子宫内膜异位症不孕患者腹腔液孕酮对精子运动的影响

Impact of Progesterone in Peritoneal Fluid on Sperm Motility in Infertile Patients with Endometriosis

目的探讨子宫内膜异位症(EMS)不孕患者的腹腔液孕酮与精子运动的关系。方法用电化学发光法检测17例EMS不孕妇女、11例生育力正常的EMS妇女和13例对照妇女腹腔液中孕酮含量;用精液自动分析仪检测正常精液与上述妇女腹腔液共同孵育4h后精子运动力参数的变化。结果在卵泡期,EMS不孕组、生育力正常的EMS组和对照组3组妇女的腹腔液孕酮含量差异无统计学意义(P>0.05);正常精液与腹腔液共同孵育后,EMS两组精子活动力参数——精子快速前向运动(A)、平均曲线运动速度(VCL)、平均直线运动速度(VSL)、平均路径运动速度(VAP)、平均侧摆幅值(ALH)均低于对照组(P<0.05);EMS两组腹腔液加入外源性孕酮后,精子运动参数增高(P<0.05);但腹腔液孕酮与精子运动无相关性。结论EMS不孕患者腹腔液对精子运动力有抑制作用,但此抑制作用与患者卵泡期腹腔液孕酮水平无直接相关关系;EMS患者腹腔液中外源性补加孕酮后,精子运动功能得到改善。

Objective To evaluate the impact of progesterone in the peritoneal fluid on human sperm motility in the infertile patients with endometriosis. Methods Peritoneal fluids were collected from 41 patients by laparoscopy, of which 17 were infertile patients with endometriosis, 11 were fertile patients with endometriosis and 12 were fertile controls. The concentrations of progesterone in the peritoneal fluids were measured by the immulyze-enzyme amplified luminescence system. After 4 h of incubation in vitro with the collected peritoneal fluids, sperm motility was assessed by the computer-assisted analyzer （CASA）. Results The concentrations of progesterone in the peritoneal fluids in the patients （infertile patients with endometriosis, fertile patients with endometriosis and the fertile controls） did not differ significantly （P〈0.05） in the proliferate phase. The sperms incubated with the peritoneal fluids from the patients with endometriosis had significant lower sperm motion parameters （A, VCL,VSL,VAP, ALH） than those of the fertile controls （P〈0. 05）. Although the sperm motility incubated with the peritoneal fluids from the patients with endometriosis was enhanced by the exogenous progesterone, no significant correlation was established between the concentrations of progesterone in the peritoneal fluids and the sperm motility （P〉0. 05）. Conclusion The peritoneal fluids of infertile patients with endometriosis inhibit the sperm motility. The inhibition is not associated with the concentrations of progesterone in the peritoneal fluids. However, the sperm motility can be enhanced by adding exogenous progesterone to the peritoneal fluids.