Punjani Nahid, Alawamlh Omar Al-Hussein, Kim Soo Jeong, Salter Carolyn A, Wald Gal, Feliciano Miriam, Williams Nicholas, Dudley Vanessa, Goldstein Marc
Center for Reproductive Medicine and Surgery, Institute for Reproductive Medicine and Department of Urology, Weill Cornell Medicine, New York, NY, USA.
Department of Biostatistics, Weill Cornell Medicine, New York, NY, USA.
World J Mens Health. 2023 Apr;41(2):382-389. doi: 10.5534/wjmh.210201. Epub 2022 Jun 13.
To examine trends of population-level semen quality over a 20-year period.
We performed a retrospective review of data from the andrology lab of a high volume tertiary hospital. All men with semen samples between 2000 and 2019 were included and men with azoospermia were excluded. Semen parameters were reported using the World Health Organization (WHO) 4th edition. The primary outcome of interest was changes in semen parameters over time. Generalized least squares (GLS) with restricted cubic splines were used to estimate average-monthly measurements, adjusting for age and abstinence period. Contrasts of the estimated averages based on GLS between the first and last months of collection were calculated.
A total of 8,990 semen samples from subfertile non-azoospermic men were included in our study. Semen volume decreased over time and estimate average at the beginning and end were statistically different (p<0.001). Similarly sperm morphology decreased over time, with a statistically significant difference between estimated averages from start to finish (p<0.001). Semen pH appeared to be increasing over time, but this difference was not significant over time (p=0.060). Sperm concentration and count displayed an increase around 2003 to 2005, but otherwise remained fairly constant over time (p=0.100 and p=0.054, respectively). Sperm motility appeared to decrease over time (p<0.001).
In a large sample of patients presenting to a single institution for fertility assessment, some aspects of semen quality declined across more than two decades. An understanding of the etiologies and driving forces of changing semen parameters over time is warranted.
研究20年间人群水平精液质量的变化趋势。
我们对一家大型三级医院男科实验室的数据进行了回顾性分析。纳入2000年至2019年间所有有精液样本的男性，排除无精子症患者。精液参数按照世界卫生组织（WHO）第4版进行报告。主要观察指标是精液参数随时间的变化。采用广义最小二乘法（GLS）和受限立方样条估计每月平均测量值，并对年龄和禁欲时间进行校正。计算基于GLS的采集首末月估计平均值的对比。
我们的研究共纳入了8990例来自亚生育力非无精子症男性的精液样本。精液量随时间减少，开始和结束时的估计平均值在统计学上有差异（p<0.001）。同样，精子形态随时间下降，开始和结束时的估计平均值有统计学显著差异（p<0.001）。精液pH值似乎随时间增加，但随时间差异不显著（p=0.060）。精子浓度和计数在2003年至2005年左右有所增加，但其他时间基本保持稳定（分别为p=0.100和p=0.054）。精子活力似乎随时间下降（p<0.001）。
在一个到单一机构进行生育力评估的大样本患者中，精液质量的某些方面在二十多年间有所下降。有必要了解精液参数随时间变化的病因和驱动因素。
