目的:探讨血清抗缪勒管激素(AMH)测定在无精子症患者睾丸功能评估中的应用价值.方法:2016年5月至2018年5月间上海交通大学附属第一人民医院泌尿中心男科收治310例接受睾丸切开取精手术的无精子症患者,其中梗阻性无精子症(OA)80 例为OA组,非梗阻性无精子症(NOA)230 例为NOA组.NOA组中38例经显微手术成功取得精子者为NOA-RS组,192例未取得精子者为NOA-RF组.NOA组根据睾丸体积分为NOA-Ⅰ组(≥10 ml,155例)和NOA-Ⅱ组(<10 ml,75例).对这些病例的临床资料进行回顾分析,应用酶联免疫的方法检测各组血清AMH水平.结果:OA组睾丸体积显著大于NOA两组(P<0.01),其血清AMH水平与睾丸体积大小不相关.OA组的AMH水平高于NOA两组,而NOA-Ⅰ及NOA-Ⅱ组的血清AMH水平均随睾丸体积缩小而降低.OA 组中AMH 水平与INHB 水平呈显著正相关(P <0.01),与FSH、LH、T水平无相关性.NOA-Ⅰ组AMH水平与INHB水平有相关性(P<0.05),与FSH、T水平呈显著相关性(P<0.01),与LH水平无相关性.伴随AMH水平下降,INHB、T水平下降,FSH水平升高.NOA-Ⅱ组AMH水平与FSH、LH水平呈显著相关性(P<0.01),伴随AMH水平下降,与INHB、T水平无关,FSH、LH水平明显升高.NOA-RS 组的 AMH 水平显著低于 NOA-RF 组(P <0.05),两组年龄差异无统计学意义.结论:血清AMH、INHB联合检测有助鉴别OA与NOA,并对于NOA患者睾丸生精功能评估具有一定意义.血清AMH不能单独用于预测NOA睾丸取精率.

Objective: To discuss the efficacy and safety of subinguinal microsurgical varicocelectomy in the treatment of non-obstructive azoospermia (NOA) with varicocele. Methods: The clinical data of 141 patients with NOA and varicocele who underwent subinguinal microsurgical varicocelectomy from March 2015 to June 2017 in Shanghai General Hospital was collected.One hundred and ten patients suffered from varicocele on the left side, 1 on the right side, and the rest (30 cases) were bilateral varicocele. Grade Ⅰ varicocele were found on 7 sides (the right and left side was count respectively), grade Ⅱ on 121 sides, and grade Ⅲ on 43 sides. Sperm analysis, pregnancy rate and complications were recorded after at least 6 months since operation. Results: Eleven cases were lost during the follow-up. Eighteen of the remaining 130 NOA patients processed successful sperm retrieval in post-operative semen analysis (18/130, 13.8%). Six couples(6/130, 4.6%) succeeded in natural pregnancy. Five couples (5/130, 3.8%)underwent successful pregnancy following with intracytoplasmic sperm injection(ICSI). Twenty-six out of the remaining 112 patients underwent the micro dissection testicular sperm extraction (micro-TESE), and 4 patients got a successful sperm retrieval (4/26, 15.4%). Among them, 2 couples had successful pregnancy with ICSI. Totally 2 cases of postoperative infection of incision were found. Conclusions: Microsurgical varicocelectomy had a beneficial effect on sperm quality of patients suffered from NOA with varicocele to some extent, even leading to unassisted pregnancy or avoiding micro-TESE before ICSI. Microsurgical varicocelectomy could be applied in the treatment of NOA with varicocele.

Objective To investigate the effect of chromosome polymorphism on the male spermatogenesis and reproductive outcomes.Methods Totally 3 203 cases of male (infertile group),who were divided into normozoospermia group,aligozoospermia group,azoospermia group according to the sperm count of semen analysis,and 4 893 cases of donor (donor group) were involved the study.Semen analysis,karyotype analysis,and Y chromosome microdeletion test were compared between the groups.The reproductive outcomes of sperm donors and infertile patients were investigated.Results The incidence of polymorphism in infertile group and donor group was 4.62％ and 3.78％ respectively,and the difference was not statistically significant.The incidence of Yqh-in infertile patients increased significantly with the decrease of sperm count (0.15％ in normozoospermia group,0.22％ in aligozoospermia group,0.99％ in azoospermia group),and the difference was statistically significant (P=0.033,compared between normozoospermia group and azoospermia group;P=0.027,compared between aligozoospermia group and azoospermia group),the rate of Y chromosome microdeletion in group C with Yqh-was 56.25％ (9/16),significantly higher than that of other groups (P＜0.05).The incidence of polymorphism in the asthenozoospermia group and teratozoospermia group was 3.92％ and 3.96％,respectively,and the difference was not statistically significant (P＞0.05).Follow-up investigation found that the spontaneous abortion rate was 6.25％ (3/48) and 6.67％ (2/30) in people with polymorphic of donor group and infertile group respectively,no statistical significance (P＞0.05),and no child birth defects were observed.Conclusion Part with azoospermia factor (AZF) microdeletion in Yqh-may lead to spermatogenesis,and other types of polymorphism have no obvious effect on male fertility.

Objective To analyze the pregnancy outcome of cases who underwent intracytoplasmic sperm injection (ICSI) with frozen-thawed sperm, which was rare and weak, cryopreserved by a novel micro-straw (LSL micro-straw). Methods The present study retrospectively analyzed the post-thaw results of cryopreserved human sperm from 83 severe infertility male patients (including oligospermia and asthenospermia). Then we investigated the evolution of embryo development and pregnancy outcome in 23 patients underwent ICSI. Results About 89.5% (94/105) frozen-thawed samples could observe motile sperm in quality control. About 73.9% (17/23) sperm were available in 18 ICSI cycles. The fertilization rate, the cleavage rate, the available embryo rate and the high-quality embryo rate were 78.0%, 92.5%, 62.7% and 78.0%, respectively. The implantation rate, the clinical pregnancy rate and the cumulative live birth rate were 31.1%, 52.5% and 55.6%, respectively. Totally 12 live births were obtained with no birth defects reported. Conclusion LSL micro-straw is a safe and feasible new carrier for cryopreservation of oligospermia and asthenospermia, which can be widely applicated in assisted reproductive technology. Key words: Rare human spermatozoa; Freezing and thawing; Novel micro-straw (LSL micro-straw); Intracytoplasmic sperm injection (ICSI); Pregnancy outcomes

Objective To analyse karyotype of chromosome in patients with infertility and sperm donors,and explore its clinical significance.Methods A total of 967 infertile patients(infertility group) and 3 184 semen donors(donor group) were selected for analysis of karyotype of chromosome,and the incidence and types of abnormal karyotypes were compared between two groups.Results The incidence of abnormal karyotypes in infertility group was significantly higher than that in donor group(14.06% vs 3.39%,P0.01).The main type of abnormal karyotype in infertility group was non-polymorphic chromosomal abnormalities,whose incidence was significantly higher than that in donor group(9.62% vs 0.25%,P0.05).The main type of abnormal karyotype in donor group was polymorphic chromosomal abnormalities,whose incidence was not significantly different from that in infertility group(3.14% vs 4.44%,P0.05).Besides,two abnormal karyotypes [46,XY,t(3;12)(p23;q24) and 46,XY,inv(20)(p13;q13.1)] were first reported worldwide in infertility group.Conclusion Chromosome non-polymorphism abnormalities is one of the major causes for male infertility,and karyotype analysis for infertile patients and sperm donors is of great significance to reduce birth defects.

Objective: To explore the necessary of chromosome screening in sperm donor population.Methods: Semen samples were collected from 1 681 cases sperm donor accord with the sperm donation standard of Ministry of Health.The leukomonocyte chromosome karyotypes were analyzed by peripheral blood leukomonocyte chromosome preparation and G binding.Results: Among the 1 681 qualified sperm donors,37 cases were of chromosome karyotype polymorphism,including 14 cases of chromosome 9 pericentric inversion,3 cases of the variation of the short arm of D/G group chromosome,6 cases of the increasing length of heterochromatic zone of chromosome(including 1,9,15,16,Y),12 cases big chromosome Y,2 cases small chromosome Y.Four cases abnormal karyotype were observed,including 1 cases Robertsonian translocation,2 cases balanced translocation and 1 case for 46,XY,/46,XY,chrg(16)(q22).Conclusion: In donor semen samples according with the sperm donation standard of Ministry of Health,carrying out chromosome karyotype screening contribute to decrease the risk of miscarriage and birth defect in assisted reproductive process.