethical problems,but they were still lack of ethical cognitions.Therefore,more ethical education should be provided to improve their ethical cognitions.