IVI-RMA, Basking Ridge, NJ; Sidney Kimmel Medical College, Thomas Jefferson University, Department of Reproductive Endocrinology and Infertility, Philadelphia, PA.
Foundation for Embryonic Competence, Basking Ridge, NJ.
Urology. 2019 Oct;132:109-116. doi: 10.1016/j.urology.2019.06.038. Epub 2019 Jul 19.
To determine whether a clinically-relevant change in the total motile sperm count (TMSC) over time exists within the subfertile population.
The first semen analysis of all men presenting to selected infertility centers in 2 countries between 2002 and 2017 were evaluated. Semen analyses were categorized into 3 clinically-relevant groups based on treatment options: TMSC >15 million (M) (Group 1), in which no insemination intervention would be required; TMSC 5-15 M (Group 2), in which intrauterine insemination would be appropriate; and TMSC of <5 M (Group 3), in which in vitro fertilization would be considered. Relationships between male age, TMSC, trend of TMSC, and TMSC group membership by year were assessed.
A total of 119,972 first semen analyses were included. The proportion of men with normal TMSC (>15 M) was found to decline approximately 10 percentage points over the past 16 years in the analysis of combined centers (odds ratio 0.967; 95% confidence interval = 0.963-0.971; P = 2.2e-16). A reciprocal increase was distributed between both the moderate (5-15 M) and severe (<5 M) oligozoospermia groups. Additionally, TMSC declined 1.1 percentage points with each year of advancing paternal age. No difference was seen in age at presentation by year.
The proportion of men with normozoospermia declined and that of men at risk of requiring fertility treatment increased over the study time period. Although several unknown factors may have influenced our data as a result of the retrospective design, a shift in treatment group membership over time may be clinically relevant.
确定在不育人群中，精子总活力计数（TMSC）随时间的变化是否存在临床相关变化。
评估了 2002 年至 2017 年间，2 个国家选定的不育中心就诊的所有男性的首次精液分析。根据治疗选择，精液分析分为 3 个具有临床意义的组：TMSC＞1500 万（M）（第 1 组），不需要进行授精干预；TMSC 5-15 M（第 2 组），适合宫腔内授精；TMSC＜5 M（第 3 组），考虑体外受精。评估了男性年龄、TMSC、TMSC 趋势与年度 TMSC 组别的关系。
共纳入 119972 例首次精液分析。综合中心分析发现，过去 16 年来，正常 TMSC（＞15 M）男性的比例下降了约 10 个百分点（比值比 0.967；95%置信区间为 0.963-0.971；P=2.2e-16）。中度（5-15 M）和重度（＜5 M）少精子症组的比例相应增加。此外，TMSC 随父亲年龄的增加每年下降 1.1 个百分点。每年就诊时的年龄无差异。
在研究期间，正常精子症男性的比例下降，需要生育治疗的男性比例增加。尽管由于回顾性设计，一些未知因素可能影响了我们的数据，但随时间推移治疗组别的变化可能具有临床意义。
