体外受精中缺乏严格标准的精液分析是否会误导决策？一项前瞻性系统研究。

Is semen analysis without strict criteria misleading decisions in IVF? A prospective systematic study.

作者信息

Paul Faduola, Obajimi Gbolahan Oladele, Kolade Charles Olubukunmi

机构信息

Vine Branch Fertility Clinic, Mokola, Ibadan, Nigeria.

University of Ibadan, College of Medicine, Department of Obstetrics and Gynaecology and University College Hospital, Ibadan, Nigeria.

出版信息

Int J Reprod Biomed. 2018 Jul;16(7):459-462.

PMID:30234187

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6129371/

Abstract

BACKGROUND

Sperm morphology has been strongly linked to fertilization. This makes it an important component in semen analysis. They are usually assessed by world health organization (WHO) standard or Kruger strict criteria in in-vitro fertilization (IVF) centers all over the world. Sperm count, motility, and morphology together form the basis by which patients are allocated into IVF or intra-cytoplasmic sperm injection.

OBJECTIVE

This study aimed to compare fertilization rates in standard IVF from patients with normal sperm count and motility with and without morphological assessment by WHO guideline.

MATERIALS AND METHODS

In this prospective cohort study, sperm count, motility, and morphology of 504 men candidate for IVF program over a three years period in our center were evaluated in two groups: Group A (case group) included men with normal sperm count and motility but with a poor morphology and group B (control group) included men with normal sperm count, motility and morphology evaluated by WHO criteria. Fertilization rate in both groups were then analyzed after 16-18 hr post insemination.

RESULTS

Fertilization rate was higher in group B (p=0.028). Participants in group B, apart from having a normal sperm count (32.9±7.2) and motility (62.4±8.9), have a strict morphology of ≥30%. Our result has shown that spermatozoa in group B had a higher fertilization rate (71.4%). Though the sperm count (36.4±6.7) and motility (66.3±7.4) in group A were slightly higher (p=0.058 and p=0.060 respectively) than group B, the fertilization rate was lower.

CONCLUSION

Our study showed that sperm morphology could be a very important consideration before decisions towards allocation of patients into IVF or intra-cytoplasmic sperm injection.

摘要

背景

精子形态与受精密切相关。这使其成为精液分析的重要组成部分。在世界各地的体外受精（IVF）中心，精子形态通常按照世界卫生组织（WHO）标准或克鲁格严格标准进行评估。精子数量、活力和形态共同构成了将患者分配到IVF或卵胞浆内单精子注射的依据。

目的

本研究旨在比较按照WHO指南对精子数量和活力正常的患者进行标准IVF时，有或没有形态学评估情况下的受精率。

材料与方法

在这项前瞻性队列研究中，将我们中心三年内504名接受IVF治疗的男性的精子数量、活力和形态分为两组进行评估：A组（病例组）包括精子数量和活力正常但形态不佳的男性，B组（对照组）包括按照WHO标准评估精子数量、活力和形态均正常的男性。授精后16 - 18小时分析两组的受精率。

结果

B组的受精率更高（p = 0.028）。B组参与者除了精子数量正常（32.9±7.2）和活力正常（62.4±8.9）外，严格形态学标准下的精子比例≥30%。我们的结果表明，B组精子的受精率更高（71.4%）。尽管A组的精子数量（36.4±6.7）和活力（66.3±7.4）略高于B组（分别为p = 0.058和p = 0.060），但其受精率较低。