评估促性腺激素治疗的低促性腺激素性性腺功能减退症男性的脱氧核糖核酸碎片化指数、睾丸体积、精液参数和激素谱。

Assessment of deoxyribonucleic acid fragmentation index, testicular volume, semen parameters, and hormone profile in gonadotropin-treated men with hypogonadotropic hypogonadism.

机构信息

Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Academic Center for Education, Culture and Research, Tehran, Iran.

出版信息

Urology. 2013 Dec;82(6):1291-5. doi: 10.1016/j.urology.2013.06.041. Epub 2013 Oct 2.

DOI:10.1016/j.urology.2013.06.041

PMID:24094652

Abstract

OBJECTIVE

To study the sperm deoxyribonucleic acid (DNA) fragmentation index (DFI), testicular volume, semen parameters, and hormone profile in human chorionic gonadotropin (hCG)- and human menopausal gonadotrophin (hMG)-treated patients with hypogonadotropic hypogonadism (HH) with and without a successful pregnancy.

METHODS

This is a cross sectional study. The study initially included 81 patients with HH and azoospermia at the Infertility Unit of Royan Institute between 2010 and 2012. Fifty-eight of 81 patients achieved >1 × 10(6) sperm/mL during hCG and hMG therapy. These 58 patients were divided into the following 2 groups: 20 patients with HH who achieved pregnancy in response to hCG/hMG (responders, 16 naturally and 4 by intrauterine insemination) and 38 gonadotropin-treated patients with HH with failed pregnancy (nonresponders, 29 naturally, 5 by intrauterine insemination, 1 by in vitro fertilization, and 3 by intracytoplasmic sperm injection). Sperm DNA fragmentation was visualized by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay.

RESULTS

Average of DFI (responders: 13.45 ± 0.64; nonresponders: 21.92 ± 0.86), age, body mass index, testis volume semen parameters, and follicle-stimulating hormone, luteinizing hormone, and testosterone levels in the 2 groups were calculated. Cut-off point for DFI was determined by receiver operating curve analysis (17.5%).

CONCLUSION

It was shown that DFI in responders is significantly lower than DFI in nonresponders (P <.001), and duration of hCG and hMG therapy in responders is significantly higher than those of nonresponders (P <.05). DFI could be predictive of conception (P <.001; odds ratio 0.57; 95% confidence interval 0.417-0.778). It can be concluded that despite low sperm quality, especially sperm concentration in these patients, decreasing sperm DNA damage may result in successful fertilization.

摘要

目的

研究人绒毛膜促性腺激素（hCG）和人绝经期促性腺激素（hMG）治疗低促性腺激素性性腺功能减退症（HH）伴和不伴成功妊娠患者的精子脱氧核糖核酸（DNA）碎片化指数（DFI）、睾丸体积、精液参数和激素谱。

方法

这是一项横断面研究。该研究最初纳入了 2010 年至 2012 年期间在罗扬研究所不孕不育科就诊的 81 例 HH 伴无精子症患者。81 例患者中有 58 例在 hCG 和 hMG 治疗后精子浓度达到＞1×10（6）/ml。这 58 例患者分为以下两组：20 例 HH 患者对 hCG/hMG 有妊娠反应（应答者，16 例自然妊娠，4 例宫腔内人工授精）和 38 例促性腺激素治疗后 HH 妊娠失败的患者（无应答者，29 例自然妊娠，5 例宫腔内人工授精，1 例体外受精，3 例胞浆内单精子注射）。采用末端脱氧核苷酸转移酶 dUTP 缺口末端标记法（TUNEL）检测精子 DNA 碎片化。

结果

计算两组患者的 DFI 平均值（应答者：13.45±0.64；无应答者：21.92±0.86）、年龄、体重指数、睾丸体积、精液参数、卵泡刺激素、黄体生成素和睾酮水平。通过受试者工作特征曲线分析确定 DFI 的截断值（17.5%）。

结论

结果表明，应答者的 DFI 明显低于无应答者（P＜0.001），应答者的 hCG 和 hMG 治疗时间明显长于无应答者（P＜0.05）。DFI 可以预测妊娠（P＜0.001；优势比 0.57；95%置信区间 0.417-0.778）。可以得出结论，尽管这些患者的精子质量低，尤其是精子浓度低，但降低精子 DNA 损伤可能会导致受精成功。