Decline of semen quality among 10 932 males consulting for couple infertility over a 20-year period in Marseille, France

Semen from 10 932 male partners of infertile couples was analysed and sperm parameter trends were evaluated at the Reproduction Biology Laboratory of the University Hospital of Marseille （France） between 1988 and 2007. After 3-6 days of abstinence, semen samples were collected. Measurements of seminal fluid volume, pH, sperm concentration, total sperm count, motility and detailed morphology of spermatozoa were performed. Sperm parameters were analysed on the entire population and in men with normal total numeration （ 〉~ 40 million per ejaculate）. The whole population demonstrated declining trends in sperm concentration （1.5% per year）, total sperm count （1.6% per year）, total motility （0.4% per year）, rapid motility （5.5% per year） and normal morphology （2.2% per year）. In the group of selected samples with total normal sperm count, the same trends of sperm quality deterioration with time were observed. Our results clearly indicate that the auality of semen decreased in this population over the study period.

Normal reference ranges for semen quality and their relations to fecundity

Several recent studies have shown that the fecundity of a man decreases progressively with sperm concentrations below 40 million spermatozoa per mL. Therefore, it is unfortunate that the new World Health Organization guidelines for semen analysis recommend lowering the lower cutoff value for normal sperm concentration from 20 to 15 million spermatozoa per mL. As a result large groups of subfertile men across the world may not receive appropriate andrological help in the future.

Correlation between sperm DNA 8-Hydroxy-2'-deoxyguanosine level and semen quality

8-hydroxy-2’-deoxyguanosine (8-OHdG), a typical form ofDNA adducts, is a key molecular biomarker for DNA oxidativedamage. The aim of the present study was to evaluote the correla-tion between the sperm DNA 8-OHdG level and the semen quality.In 52 male infertile patients, the sperm DNA 8-OHdG level wasdetermined by a high performance liquid chromatograph with elec-trochemical detector and the semen quality was examined according

Impact of chronological ageing on semen parameters in southern Indian men visiting infertility centre:A retrospective study

Objective:To investigate the association between age and semen parameters among male partners of subfertile couples.Methods:This retrospective study analyzed the semen of 1523 infertile men aged 26 to 50 years.Data were extracted from GarbhaGudi IVF Centre database from January 2019 to September 2020.The basic semen parameters were interpreted according to the WHO manual 2021,6th edition.Semen parameters in different age groups were compared.Results:Total and progressive motile sperms were significantly higher in the age group of 26-30 years compared to other age groups(P<0.05).Normal sperm count was significantly higher in the age group of 26-30 years compared to the age groups of 41-45 years and>46 years(P=0.001).However,sperm head defects,neck and midpiece defects,tail defects,and cytoplasmic droplets showed statistically insignificant difference in all the age groups(P>0.05).Semen viscosity showed no statistical difference in all the age groups compared to the reference age group of 26 to 30 years.Conclusions:Higher age can lead to a significant decrease in normal sperms and motility in subfertile men.Hence,male partner age should be considered as one of the major determining factors for reproductive outcomes.

Decline of semen quality among Chinese sperm bank donors within 7 years （2008-2014）

Semen from 5210 sperm bank donors was analyzed and trends in semen quality were evaluated at Shandong Human Sperm Bank between 2008 and 2014. After 2-7 days of abstinence, semen samples were collected. Measurements of semen volume, sperm concentration, sperm forward motility, and total sperm count were performed. There were significant declining trends in semen volume, sperm concentration, sperm forward motility, and total sperm count. Our results indicate that the quality of semen in this cohort of sperm donors had decreased during the study period.

Increased expression of PELP1 in human sperm is correlated with decreased semen quality

Proline-, glutamic acid-, and leucine-rich protein 1 （PELP1） is a scaffolding protein involved in both genomic and nongenomic estrogen signal transduction pathways. To date, the role of PELP1 protein has yet to be characterized in human sperm and has not been associated with sperm parameters. To confirm the presence of PELP1 in human sperm, fresh semen samples were obtained from 178 donors. The study was designed to establish both mRNA and protein presence, and protein cellular localization. Additionally, the number of PELP1-positive spermatozoa was analyzed in men with normal and abnormal semen parameters. Sperm parameters were assessed according to the World Health Organization （WHO） 2010 standards. The presence of PELP1 in spermatozoa was investigated using four precise, independent techniques. The qualitative presence of transcripts and protein was assessed using reverse transcription-polymerase chain reaction （RT-PCR） and western blot protocols, respectively. The cellular localization of PELP1 was investigated by immunocytochemistry. Quantitative analysis of PELP1-positive cells was done by flow cytometry. PELP1 mRNA and protein was confirmed in spermatozoa. Immunocytochemical analysis identified the presence of PELP1 in the midpieces of human sperm irrespective of sperm parameters. Becton Dickinson fluorescence-activated cell sorting （FACSCalibur^Tm） analysis revealed a significantly lower number of PELP1-positive cells in males with normal semen parameters versus abnormal samples （42.78% ± 11.77% vs 61.05% ± 21.70%, respectively; P = 0.014）. The assessment of PELP1 may be a time-saving method used to obtain information about sperm quality. The results of our study suggest that PEPL1 may be utilized as an indicator of sperm quality; thereby, PELP1 may be an additional biomarker useful in the evaluation of male infertility.

Sperm Quality and Environment: A Retrospective, Cohort Study among 21,715 Semen Samples in a Southern Province of China

To explore the differences of male semen parameters in different seasons of the year, so as to explore the potential climatic factors affecting spermatogenesis and male reproductive ability, we retrospectively analyzed 21,715 semen analysis data from January 2018 to February 2021, grouped by year and season, and finally the relationships among semen parameters and semen and meteorological parameters were compared. Environmental exposures prior to 3 months were analyzed and correlation analysis was performed.The semen concentration decreased year by year (p < 0.01). However, the Progressive motility (PR) and total PR number had been increased (p < 0.01). There were statistical differences in sperm parameters which include semen volume, sperm concentration, total sperm number, progressive motility (PR), total PR number and total motility in different seasons, winter and spring were better than summer and autumn (p < 0.01). Total sperm number and sperm concentration were positively correlated with PR (R = 0.420, R = 0.440, p < 0.01). There was no correlation between daylight duration and semen parameters. Sperm parameters were positively or negatively correlated with environmental temperature, air pressure or humidity which had an overall effect on semen quality. It is suggested that seasonal factors should be considered when evaluating male reproductive ability. Besides referring to conventional semen parameters, other factors such as season and climate should also be considered.

Semen analysis and sperm function testing

Despite controversy regarding the clinical value of semen analysis, male fertility investigation still relies on a standardized analysis of the semen parameters. This is especially true for infertility clinics in both developing and developed countries. Other optional tests or sophisticated technologies have not been widely applied. The current review addresses important changes in the analysis of semen as described in the new World Health Organization （WHO） manual for semen analysis. The most important change in the manual is the use of evidence-based publications as references to determine cutoff values for normality. Apart from the above mentioned changes, the initial evaluation and handling methods remain, in most instances, the same as in previous editions. Furthermore, the review evaluates the importance of quality control in andrology with emphasis on the evaluation of sperm morphology. WHO sperm morphology training programmes for Sub-Saharan countries were initiated at Tygerberg Hospital in 1995. The external qualitY control programme has ensured that the majority of participants have maintained their morphological reading skills acquired during initial training. This review reports on current sperm functional tests, such as the induced acrosome reaction, and sperm-zona pellucida binding assays, as well as the impact of sperm quality in terms of DNA integrity, and the relationship of sperm function tests to sperm morphology.

Sperm DNA damage in men from infertile couples

Aim： To investigate the prevalence of high levels of sperm DNA damage among men from infertile couples with both normal and abnormal standard semen parameters. Methods： A total of 350 men from infertile couples were assessed. Standard semen analysis and sperm chromatin structure assay （SCSA） were carried out. Results： Ninety-seven men （28% of the whole study group） had a DNA fragmentation index （DFI） 〉 20%, and 43 men （12%） had a DFI 〉 30%. In the group of men with abnormal semen parameters （n = 224）, 35% had a DFI 〉 20%, and 16% had a DFI 〉 30%, whereas these numbers were 15% and 5%, respectively, in the group of men with normal semen parameters （n = 126）. Men with low sperm motility and abnormal morphology had significantly higher odds ratios （ORs） for having a DFI 〉 20% （4.0 for motility and 1.9 for morphology） and DFI 〉 30% （6.2 for motility and 2.8 for morphology） compared with men with normal sperm motility and morphology. Conclusion： In almost one-third of unselected men from infertile couples, the DFI exceeded the level of 20% above which, according to previous studies, the in vivo fertility is reduced. A significant proportion of men with otherwise normal semen parameters also had high sperm DNA damage levels. Thus, the SCSA test could add to explaining causes of infertility in cases where semen analysis has not shown any deviation from the norm. We also recommend running the SCSA test to choose the appropriate assisted reproductive technique （ART）.

The usefulness and significance of assessing rapidly progressive spermatozoa

It is possible and clinically relevant to distinguish between slow and rapid progressive spermatozoa in basic semen analysis. This is discussed in light of the different purposes of semen analysis for the subfertile couple and the male patient. The two groups of progressive spermatozoa should be distinguished to help ensure that pertinent information available in the semen sample is not neglected.

性激素水平、精液质量与不育症患者精子DNA碎片指数的相关性

目的:分析性激素指标水平、精液质量与不育症患者精子DNA碎片指数(DFI)的相关性。方法:回顾性分析2022年1—12月于该院就诊的80例不育症患者的临床资料,设为观察组,另回顾性分析同期该院80名男性健康体检者的临床资料,设为对照组。统计两组DFI,依据DFI将观察组患者分为异常患者(DFI≥30%)和正常患者(DFI<30%),比较两组及异常患者、正常患者性激素指标[睾酮、卵泡刺激素(FSH)、促黄体生成素(LH)]水平和精液质量,分析性激素指标水平、精液质量与DFI的相关性。结果:观察组DFI为(18.93±2.10)%,高于对照组的(15.38±2.05)%,差异有统计学意义(P<0.05);观察组DFI≥30%有58例,占72.50%(58/80);DFI<30%有22例,占27.50%(22/80);观察组LH、FSH水平均高于对照组,睾酮水平和精子总数、精子浓度、精子总活力、精子前向运动比例均低于对照组,差异有统计学意义(P<0.05);异常患者睾酮水平和精子总数、精子浓度、精子总活力、精子前向运动比例均低于正常患者,LH、FSH水平均高于正常患者,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,睾酮水平和精子总数、精子浓度、精子总活力、精子前向运动比例均与不育症患者精子DFI呈负相关(r<0,P<0.05);LH、FSH水平均与不育症患者精子DFI呈正相关(r>0,P<0.05)。结论:精液质量、睾酮水平均与不育症患者精子DFI呈负相关,LH、FSH水平均与不育症患者精子DFI呈正相关。

男性免疫性不育患者精子参数与DNA完整性的交互作用及支原体感染对其的影响

目的研究男性免疫性不育患者精子参数与DNA完整性的交互作用及支原体感染对其的影响。方法回顾性选取四川锦欣西囡妇女儿童医院2022年1月至12月诊断的120例男性免疫性不育患者作为研究组,根据是否有支原体感染分为感染组(n=33)和未感染组(n=87)。另选取同期同一医院进行健康体检的120例正常男性作为对照组。比较研究组和对照组、感染组和未感染组的精液质量、DNA完整情况,研究精子DNA完整情况与精液质量的相关性。结果研究组患者的精液液化时间长于对照组,精子活率、精子浓度、前向运动精子百分率及正常形态率低于对照组;感染组患者的精液液化时间长于非感染组,精子活率、精子浓度、前向运动精子百分率及正常形态精子百分率低于非感染组。研究组患者的无光晕、小光晕、中光晕、大光晕、DNA碎片率显著高于对照组,感染组患者的无光晕、小光晕、中光晕、大光晕、DNA碎片率显著高于对照组。相关性分析显示,精液液化时间与大光晕、DNA碎片率呈负相关,与精子活率、精子浓度、前向运动精子百分率、正常形态精子百分率呈正相关。结论男性免疫性不育患者精子参数、支原体感染与DNA完整性呈显著相关性,支原体感染可能会造成DNA完整性下降,进而影响精子质量。

解脲支原体感染对不育男性精液质量及性激素水平的影响

目的探讨解脲支原体(ureaplasma urealyticum,UU)感染对不育男性精液质量及血清性激素水平的影响。方法选取2021年8月至2022年11月期间在厦门大学附属成功医院生殖中心就诊的经实时荧光定量聚合酶链式反应检测UU为阳性的102例男性不育患者为UU感染组,年龄21~50岁;同时收集同期在厦门大学附属成功医院进行健康体检且有正常生育史的男性145例为健康对照组,年龄23~48岁。检测并比较两组研究对象精液量、pH值、精子浓度、精子活率、精子前向运动率、精子形态学及血清性激素水平。统计学分析采用独立样本t检验。结果UU感染组的精子浓度、精子存活率、精子前向运动率及正常形态精子百分率均明显低于健康对照组[(40.38±16.04)×106/ml比(51.12±13.39)×106/ml、(36.31±13.75)%比(48.15±12.21)%、(29.23±11.54)%比(36.21±10.98)%、(10.86±6.71)%比(15.92±10.65)%],差异均有统计学意义(均P<0.05);两组间精液量、pH值及血清雌二醇(estradiol,E2)、卵泡刺激素(follicle stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、泌乳素(prolactin,PRL)和睾酮(testosterone,T)水平差异均无统计学意义(均P>0.05)。结论UU感染会使男性精液质量下降,影响男性生育能力。

Practical semen analysis： from A to Z

Accurate semen analysis is critical for decisions about patient care, as well as for studies addressing overall changes in semen quality, contraceptive efficacy and effects of toxicant exposure. The standardization of semen analysis is very difficult for many reasons, including the use of subjective techniques with no standards for comparison, poor technician training, problems with proficiency testing and a reluctance to change techniques. The World Health Organization （WHO） Semen handbook （2010） offers a vastly improved set of standardized procedures, all at a level of detail that will preclude most misinterpretations. However, there is a limit to what can be learned from words and pictures alone. A WHO- produced DVD that offers complete demonstrations of each technique along with quality assurance standards for motility, morphology and concentration assessments would enhance the effectiveness of the manual. However, neither the manual nor a DVD will help unless there is general acknowledgement of the critical need to standardize techniques and rigorously pursue quality control to ensure that laboratories actually perform techniques ＇according to WHO＇ instead of merely reporting that they have done so. Unless improvements are made, patient results will continue to be compromised and comparison between studies and laboratories will have limited merit.

男性不育患者精液质量异常特征分析

目的 分析男性不育患者精液质量异常的特征。方法 回顾性分析2020年10月至2022年9月厦门大学附属中山医院收治的613例男性不育患者的临床资料,其中精液质量异常男性不育患者512例,按照年龄将精液质量异常男性患者分为≤25岁组(58例)、>25~30岁组(179例)、>30~35岁组(185例)、>35~41岁组(65例)与≥41岁组(25例),比较五个亚组患者的精液参数,分析精子顶体酶活性与精子总活力、前向运动精子(PR)百分率的相关性。结果 患者精液质量的异常率为83.5%。≥41岁组患者的PR百分率、精子总活力、精子存活率均低于≤25岁组、>25~30岁组、>30~35岁组和>35~41岁组,差异有统计学意义(P<0.05)。精子存活率、PR百分率和液化时间为最常出现异常的参数,异常率分别为55.9%、54.9%和51.4%。液化时间、精液pH、“精子存活率+PR百分率+精子总活力”为最常见的异常模式,分别占异常精液的16.4%、11.1%、9.8%。精子顶体酶活性与精子总活力(r=0.390,P<0.01)、PR百分率(r=0.301,P<0.01)呈正相关。结论 男性不育患者的精液异常主要表现为精子存活率、PR百分率和液化时间的异常,PR百分率、精子总活力、精子存活率从41岁后就出现明显下降。

男性不育症患者精子核DNA完整性的临床研究

目的:探讨男性不育症患者的精子核DNA完整性情况及治疗措施。方法:选取2022年5—8月在我院生殖医学中心诊治的210例男性不育症患者作为研究对象。收集分析精液样本,根据常规参数的参考值将患者分为正常精液组、少精子症组、弱精子症组和畸形精子症组,再对四组患者的精子核DNA完整性进行检测,比较精子DNA碎片指数(DFI)。按照DFI值将患者分为精子核DNA完整性正常组和异常组,比较常规参数精子浓度、活动力、前向运动精子率(PR)和正常形态精子率。分析患者精子DFI与常规参数之间的相关性。给予精子核DNA完整性异常组患者左卡尼汀(LC)联合辅酶Q_(10)(CoQ_(10))治疗,比较治疗前后的DFI和常规参数。结果:少精子症组、弱精子症组、畸形精子症组和正常精液组的DFI比较,差异有统计学意义(P<0.05)。与精子核DNA完整性正常组比较,DNA完整性异常组的精子浓度、活动力、PR和正常形态精子率均偏低,差异有统计学意义(P<0.05)。相关性分析得出男性不育症患者的精子DFI与所测常规参数之间呈负相关。经LC联合CoQ_(10)治疗后,DNA完整性异常组患者的精子浓度、活动力、PR和正常形态精子率较治疗前增高,而DFI值较治疗前有所降低,差异有统计学意义(P<0.05)。结论:精子核DNA完整性主要与精液质量相关,临床实践中采用LC联合CoQ_(10)对精子核DNA完整性异常的患者予以治疗,可有效改善其精液质量并减轻DNA损伤。

2013—2022年生殖门诊男性精液质量单中心分析

目的调查本中心10年内接受常规精液分析的男性人群精液质量是否随着时间的推移而变化。方法收集2013年1月至2022年12月在山东大学附属生殖医院门诊行精液常规检查的231519例精液检测数据,按照第5版《WHO人类精液检查与处理实验室手册》标准分析精子浓度、精子活动率、前向运动精子百分率、正常形态精子百分率等参数,比较近10年间不同年份精液参数的变化。结果2013年至2022年生殖门诊男性不同精子浓度、活动率、前向运动精子百分率人群占比变化不大,年平均27%的男性精子浓度偏低,年平均10%的男性为无精子症患者,年平均34%的男性精子活动率较低,年平均57%的男性正常形态精子百分率低于参考值下限,年平均50%的男性精液常规分析结果在正常范围,正常精液人群占比变化不大。结论近10年间不育男性精液质量变化不明显。

精索静脉曲张不育患者的精液质量和精子形态学观察

目的:观察不育伴精索静脉曲张(VC)患者的精液质量和精子形态学变化。方法:98例不育伴VC患者精液按WHO标准常规分析并对精子形态学进行评价。130例正常供精者精液检测结果作为对照。结果:VC患者正常形态精子和前向运动精子明显低于对照组(P<0.001),精子畸形的类型以梨形、锥形和不定型头部畸形为主。结论:VC可导致精子畸形率升高,后者可能是男性生育力受损的重要标志之一,经染色后的精子形态学分析是判定VC患者精子受损的一个敏感指标。

《世界卫生组织人类精液分析实验室技术手册》与我国男科实验室现状

2010年出版的《世界卫生组织人类精液分析实验室技术手册》第5版是最为全面的一次修订。本文结合我国男科实验室精液分析的现状,从包括精子计数、精子活力、精子形态学、精子功能、抗精子抗体和精浆生化、以及精液分析的质量保证与质量控制等7个方面,对新出版的WHO手册进行了评论。笔者认为,该手册对精子浓度分析方法和参考值下调的推荐缺乏循证医学依据;精子活力分级标准的修订和精子形态学的严格标准和较低的4%的正常参考值与我国男科实验室目前使用的标准差距较大;精子功能指标尚未完善;抗精子抗体和精浆生化指标的检测方法显然不适合我国男科实验室现状;但精液分析的质量保证和质量控制对我国男科实验室有重要指导作用。需要指出的是,WHO手册中并没有涉及来自占世界人口1/5的中国人的任何临床数据和资料。因此,尽管WHO手册非常重要,它能否适应中国人精液分析实验室参考,仍需要评估。

男性不育患者精子形态学分析与生殖激素关系的研究

目的:研究男性不育患者精子形态与生殖激素的关系,探讨畸形精子症的发病机制。方法:研究对象为90例男性不育患者,年龄25～40岁,利用Prader睾丸计评估患者睾丸容积,根据世界卫生标准进行精液常规分析,利用化学发光法测定血清生殖激素和性激素结合球蛋白(SHBG)浓度,计算得出游离睾酮和生物活性睾酮的浓度。结果:90例男性不育患者精子浓度均在正常范围,根据精子形态分析结果分为3个研究组,即组1(正常形态精子<4%)、组2(正常形态精子≥4%且<10%)和组3(正常形态精子≥10%),每组30例。3组之间年龄没有统计学差异(P>0.05);左侧睾丸容积分别为(14.27±3.65)ml,(16.90±3.57)ml和(14.57±3.57)ml,P组1,2=0.006,P组1,3=0.741和P组2,3=0.014;右侧睾丸容积分别为(14.60±3.70)ml,(16.60±3.35)ml和(14.67±3.54)ml,P=0.05;血清泌乳素(PRL)、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、总睾酮(TT)和SH-BG在3组之间均没有统计学差异(P>0.05);血清游离睾酮(FT)水平分别为(0.25±0.07)nmol/L,(0.29±0.07)nmol/L和(0.31±0.13)nmol/L,P组1,2=0.086,P组1,3=0.010和P组2,3=0.364;生物活性睾酮(Bio-T)水平分别为(5.81±1.58)nmol/L,(6.78±1.55)nmol/L和(7.29±3.02)nmol/L,P组1,2=0.086,P组1,3=0.010和P组2,3=0.364。另外,正常形态精子百分率与血清FT、Bio-T水平之间均存在正相关(P<0.05)。结论:男性不育患者血清FT和Bio-T水平越高,则正常形态精子百分率越高,提示FT和Bio-T可能参与畸形精子症发病过程。