Lindheim S R, Barad D H, Zinger M, Witt B, Amin H, Cohen B, Fisch H, Barg P
Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Fertility Hormone Center of Montefiore Medical Center, Dobbs Ferry, New York 10522, USA.
J Assist Reprod Genet. 1996 Aug;13(7):569-72. doi: 10.1007/BF02066610.
The purpose of this study was to assess the predictive value of a modified form of Kruger's strict criteria for sperm morphology for pregnancy outcomes after intrauterine insemination (IUI) and controlled ovarian hyperstimulation (COH) in the presence of normal sperm concentration and motility.
A retrospective review of 42 couples undergoing COH/IUI was stratified by favorable or unfavorable sperm morphology. End points were pregnancy or failure of treatment as defined by four or more cycles of COH/ IUI without pregnancy.
An unfavorable morphology (< 4%) was highly predictive of failure during COH-IUI (94.45%; 17/18). A normal PIF was a sensitive indicator of those patients who became pregnant (93.8%; 15/16) and had a fair specificity for failure to achieve pregnancy after four cycles of treatment (65.4%; 17/26). Couples with a favorable sperm morphology were 28.3 times as likely to achieve a pregnancy within four cycles of treatment as those with unfavorable sperm morphology [95% confidence limits, 3.2 to 250.5; P < 0.001].
Abnormal strict morphologic assessment is both sensitive and specific for pregnancy outcomes in couples undergoing COH/IUI. Couples with persistently unfavorable sperm morphology should be counseled appropriately and would be better served by more aggressive treatment with in vitro fertilization and embryo transfer.
本研究旨在评估在精子浓度和活力正常的情况下，改良版克鲁格精子形态严格标准对宫腔内人工授精（IUI）及控制性卵巢过度刺激（COH）后妊娠结局的预测价值。
对42例行COH/IUI的夫妇进行回顾性研究，根据精子形态是否良好进行分层。终点指标为妊娠或治疗失败，治疗失败定义为经过四个或更多周期的COH/IUI仍未妊娠。
形态不佳（<4%）对COH-IUI期间的治疗失败具有高度预测性（94.45%；17/18）。正常的预测指标因子（PIF）是妊娠患者的敏感指标（93.8%；15/16），对于四个周期治疗后未妊娠的情况具有一定的特异性（65.4%；17/26）。精子形态良好的夫妇在四个周期治疗内妊娠的可能性是精子形态不佳夫妇的28.3倍[95%置信区间，3.2至250.5；P<0.001]。
异常严格的形态学评估对于接受COH/IUI的夫妇的妊娠结局具有敏感性和特异性。精子形态持续不佳的夫妇应得到适当咨询，体外受精和胚胎移植等更积极的治疗可能对他们更有益。
