| Section I:Assessment of Overweight and Obese Male Infertility Patients’ Psychological and Sexual FunctionObjective:To investigate psychological status in different body mass index group male infertility patients. the frequency and the clinical characteristics of premature ejaculation (PE) in the different body mass index of infertile males,the frequency and the clinical characteristics of late onset of hypogonadism in the different body mass index of infertile males,the frequency and the clinical characteristics of index of erectile function in the different body mass index of infertile males. the frequency and the clinical characteristics of index of erectile function in the different body mass index of infertile males.Materials and methods:We randomly selected 292 infertile males, according to the different BMI groups, patients were grouped to compare them with body mass index (BMI),normal group: 84 patients, overweight group:117 patients and obese group:91 patients.The psychological conditions was investigated with symptom self-assessment scale (SCL-90) to investigate. The premature ejaculation was investigated with Schedule for Chinese index of sexual function for premature ejaculation. PADAM symptoms was investigated with the patients for Partial Androgen Deficiency of The Aging Male. Erectile function was investigated with the Schedule for international index of erectile function-5 erectile function.Results:The normal weight group of male infertility patients compared with the norm, anxiety (1.75±0.33) and depression (1.90±0.35), total score(152.80±23.02), grand average (1.70± 0.26) were higher than norm, statistically significant (P< 0.05). Overweight group compared with the norm, interpersonal sensitivity (1.85±0.41) and depression (2.04±0.32), anxiety (2.15± 0.33),total score (158.48±24.17), grand average (1.76±0.27) were higher than norm, statistically significant (P<0.05). Obese group compared with norm, forcing factor (1.74±0.35), interpersonal sensitivity (1.93±0.45) and depression (2.05±0.30), anxiety (2.16±0.30), total score (161.74±23.65), grand average (1.80±0.26) higher than norm, statistically significant (P< 0.05).Body mass index and forced symptoms, depression and anxiety were positively correlated (P< 0.05), and no obvious correlation and other factors.The overall prevalence of PE in male infertility patients was 37.3%. The prevalence of PE in obesity 50.5% were respectively higher than normal weight group 25.5%(P< 0.05),overweight group 36.9%(P<0.05).In the CIPE scores of different BMI groups, obesity group (34.8±6.4) lower than normal weight group (39.1±7.1)(P<0.05), obesity group score was lower than overweight group (37.8±6.8)(P<0.05), while normal and overweight no significant statistical difference (P>0.05).In different body mass index group of PADAM vasomotor symptoms score, obese overweight rating score higher than the normal weight group, there was statistically difference (P <0.05), the score is higher than that of overweight obesity group, statistically significant (P< 0.05), the normal group and the overweight no significant statistical difference (P>0.05). Vasomotor symptoms and body mass index were positively correlation (R=0.156,P<0.01).IIEF-5 scores in different BMI groups, the normal weight group score (22.92±3.06) compared with overweight group (21.85±3.58), the difference was statistically significant (P< 0.05). The normal weight group score (22.92±3.06)compared with obesity group (20.67±3.97), there was statistically difference (P<0.01), overweight group (21.85±3.58) compared with obese (20.67±3.97) score, statistically significant (P<0.05). IIEF-5 scores had negative correlation with body mass index (R=-0.20,P<0.01).Conclusion:The diagnosis and treatment of obesity and overweight male infertility, which is need to guide them to exercise, a healthy diet.,in addition to psychological intervention.Body mass index has obvious effect on premature ejaculation of infertile males To improve the treatment of sexual dysfunction, infertile male reduce weight is more important..Body mass index has obvious effect on frequency and the clinical characteristics LOH of male infertility patients.To improve the treatment of LOH, male infertility patients lose weight is more important..Body mass index has obvious effect on frequency and the clinical characteristics ED of male infertility patients.To improve the treatment of ED, male infertility patients lose weight is more important.Section Ⅱ:Relatioship of Semen Analysis and Free Fatty Aciid, Reactive Oxygen Species, InhibinB, Glutathione Peroxidase,Interleukin-1,Insulin-like factor-I, in the Seminal Plasma of Overweight and obese Male Infertility PatientsObjective:In order to understand the effect of obesity and overweight on the male fertility,To investigate the relationship between the abdomen circumferencewith the sperm quality of male sterility. To explore the influence of body mass index on semen and gonadotropin and sex hormones. To analysis relationship of semen qulity and FFA,INHB,GSHPx,IL-1,ROS,IGF-1 in the Seminal Plasma.we studied the different body mass index(BMI) male Infertility Patients, Free Fatty Aciid, Reactive Oxygen Species, InhibinB, Glutathione Peroxidase,Interleukin-1,Insulin-like factor-Ⅰ. in the Seminal Plasma.Materials and methods:We randomly selected 524 male infertility patients according to the abdomen circumference levels divide into groups:normal group:177, the early stage of central obesity group:86. Central obesity group:261. semen analysis by the routine detection.We randomly selected 524 patients, according to body mass index criterion. Normal body mass index grouo:179 patients, overweight group:219 patients, obese group:126 patients, semen routine analysis.to detect level of follicle stimulating hormone, luteinizing hormone, testosterone and estradio by chemiluminescence method.We randomly selected 227 male, in which the normal weight have birth a child:50 people, normal body mass infertility group:58 patients,overweigh infertility group:60 patients, obese infertility group:59 patients. Semen specimen by conventional analysis. To detect level of seminal plasmaIGF-1、ROS、FFA、IGF-1、INHB、GSH-P-x by ELISA.Choosea 34 patients BMI≥28 with weak sperm disease, injection with recombinant human growth hormone 4.5 IU, subcutaneous injection, once every three days. Every time to letrozole tablets 2.5 mg, oral,1 times a day. For three consecutive monthsResults:The volumes of semen in normal group (2.7±1.4) ml. the early stage of central obesity group (2.0±1.3)ml and central obesity group (1.5±1.1) ml, there was statistically difference between three groups (P<0.05). Sperm liquefaction time in normal group (26.7±5.1)min, the early stage of central obesity group (28.4±10.2)min and central obesity group (30.6±17.2) min, there was statistically difference between three groups (P< 0.05).Total number of sperm ejaculated for one time in normal group (125.±117.6)×106,the early stage of central obesity group (119.7±115.8)×106 and central obesity group(102.6±86.2)×106, there was statistically difference between three groups (P< 0.05).Semen volume with abdomen circumference increased gradually decreased, and 6 showed a negative correlation (R=-0.13, P< 0.01). An ejaculation in the total number of sperm and abdomen circumference showed a negative correlation (R=0.12, P<0.05). Testosterone levels of normal weight group (449.70±120.07) (ng/dl), overweight (394.47± 178.28) (ng/dl), obesity (323.37±137.34) (ng/dl), Comparison between the three groups, with significant difference (p< 0.05). With the increase of body mass index,testosterone of three groups decreased gradually. Although estradiol has increased, but there was no significant difference between groups. Body mass index and luteinizing hormone showed a negative correlation (R=0.17, p<0.05). Body mass index and total testosterone level was significantly negative correlation (R=0.31, p< 0.01), body mass index and follicle-stimulating hormone and estrogen has no relevance. Obesity infertility group growth hormone levels (0.11±0.26) (mu g/L) compared to normal BMI infertility group (0.52±1.29) (mu g/L), were less than the latter, the difference was statistically significant (P<0.05).The normal weight of infertility group IGF-1 count in the seminal plasma (144.27±61.45) ng/mL was lower than the control group (108.22±52.42) ng/mL, the difference was statistically significant(P<0.05).Overweight (182.30±95.70)ng/mL and obesity209.03±69.88) ng/mL were higher than the control group, the difference was statistically significant(P<0.05).Overweight infertility group in the seminal plasma IGF-1 is higher than normal weight infertility group and the difference was statistically significant.ROS count in seminal plasma of normal weight group (499.04±195.39) U/L was compared to the control group (438.00±134.17) U/L, the difference was not statistical significance. Overweight and obesity were higher than the control group, the difference was statistically significant. Overweight infertility infertility group of ROS (709.47±320.0) U/L in the seminal plasma is higher than control group, (438.00±134.17) U/L, the difference was statistically significant(P<0.05). ROS in seminal plasma obese group (812.93±243.30)U/L were higher than that of normal infertility group (499.04±195.39) U/L and the overweight, the difference was statistically significant(P<0.05). FFA count in seminal plasma of normal weight group (348.64±119.72) ng/ml was compared to the control group (382.56±150.25) ng/ml, the difference was not statistical significance. Overweight (535.81±133.90) ng/ml and obesity (595.26±146.69) ng/ml were higher than the control group, the difference was statistically significant(P<0.05). Overweight infertility infertility group of FFA in the seminal plasma is higher than normal weight group, the difference was statistically significant(P<0.05). FFA in seminal plasma obese group were higher than that of normal infertility group and the overweight, the difference was statistically significant(.P<0.05) INHB count in seminal plasma of normal weight group (30.61±11.17) ng/L was compared to the control group (35.30±13.79) ng/L, the difference was not statistical significance. Overweight (48.09±11.66) ng/L and obesity (48.40±13.95) ng/L were higher than the control group, the difference was statistically significant(P<0.05). Overweight infertility infertility group of INHB in the seminal plasma is higher than normal weight group, the difference was statistically significant(P<0.05).INHB in seminal plasma obese group were higher than that of normal infertility group, the difference was statistically significant(P<0.05). GSH-Px count in seminal plasma of normal weight group (116.73±30.06) U/ml was compared to the control group (127.31±22.32)U/ml, the difference was not statistical significance. Overweight (95.56±34.55) U/ml and obesity (84.47±29.81) U/ml were higher than the control group, the difference was statistically significant(P<0.05). Overweight infertility group of GSH-Px in the seminal plasma is less than normal weight group, the difference was statistically significant(P<0.05). GSH-Px in seminal plasma obese group were less than that of normal infertility group and the overweight, the difference was statistically significant(P<0.05). IL-1 count in seminal plasma of normal weight group (49.30±15.4) ng/L was compared to the control group (44.23±13.21) ng/L, the difference was not statistical significance. Overweight (63.90±14.00) ng/L and obesity (64.07±13.44) ng/L were higher than the control group, the difference was statistically significant(P<0.05). Overweight infertility infertility group of IL-1 in the seminal plasma is higher than normal weight group, the difference was statistically significant(P<0.05).IL-1 in seminal plasma obese group were higher than that of normal infertility group and the overweight, the difference was statistically significant(P<0.05)BMI was positively correlated with age (R=0.14, P<0.05); BMI and semen quantity showed a negative correlation (R=-0.29, P<0.01); BMI was positively correlated with FFA in seminal plasma (R=0.54, P<0.01); BMI was positively related with INHB (R=0.43, P<0.01); Positive correlation between IGF 1 and BMI (R=0.39, P< 0.01); BMI was positively related with ROS (R=0.49, P<0.01); BMI was positively correlated with IL-1 (R=0.43, P<0.01); Negatively correlated with BMI and GSH-Px (R=-0.45, P<0.01). In the seminal plasma FFA was positively related with INHB (R=0.47, P<0.01); Positive correlation between IGF 1 and FFA (R=0.19, P<0.01); FFA and ROS were positively correlated (R=0.28, P<0.01); FFA was positively correlated with IL-1 (R=0.34, P<0.01); FFA and negatively correlated with GSH-Px (R=-0.26, P<0.01). In the seminal plasma ROS was positively related with INHB (R=0.18, P< 0.01); Positive correlation between IGF 1 and ROS (R=0.63, P<0.01); ROS was positively correlated with IL-1 (R=0.32, P<0.01); ROS and negatively correlated with GSH-Px (R=-0.57, P<0.01).Sperm concentration and the total number of sperm, sperm forward movement rate was significantly increased, the difference was statistically significant (p< 0.05).Testosterone and estrogen both before and after treatment there was no statistically significant difference (p> 0.05). There are 2 patients had his wife is pregnant during treatmentConclusion:With the increase of male abdomen circumference, the total sperm and semen volume also decrease, liquefaction time gradually reduce,these factors will reduce the male fertility, lead to increased risk of male infertility. Androgen should be added in the treatment of obese patients with male infertility patients, patients should lose weight. We detect the above indicators to analyze the infetility effect of overweight and obesity provides theory basis for the cause of male infertility, and provide reference for clinical treatment. Detection of the index to analyze the effect of obesity provides theory basis for the cause of male infertility, and provide reference for clinical treatment.Through joint recombinant human growth hormone, needle letrozole treatment of obese patients with male infertility and oligo-atheno-spermia, we can improve the quality of sperm。Section Ⅲ:Research of Sperm Apotosis and Sperm DNA Integrity in Overweight and Obese Male Infertility PatientsObjective:In order to further understand the overweight and obesity in male fertility, to explore the early sperm apoptosis occurred and influence factors. In order to investigate the change of the obese male infertility patients with mitochondrial membrane potential,to explore relationship of sperm mitochondrial membrane、potential the reactive oxygen species.and free fatty acids in seminal plasma.Materials and methods:We randomly take samples control group:26 people,26 male infertility patients among overweight:12 people; Obesity groups:14 people. Semen routine detection, Annexin V-FITC/PI double dye the sperm, flow cytometry instrument to detect early sperm apoptosis rate, enzyme-linked immunoassay ELISA detecting reactive oxygen species in the seminal plasma, glutathione peroxidase.According to the research conditions,we randomly selected from the normal male 51 people as control group, patients with normal body mass index male sterility 36 people, overweight infertile men 44 people, obesity infertile men 45 people. Semen routine analysis, ELSA method detect GSH-Px,ROS in seminal plasma, flow cytometry instrument to detect sperm chromatin structure assay. ELSA method in the detection of seminal plasma free fatty acid, reactive oxygen species, flow cytometry instrument to detect sperm mitochondrial membrane potential.Results:In the early sperm apoptosis rate comparison and overweight (15.73±6.49)%, compared with the control group (10.48±6.21)% higher than that of the latter, there are significant difference (P<0.05). Obesity group (16.16±6.57)% compared with control group, higher than the latter, there are significant difference (P<0.05). Overweight and obese group compared with no significant difference (P>0.05). Body mass index (BMI) were negatively related with the rate of sperm activity in semen analysis (R=-0.31, P< 0.05), and the inactivity rate of sperm were positively correlated (R=0.31, P<0.05), and early sperm apoptosis rate was significantly positive correlation (R=0.41, P<0.01). Reactive oxygen species and early sperm apoptosis rate were positively correlated (R=0.61, P<0.01), glutathione peroxidase and sperm early apoptosis rate showed a negative correlation (R=-0.46, P<0.01). ROS in overweight infertility group [(614.15±301.92) u/1]. obesity infertility group [(750.66±221.00) u/l] were higher than the control group (445.73±143.82) u/l]. the difference was statistically significant (P<0.05). GSH-Px in overweight infertility group [(107.87±30.65) u/ml], obesity infertility group[(90.15±27.81) u/ml] were lower than the control group [(126.96±22.53) u/ml], the difference was statistically significant (P< 0.05).DFI in normal weight infertility group [(47.08±19.64)%,]over weight infertility group [(51.82±18.50)%]. obesity infertility group [(59.27±20.83)%] three group were higher than that of control group[[(35.63±18.85)%], the difference was statistically significant (P< 0.05). BMI was positively correlated with sperm DFI (R=0.27, P<0.27), Sperm DFI was negatively correlaed with sperm concentration (R=0.17, P<0.05). And negatively correlated with the total number of sperm (R=-0.19, P<0.05). ROS in seminal plasma was significantly positive correlation with sperm DFI (R=0.35, P<0.01). GSH-Px in seminal plasma was significantly negative correlation with sperm DFI (R=-0.36, P<0.01). The rate of normal mitochondrial membrane potential in normal weight infertility[(27.34±13.38)%], overweight infertility[(28.26±9.76)%], obesity infertility group[(25.27±7.51)%] were lower than the control group[(35.12±15.90)%], the difference was statistically significant (P<0.05). Although obesity infertility group normal rate of MMPS were lower than normal weight infertility group and the overweight infertility group, but no statistically significant difference. Sperm normal MMP and sperm progressive motility% was significantly positive correlation (R=0.29, P<0.01). In the seminal plasma FFA and ROS in seminal plasma was significantly positive correlation (R=0.30, P<0.01),ROS in seminal plasma and sperm normal MMP was significantly negative correlation (R=0.24, P< 0.01).Conclusion:Overweight and obese patients with male infertility in the seminal plasma level of reactive oxygen species increased, and glutathione peroxidase decrease in sperm early apoptosis rate increased, may lead to overweight, obesity affects male infertility. overweight and obese patients with male infertility elevate ROS,in the seminal plasma, ROS induce GSH-Px down, could eventually lead sperm chromatin integrity decline. Treatment should be considered to add antioxidants in treatment and advise patients reduce the high fat diet, proper exercise. overweight and obese patients with male infertility elevate FFA,in the seminal plasma,which cause increase ROS, ROS induce MMP down, could eventually lead sperm movement ability decline. Treatment should be considered to advise patients reduce the high fat diet, proper exercise. |
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