不妊治療の現状と展望 : 特に男性不妊
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概要
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About 90% of male infertile patients are complaint of semen with poor quality, and of which majority are caused by idiopathic disturbance of spermatogenesis. To date, various trials have been made to stimulate spermatogenesis by means of pharmaceutital administrations, their efficacies were, however, poor as expected. The treatment of the patients with poor quality semen is, therefore, mainly focused on artificial insemination, such as intrauterine insemination (IUI) and in vitro fertilization-embryo transfer (IVF-ET), etc. (1) To inseminate the sperm artificially, it is necessary to separate progressively motile sperm with normal morphology from seminal plasma, immotile and abnormal sperm, leucocytes and bacteria. There are two methods for separating progressively motile sperm, one is the density gradient centrifugation and another is the diffusion by their own motility. We have developed various types of density gradients using Percoll, a modified silica gel; the mono-layer Percoll method and the cushion method are employed for sperm concentration, and the discontinuous Percoll density gradient with 4 steps and the continuous-step density gradient are capable of separating progressively motile sperm. The continuous-step density gradient have been employed for 271 cases of IUI, and successful 84 pregnancies were obtained with the pregnancy rate of 30.9%. (2) Cryopreservation of sperm produce various advantages in the treatment of male infertility. Cryoaccumulation of oligozoospermic semen is effective for obtaining a sufficient number of sperm, and frequent insemination with cryopreserved sperm increase the chance of fetilization. To improve the quality of cryopreserved sperm, ejaculated semen was concentrated prior freezing by means of the continuous-step density gradient. Freezing was simplified by employing liquid nitrogen vapor with the newly developed cryo-medium, KS-II medium. Application of cryoaccumultion method to 134 cases of IUI gave 14 pregnancies with the pregnancy rate of 9.8%. Addition of pentoxifilline, a phosphodiesterase inhibitor, prior to freezing improved post thaw sperm motility. (3) Our new approach for artificial insemination, "hysteroscopic insemination into tube (HIT)", have succeeded to transfer the sperm into the tube under the histeroscopic guidance. More than 40 pregnancies have been obtained. (4) The above achievements have produced successful two pregnancies in the cases of retrograde ejaculation and obstructive azoospermia. After retrograde ejaculation, the sperm recovered from the bladder was cryoaccumulated, and the several ejaculates were combined and inseminated through HIT. In the case of obstructive azoospermia, an artificial spematoseal was acquired on the epididymis, and the sperm suctioned from the spermetoseal was cryoaccumulated and provided for IVF-ET.
- 社団法人日本産科婦人科学会の論文
- 1992-08-01
著者
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