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关于精子完整性与生殖成功率的体外受精程序数据研究。

Examination of data from programs of in vitro fertilization in relation to sperm integrity and reproductive success.

作者信息

Rogers B J

机构信息

Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN 37232.

出版信息

Prog Clin Biol Res. 1989;302:69-89; discussion 90-3.

PMID:2666992
Abstract

This paper reviews the work of 11 different in vitro fertilization (IVF) groups from around the world in an effort to determine the effectiveness of IVF as a therapy for male factor infertility as well as threshold values for semen parameters that are synonymous with success. Two key questions that are asked are: 1) What fertilization rate is expected for male factor patients and 2) Can we predict which patients will fertilize. The immediate problem which arises in attempting to compare results from various groups is that there is no standardization in male factor criteria. This lack of agreement in what constitutes an abnormal semen sample is also reflected in the fertilization rates and threshold values. The first group reviewed (Mahadevan, 1983) suggest greater than 20% motile in the initial semen sample as a threshold value required for success while the second group (Cohen, 1985) presents 6 couples with less than 20% motility achieving pregnancy. Such inconsistencies in results are typical of this confusing and controversial area. Fertilization in IVF has been achieved with as few as 2 x 10(6) sperm/ml or as low as only 2% motility in the initial semen sample. It appears that most workers would agree that the lower limits of traditional semen parameters that are compatible with success are not well defined. Consensus might also be reached on the fact that fertilization rates are usually significantly lower in male factor cases than in normal semen parameters coupled with tubal infertility. Beyond those two factors, little agreement is found in the literature. The spectrum of methodology for semen processing is very broad and often not clearly detailed. In addition to the additional semen parameters of count, motility, and morphology, attempts have been made to establish other prognostic tests such as the sperm penetration assay (SPA), acrosome reaction determinations, and motility parameters such as velocity, linearity and lateral head displacement. Controversy abounds concerning the value of these newer tests. Threshold values for acrosome reaction and motility parameters have not been established. The SPA is believed to be highly predictive by some and unreliable by others. The one redeeming feature of this IVF male factor area is that it seems to be one of the most effect treatments for male factor infertility.

摘要

本文回顾了来自世界各地11个不同体外受精(IVF)小组的工作,旨在确定IVF作为男性因素不孕症治疗方法的有效性以及与成功同义的精液参数阈值。提出的两个关键问题是:1)男性因素患者的预期受精率是多少,以及2)我们能否预测哪些患者会受精。在试图比较各个小组的结果时出现的直接问题是,男性因素标准没有标准化。在什么构成异常精液样本方面缺乏一致性也反映在受精率和阈值上。审查的第一组(马哈德万,1983年)建议初始精液样本中活力大于20%作为成功所需的阈值,而第二组(科恩,1985年)提出6对活力低于20%的夫妇实现了怀孕。结果中的这种不一致是这个令人困惑和有争议的领域的典型特征。IVF中,初始精液样本中每毫升仅有2×10⁶个精子或活力低至仅2%时也实现了受精。似乎大多数研究人员都同意,与成功相容的传统精液参数下限没有得到很好的界定。对于受精率在男性因素病例中通常明显低于正常精液参数合并输卵管性不孕这一事实,也可能达成共识。除了这两个因素外,文献中几乎没有达成一致意见。精液处理的方法范围非常广泛,而且往往没有详细说明。除了计数、活力和形态等额外的精液参数外,还尝试建立其他预后测试,如精子穿透试验(SPA)、顶体反应测定以及活力参数,如速度、线性度和头部侧向位移。关于这些新测试的价值存在诸多争议。顶体反应和活力参数的阈值尚未确定。一些人认为SPA具有高度预测性,而另一些人则认为它不可靠。IVF男性因素领域的一个可取之处在于,它似乎是男性因素不孕症最有效的治疗方法之一。

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