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精子功能检测与男性不育诊治的新进展 被引量:66

Assessment of Human Sperm Function and Clinical Management of Male Infertility
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摘要 传统的精液常规分析是用于判断男性生育力的最基本临床指标,但是,只依靠精液分析的结果来预测男性生育状况仍是很不准确的。精子功能正常与否,对临床选择IVF还是ICSI治疗不育症极为重要。因为IVF需要功能完全正常的精子才能受精,而ICSI的受精只需要精子的正常核DNA,不需要其它的精子功能。在发明ICSI以前,患者IVF受精失败或低下(〈30%)发生率很高(20%~35%)。研究证明,这些IVF受精失败的患者主要与精子功能障碍有关。常见的是少精子症,弱精子症和畸形精子症。但是有很多患者,精液分析结果仍正常。为了提高临床对精子功能测定的准确性,文献里有很多新的精子功能试验的研究报导,比如丫啶橙(AO)测定精子DNA、精子与透明带结合和穿透、顶体诱发精子顶体反应和精子与透明质酸结合试验。精子形态测定是常规精液分析中最重要的临床指标之一。但精子形态又是最难测定准确和稳定。IVF/ICSI受精失败的人卵可以用来测定精子功能。人卵透明带选择性地与正常形态和顶体完整的精子结合,透明带诱发的顶体反应与精子穿透明带的能力有很强的相关性。在不明原因的男性不育患者中,由于透明带诱发顶体反应障碍所导致的不育症占25%左右。少精子症(精子计数〈2×10^6/ml)和严重精子形态畸形症(严格正常形态〈5%)的男性不育患者,精子-透明带结合反应缺陷的发生率很高(〉70%)。这类患者用IVF治疗受精率会很低,因此只能用ICSI治疗。精子与透明质酸结合试验与精子活力和形态有很强的相关性,但它不是很有用的精子功能试验。AO测定精子DNA对预测ART的受精和妊娠率的临床意义目前还没有肯定的结论,需要进一步研究。总之,在常规精液分析时,增加一些新的精子功能试验,在临床ART中对男性不育患者的诊治会有很大的帮助。 In this article, we provide an update review on the implication of the assessment of human sperm function and the management of male infertility in clinical assisted reproductive technology (ART) known as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In most ART clinics, the assessment of male fertility is still mainly based on routine semen analysis but it is inaccurate in predicting sperm fertilizing ability. Thus it is often difficult to determine if IVF or ICSI will be an optimal treatment for patients in the initial cycle. Before introduction of ICSI, frequency of low ( 〈30% ) fertilization rate in IVF was very high (20-35% of patients). Evidence suggests that sperm defects axe the major contributors to complete failure of fertilization in IVF. Most common sperm defects are oligozoospermia, asthenozoospermia and teratozoospermia though many of the patients are shown to be normal in routine semen analysis. In the literature, many new sperm function tests have been developed, including sperm DNA normalities assessed by Acridine Orange (AO), sperm-zona pellucida (ZP) binding, the ZP-induced acrosome reaction (AR), sperm-ZP penetration and recently hyaluronan binding assay (HBA). For routine semen analysis, sperm morphology is one of the most useful values for the prediction of sperm function but is also the most difficult test to perform accurately and consistently. Oocytes that failed to fertilize in clinical IVF/ICSI are valuable biological materials for testing sperm function. The human ZP selectively binds sperm with normal morphology and an intact acrosome. The ZP-induced AR is highly correlated with sperm-ZP penetration and disordered ZP-induced AR causes infertility in about 25% men with unexplained infertility with normal semen analysis. Both oligozoospermic ( sperm count 〈 20 × 10^6/ ml) and severe teratozoospermic (strict normal sperm morphology ≤5% ) men have a very high ( 〉 70% ) frequency of defective sperm-ZP interaction. Thus patients with defects of sperm-ZP interaction should be identified and treated with ICSI since they have high risk of low or zero fertilization rate in IVF. HBA test highly correlates with sperm motility and normal morphology but provides no additional information about sperm fertility. Clinical value of sperm DNA normalities detected by AO for the prediction of ART outcomes is currently still inconclusive and requires fuaher investigation. In conclusion, addition of some of these new sperm tests to routine semen analysis could significantly improve the management of male infertility in clinical ART. Nail J Androl,2007,13(2 ) :99-109
出处 《中华男科学杂志》 CAS CSCD 2007年第2期99-109,共11页 National Journal of Andrology
关键词 精子功能 男性不育 体外受精 单精子卵细胞胞质内注射 sperm function tests male infertility IVF/ICSI
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  • 1Wassarman PM. Zona pellucida glycoproteins. Annu Rev Biochem 1988; 57: 415-42.
  • 2Bercegeay S, Jean M, Lucas H, Barriere P. Composition of human zona pellucida as revealed by SDS-PAGE after silver staining. Mol Reprod Dev 1995; 41: 355-9.
  • 3Harris JD, Hibler DW, Fontenot GK, Hsu KT, Yurewicz EC,Sacco AG. Cloning and characterization of zona pellucida genes and cDNAs from a variety of mammalian species: the ZPA,ZPB and ZPC gene families. DNA Seq 1994; 4: 361-93.
  • 4Epifano O, Liang LF, Dean J. Mouse Zpl encodes a zona pellucida protein homologous to egg envelope proteins in mammals and fish. J Biol Chem 1995; 270: 27254-8.
  • 5Gupta SK, Yurewicz EC, Sacco AG, Kaul R, Jethanandani P,Govind CK. Human zona pellucida glycoproteins: characterization using antibodies against recombinant non-human primate ZP1, ZP2 and ZP3. Mol Hum Reorod 1998: 4: 1058-64.
  • 6Hughes DC, Barratt CL. Identification of the true human orthologue of the mouse Zpl gene: evidence for greater complexity in the mammalian zona pellucida? Biochim Biophys Acta 1999: 1447: 303-6.
  • 7Williams Z, Wassarman PM. Secretion of mouse ZP3, the sperm receptor, requires cleavage of its polypeptide at a consensus furin cleavage-site. Biochemistry 2001; 40: 929-37.
  • 8Wassarman PM. Profile of a mammalian sperm receptor. Development 1990; 108: 1-17.
  • 9Liu DY, Baker HW. Tests of human sperm function and fertilization in vitro. Fertil Steril 1992; 58: 465-83.
  • 10Liu DY, Baker HW. Disordered acrosome reaction of spermatozoa bound to the zona pellucida: a newly discovered sperm defect causing infertility with reduced sperm-zona pellucida penetration and reduced fertilization in vitro. Hum Reprod 1994; 9: 1694-700.

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