Guérif F
Service de médecine et biologie de la reproduction, CHRU de Tours, hôpital Bretonneau, 2, bis, boulevard Tonnellé, 37044 Tours, France.
Gynecol Obstet Fertil. 2010 Sep;38(9):508-10. doi: 10.1016/j.gyobfe.2010.07.002. Epub 2010 Aug 7.
Semen analysis is routinely part of the evaluation of male fertility and includes sperm morphology. How sperm morphology can be a diagnostic tool to decide which ART to apply for infertile couples (insemination, classical IVF or ICSI)? Teratozoospermia has been reported to be one of the most relevant semen parameters of clinical interest compared with sperm concentration and sperm motility. However, the true potential of this parameter has some limitations because of several methodological factors: differences in the classification systems, influence of the staining method used, subjective nature of evaluation of sperm morphology, regular decreasing of the WHO threshold. According to Tygerberg strict criteria that is the most frequently used classification worldwide, poor fertilization has been reported when the rate of normal forms was less or equal to 4%, suggesting to perform ICSI. However, influence of sperm morphology on fertilization outcome remains much debated. Regarding David's classification, the threshold of 30% does seem helpful to discriminate in the prediction of fertilization success and should probably be reconsidered.
精液分析是男性生育力评估的常规组成部分，包括精子形态学。精子形态学如何成为一种诊断工具，以决定为不孕夫妇采用何种辅助生殖技术（人工授精、传统体外受精或卵胞浆内单精子注射）？与精子浓度和精子活力相比，畸形精子症据报道是临床上最相关的精液参数之一。然而，由于几个方法学因素，该参数的真正潜力存在一些局限性：分类系统的差异、所用染色方法的影响、精子形态评估的主观性、世界卫生组织阈值的不断降低。根据全球最常用的泰格堡严格标准，当正常形态率小于或等于4%时，据报道受精不良，建议进行卵胞浆内单精子注射。然而，精子形态对受精结果的影响仍存在诸多争议。关于大卫的分类，30%的阈值似乎确实有助于区分受精成功的预测，可能应该重新考虑。
