Liversedge N H, Jenkins J M, Keay S D, McLaughlin E A, Al-Sufyan H, Maile L A, Joels L A, Hull M G
Department of Obstetrics and Gynaecology, University of Bristol, St Michael's Hospital, Bristol, BS2 8EG, UK.
Hum Reprod. 1996 Jun;11(6):1227-31. doi: 10.1093/oxfordjournals.humrep.a019361.
We questioned the policy of routine microbiological culture of semen prior to in-vitro fertilization (IVF) with a view to prescribing antibiotics to reduce the risk of introducing seminal infection into the embryo culture system. An initial retrospective study examined serum microbiology reports of 449 couples undergoing IVF or gamete intra-Fallopian transfer (GIFT). In semen samples taking >/=1 days to reach the microbiology laboratory compared with same-day delivery there was increased frequency of significant culture of enterococci (27 versus 15%, P < 0.01). In samples taking >/=2 days there was increased frequency of significant culture of Gram-negative bacilli (31 versus 12%, P < 0.01) and of overall culture of other potentially pathogenic organisms (26 versus 14%, P < 0.01). We questioned diagnostic accuracy and relevance. Therefore, in a prospective study, semen and high vaginal swabs obtained on the day of oocyte collection were cultured from 100 couples having IVF or GIFT, of whom 52 male partners had been treated with antibiotics following positive pre-IVF semen culture. The presence of bacteria in semen samples used only for IVF (n = 90) did not reduce fertilization rates nor lead to infection of the embryo culture system. However, there was an increased incidence of significant culture of vaginal Gram-negative bacilli in patients with treated partners compared with untreated partners [15/52 (29%) versus 5/48 (10%), P < 0.05]. Thus antibiotic therapy in the male partner may increase the likelihood of inoculation of antibiotic-resistant pathogenic bacteria from the vagina into the embryo culture system during vaginal oocyte collection. In asymptomatic patients, microbiological screening of semen samples prior to IVF treatment and subsequent treatment with antibiotic therapy in those with positive cultures appears to be unnecessary and may be detrimental to IVF outcome.
我们对体外受精（IVF）前进行精液常规微生物培养的政策提出质疑，目的是开具抗生素以降低将精液感染引入胚胎培养系统的风险。一项初步回顾性研究检查了449对接受IVF或配子输卵管内移植（GIFT）夫妇的血清微生物学报告。与当天送检的精液样本相比，送达微生物实验室时间≥1天的精液样本中，肠球菌显著培养的频率增加（27%对15%，P<0.01）。送达时间≥2天的样本中，革兰氏阴性杆菌显著培养的频率增加（31%对12%，P<0.01），其他潜在致病生物体的总体培养频率也增加（26%对14%，P<0.01）。我们对诊断准确性和相关性提出质疑。因此，在一项前瞻性研究中，对100对接受IVF或GIFT的夫妇在卵母细胞采集当天获取的精液和高阴道拭子进行培养，其中52名男性伴侣在IVF前精液培养呈阳性后接受了抗生素治疗。仅用于IVF的精液样本（n=90）中存在细菌，既未降低受精率，也未导致胚胎培养系统感染。然而，与未治疗伴侣相比，伴侣接受治疗的患者中阴道革兰氏阴性杆菌显著培养的发生率增加[15/52（29%）对5/48（10%），P<0.05]。因此，男性伴侣使用抗生素治疗可能会增加在经阴道卵母细胞采集过程中，阴道内耐抗生素病原菌接种到胚胎培养系统的可能性。对于无症状患者，IVF治疗前对精液样本进行微生物筛查以及对培养阳性者随后进行抗生素治疗似乎没有必要，而且可能对IVF结局有害。
