Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, Brazil.
Reprod Biol Endocrinol. 2011 Aug 23;9:120. doi: 10.1186/1477-7827-9-120.
Although the motile sperm organelle morphology examination (MSOME) was developed merely as a selection criterion, its application as a method for classifying sperm morphology may represent an improvement in the evaluation of semen quality. The aim of this study was to determine the prognostic value of normal sperm morphology using MSOME with regard to clinical pregnancy (CP) after intrauterine insemination (IUI).
A total of 156 IUI cycles that were performed in 111 couples were prospectively analysed. Each subject received 75 IU of recombinant FSH every second day from the third day of the cycle. Beginning on the 10th day of the cycle, follicular development was monitored by vaginal ultrasound. When one or two follicles measuring at least 17 mm were observed, recombinant hCG was administered, and IUI was performed 12-14 h and 36-40 h after hCG treatment. Prior to the IUI procedure, sperm samples were analysed by MSOME at 8400× magnification using an inverted microscope that was equipped with DIC/Nomarski differential interference contrast optics. A minimum of 200 motile spermatozoa per semen sample were evaluated, and the percentage of normal spermatozoa in each sample was determined.
Pregnancy occurred in 34 IUI cycles (CP rate per cycle: 21.8%, per patient: 30.6%). Based on the MSOME criteria, a significantly higher percentage of normal spermatozoa was found in the group of men in which the IUI cycles resulted in pregnancy (2.6+/-3.1%) compared to the group that did not achieve pregnancy (1.2+/-1.7%; P = 0.019). Logistic regression showed that the percentage of normal cells in the MSOME was a determining factor for the likelihood of clinical pregnancy (OR: 1.28; 95% CI: 1.08 to 1.51; P = 0.003). The ROC curve revealed an area under the curve of 0.63 and an optimum cut-off point of 2% of normal sperm morphology. At this cut-off threshold, using the percentage of normal sperm morphology by MSOME to predict pregnancy was 50% sensitive with a 40% positive predictive value and 79% specificity with an 85% negative predictive value. The efficacy of using the percentage of normal sperm morphology by MSOME in predicting pregnancy was 65%.
The present findings support the use of high-magnification microscopy both for selecting spermatozoa and as a routine method for analysing semen before performing IUI.
虽然精子运动器官形态检查（MSOME）仅作为一种选择标准而开发，但将其应用于精子形态分类可能会改善精液质量评估。本研究旨在通过 MSOME 确定正常精子形态对宫腔内人工授精（IUI）后临床妊娠（CP）的预后价值。
前瞻性分析了 111 对夫妇的 156 个 IUI 周期。每位受试者从周期的第三天开始每两天接受 75IU 的重组 FSH。从周期的第 10 天开始，通过阴道超声监测卵泡发育。当观察到至少 17mm 的一个或两个卵泡时，给予重组 hCG，hCG 治疗后 12-14 小时和 36-40 小时进行 IUI。在 IUI 程序之前，使用配备 DIC/Nomarski 微分干涉对比光学的倒置显微镜在 8400×放大倍数下通过 MSOME 分析精子样本。对每个样本中的至少 200 个活动精子进行评估，并确定每个样本中正常精子的百分比。
34 个 IUI 周期发生妊娠（周期妊娠率：21.8%，患者妊娠率：30.6%）。根据 MSOME 标准，在导致妊娠的 IUI 周期中，男性的正常精子百分比明显高于未妊娠组（2.6±3.1%比 1.2±1.7%；P=0.019）。逻辑回归显示，MSOME 中的正常细胞百分比是临床妊娠可能性的决定因素（OR：1.28；95%CI：1.08 至 1.51；P=0.003）。ROC 曲线显示曲线下面积为 0.63，最佳截断点为 2%的正常精子形态。在此截断阈值下，使用 MSOME 测量的正常精子形态百分比预测妊娠的敏感性为 50%，阳性预测值为 40%，特异性为 79%，阴性预测值为 85%。使用 MSOME 测量的正常精子形态百分比预测妊娠的效能为 65%。
本研究结果支持在进行 IUI 之前，使用高倍显微镜选择精子和常规方法分析精液。
