Ombelet W, Wouters E, Boels L, Cox A, Janssen M, Spiessens C, Vereecken A, Bosmans E, Steeno O
Genk Institute for Fertility Technology, Z.O.L., Belgium.
Int J Androl. 1997 Dec;20(6):367-72. doi: 10.1046/j.1365-2605.1998.00079.x.
This prospective study compared the diagnostic and predictive potential of sperm morphology assessments in a fertile vs. a subfertile population, evaluated in three different laboratories. The fertile population included 144 men who had recently fertilized their partners. As subfertile controls, 136 men with a history of subfertility for more than 12 months were used. All semen samples (280) were evaluated in three different centres in a blind fashion, without any patient information. The evaluation of sperm morphology was performed according to the criteria normally used in the different laboratories: WHO (1992) criteria for laboratory A, and Tygerberg strict criteria for laboratories B and C. Using ROC analysis, the predictive power of sperm morphology turned out to be different in the three laboratories (area under ROC curve: 69% for lab A, 72% for lab B and 78% for lab C). Using percentile 10 of the fertile population as the cut-off value for normality, we obtained the following results: 2, 1 and 5% for laboratories A, B and C, respectively. Using ROC analysis cut-off values with optimal specificity and sensitivity were 6, 1 and 10%, respectively. Although our data highlight a reasonable predictive power of sperm morphology in centres using different or the same criteria, cut-off values for normality were different, even when the same criteria were applied. These results stress the importance of standardization in sperm morphology evaluation and the need for examining a reference population in estimating the real threshold value in different laboratories.
这项前瞻性研究比较了在三个不同实验室中对可育人群与亚不育人群进行精子形态评估的诊断和预测潜力。可育人群包括144名近期使其伴侣受孕的男性。作为亚不育对照，使用了136名有超过12个月亚不育病史的男性。所有精液样本（共280份）在三个不同中心以盲法进行评估，不提供任何患者信息。精子形态评估按照不同实验室通常使用的标准进行：实验室A采用世界卫生组织（1992年）标准，实验室B和C采用泰格堡严格标准。通过ROC分析，发现精子形态的预测能力在三个实验室中有所不同（ROC曲线下面积：实验室A为69%，实验室B为72%，实验室C为78%）。以可育人群的第10百分位数作为正常的临界值，我们得到了以下结果：实验室A、B和C分别为2%、1%和5%。使用具有最佳特异性和敏感性的ROC分析临界值分别为6%、1%和10%。尽管我们的数据表明，无论使用不同标准还是相同标准，精子形态在各中心都具有合理的预测能力，但即使应用相同标准，正常的临界值也不同。这些结果强调了精子形态评估标准化的重要性，以及在估计不同实验室的实际阈值时检查参考人群的必要性。
