禁欲时间对少精子症和弱精子症精液参数的影响

Effect of sexual abstinence on semen analysis parameters in oligospermia and asthenozoospermia

目的研究禁欲时间对少精子症和弱精子症患者精液参数的影响。方法采用回顾性队列研究,收集2018年1月至2019年12月期间就诊于四川大学华西第二医院生殖男科的正常育前检查、少精子症和弱精子症人群的临床资料。比较不同禁欲时间(分别为禁欲2 d、3 d、4 d、5 d、6 d、7 d)对少精子症(n=5127)、弱精子症(n=4003)和正常对照男性(n=4529)精液参数的影响,观察不同组别男性的精子浓度、前向精子百分比、活动精子总数(total motile sperm count,TMSC)等参数随禁欲时间的变化。结果正常育前检查组随禁欲时间延长,精液体积从(3.3±1.2)mL升至(4.1±1.3)mL(r=0.167,P<0.001),精子浓度从(89.0±60.9)×10^(6)/mL升至(125.2±82.3)×10^(6)/mL(r=0.181,P<0.001),精子总数从(273.2±169.8)×10^(6)/次升至(473.5±193.7)×10^(6)/次(r=0.310,P<0.001),前向精子百分比从62.1%±13.0%降至59.5%±13.3%(r=-0.057,P<0.001),存活率从80.6%±8.5%降至79.0%±9.1%(r=-0.048,P<0.001)。少精子症组随禁欲时间延长,精液体积从(3.1±1.4)mL升至(3.9±1.6)mL(r=0.171,P<0.001),精子浓度从(10.3±5.5)×10^(6)/mL降至(8.7±4.3)×10^(6)/mL(r=-0.043,P<0.001),精子总数从(29.0±17.1)×10^(6)/次升至(38.6±19.8)×10^(6)/次(r=0.285,P<0.001),前向精子百分比从41.1%±17.0%降至35.1%±17.3%(r=-0.141,P<0.001),存活率从71.1%±12.3%降至63.1%±16.6%(r=-0.225,P<0.001),禁欲2 d时精子浓度和前向精子百分比达峰值。弱精子症组随禁欲时间延长,精液体积从(3.1±1.4)mL升至(3.8±1.9)mL(r=0.197,P<0.001),精子浓度从(35.1±30.5)×10^(6)/mL升至(49.7±31.9)×10^(6)/mL(r=0.071,P<0.001),精子总数从(109.1±82.3)×10^(6)/次升至(170.1±99.3)×10^(6)/次(r=0.394,P<0.001),存活率从59.6%±16.4%降至54.0%±16.4%(r=-0.081,P<0.001),前向精子百分比、圆细胞浓度与禁欲时间均无相关性(均P>0.05),TMSC(r=0.119,P<0.001)随禁欲时间延长而增高。结论延长禁欲时间可不同程度地增加少精子症患者、弱精子症患者和正常生育男性的精液体积和精子总数,并使精子存活率降低。少精子症患者缩短禁欲时间可得到精子浓度、前向精子百分比、存活率、正常形态精子百分比较高的精子,但TMSC并未显著增加;弱精子症患者通过延长禁欲时间能得到浓度、TMSC较高的精子,但前向精子百分比并未显著改善。

Objective To investigate the impact of sexual abstinence(SA)on semen parameters in oligospermia and asthenozoospermia.Methods This retrospective cohort study was conducted for the clinical data from oligospermia(n=5127),asthenozoospermia(n=4003)and normozoospermia(n=4529)with different SAs(2 d,3 d,4 d,5 d,6 d,7 d)who were treated in Andrology Department of West China Second University Hospital during January 2018 to December 2019.The correlation between semen parameters(sperm concentration,motility,total motile sperm count etc.)and SA were observed.Results In normozoospermia,as the SA was getting longer,the semen volume was increased from(3.3±1.2)mL to(4.1±1.3)mL(r=0.167,P<0.001),the sperm concentration was increased from(89.0±60.9)×10^(6)/mL to(125.2±82.3)×10^(6)/mL(r=0.181,P<0.001),the total sperm count was increased from(273.2±169.8)×10^(6)/ejaculate to(473.5±193.7)×10^(6)/ejaculate(r=0.310,P<0.001).The progressive motility was decreased from 62.1%±13.0%to 59.5%±13.3%(r=-0.057,P<0.001).The viability was decreased from 80.6%±8.5%to 79.0%±9.1%(r=-0.048,P<0.001).In oligospermia,the semen volume was increased from(3.1±1.4)mL to(3.9±1.6)mL(r=0.171,P<0.001)and the sperm concentration was decreased from(10.3±5.5)×10^(6)/mL to(8.7±4.3)×10^(6)/mL(r=-0.043,P<0.001),the total sperm count was increased from(29.0±17.1)×10^(6)/ejaculate to(38.6±19.8)×10^(6)/ejaculate(r=0.285,P<0.001).The progressive motility was decreased from 41.1%±17.0%to 35.1%±17.3%(r=-0.141,P<0.001).The viability was decreased from 71.1%±12.3%to 63.1%±16.6%(r=-0.225,P<0.001).The peak value of sperm concentration and motility were observed on day 2.In asthenozoospermia,the semen volume was increased from(3.1±1.4)mL to(3.8±1.9)mL(r=0.197,P<0.001)and the sperm concentration was increased from(35.1±30.5)×10^(6)/mL to(49.7±31.9)×10^(6)/mL(r=0.071,P<0.001),the total sperm count was increased from(109.1±82.3)×10^(6)/ejaculate to(170.1±99.3)×10^(6)/ejaculate(r=0.394,P<0.001).The viability was decreased from 59.6%±16.4%to 54.0%±16.4%(r=-0.081,P<0.001).The SA was not related to motility and round cells(P>0.05).TMSC was slightly increased with extending EAT(r=0.119,P<0.001).Conclusion The longer SA has positive influence on semen volume and total sperm count on different levels in males with normozoospermia,oligospermia and asthenozoospermia.The viability was decreased by extended SA.Shortening the SA was likely to help oligospermic patients conduct sperm with higher concentration,motility,viability and normal morphology.TMSC was not significantly increased by extended SA.Asthenozoospermia can conduct sperm with higher concentration and TMSC when applying longer SA.The progressive motility was not significantly influenced by SA.