Holt W V
Institute of Zoology, Zoological Society of London, Regent's Park, London NW1 4RY, UK.
Hum Reprod. 2005 Nov;20(11):2983-6. doi: 10.1093/humrep/dei189. Epub 2005 Jul 8.
In a provocative article to this Journal, Anne Jecquier, an eminent andrologist who, more than 20 years ago, was a prime mover in suggesting the need for quality assurance (QA) in andrology laboratories, has now proposed that the QA schemes may no longer be needed. Here I reply to that proposition, largely by agreeing that, since the QA schemes have brought about higher technical standards in laboratories, Anne Jecquier's assertion is possibly true. However, vigilance is still needed in discriminating between unproductive investment of time and energy in the refinement of tests that may offer little information about fertility, and maintaining technical standards such that where necessary they provide the requisite information. Thus, although it may not matter in practice whether a sperm concentration is estimated as 100 or 200 x 10(6)/ml, distinguishing between 25 and 100 x 10(6)/ml would probably influence a clinician's treatment decisions. Anne Jecquier also suggested that sperm function tests have limited predictive value in terms of fertility assessment. While I agree that this is largely true at present, I also argue that these tests are probably not developed to their full potential. I am optimistic that tests to distinguish and quantify the population of fertilization-competent sperm within an ejaculate will eventually become available.
在一篇发表于本刊的颇具争议性的文章中，杰出的男科学家安妮·杰奎尔提出，质量保证（QA）方案可能不再必要。20多年前，她是倡导男科实验室需要质量保证的主要推动者。在此，我对这一观点作出回应，大体上同意安妮·杰奎尔的看法，即由于质量保证方案已使实验室达到了更高的技术标准，她的断言可能是正确的。然而，在区分那些对生育力提供信息甚少的检测项目上投入时间和精力的非生产性投资，以及维持技术标准以在必要时提供所需信息方面，仍需保持警惕。因此，虽然在实际操作中精子浓度估计为100还是200×10⁶/ml可能无关紧要，但区分25×10⁶/ml和100×10⁶/ml可能会影响临床医生的治疗决策。安妮·杰奎尔还指出，精子功能检测在生育力评估方面的预测价值有限。虽然我认同目前大体如此，但我也认为这些检测可能尚未发挥出全部潜力。我乐观地认为，最终将会有检测方法来区分和量化射精中具有受精能力的精子群体。
