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<正>男性不育是指育龄夫妇有规律性生活且未采取避孕措施,由男方因素导致女方在一年内未能自然受孕。男性不育分为原发性不育和继发性不育,前者是指男性从未使女方受孕,后者是指男性曾经使女性伴侣怀孕或生育。随着我国人口老龄化的不断加剧和生育率的下降,加剧了对男性生育的关注,而前一版指南已经历时5年,知识和理念的更新需求迫切。为促进男性不育的规范化诊断与治疗,自2020年12月启动以来,中华医学会男科学分会组织国内相关专家,对男性不育的病因、诊断、治疗和预后等进行归纳总结和反复讨论。
Abstract:[1] Inhorn MC,Patrizio P.Infertility around the globe:New thinking on gender,reproductive technologies and global movements in the 21st century.Hum Reprod Update,2015,21(4):411-426.
[2] Keihani S,Verrilli LE,Zhang C,et al.Semen parameter thresholds and time-to-conception in subfertile couples:How high is high enough?Hum Reprod,2021,36(8):2121-2133.
[3] Lv MQ,Ge P,Zhang J,et al.Temporal trends in semen concentration and count among 327 373 Chinese healthy men from 1981 to 2019:A systematic review.Hum Reprod,2021,36(7):1751-1775.
[4] Wu C,Lipshultz LI,Kovac JR.The role of advanced paternal age in modern reproductive medicine.Asian J Androl,2016,18(3):425.
[5] Nassan FL,Chavarro JE,Tanrikut C.Diet and men's fertility:Does diet affect sperm quality?Fertil Steril,2018,110(4):570-577.
[6] Skoracka K,Eder P,Lykowska-Szuber L,et al.Diet and nutritional factors in male (In) fertility-underestimated factors.J Clin Med,2020,9(5):1400.
[7] Batiha O,Al-Deeb T,Al-Zoubi E,et al.Impact of COVID-19 and other viruses on reproductive health.Andrologia,2020,52(9):e13791.
[8] 李兰芳,葛青,陆文昊.男性不育的相关影响因素流行病学调查分析.中国优生与遗传杂志,2020,28(4):515-517.
[9] Salonia ACB,CarvalhoJ,Corona G,et al.EAU Guidelines on Sexual and Reproductive Health.EAU Annual Congress Milan 2021,Arnhem,The Netherlands:EAU Guidelines Office,2020.106-116.
[10] Boehm U,Bouloux PM,Dattani MT,et al.Expert consensus document:European Consensus Statement on congenital hypogonadotropic hypogonadism — pathogenesis,diagnosis and treatment.Nat Rev Endocrinol,2015,11(9):547-564.
[11] Melmed S,Casanueva FF,Hoffman AR,et al.Diagnosis and treatment of hyperprolactinemia:An Endocrine Society clinical practice guideline.J Clin Endocrinol Metab,2011,96(2):273-288.
[12] Zahringer S,Tomova A,von Werder K,Brabant G,Kumanov P,Schopohl J.The influence of hyperthyroidism on the hypothalamic-pituitary-gonadal axis.Exp Clin Endocrinol Diabetes,2000,108(4):282-289.
[13] Mc Dermott JH,Walsh CH.Hypogonadism in hereditary hemochromatosis.J Clin Endocrinol Metab,2005,90(4):2451-2455.
[14] Krausz C,Riera-Escamilla A.Genetics of male infertility.Nat Rev Urol,2018,15(6):369-384.
[15] Harton GL,Tempest HG.Chromosomal disorders and male infertility.Asian J Androl,2012,14(1):32-39.
[16] Kohn TP,Kohn JR,Owen RC,et al.The prevalence of Y-chromosome microdeletions in oligozoospermic men:A systematic review and meta-analysis of European and North American Studies.Eur Urol,2019,76(5):626-636.
[17] Loebenstein M,Thorup J,Cortes D,et al.Cryptorchidism,gonocyte development,and the risks of germ cell malignancy and infertility:A systematic review.J Pediatr Surg,2020,55(7):1201-1210.
[18] Kasturi SS OC,Tannir J,Brannigan RE.The effect of genital tract infection and inflammation on male infertility.In:Lipshultz LI HS,CS N,editor.Infertility in the male.4th ed.New York:Cambridge University Press,2009.295-329.
[19] Visser AJ,Heyns CF.Testicular function after torsion of the spermatic cord.BJU Int,2003,92(3):200-203.
[20] Jensen CFS,Ostergren P,Dupree JM,et al.Varicocele and male infertility.Nat Rev Urol,2017,14(9):523-533.
[21] Ostrowski KA,Walsh TJ.Infertility with testicular cancer.Urol Clin North Am,2015,42(3):409-420.
[22] Meistrich ML.Effects of chemotherapy and radiotherapy on spermatogenesis in humans.Fertil Steril,2013,100(5):1180-1186.
[23] Practice Committee of the American Society for Reproductive Medicine.Electronic address aao.Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy:A committee opinion.Fertil Steril,2019,112(6):1022-1033.
[24] Finelli R,Leisegang K,Finocchi F,et al.The impact of autoimmune systemic inflammation and associated medications on male reproductive health in patients with chronic rheumatological,dermatological,and gastroenterological diseases:A systematic review.Am J Reprod Immunol,2021,85(5):e13389.
[25] Auger J,Sermondade N,Eustache F.Semen quality of 4480 young cancer and systemic disease patients:Bbaseline data and clinical considerations.Basic Clin Androl,2016,26:3.
[26] Ma Y,He X,Qi K,et al.Effects of environmental contaminants on fertility and reproductive health.J Environ Sci (China),2019,77:210-217.
[27] Kesari KK,Agarwal A,Henkel R.Radiations and male fertility.Reprod Biol Endocrinol,2018,16(1):118.
[28] Benoff S,Jacob A,Hurley IR.Male infertility and environmental exposure to lead and cadmium.Hum Reprod Update,2000,6(2):107-121.
[29] Sansone A,Di Dato C,de Angelis C,et al.Smoke,alcohol and drug addiction and male fertility.Reprod Biol Endocrinol,2018,16(1):3.
[30] Sharma R,Harlev A,Agarwal A,et al.Cigarette smoking and semen quality:A new meta-analysis examining the effect of the 2010 World Health Organization Laboratory Methods for the Examination of Human Semen.Eur Urol,2016,70(4):635-645.
[31] Alshahrani S,Ahmed AF,Gabr AH,et al.The impact of body mass index on semen parameters in infertile men.Andrologia,2016,48(10):1125-1129.
[32] Peng J,Yuan Y,Cui W,et al.Causes of suspected epididymal obstruction in Chinese men.Urology,2012,80(6):1258-1261.
[33] Silber SJ,Grotjan HE.Microscopic vasectomy reversal 30 years later:A summary of 4010 cases by the same surgeon.J Androl,2004,25(6):845-859.
[34] Patat O,Pagin A,Siegfried A,et al.Truncating mutations in the adhesion G protein-coupled receptor G2 gene ADGRG2 cause an X-linked congenital bilateral absence of vas deferens.Am J Hum Genet,2016,99(2):437-442.
[35] Modgil V,Rai S,Ralph DJ,et al.An update on the diagnosis and management of ejaculatory duct obstruction.Nat Rev Urol,2016,13(1):13-20.
[36] Kaushal M,Baxi A.Birth after intracytoplasmic sperm injection with use of testicular sperm from men with Kartagener or immotile cilia syndrome.Fertil Steril,2007,88(2):497 e9-11.
[37] Agarwal A,Farkouh A,Parekh N,et al.Sperm DNA fragmentation:A critical assessment of clinical practice guidelines.World J Mens Health,2022,40(1):30-37.
[38] Bjorkgren I,Sipila P.The impact of epididymal proteins on sperm function.Reproduction,2019,158(5):R155-R67.
[39] Yang B,Xu P,Shi Y,et al.Erectile dysfunction and associated risk factors in Chinese males of infertile couples.J Sex Med,2018,15(5):671-677.
[40] Schlegel PN,Sigman M,Collura B,et al.Diagnosis and treatment of infertility in men:AUA/ASRM guideline part I.Fertil Steril,2021,115(1):54-61.
[41] 郭应禄,胡礼泉.男科学.北京:人民卫生出版社,2004.
[42] 吴阶平.吴阶平泌尿外科学.济南:山东科学技术出版社,2004.
[43] Ogundoyin OO,Atalabi OM.Comparison between testicular volumes as measured with prader orchidometer and ultrasonography in healthy nigerian Newborns.Afr J Paediatr Surg,2018,15(2):93-96.
[44] TG C.WHO Laboratory Manual for the Examination and Processing of Human Semen 2010.
[45] Martin-du-Pan RC,Bischof P.Increased follicle stimulating hormone in infertile men.Is increased plasma FSH always due to damaged germinal epithelium?Hum Reprod.1995,10(8):1940-1945.
[46] Ramasamy R,Lin K,Gosden LV,et al.High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction.Fertil Steril,2009,92(2):590-593.
[47] Ishikawa T,Fujioka H,Fujisawa M.Clinical and hormonal findings in testicular maturation arrest.BJU Int,2004,94(9):1314-1316.
[48] Goulis DG,Polychronou P,Mikos T,et al.Serum inhibin-B and follicle stimulating hormone as predictors of the presence of sperm in testicular fine needle aspirate in men with azoospermia.Hormones (Athens),2008,7(2):140-147.
[49] 中国医师协会生殖医学专业委员会生殖男科学组无精子症诊疗中国专家共识编写组.无精子症诊疗中国专家共识.中华生殖与避孕杂志,2021,41(7):573-585.
[50] Takeshima T,Usui K,Mori K,et al.Oxidative stress and male infertility.Reprod Med Biol,2021,20(1):41-52.
[51] Liang Y,Jin X,Yuan F,et al.Comparison of rRNA-based and DNA-based nucleic acid amplifications for detection of Chlamydia trachomatis,Neisseria gonorrhoeae,and Ureaplasma urealyticum in urogenital swabs.BMC Infect Dis,2018,18(1):651.
[52] Turek PJ,Magana JO,Lipshultz LI.Semen parameters before and after transurethral surgery for ejaculatory duct obstruction.J Urol.1996,155(4):1291-1293.
[53] Palnitkar G,Phillips CL,Hoyos CM,et al.Linking sleep disturbance to idiopathic male infertility.Sleep Med Rev,2018,42:149-159.
[54] Kahn BE,Brannigan RE.Obesity and male infertility.Curr Opin Urol,2017,27(5):441-5.
[55] Ibaňez-Perez J,Santos-Zorrozua B,Lopez-Lopez E,et al.An update on the implication of physical activity on semen quality:A systematic review and meta-analysis.Arch Gynecol Obstet,2019,299(4):901-921.
[56] Konishi S,Saotome TT,Shimizu K,et al.Coital frequency and the probability of pregnancy in couples trying to conceive their first child:A prospective cohort study in Japan.Int J Environ Res Public Health,2020,17(14):4985.
[57] Lipovac M,Nairz V,Aschauer J,et al.The effect of micronutrient supplementation on spermatozoa DNA integrity in subfertile men and subsequent pregnancy rate.Gynecol Endocrinol,2021,37(8):711-715.
[58] 周青松,曾凡春,张祯雪,等.复方氨基酸胶囊联合维生素E治疗特发性弱精子症的临床研究.中华男科学杂志,2016,22(04):343-346.
[59] 王益鑫,王毓斌,卢永宁,等.金冷法治疗少、弱精子症的疗效及安全性临床观察.中华男科学杂志,2009,15(10):952-955.
[60] 施长春,白文俊,刘贵中.男性阴囊冷敷贴对精液参数影响的研究.中国男科学杂志,2021,35(2):61-65.
[61] Agarwal A,Leisegang K,Majzoub A,et al.Utility of antioxidants in the treatment of male infertility:Clinical guidelines based on a systematic review and analysis of evidence.World J Mens Health,2021,39(2):233-290.
[62] 姜辉,邓春华,商学军,等.维生素E在男性不育中临床应用专家共识(2014版).中华男科学杂志,2015,21(3):277-279.
[63] 张航,王亚轩,李景东,等.α-硫辛酸胶囊联合枸橼酸他莫昔芬片治疗少弱精子症的疗效观察.中华男科学杂志,2017,23(10):899-902.
[64] Micic S,Lalic N,Djordjevic D,Bojanic N,Bogavac-Stanojevic N,Busetto GM,et al.Double-blind,randomised,placebo-controlled trial on the effect of L-carnitine and L-acetylcarnitine on sperm parameters in men with idiopathic oligoasthenozoospermia.Andrologia,2019,51(6):e13267.
[65] Lipovac M,Bodner F,Imhof M,et al.Comparison of the effect of a combination of eight micronutrients versus a standard mono preparation on sperm parameters.Reprod Biol Endocrinol,2016,14(1):84.
[66] Ahmadi S,Bashiri R,Ghadiri-Anari A,et al.Antioxidant supplements and semen parameters:An evidence based review.Int J Reprod Biomed,2016,14(12):729-736.
[67] Mongioi L,Calogero AE,Vicari E,et al.The role of carnitine in male infertility.Andrology,2016,4(5):800-807.
[68] Fang Y,Zhao L,Yan F,et al.Escin improves sperm quality in male patients with varicocele-associated infertility.Phytomedicine,2010,17(3-4):192-196.
[69] 白刚,佟宪,李宏军.胰激肽原酶在男科疾病中的应用.生殖医学杂志,2014,23(2):165-168.
[70] Young J,Xu C,Papadakis GE,et al.Clinical management of congenital hypogonadotropic hypogonadism.Endocr Rev,2019,40(2):669-710.
[71] Gong C,Liu Y,Qin M,et al.Pulsatile GnRH is superior to hCG in therapeutic efficacy in adolescent boys with hypogonadotropic hypogonadodism.J Clin Endocrinol Metab,2015,100(7):2793-2799.
[72] Cannarella R,Condorelli RA,Mongioì LM,et al.Effects of the selective estrogen receptor modulators for the treatment of male infertility:A systematic review and meta-analysis.Expert Opin Pharmacother,2019,20(12):1517-1525.
[73] Shoshany O,Abhyankar N,Mufarreh N,et al.Outcomes of anastrozole in oligozoospermic hypoandrogenic subfertile men.Fertil Steril,2017,107(3):589-594.
[74] Del Giudice F,Busetto GM,De Berardinis E,et al.A systematic review and meta-analysis of clinical trials implementing aromatase inhibitors to treat male infertility.Asian J Androl,2020,22(4):360-367.
[75] Jha S,El-Maouche D,Marko J,et al.Individualizing management of infertility in classic congenital adrenal hyperplasia and testicular adrenal rest tumors.J Endocr Soc,2019,3(12):2290-2294.
[76] Mendes-Dos-Santos CT,Martins DL,Guerra-Júnior G,et al.Prevalence of testicular adrenal rest tumor and factors associated with Its development in congenital adrenal hyperplasia.Horm Res Paediatr,2018,90(3):161-168.
[77] Molitch ME.Diagnosis and Treatment of Pituitary Adenomas:A Review.Jama,2017,317(5):516-524.
[78] Cito G,Cocci A,Micelli E,et al.Vitamin D and male fertility:An updated review.World J Mens Health,2020,38(2):164-177.
[79] Dong L,Zhang X,Yan X,et al.Effect of phosphodiesterase-5 inhibitors on the treatment of male infertility:A systematic review and meta-analysis.World J Mens Health,2021:Online ahead of print.
[80] Tenuta M,Carlomagno F,Cangiano B,et al.Somatotropic-testicular axis:A crosstalk between GH/IGF-I and gonadal hormones during development,transition,and adult age.Andrology,2021,9(1):168-184.
[81] Oh JK,Im YJ,Park K,et al.Effects of combined growth hormone and testosterone treatments in a rat model of micropenis.Endocr Connect,2018,7(11):1150-1157.
[82] 郭军.“脑-心-肾-精室”轴在中医男科学中的理论构建及应用.世界中西医结合杂志,2020,15(8):1553-1556.
[83] 王福,俞旭君.生精胶囊在男性不育症中的临床应用中国专家共识.中华男科学杂志,2019,25(4):368-371.
[84] 李亚峰,谢建兴.黄精赞育胶囊治疗男性不育弱精子症40例疗效观察.世界中西医结合杂志,2009,4(7):493-495.
[85] 郭军,赵丰,刘胜京,等.基于网络药理学探讨灵归方治疗少弱精子症的作用机制.世界中西医结合杂志,2020,15(10):1828-1834,1840.
[86] 张开舒,傅龙龙,商学军,等.麒麟丸治疗少弱精子症的临床研究进展.中华男科学杂志,2017,23(10):938-941.
[87] 张兴源,潘连军.仙鹿口服液联合左卡尼汀口服液治疗精子DNA损伤的临床观察.中国男科学杂志,2015,29(12):56-59.
[88] 杨长海,孙中义,王波,等.还少胶囊治疗少弱精子症的多中心临床观察.中华男科学杂志,2018,24(7):635-639.
[89] 华众,陈如兵,王晨,等.罗补甫克比日丸对弱精子症患者精液质量及精浆相关生化指标的影响.中华男科学杂志,2020,26(11):1020-1024.
[90] 欧阳斌,耿强.针刺治疗男性不育症的疗效及作用机制述评.中国中西医结合杂志,2018,38(5):520-522.
[91] Fantus RJ,Halpern JA.Vasovasostomy and vasoepididymostomy:Indications,operative technique,and outcomes.Fertil Steril,2021,115(6):1384-1392.
[92] Hayden RP,Li PS,Goldstein M.Microsurgical vasectomy reversal:Contemporary techniques,intraoperative decision making,and surgical training for the next generation.Fertil Steril,2019,111(3):444-453.
[93] Tatem AJ,Brannigan RE.The role of microsurgical varicocelectomy in treating male infertility.Transl Androl Urol,2017,6(4):722-729.
[94] Schlegel PN.Testicular sperm extraction:microdissection improves sperm yield with minimal tissue excision.Hum Reprod.1999,14(1):131-135.
[95] Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Male R,Urology.Electronic address aao.The management of obstructive azoospermia:A committee opinion.Fertil Steril,2019,111(5):873-880.
[96] Silber SJ.Microscopic vasectomy reversal.Fertil Steril.1977,28(11):1191-1202.
[97] Schiff J,Chan P,Li PS,et al.Outcome and late failures compared in 4 techniques of microsurgical vasoepididymostomy in 153 consecutive men.J Urol,2005,174(2):651-655,801.
[98] Goldstein M,Li PS,Matthews GJ.Microsurgical vasovasostomy:The microdot technique of precision suture placement.J Urol,1998,159(1):188-190.
[99] Fuchs EF,Burt RA.Vasectomy reversal performed 15 years or more after vasectomy:Correlation of pregnancy outcome with partner age and with pregnancy results of in vitro fertilization with intracytoplasmic sperm injection.Fertil Steril,2002,77(3):516-519.
[100] Namekawa T,Imamoto T,Kato M,et al.Vasovasostomy and vasoepididymostomy:Review of the procedures,outcomes,and predictors of patency and pregnancy over the last decade.Reprod Med Biol,2018,17(4):343-355.
[101] Zhao L,Deng CH,Sun XZ,et al.A modified single-armed technique for microsurgical vasoepididymostomy.Asian J Androl,2013,15(1):79-82.
[102] Liu N,Li P,Zhi E,et al.A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia:Intraoperative choice and postoperative consideration.BMC Urol,2020,20(1):121.
[103] Stuhrmann M,D?rk T.CFTR gene mutations and male infertility.Andrologia,2000,32(2):71-83.
[104] Silber SJ,Ord T,Balmaceda J,et al.Congenital absence of the vas deferens:the fertilizing capacity of human epididymal sperm.N Engl J Med.1990,323(26):1788-1792.
[105] Chan PT,Schlegel PN.Nonobstructive azoospermia.Curr Opin Urol,2000,10(6):617-624.
[106] Hauser R,Yogev L,Paz G,et al.Comparison of efficacy of two techniques for testicular sperm retrieval in nonobstructive azoospermia:Multifocal testicular sperm extraction versus multifocal testicular sperm aspiration.J Androl,2006,27(1):28-33.
[107] Schlegel PN,Li PS.Microdissection TESE:Sperm retrieval in non-obstructive azoospermia.Hum Reprod Update.1998,4(4):439.
[108] Su LM,Palermo GD,Goldstein M,et al.Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia:Testicular histology can predict success of sperm retrieval.J Urol.1999,161(1):112-116.
[109] Palermo GD,Schlegel PN,Hariprashad JJ,et al.Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men.Hum Reprod.1999,14(3):741-748.
[110] Lima TFN,Frech FS,Patel P,et al.Effect of microsurgical varicocelectomy on semen parameters,serum,and intratesticular testosterone levels.BJUI Compass,2020,1(3):93-99.
[111] Birowo P,Tendi W,Widyahening IS,et al.The benefits of varicocele repair for achieving pregnancy in male infertility:A systematic review and meta-analysis.Heliyon,2020,6(11):e05439.
[112] Li X,Yang X,Wang X,et al.Comparison of outcomes in intrauterine insemination,in vitro fertilisation and intracytoplasmic sperm injection in men with and without varicocele.Int J Med Sci,2020,17(14):2155-2162.
[113] Al-Mohammady AA,El-Sherbiny AF,Mehaney AB,et al.Varicocele repair in patients prepared for intracytoplasmic sperm injection:To do or not to do?Andrologia,2019,51(2):e13185.
[114] 人类辅助生殖技术管理办法.中华人民共和国国务院公报,2002(6):25-26.
[115] 人类辅助生殖技术规范.中国生育健康杂志,2004,(1):4-9.
[116] 中华医学会男科学分会.中国男科疾病诊断治疗指南与专家共识(2016版).北京:人民卫生出版社,2017.39-54.
[117] 陈振文.辅助生殖男性技术.北京:人民卫生出版社,2016.171-172.
[118] Schlegel PN,Sigman M,Collura B,et al.Diagnosis and treatment of infertility in men:AUA/ASRM guideline part II.Fertil Steril,2021,115(1):62-69.
[119] Liu H,Xie Y,Gao L,et al.Impact on using cryopreservation of testicular or epididymal sperm upon intracytoplasmic sperm injection outcome in men with obstructive azoospermia:A systematic review and meta-analysis.J Assist Reprod Genet,2020,37(11):2643-2651.
[120] 李宏军,彭靖.男科诊疗常规.北京:中国医药科技出版社,2020.
[121] Heffner LJ.Advanced maternal age — how old is too old?N Engl J Med,2004,351(19):1927-1929.
[122] 张姝,陈学东.性激素检测影响因素的研究进展.检验医学与临床,2019,16(16):2412-2415.
基本信息:
DOI:10.13263/j.cnki.nja.2022.01.012
中图分类号:R698.2
引用信息:
[1]李宏军,洪锴,李铮,等.男性不育诊疗指南[J].中华男科学杂志,2022,28(01):66-76.DOI:10.13263/j.cnki.nja.2022.01.012.
2022-01-20
2022-01-20