Department of Reproductive Biology, Nîmes University Hospital, Nîmes, France.
Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, Nîmes University Hospital, Nîmes, France.
PLoS One. 2024 Jul 15;19(7):e0307080. doi: 10.1371/journal.pone.0307080. eCollection 2024.
In the field of male infertility, when sperm is normal/subnormal, a few "add-on" routine tests can complete the basic semen examination.
The aim of this study was to develop and evaluate a faster, simplified motile sperm organelle morphology examination (MSOME) technique for selected infertile patients with apparently normal/subnormal sperm and, in their background: failure of two or three intrauterine insemination (IUI) cycles, repeatedly fragmented embryos, embryonic development to blastocyst-stage failures, repeated miscarriages, a long period of infertility or 2 or more IVF attempts without pregnancy. Our test results were correlated with IUI, conventional in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and intracytoplasmic morphologically selected sperm injection (IMSI) outcomes.
We validated an adapted version of the MSOME analysis called the pre-IMSI test (PIT), based on vacuole evaluation alone. 248 infertile patients from our assisted reproductive technology (ART) Center were retrospectively selected and split into three PIT score subgroups (patients with ≤8% (score I), 9 to 15% (score II) and ≥16% normal spermatozoa (score III)) based on the correlation between PIT results and each ART technique outcome. The choice of one or another of these ART techniques had been made according to the usual clinico-biological criteria.
Clinical outcomes for each of the three PIT subgroups were compared individually for the different ART techniques. For ICSI, the effect of the PIT score subgroup was significant for clinical pregnancies (p = 0.0054) and presented a trend for live births (p = 0.0614). Miscarriage rates of IVF attempts were statistically different depending on the PIT score (p = 0.0348). Furthermore, the odds ratios of clinical pregnancy rates were significantly different according to PIT score subgroup when comparing ICSI vs. IMSI or IVF vs. ICSI attempts.
IMSI appears to be recommended when sperm belongs to PIT score I, ICSI when it belongs to PIT score II and IVF or IUI when sperm is of PIT score III quality in selected infertile couples. The lack of statistical power in these PIT subgroups means that we must remain cautious in interpreting results.
Our results support the interest of this simplified test for certain couples with normal/subnormal sperm to help choose the most efficient ART technique, even as first-line treatment.
在男性不育领域，当精子正常/异常时，一些“附加”常规测试即可完成基本的精液检查。
本研究旨在开发和评估一种更快、更简化的精子运动器官形态检查（MSOME）技术，用于选择那些精子看似正常/异常但有以下情况的不孕患者：两次或三次宫腔内人工授精（IUI）失败、胚胎碎片严重、胚胎发育至囊胚阶段失败、反复流产、不孕时间较长或 2 次以上 IVF 尝试未怀孕。我们的测试结果与 IUI、常规体外受精（IVF）、胞浆内单精子注射（ICSI）和胞浆内形态选择精子注射（IMSI）的结果相关。
我们基于空泡评估验证了一种改良的 MSOME 分析方法，称为 pre-IMSI 测试（PIT）。我们从辅助生殖技术（ART）中心回顾性选择了 248 名不孕患者，根据 PIT 结果与每种 ART 技术结果之间的相关性，将其分为三个 PIT 评分亚组（精子正常率≤8%（评分 I）、9%至 15%（评分 II）和≥16%（评分 III））。选择一种或另一种 ART 技术是根据通常的临床生物学标准做出的。
我们分别比较了每个 PIT 亚组的三个亚组的临床结果与不同的 ART 技术。对于 ICSI，PIT 评分亚组对临床妊娠（p=0.0054）有显著影响，对活产有趋势（p=0.0614）。IVF 尝试的流产率因 PIT 评分而异（p=0.0348）。此外，比较 ICSI 与 IMSI 或 IVF 与 ICSI 尝试时，根据 PIT 评分亚组，临床妊娠率的优势比有显著差异。
在选择不孕夫妇时，如果精子属于 PIT 评分 I，建议使用 IMSI；如果精子属于 PIT 评分 II，建议使用 ICSI；如果精子属于 PIT 评分 III，建议使用 IVF 或 IUI。这些 PIT 亚组的统计效能不足意味着我们在解释结果时必须保持谨慎。
我们的结果支持对某些精子正常/异常的夫妇进行这种简化测试，以帮助选择最有效的 ART 技术，甚至作为一线治疗。
