男性阴囊冷敷贴对精液参数影响的研究

Study on the effect of cold compress of male scrotum on semen parameters

目的探索男性阴囊冷敷贴对男性不育患者精液参数和自然怀孕率的影响。方法回顾总结自2018年11月至2020年8月期间,使用药物和(或)男性阴囊冷敷贴对患有精索静脉曲张(varicocele, VC)不愿意接受手术治疗、职业司机、肥胖(BMI>28Kg/m2)、长期久坐合并少弱精子症和(或)畸形精子症患者203例的治疗情况。203例患者按照是否使用男性阴囊冷敷贴分为两组,组1为外用男性阴囊冷敷贴联合口服Vit E、左卡尼汀口服液治疗,共100例;组2为单纯口服Vit E、左卡尼汀口服液治疗,共103例。所有患者均在治疗前及治疗后4周、8周、12周行精液常规和精子形态学分析,在治疗前和摘除冷敷贴后立即自测阴囊表面温度。结果 203名入组患者治疗前阴囊表面平均温度为(36.1±1.1)℃,明显高于正常人阴囊平均体温(33.5±1.5)℃,差异具统计学意义(P<0.05)。组1治疗前阴囊平均温度为(36.2±1)℃,与组2(36±0.4)℃相比无显著性差异。治疗12周后,组1阴囊平均温度降至(34.2±0.4)℃,明显低于组2(36±0.3)℃,差异具统计学意义(P<0.05);组1精子浓度平均为27.5×10^(6)/ml,明显高于组2(14.8×10^(6)/ml),差异具统计学意义(P<0.05)。组1前向运动精子比例增至38.6%,明显优于组2(23.1%),差异具统计学意义(P<0.01)。组1正常形态精子比例增至6%,明显优于组2(3%),差异具统计学意义(P<0.05)。组1治疗期间女方自然妊娠率25%,组2治疗期间女方自然妊娠率4.8%,差异具统计学意义(P<0.01)。组1失访7例(占比7%),组2失访12例(占比11.6%),差异均具有统计学意义(P<0.05)。组1阴囊皮肤对冷敷贴过敏1例(占比1%),组2未出现不良反应,差异均无统计学意义(P>0.05)。结论男性患者阴囊温度升高是造成其精液参数下降的原因之一,应用男性阴囊冷敷贴降低阴囊温度,对改善精液参数和提高自然怀孕率有积极作用,且安全无明显副作用。

Objective To explore the influence of cold compress on male scrotum on semen parameters and natural pregnancy rate of male infertile patients. Methods Review and summary From November 2018 to August 2020, the use of drugs and/or male scrotum cold compresses is not willing to accept surgery for patients with varicocele(VC), professional drivers, obesity(BMI >28 Kg/m2), the treatment of 203 patients with long-term sedentary oligoasthenospermia and/or teratozoospermia. 203 patients were divided into two groups according to whether or not to use male scrotal cold compress.Group 1 was external male scrotal cold compress combined with oral Vit E and L-carnitine oral liquid treatment, a total of 100 cases;Group 2 was simply oral Vit E and L-carnitine 103 cases were treated with oral liquid. All patients underwent semen analysis and sperm morphology analysis before treatment and 4 weeks, 8 weeks, 12 weeks after treatment, and self-measured the surface temperature of the scrotum before treatment and immediately after removing the cold compress. Results The average temperature of the scrotum surface of the 203 patients before treatment was(36.1 ±1.1)℃, which was significantly higher than the average scrotal temperature of normal people(33.5 ±1.5)℃[1], and the difference was statistically significant(P<0.05). The average scrotal temperature before treatment in group 1 was(36.2±1)℃, which was not significantly different from group 2(36±0.4)℃. After 12 weeks of treatment, the average scrotal temperature of group 1 dropped to(34.2±0.4)℃,which was significantly lower than that of group 2(36±0.3)℃, the difference was statistically significant(P<0.05);the average sperm density of group 1 was 27.5×10^(6)/ml, significantly higher than group 2(14.8×10^(6)/ml), the difference was statistically significant(P<0.05). The proportion of forward motile sperm in group 1 increased to 38.6%, which was significantly better than that in group 2(23.1%), and the difference was statistically significant(P<0.01). The proportion of normal sperm in group 1 increased to 6%, which was significantly better than that in group 2(3%), and the difference was statistically significant(P <0.05). The natural pregnancy rate of the women in group 1 was 25% during treatment, and the natural pregnancy rate of women in group 2 was 4.8% during the treatment. The difference was statistically significant(P<0.01).7 cases were lost to follow-up in group 1(7%), and 12 cases were lost to follow-up in group 2(11.6%). The difference was statistically significant(P <0.05). 1 case(1%) of group 1 scrotal skin allergy to cold compress, group 2 had no adverse reactions, and the difference was not statistically significant(P>0.05). Conclusion The increase in the temperature of the scrotum of male patients is one of the reasons for the decrease of their semen parameters. The application of male scrotal cold compresses to reduce the temperature of the scrotum has a positive effect on improving semen parameters and increasing the natural pregnancy rate, and it is safe and has no obvious side effects.