Zollner U, Schleyer M, Steck T
Department of Obstetrics and Gynecology, University of Würzburg, Germany.
Hum Reprod. 1996 Oct;11(10):2155-61. doi: 10.1093/oxfordjournals.humrep.a019068.
The predictive value of sperm morphology evaluation using strict criteria (MEUSC) on fertilization and pregnancy rates was evaluated in 60 couples undergoing in-vitro fertilization (IVF) and embryo transfer. In all, 47 of the male partners had a progressive sperm motility < 50% with a density > 20 x 10(6)/ml (asthenozoospermia) and 13 had normozoospermia. MEUSC was performed on the same semen sample that was used for IVF on at least 100 spermatozoa after Papanicolaou staining at x 1250 magnification. Defects in the head, mid-piece and tail were counted separately, borderline forms were classified as abnormal and the teratozoospermia index was calculated for each sample. Of the spermatozoa in the asthenozoospermic group, 13.0% were judged as normal on MEUSC versus 19.8% in normozoospermia (P = 0.0013). The number of normal spermatozoa on MEUSC correlated with the progressive motility in asthenozoospermia (rho = 0.41, P = 0.0043). Defects in the mid-piece (P = 0.0004) and tail (P = 0.025) were more common, and the teratozoospermia index (P = 0.015) was higher in asthenozoospermic than normozoospermic samples. The parameters of MEUSC did not correlate with the fertilization rate. In asthenozoospermia, differences in fertilization rates were calculated for each cut-off value between 4 and 10% normal spermatozoa on MEUSC. A cut-off value of 6% gave the best statistical power. If > 6% of spermatozoa were normal, a median of 66.7% of ova were fertilized, compared with a median fertilization rate of 35.4% if < or = 6% of spermatozoa were normal (P = 0.022). The highest cut-off value still giving significant discrimination was 8% (normal MEUSC > 8%, median fertilization rate 66.7%; < or = 8%, median fertilization rate 35.7%, P = 0.028), and this may be used as the critical value for normal morphology in asthenozoospermia. It is concluded that despite a significant linear relationship between morphology using strict criteria and progressive motility, MEUSC is still useful as a predictor for fertilization in asthenozoospermia. In cases of asthenozoospermia with < or = 8% normal spermatozoa on MEUSC, micromanipulation should be considered.
在60对接受体外受精（IVF）和胚胎移植的夫妇中，评估了使用严格标准的精子形态学评估（MEUSC）对受精率和妊娠率的预测价值。总共有47名男性伴侣的精子进行性运动能力<50%，密度>20×10⁶/ml（弱精子症），13名男性伴侣精子正常。在1250倍放大倍数下进行巴氏染色后，对用于IVF的同一份精液样本至少100条精子进行MEUSC评估。分别计数头部、中段和尾部的缺陷，临界形态归为异常，并计算每个样本的畸形精子指数。弱精子症组中，MEUSC判定为正常的精子为13.0%，而正常精子症组为19.8%（P = 0.0013）。MEUSC评估的正常精子数量与弱精子症患者的进行性运动能力相关（rho = 0.41，P = 0.0043）。中段（P = 0.0004）和尾部（P = 0.025）的缺陷在弱精子症中更常见，且弱精子症样本的畸形精子指数（P = 0.015）高于正常精子症样本。MEUSC参数与受精率无关。在弱精子症中，计算MEUSC评估正常精子比例在4%至10%之间的每个临界值的受精率差异。临界值为6%时具有最佳统计学效力。如果>6%的精子正常，卵子受精中位数为66.7%，而如果≤6%的精子正常，受精率中位数为35.4%（P = 0.022）。仍具有显著区分度的最高临界值为8%（MEUSC评估正常精子>8%，受精率中位数66.7%；≤8%，受精率中位数35.7%，P = 0.028），这可作为弱精子症中正常形态的临界值。结论是，尽管使用严格标准的形态学与进行性运动能力之间存在显著线性关系，但MEUSC仍可作为弱精子症受精的预测指标。对于MEUSC评估正常精子≤8%的弱精子症病例，应考虑显微操作。
