Department of Clinical and Surgical Andrology, Centre for Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany.
Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Andrology. 2023 Oct;11(7):1386-1397. doi: 10.1111/andr.13426. Epub 2023 Mar 29.
There is a strong within-subject alteration of semen parameters in men with infertility. However, it remains unknown in which subgroup variations are likely to occur and which semen parameters are affected.
To evaluate parameters associated with spontaneous alterations in semen analysis.
We retrospectively selected 3456 men with infertility without known causes affecting spermatogenesis or sperm output for analysis of repeated ejaculate samples. Exclusion criteria comprised sperm concentration <1 million/mL, abnormal follicle-stimulating hormone or low testosterone, and low bitesticular volume (<10 mL). Grouped linear two-level nested mixed-effect models were applied. The analyzed parameters included abstinence time, bitesticular volume, age, accessory gland markers, follicle-stimulating hormone, and FSHB c.-211 variants.
Groups include A (n = 397): ≥1.0 to <5.0 million/mL, B (n = 708): ≥5.0 to <15.0 million/mL, and C (n = 2351): ≥15.0 million/mL. Groups A, B, and C: changes in ejaculate volume were associated with alterations in total sperm count and motility (p < 0.003). Changes were, controlled for abstinence time (p < 0.001), related to α-glucosidase, fructose, or zinc (p = 0.005-0.02). Group A + B: fluctuations in follicle-stimulating hormone level influenced sperm concentration/count (p = 0.004-0.02), albeit only in men with FSHB c.-211 GG (p = 0.007-0.02). T-allele carriers did not show changes in follicle-stimulating hormone levels (p > 0.1). Group B: age <50 years (p = 0.007-0.01) and normal bitesticular volume (p = 0.008-0.02) were associated with spontaneous increases in sperm concentration, count, and motility.
Semen parameters exhibit intra-individual alterations associated with organic, hormonal, and genetic variables. Changes are pronounced in younger men with normal bitesticular volume and oligozoospermia to almost normozoospermia. The effect is modulated by abstinence time, accessory gland function, and fluctuations in follicle-stimulating hormone level, which is bound to FSHB c.-211G>T variant. Judgment of semen analysis should be based on two semen samples, with abstinence times between 4 and 5 days. As a future perspective, it might be investigated whether younger men with normal bitesticular volume who are unable to elicit increases in serum follicle-stimulating hormone (FSHB c.-211 genotype of GT/TT) benefit from improving accessory gland function and increasing follicle-stimulating hormone.
男性不育患者的精液参数在个体内存在强烈的变化。然而，目前尚不清楚哪些亚组可能发生变化，以及哪些精液参数受到影响。
评估与精液分析自发性变化相关的参数。
我们回顾性选择了 3456 名无已知原因影响生精或精子输出的不育男性，对其重复射精样本进行分析。排除标准包括精子浓度<100 万/mL、异常促卵泡激素或低睾酮以及睾丸体积低(<10mL)。应用分组线性两级嵌套混合效应模型。分析的参数包括禁欲时间、睾丸体积、年龄、附属腺标志物、促卵泡激素和 FSHB c.-211 变体。
组 A(n=397)：≥1.0 至<5.0 百万/mL，组 B(n=708)：≥5.0 至<15.0 百万/mL，组 C(n=2351)：≥15.0 百万/mL。组 A、B 和 C：精液量的变化与总精子计数和活力的变化相关(p<0.003)。控制禁欲时间(p<0.001)后，变化与α-葡萄糖苷酶、果糖或锌有关(p=0.005-0.02)。组 A+B：促卵泡激素水平的波动影响精子浓度/计数(p=0.004-0.02)，但仅在 FSHB c.-211 GG 男性中(p=0.007-0.02)。T 等位基因携带者的促卵泡激素水平没有变化(p>0.1)。组 B：年龄<50 岁(p=0.007-0.01)和正常睾丸体积(p=0.008-0.02)与精子浓度、计数和活力的自发性增加相关。
精液参数表现出与有机、激素和遗传变量相关的个体内变化。这种变化在年龄较小、睾丸体积正常和少精子症至几乎正常精子症的男性中更为明显。这种影响受禁欲时间、附属腺功能和促卵泡激素水平波动的调节，这与 FSHB c.-211G>T 变体有关。精液分析的判断应基于两份精液样本，禁欲时间为 4 至 5 天。作为未来的展望，可以研究是否可以通过改善附属腺功能和增加促卵泡激素来使睾丸体积正常的年轻少精子症男性(n=136)增加血清促卵泡激素(FSHB c.-211 基因型 GT/TT)。
