[Discussion on the treatment of male infertility from spleen and stomach based on intestinal flora]

Human reproduction is based on the physiological structures of men and women and affected and restricted by various physiological factors. Infertility is now receiving more and more attention and male infertility reportedly accounts for about half of the infertility cases and is becoming one of the serious problems affecting human reproduction and health. The normal intestinal microbiota flora is an important substance to maintain normal metabolism of the human body and closely related to its physiology and pathology. This paper discusses the correlation between the intestinal flora, spleen and stomach theory in TCM and male infertility, from the perspective of the gut flora and the TCM prescriptions for strengthening the spleen and stomach and regulating the imbalance of intestinal flora, aiming to provide some more ideas and theoretical evidence for the clinical studies and treatment of male infertility.

[Impact of plateau environment on seminal characteristics of native Tibetans and immigrated Tibetan Hans]

OBJECTIVE

To investigate the characteristics of the semen parameters of native Tibetans and immigrated Tibetan Hans in the high-altitude area and analyze the influence of altitude adaptation on male fertility.

METHODS

This study included 1 563 infertile male patients, including 698 native Tibetans and 865 immigrated Tibetan Hans, and 56 normal fertile men, including 33 native Tibetans and 23 Tibetan Hans. We obtained semen samples from the subjects for routine semen analysis and sperm DNA fragmentation index (DFI) examination and collected peripheral blood for determination of the reproductive hormone levels.

RESULTS

In the infertile patients, the native Tibetans, as compared with the immigrated Hans, showed significantly higher incidence rates of azoospermia (5.87% vs 2.89%, P <0.05), severe oligozoospermia (3.15% vs 1.73%, P <0.05) and abnormal seminal viscosity (43.12% vs 25.89%, P<0.01), but no statistically significant differences in the percentages of normozoospermia (81.08% vs 87.39%, P >0.05), oligozoospermia (5.44% vs 3.93%, P >0.05), severe asthenozoospermia (4.44% vs 4.04%, P >0.05) or severe teratozoospermia (4.58% vs 6.59%, P >0.05). In the normal fertile men, there were no statistically significant differences between the native Tibetans and immigrated Hans in age (［32.42 ± 4.82］ vs ［34.57 ± 6.01］ yr, P >0.05), sperm concentration (［143.69 ± 85.74］ vs ［155.11 ± 82.56］ ×10⁶/ml, P >0.05), straight line velocity (［25.74 ± 3.94］ vs ［27.24 ± 3.46］ μm/s, P >0.05), percentage of morphologically normal sperm (［8.22 ± 4.35］ vs ［7.28±2.46］ %, P >0.05), total testosterone concentration (［17.97 ± 2.98］ vs ［15.72 ± 6.38］ nmol/L, P >0.05), or follicle stimulating hormone level (［5.51 ± 1.62］ vs ［4.17 ± 2.08］ IU/L, P >0.05). However, the immigrated Hans, in comparison with the native Tibetans, exhibited a higher sperm motility (［79.75 ± 14.67］ vs ［66.58 ± 17.21］%, P <0.05), a lower curvilinear velocity (［60.97 ± 2.71］ vs ［71.14 ± 82.13］ μm/s, P <0.05) and a lower level of luteinizing hormone (［4.28 ± 1.20］ vs ［5.84 ± 1.15］ IU/L, P <0.05).

CONCLUSIONS

During the acclimatization to the plateau hypoxia environment, the immigrated Tibetan Hans undergo adaptive changes in sperm concentration and motility and have lower incidence rates of azoospermia and severe oligozoospermia than native Tibetan males.

[Estradiol benzoate induces abnormal proliferation of spermatogenic cells in the testis of infertile male mice]

OBJECTIVE

To explore the change in the proliferation of spermatogenic cells in the male mouse with infertility induced by exogenous estradiol benzoate (EB).

METHODS

Sixty male mice aged 4 weeks were randomly divided into a control, a low-dose EB, and a high-dose EB group to be injected intramuscularly with corn oil at 150 μl or EB at 5 or 10 mg/kg, respectively, every other day for 4 weeks. Then, we obtained the weight and indexes of the testis, performed HE staining of the paraffin sections of the testis tissue and epididymal cauda, counted the spermatozoa in the epididymal sperm suspension, and determined the expression of the proliferating cell nuclear antigen (PCNA), the mRNA expressions of CyclinA1, CyclinB1, VASA and p53, and the protein expressions of p53 and phosphorylated p53 in the testis by immunohistochemistry, qRT-PCR and Western blot, respectively.

RESULTS

In comparison with the controls, the mice treated with EB showed significantly decreased testicular indexes (P <0.05), no sperm in the sperm suspension or epididymal tubes, remarkably reduced numbers of spermatogonia, primary spermatocytes and Sertoli cells (P <0.05), down-regulated expression of PCNA (P <0.05) and mRNA expressions of CyclinA1, CyclinB1, PCNA and VASA in the seminiferous tubules (P <0.05), but a dose-dependent increase of the p53 level (P <0.05). Western blot revealed markedly higher levels of p53 protein expression and phosphorylation in the EB than in the control group (P <0.05) and even higher in the 10 mg/kg than in the 5 mg/kg EB group (P <0.05).

CONCLUSIONS

EB inhibited the proliferation of spermatogenic cells by down-regulating the expressions of cell cycle-related factors in a dose-dependent manner, which might contribute to abnormal proliferation of spermatogenic cells in the testis of infertile male mice.

[Combined therapy of Compound Xuanju Capsules and traditional Chinese medicinal formula for infertility in male smokers]

OBJECTIVE

To investigate the clinical effects of the combined therapy of Compound Xuanju Capsules (CXJC) and traditional Chinese medicinal formula on infertility in male smokers.

METHODS

A total of 176 male infertility patients were divided into a smoking and a non-smoking group and the former further divided into mild, moderate and heavy smokers according to the daily consumption of cigarettes and the length of smoking history. The patients were treated with CXJC combined with traditional Chinese medicinal formula for 3 four-week courses and the therapeutic results were evaluated by comparing the indicators of the traditional Chinese medicine (TCM) syndrome, routine semen parameters, sperm morphology, and sperm DNA fragmentation index (DFI) among different groups before and after treatment.

RESULTS

The baseline TCM syndrome scores were remarkably higher in the heavy smokers than in the non-smoking group (P < 0.05) but showed no statistically significant differences between the mild and moderate smokers (P > 0.05). The baseline percentage of sperm head defects and DFI were also markedly higher in the heavy and moderate smokers than in the non-smoking group (P < 0.05). Compared with the baseline, significant improvement was achieved after treatment in the TCM syndrome, routine semen parameters, sperm morphology and sperm DFI, especially in the heavy smokers in the percentages of grade a+b sperm (［17.12 ± 2.54］ vs ［30.15 ± 3.10］%, P < 0.05), morphologically normal sperm (［15.54 ± 1.98］ vs ［26.82 ± 3.52］%, P < 0.05), and head-defective sperm (［27.02 ± 2.14］ vs ［22.07 ± 1.52］%, P < 0.05).

CONCLUSIONS

Sperm quality is significantly decreased while the risk of infertility remarkably increased in moderate and heavy smokers. The combined therapy of CXJC and traditional Chinese medicinal formula can effectively improve semen quality, sperm morphology and sperm DFI in male smokers with infertility, though more evidence is to be collected from further studies.

[Tongjingling improves sperm DNA integrity and reduces oxidative stress in the testis of experimental varicocele rats]

OBJECTIVE

To explore the protective effect of Tongjingling (TJL) against sperm DNA damage and oxidative stress in the rat model of experimental varicocele (EVC).

METHODS

We randomly divided 75 Wistar male rats into five groups of equal number: sham operation, EVC model, high-dose TJL, mid-dose TJL, and low-dose TJL. The EVC model was established in the rats by partial ligation of the left renal vein, followed by 8 weeks of medication from the 4th week after modeling. Then we observed the general status of the rats, detected the sperm DNA fragmentation index (DFI) in the epididymis by sperm chromatin structure assay (SCSA), and measured the content of hydroperoxide (H2O2) and the activities of catalase (CAT) and superoxide dismutase (SOD) in the testis by colorimetry.

RESULTS

Compared with the sham operation group, the EVC models showed significantly increased sperm DFI in the epididymis (P <0.01) and elevated level of H2O2 and activities of CAT and SOD in the testis (P <0.01). In comparison with the EVC models, the rats of the TJL groups exhibited remarkably reduced sperm DFI and H2O2 content, but increased activities of SOD and CAT.

CONCLUSIONS

TJL can improve sperm DNA integrity by increasing the activities of SOD and CAT and reducing the H2O2 level and hence oxidative stress in the testis tissue.

[ilin Pills for oligoasthenospermia: Advances in clinical studies]

Industrialization and environmental pollution are bringing more problems to human reproduction and increasing the prevalence of male infertility. Western medicine has shown its limitations in the management of male infertility, especially that of oligoasthenospermia. Traditional Chinese medicine (TCM), however, has long and rich experiences in the treatment of oligoasthenospermia, with a large variety of medicinal prescriptions based on the TCM theories, among which Qilin Pills shows a particularly significant therapeutic effect on oligoasthenospermia, especially when combined with Western medicine. At present, published studies on Qilin Pills are mainly in the stage of clinical observation, while basic researches and studies on its relevant mechanisms are rarely seen.

[Microdissection testicular sperm extraction for patients with non-mosaic Klinefelter's syndrome: An update]

Klinefelter's syndrome (KS) is a most frequent sex chromosomal disorder in males, which is characterized by hypogonadism and infertility. The development of assisted reproductive technology has made it possible for KS males to father children. Microdissection testicular sperm extraction (mTESE) is widely considered to be the best method for sperm retrieval in KS patients. This article presents an overview on mTESE for men with non-mosaic KS in the aspects of its predictors, sperm retrieval rate, operation procedure, preoperative hormonal therapy, and postoperative complications and testosterone reduction.

[Content of neutrophil elastase in EPS and seminal plasma: A combined predictor in the diagnosis of type IIIA prostatitis with secondary infertility]

OBJECTIVE

To investigate the value of the content of neutrophil elastase (NE) in the expressed prostatic secretion (EPS) and seminal plasma (SP) as a combined predictor in the diagnosis of type IIIA prostatitis with secondary infertility.

METHODS

This study included 62 fathers (group A) and 67 infertile men (group B), all with type IIIA prostatitis, and another 57 controls with no genitourinary tract disease (group C). We measured the NE contents in the EPS and SP, obtained the results of routine semen and EPS examinations and Chronic Prostatitis Symptom Index (CPSI), and calculated the ratio of EPS NE/SP NE by binary logistic regression analysis.

RESULTS

The combined predictor of type IIIA prostatitis with secondary infertility was SP NE-2 × EPS NE. Among the 129 patients with type IIIA prostatitis, the combined predictor was correlated strongly negatively with the WBC count in the EPS (r = －0.914, P <0.01), negatively with CPSI, sperm concentration, sperm mobility and sperm viability (P <0.01), but not significantly with the WBC count or pH value in the SP (P >0.05). The mean values of the combined predictor in groups A, B, and C were －2 238 (95% CI: －2 595 to －2 054), －1 511 (95% CI: －1 778 to －1 307), and －148 (95% CI: －181 to －118), respectively, with statistically significant differences between the cases and controls as well as between groups A and B (P <0.01). The area under the ROC curve of the combined predictor for the diagnosis of type IIIA prostatitis with secondary infertility was 0.71 (P <0.001).

CONCLUSIONS

The content of neutrophil elastase in the EPS combined with that in the seminal plasma contributes to the diagnosis of type IIIA prostatitis with secondary infertility, which is superior to either the neutrophil elastase content in the EPS or that in the seminal plasma used alone.

[Diagnosis and treatment of ejaculatory duct obstruction: Current status and advances]

Ejaculatory duct obstruction (EDO) is one of the obstructive factors for 1－5% of all cases of male infertility and it is, however, surgically correctable. Congenital developmental abnormality is a most common cause of EDO. The clinical manifestations of EDO are varied, typically with the decline of four semen parameters. Transrectal ultrasonography is an important imaging method for the diagnosis of EDO and guidance in its surgery. MRI provides high-resolution images of the reproductive system as evidence. Transurethral resection of the ejaculatory duct (TURED) is a classical operation, the application of transurethral seminal vesiculoscopy has become a new trend of minimally invasive surgery in the treatment of EDO, and the latest flexible vesiculovasoscopy (FVV) or vasoscopy techniques may further improve the diagnosis and treatment of EDO.