Guérin J F
Département de gynécologie, oncologie gynécologique, sénologie, médecine de la reproduction, hôpital Edouard-Herriot, Lyon.
Rev Prat. 1993 Apr 15;43(8):932-5.
The evaluation of male infertility rationally begins with a study of the characteristics of the semen, notably sperm count and motility assessment. However, this examination is difficult to interpret due to the important intra- and interindividual variability of these parameters, making it impossible to determine accurately the criteria of "normality". In each given subject the characteristics of semen can be influenced by the conditions of sample collection, the length of abstinence, and any disease that may have occurred in the 3 months preceding the examination. To draw firm conclusions from one single examination would be misleading and a second examination is advised. The criteria of normality laid down by WHO are not very useful to determine the degree of fertility in males: one may speak of oligozoospermia when the sperm count is below 20 million/ml, but several recent prospective studies have shown that fertility significantly falls only below 5 million/ml. A threshold value concerning the percentage of normal forms has been established at 30-40%, whereas teratozoospermia has been defined by the WHO as from 50% onwards. Sperm count can be completed by a fine analysis of sperm motions, and this has been made possible by the development of digital microvideographic analysis techniques. However, defining norms for the main parameters of sperm motility is delicate and can only be done by teams of specialists.
男性不育的评估合理地始于对精液特征的研究，尤其是精子数量和活力评估。然而，由于这些参数在个体内和个体间存在重要的变异性，这项检查难以解释，从而无法准确确定“正常”标准。在每个特定个体中，精液特征会受到样本采集条件、禁欲时间以及检查前3个月内可能发生的任何疾病的影响。仅根据一次检查就得出确凿结论会产生误导，因此建议进行第二次检查。世界卫生组织制定的正常标准对于确定男性生育能力的程度并非非常有用：当精子数量低于2000万/毫升时，可称为少精子症，但最近的几项前瞻性研究表明，只有当精子数量低于500万/毫升时，生育能力才会显著下降。正常形态百分比的阈值已确定为30% - 40%，而世界卫生组织将畸形精子症定义为从50%起。精子数量分析可通过对精子运动的精细分析来完善，数字显微摄像分析技术的发展使之成为可能。然而，确定精子活力主要参数的标准很微妙，只能由专家团队来完成。
