少弱精子症患者精子候选差异蛋白Trx 2、TrxR 1的验证及在少精、弱精子症中的表达研究

目的:根据TMT技术筛选少弱精子症患者精子差异蛋白的结果,选取硫氧还蛋白2(thioredoxin 2,Trx 2)、硫氧还蛋白还原酶1(thioredoxin reductase 1,TrxR 1)进行验证,探讨二者在少精、弱精和少弱精子症中的表达变化及其意义。方法:收集105例少精子症组(O组)、150例弱精子症组(A组)、50例少弱精子症组(OA组)和106例正常精液男性(N组)精液,分离出精子,对少弱精子症进行串联质谱标签(Tandem Mass Tag,TMT)技术蛋白质组学分析,根据少弱精子症组的精子差异蛋白结果选取Trx 2、TrxR 1,通过免疫荧光和免疫印迹方法检测其在O组、A组、OA组的表达情况。结果:TMT技术蛋白质组学结果显示Trx 2为上调差异蛋白(为N组的1.31倍),TrxR 1为下调差异蛋白(为N组的0.82倍)。免疫荧光和免疫印迹结果显示O组、A组、OA组Trx 2表达显著高于N组(P0.05),O组、OA组TrxR 1的表达显著低于N组(P0.05)。二者在OA组的结果与蛋白质组学结果一致。结论:Trx 2、TrxR 1可能在少精、弱精及少弱精子症的发生中起着重要的作用,并有望成为少弱精子症患者精子的候选标志物及治疗靶点。     

精浆Zn 水平与精子密度之间的关系研究

目的:探讨精浆Zn水平与精子密度的关系。方法:567份精液包括精子密度正常组(>20×106/ml)285份,无精症患者组(精子密度为0)55份;少精症患者组(0<精子密度<20×106/ml)227份。其中,少精症患者组又可进一步分为严重少精症患者组73例(0<精子密度<5×106/ml);精子密度在(5～10)×106/ml患者组39例;精子密度在(10～20)×106/ml患者组115例。每份精液分别进行常规分析和精浆Zn水平的测定。结果:严重少精症患者中,精浆锌值低于精子密度正常个体,两者表现出统计学差异;精子密度在(5～10)×106/ml和(10～20)×106/ml的患者,其精浆Zn水平尽管也低于密度正常个体,但是没有表现出统计学差异;无精症患者组精浆Zn水平却明显高于精子密度正常组,两者之间的差别具有显著性意义。结论:Zn与精子密度之间的关系复杂,临床补锌要慎重。     

复方玄驹胶囊治疗精液液化异常的临床研究

目的：观察复方玄驹胶囊治疗精液液化异常的临床疗效。方法：选择2010年1月至2012年1月在广西医科大学第四附属医院男性科门诊精液液化异常患者182例,采用简单随机分组,其中100例口服复方玄驹胶囊,82例口服生精胶囊为对照组,观察患者治疗前后精子质量及精液液化状态。结果：两组患者在治疗少、弱精方面均较同组治疗前差异有统计学意义（P〈0.05）,在治疗精液液化异常方面,复方玄驹胶囊治疗组总有效率及治愈率较生精胶囊对照组差异均有统计学意义（P〈0.05）。结论：复方玄驹胶囊对少、弱精子症并精液液化异常具有较好的疗效,可作为治疗男性不育症的一种有效治疗方法。     

血清抑制素B评估成年隐睾患者术后睾丸功能恢复的临床价值

目的:探讨血清抑制素B(InhB)用于评价成年隐睾患者术后睾丸功能恢复的临床价值。方法:收集2011年10月~2015年9月于我科就诊的138例成年隐睾患者作为观察组,另收集100例健康志愿者作为正常对照组。用双抗体夹心酶联免疫吸附法检测观察组患者术前、术后30天和90天及正常对照组的血清InhB水平,并参照WHO人类精液检查与处理实验室手册(第五版)方法进行精液常规检查。结果:与正常对照组比较,观察组患者术前、术后30天和90天血清InhB水平、精子活率、精子密度均明显降低,差异均有统计学意义(P0.05)。观察组术后30天血清InhB水平、精子活率、精子密度与术前比较差异均无统计学意义(P0.05),观察组术后90天血清InhB水平、精子活率、精子密度明显高于术前,差异均有统计学意义(P0.05)。观察组组术前、术后30天和90天的精液量与正常对照组对比差异均无统计学意义(P0.05)。观察组术前、术后30天和90天及正常对照组血清InhB水平与精子浓度均呈正相关(观察组术前:r=0.81,P0.05,观察组术后30天:r=0.78,P0.05,观察组术后90天:r=0.84,P0.05,正常对照组:r=0.77,P0.05)。结论:血清InhB用于评估成年隐睾患者术后睾丸功能恢复具有一定的临床应用价值。     

男性不育与Y染色体

目的:观察精子数目异常与小Y染色体及内分泌性腺激素水平。方法:对262名少精及无精症患者检测染色体,并对其中11例小Y染色体及随机抽取的15例Y染色体正常的患者运用磁性分离酶免疫测定法分别检测性腺激素。结果:小Y染色体检出率为4.19%(11/262),其内分泌性腺激素均呈高卵泡刺激素、高黄体生成素和低睾酮水平,与Y染色体正常的无精及少精症患者相比较,差异有显著性(P<0.05)。而小Y染色体不同精子数组各内分泌性腺激素比较,差异无显著性(P>0.05)。结论:精子数目异常可能与小Y染色体有关,小Y染色体基因改变可能是导致其内分泌性腺激素的变化因素。     

左卡尼汀配合复方玄驹胶囊对特发性少弱精子症的疗效观察

目的：观察复方玄驹胶囊联合左卡尼汀口服液治疗不同程度的特发性少弱精症的临床疗效。方法：选择2010年6月．2012年9月就诊于内蒙古医科大学第一附属医院的少弱精症者300例,其中重度少、弱精症者70例（治疗l组）,中度少、弱精症者110例（治疗2组）,轻度少、弱精症者120例（治疗3组）。另选择同期来我院进行健康体检者100例,将其作为对照纽。治疗组口服左卡尼汀口服溶液及复方玄驹胶囊,持续时间3个月。每一位被研究对象都在治疗前后定期进行血常规、尿常规、肝功能和肾功能四个方面的检查,同时观察服药患者在治疗过程中发生的不良反应。并对精液量、精子密度、A级精子等指标进行观察和比较。轻中度患者观察其（A＋B）级精子,重度患者观察其（B＋C）级精子,同时评价其治疗前后的生育能力,并与对照组比较。结果：与治疗前比较,治疗1、2、3组治疗后精液量[（3．7±1．6、3．7±1．1、3．8±1．2）mL]、精子密度[（3．4±1．4、23．2±1．8、39．6±14．2）（mol/L）]、A级精子[（3．6±2．5、15．6±6.3、28．6±9．6）％]、（A＋B）级精子、（B＋C）级精子比例、生育力指数（0．2±0．0、0．8±0．1、1．4±0．1）均升高明显,差异显著（P〈0．05）;与对照组比较,治疗1、2、3组治疗前均有所减少,治疗1、2组治疗后虽有所上升,但还是显著低于对照组（P〈0．05）,治疗3组治疗后与对照组差异不大,提示该方法对轻度少、弱精症者效果较重、中度好。结论：左卡尼汀配合复方玄驹胶囊对特发性少弱精子症效果显著。     

mtATPase6基因变异与弱精子症的相关分析

为了分析mtATPase6基因突变与弱精子症的相关性,按wHO标准收集了27例弱精子症精液标本和28例精子活力正常精液标本,PCR扩增mtATPase6基因,纯化测序,分析mtATPase6基因突变,比较两组突变频率的差异.结合生物信息学工具分析错义突变位点的氨基酸进化保守性及其蛋白质部分三级结构.结果显示:发现了6个未曾报道过的突变位点;弱精子症组mtATPase6基因平均突变率显著高于对照组,可能与弱精子症有一定的相关性.G8584A、A8701G和G9053A三个错义突变可能是多态性位点,其余8个错义突变中的6个具有进化保守性的位点累计突变频率显著高于对照组,这些位点突变可能与弱精子症有关.     

POLG1外显子1、3、4、7突变与弱精子症的相关性及其对mtDNA和4977bp缺失的影响

为了探索POLG1外显子1、3、4、7突变与弱精子症的相关性及对mtDNA序列突变和4977bp缺失的影响,按WHO标准收集了120例弱精子症和101例精子活力正常的精液标本,经PCR测序分析POLG1外显子1、3、4、7突变,继而测序检测9例外显子4c．948G〉A突变的弱精子症标本、9例无C．948G〉A突变的弱精子症标本和9例正常对照标本的mtDNA全序列,利用巢式PCR技术分析94Pie．948G〉A突变标本、9例无C．948G〉A突变的弱精子症标本和9例对照标本的4977bp缺失。结果显示：在120例弱精子症中发现P说G,外显子4c．948G〉A突变9例（7．5％）,显著高于对照组（0％,P〈0．05）。c．948G〉A突变组mtDNA全序中突变率与对照组比无统计学差异俨〉0．05）。作者关注的两组中,突变数有差异的位点累积突变频次突变组显著高于对照组俨〈0．05）,但与无C．948G〉A突变的弱精子症标本的累积突变频次比较无统计学意义;突变组mtDNA4977bp缺失率（7／9,77．8％）显著高于对照组（2／9,22．2％,P〈0．05）和无c．948G〉A突变的弱精子症组（2／9,22．2％,P〈0．05）。以上结果提示,弱精子症的发生可能与POLG,c．948G〉A突变有相关性,弱精子症线粒体DNA某些位点的累积突变率增高,但可能不是POLGlc．948G〉A突变引起;c．948G〉A突变可能会增加mtDNA4977bp缺失,从而影响精子线粒体功能,导致精子活动力下降。     

Y染色体单倍群与西南地区男性生精障碍的相关性

男性不育中, 原发无精、少精是最为重要的因素之一, 核型异常和无精子症因子(Azoospermia factor, AZF)微缺失能解释部分原发无精、少精的原因, 然而还有许多致病因素尚不清楚。Y染色体作为男性特有的染色体, 与男性生殖系统的正常功能密切相关。文章主要对Y染色体单倍群这一分子遗传背景与男性原发无精、严重少精症之间是否存在相关性进行探讨, 为进一步探索原发无精、严重少精症的遗传学致病原因提供依据和可行的方向。采集265名生精障碍患者(原发无精症患者193名, 原发严重少精症患者72名)以及193名正常男性样本的外周血, 进行核型分析和AZF缺失分析, 以排除有此两类异常的样本。将经过筛选的样本进行Y染色体单倍群分析, 并对其单倍群分布情况进行统计分析。分析显示, 生精障碍组和对照组分别在D1*、F*、K*、N1*和O3* 上有显著性差异(P=0.032, 0.022, 0.009, 0.009, 0.017, <0.05)。Y染色体单倍群, 这一Y染色体遗传背景与男性原发生精障碍的发生有相关性。     

男性精浆中IL-6 和sICAM-1 与免疫性不育的关系研究

目的:探究男性精浆中白细胞介素-6(IL-6)和可溶性细胞黏附分子-1(sICAM-1)与免疫性不育的关系。方法:选择2014年6月至2015年12月我院收治不育症患者189例及100例健康体检者为研究对象,根据患者精子混合抗球蛋白反应实验(MAR)结果将不育症患者分为免疫性不育组(88例)和非免疫性不育组(101例);免疫不育组患者按照精液白细胞过氧化物酶染色情况分为免疫性阳性白细胞组(WBC≥1×10~6/mL)36例和免疫性阴性白细胞阴性组(1×10~6/m L)52例,分析并比较各组间精子质量、IL-6和sICAM-1水平。结果:免疫性不育组与非免疫性不育组患者精液精子向前运动比率、存活率均低于对照组(P0.05);免疫性不育组与非免疫性不育组精液各项参数均不存在差异(P0.05);免疫性不育组患者IL-6、sICAM-1水平均高于非免疫性不育组及对照组,差异有统计学意义(P0.05);非免疫性不育组IL-6、sICAM-1水平均高于对照组,差异有统计学意义(P0.05)。相关性分析显示,精子被Ig G黏附数比例与研究对象精液IL-6、sICAM-1水平呈正相关关系(r=0.438,0.561;P0.05);免疫性阳性白细胞组患者精液IL-6与sICAM-1水平均高于免疫性阴性白细胞组(P0.05)。结论:免疫性不育症患者精子质量下降,男性精液中IL-6和sICAM-1水平表达越高,MAR阳性率越高,男性免疫性不育发生的可能性越大。     

Prevalence of carcinoma in situ of the testis in 207 oligozoospermic men from infertile couples: prospective study of testicular biopsies.

OBJECTIVE: To investigate the prevalence of carcinoma in situ of the testis in a group of oligozoospermic men from infertile couples. DESIGN: A consecutive group of oligozoospermic men from infertile couples were offered bilateral testicular biopsy. The observed prevalence of carcinoma in situ was compared with the expected prevalence of testicular cancer in a corresponding age matched population of Danish men, assuming all untreated cases of carcinoma in situ progress to tumour stage. This calculation was based on data from the Danish Cancer Registry. SUBJECTS: 207 men aged 18-50 years who had sperm density below 10 million/ml in two samples within the previous 2 years or sperm density below 20 million/ml in two samples within the previous 2 years and a history of cryptorchidism or one or two atrophic testicles (orchidometer volume less than 15 cm3), or both. INTERVENTIONS: Bilateral testicular biopsies. MAIN OUTCOME MEASURES: Carcinoma in situ in the biopsy specimen. RESULTS: No case of carcinoma in situ was found among the 207 men. The expected number in a normal age matched population of corresponding size was 0.8. CONCLUSIONS: There is no increase in risk of carcinoma in situ of the testis in moderately oligozoospermic men of couples referred because of infertility.     

Use of Xenopus laevis frog egg extract in diagnosing human male unexplained infertility.

Approximately one in six married couples find themselves involuntarily infertile. This ratio translates to between two and four million U.S. couples. Although numerous tests are available for diagnosing infertility problems, 5-10 percent of all couples who seek medical treatment are diagnosed with unexplained infertility. Several tests are presently available for diagnosing male infertility; however, none of the present procedures test for activation of the sperm nucleus following entry into the fertilized egg, a series of events critical for the entry of the zygote into the developmental program. We have developed an in vitro human sperm activation assay, using Xenopus laevis frog egg extract. When normal human sperm is permeabilized and then mixed with frog egg extract, the sperm nuclei decondense, synthesize DNA, and recondense during a three-hour time course. We have tested this assay's utility in diagnosing previously unexplained infertility. We found that 20 percent of the male infertility patients produced sperm that responded abnormally in the assay (95 percent confidence interval, 4-48 percent; n = 15), while sperm samples from 15 fertile males showed no abnormal responses (p = 0.0112). These preliminary results indicate that the human sperm activation assay may be a useful tool for diagnosing some cases of human infertility.     

男性不育症和Galntl5基因突变位点的相关性

目的:探讨男性不育症患者Galntl55基因的一个突变位点与男性不育症的关系及意义。方法:运用聚合酶链反应(PCR)结合琼脂糖凝胶电泳和基因序列分析等方法,对119例原发性男性不育症患者以及135名已生育的正常男性进行Galntl5基因筛查。结果:与精子形成相关的关键基因GALNTL5中1个突变位点G323A和男性不育症存在一定相关性。因此Galntl5基因蛋白质编码序列区G323A可能是特发性少精症无精症的诱发因素之一。临床上对原发性不孕不育患者进行GALNTL5基因突变筛查是十分必要。     

Polycyclic aromatic hydrocarbon-DNA adducts in human sperm as a marker of DNA damage and infertility

Severe DNA damage, which might prevent egg fertilization or the development of the embryo, could be a cause of infertility. In order to assess whether polycyclic aromatic hydrocarbon (PAH)-DNA adducts are an early marker of sperm genotoxicity and infertility, we studied 205 men consecutively recruited from 1 January to 30 May 2001 through the Infertility Clinic of the University of Milan (Italy), with morphological abnormalities in the sperm. No known causes of infertility were present in their female partners. Sperm were collected after 3-5 days of abstinence, fixed on polylysine slides, and frozen at -20 degrees C. PAH-DNA adducts were measured by immunofluorescence using a polyclonal antiserum. A questionnaire was filled out at the time of the visit, with demographic information, smoking and drinking habits, and occupational history. Data on PAH-DNA adducts were available for 182 men. The mean age of the subjects was 35.5+/-5.0 years; 38.6% of them were current smokers. PAH-DNA adducts were negatively correlated with the percentage of physiologic forms (r=-0.18; P=0.016) and with abnormalities of the neck of the sperm cell (r=-0.21; P>/=0.009), while they were positively correlated with morphological abnormalities of the head (r=0.30; P>0.0001). Occupational exposure to PAH, but not smoking, was significantly associated with higher levels of PAH-DNA adducts. A significant negative association was observed between daily alcohol consumption and PAH-DNA adducts in sperm (P=0.01). PAH-DNA adducts levels were significantly higher in infertile versus fertile men (P=0.04). These results suggest a role for DNA damage in infertility.     

Retentissement de l’infection genitale a chlamydia trachomatis sur le sperme chez les hommes consultant pour infertilite du couple

Chlamydia trachomatis (CT) genital infection is one of the most frequent causes of infertility. Its repercution on semen parameters and male infertility is controversial. The objective of this study was to evaluate the impact of CT genital infection on semen parameters in male partners of infertile couples. Ninety-seven infertile couples were studied. Semen, urethral and cervical samples were tested for CT by means of direct fluorescence antibodies assay (DFA), cell culture, polymerase chain reaction (PCR) and FLISA. Sera from both parteners were tested for immunoglobulin M, A and G antibodies to Chlamydia by means of the microimmunofluorescence MIF). For all mens, standard semen parameters were analysed according to the guidlines of the word health organisation. CT infection was identified in 34% of the male partners. In 76% of cases, the infection was asymptomatic. 60,6% of infected patients’s wives were also infected by CT. There was no significant difference between the mean values of concentration, motility and morphology of spermatozoa in both groups of male patients, infected by CT (CT+ group) and lacked infection (CT-group). The mean values of motility, vitality, concentration and normal forms of spermatozoa, in both CT+ and CT- groups were respectively: 39,6%±17,5% vs 40,4% ± 14,9%, 61,9% ±18,1% vs 62,4% ± 18,5%, 80,7×10⁶±67,5×10⁶ vs 67,1×10⁶ ±65,2×10⁶ and 34,7% ± 16,7% vs 33% ± 0,1%. Oligospermia was significantly more frequent in CT+ group (54,9%) than in CT-group (26,9%). High levels of coiled flagella (≥20) were more frequently observed in CT+ group (18,5%) than in CT-group (7,4%), but the difference was not significant. We found in this study a high prevalence of genital chlamydial infection into infertile couples. This infection has no repercution on sperm quality, suggesting that there is no effect of CT upon the spermatozoa. But, we can not exclude any impact on fertilisation ability and/or ultrastructure of these gametes. The finding that oligospermia was more frequent in CT+group, leds us to suggest thas chlamydial infection has a repercution on the gametogenesis or on genital ducts permeability. Another hypothesis would be that oligospermia, reflect of spermatogenesis disorder would be associated with reduction of local immunity. Other studies with wide exploration of spermatic functions and of different parts of genital tract are needed to specify the real impact of genital chlamydial infection upon men reproduction function.     

The Use of In Vitro Fertilization in the Management of Male Infertility: What the Urologist Needs to Know

Infertility affects approximately 10% to 20% of reproductive-age couples, many of whom may present initially to a urologist. Some couples may be treated medically to increase spontaneous conception rates; however, many will require more aggressive management with in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI). IVF involves ovarian stimulation, oocyte retrieval, and fertilization outside of the body; ICSI involves injecting one sperm into the oocyte to promote fertilization. Here we provide a brief overview of IVF and ICSI along with a discussion of the risks involved to facilitate the counseling and care of the infertile couple.Key words: Intracytoplasmic sperm injection, Male infertilityInfertility, defined as the inability to conceive within 12 months of unprotected intercourse, affects approximately 10% to 20% of reproductive-age couples.¹ As couples defer childbearing until later ages and as the obesity epidemic grows, the incidence of infertility is likely to continue to rise.^2,3 Male factor infertility is estimated to contribute to two-thirds of all cases. Of men seeking care for infertility, 18.1% reported being diagnosed with male factor infertility and 13.7% with a sperm or semen problem.⁴The evaluation for male infertility includes a thorough history and physical examination, and the mainstay of diagnostic testing continues to be the semen analysis. If abnormalities are noted on semen analysis, further testing is warranted to evaluate for possible etiologies. Where applicable, treatment is initiated with the goal of improving semen quality and male fertility. Previously, in cases in which semen quality remained profoundly impaired, the successful treatment for male factor infertility was once limited to donor insemination.The development of in vitro fertilization (IVF) revolutionized the management of female infertility. As powerful a tool as this proved to be, however, IVF fertilization rates remained poor in the presence of compromised semen parameters. A significant breakthrough in the treatment of severe male infertility was the development of intracytoplasmic sperm injection (ICSI) in 1992.⁵ By allowing the injection of a single sperm into each oocyte, ICSI provides the possibility of genetic offspring to men who have very scant numbers of motile sperm on semen analysis or who require surgical harvesting.From its inception, assisted reproduction has involved a gynecologist and an embryologist. The urologist is a critical collaborator for the treatment of couples with male factor infertility. Sperm harvested by microsurgical epididymal sperm aspiration, testicular sperm aspiration, or biopsy can be used to fertilize harvested oocytes by ICSI. The urologist may be the first to evaluate a couple for infertility, and will certainly be involved if sperm harvesting is indicated. Therefore, this article reviews the process of assisted reproduction by IVF/ICSI for urologists who may be seeing patients with infertility issues.     

Evaluation of telomere length,reactive oxygen species,and apoptosis in spermatozoa of patients with oligospermia

50% of cases of infertility are caused by male factor, which acquired or congenital problems may bring on. Male infertility can be caused by oligospermia and asthenozoospermia, which are common. Since the same mutations that cause azoospermia in some people also cause oligozoospermia in others, oligozoospermia may be thought of as a less severe form of azoospermia. Studies have demonstrated telomere length, catalase activity, super oxide dismutase (SOD), and DNA fragmentation can be influential factors for male infertility. The amount of apoptosis, oxidative stress factors, telomere length, and DNA fragmentation were some aspects of healthy sperm that we chose to look into in this study and compare to oligospermia individuals. Oligospermia patients (n = 24) and fertile men (n = 27) semen samples were collected, and the apoptosis rate of sperms in both groups was analyzed (Flow cytometry). Also, gene expression of apoptotic and antiapoptotic markers and telomere length were examined (real-time polymerase chain reaction). The sperm DNA fragmentation kit was used to determine DNA fragmentation and to evaluate catalase and SOD activity; the specific kits and methods were utilized. Higher expression levels of caspase3 (p = .0042), caspase8 (p = .0145), caspase9 (p = .0275), and BAX (p = .0202) mRNA were observed in patients who had oligospermia. In contrast, lower mRNA expression of BCL-2 (p = .0009) was detected in this group. In addition, telomere length was decreased in the oligospermia group (p < .0001) compared to the health group. Moreover, the frequency of apoptosis is induced in patients (p = .0026). The catalase activity is low (p = .0008), but the SOD activity is high (p = .0015) in the patient group. As a result of our findings, we may list the sperm cell apoptosis rate, telomere length, the degree of sperm DNA fragmentation, and lastly, the measurement of significant and efficient oxidative stress markers like SOD and catalase in semen plasma among the principal diagnostic characteristics for oligospermia. Future studies will be better able to treat oligospermia by showing whether these indicators are rising or falling.     

Sperm transport in the human female reproductive tract in relation to semen analysis characteristics and time of ovulation

Laparoscopic sperm recovery from the pouch of Douglas and tubal fimbriae was performed in 64 infertile couples. Spermatozoa were recovered from 16/35 couples investigated after AIH, and from 13/29 couples post coitum. The method of insemination had no effect on the result, which was positive in 45.3% of all couples, although AIH did result in significantly larger numbers of peritoneal spermatozoa. The number of peritoneal spermatozoa did not show any direct correlation with the number inseminated, but there were reductions along the tract of 5.83 (+/- 1.4 s.d.) orders of magnitude for total sperm count, and 5.52 (+/- 1.21 s.d.) for the number of motile spermatozoa. Only sperm motility had a significant influence on the success of sperm transport; spermatozoa were recovered from patients with sperm densities as low as 3.0 and 3.5 x 10(6)/ml, but with 56 and 44% motile spermatozoa. No influence of cycle day within the range +/- 4 days of ovulation on sperm transport was found. In 45 couples, routine semen analyses were apparently completely normal, but the incidence of sperm recovery was still only 49% (22/45), suggesting that a failure of sperm transport may have been a significant causative factor in their infertility.     

Éjaculation provoquée par le vibromassage ou l’électrostimulation endorectale chez le blessé médullaire: injection intracytoplasmique de spermatozoïdes obtenus par stimulation endorectale chez neuf couples

800 to 1,000 cases of traumatic spinal cord injury (S.C.I.) are observed in France each year. At present time, there are more than 35,000 survivors of S.C.I. in France. Studies show that 80% of injuries occur in men and 82% occur in individuals between the ages of 16 and 45 years. It is well known that more than 80% of men with S.C.I. suffer from ejaculation dysfunction. Since most of these couples are young, many desire a family and seek help to remedy their infertility. Two methods are mainly used to retrieve sperm from S.C.I. men: penile vibratory stimulation and rectal electrostimulation. Penile vibratory stimulation to induce ejaculation is recommended as first-line treatment, and S.C.I. men should only be referred for electroejaculation after failure of this technique. More than 70% of patients respond to penile vibratory stimulation with anterograde ejaculation. Patients who fail to ejaculate by penile vibratory stimulation are treated by electroejaculation. Their ejaculates often have normal sperm counts, but with a higher proportion of immotile sperm than in men without S.C.I. The authors report the pregnancy outcome of a series of 9 couples undergoing combined electroejaculation and in vitro fertilization with intracytoplasmic sperm injection: 25% pregnancies per cycle and 33% pregnancies per couple.