Buckett W M, Luckas M J, Aird I A, Kingsland C R, Lewis-Jones D I
McGill University, Montreal, Quebec, Canada.
Int J Fertil Womens Med. 1998 Sep-Oct;43(5):257-61.
The objective of this study was to prospectively evaluate the sperm migration test (SMT) as a discriminator in couples undergoing intrauterine insemination (IUI).
261 couples underwent 797 IUI treatment cycles involving gonadotropin stimulation in the three year period. All had a diagnosis of unexplained infertility. All male partners underwent a repeat standard seminal analysis and SMT prior to the female partner undergoing controlled ovarian stimulation.
Despite apparently normal seminal analyses before referral, in 22 samples the sperm concentration, motility or morphology were abnormal (WHO criteria). Of these, 20 couples underwent 109 cycles and achieved 2 pregnancies giving a pregnancy rate of 1.8% per cycle and a cumulative pregnancy rate of 10% per couple. From the remaining couples with normal seminal analyses, 71 had an SMT <5 million/mL and 168 had an SMT >5 million/mL. The suboptimal SMT group underwent 276 cycles (3.89 cycles per couple) and achieved 18 pregnancies giving a pregnancy rate of 6.5% per cycle and a cumulative pregnancy rate of 25.4%. The normal SMT group underwent 412 cycles (2.45 cycles per couple) and achieved 60 pregnancies giving a pregnancy rate of 14.6% per cycle and a cumulative pregnancy rate of 35.7%.
We confirm that abnormal seminal analysis leads to poor pregnancy rates with IUI. However, an SMT <5 million/mL despite normal seminal analysis (WHO criteria) also leads to significantly worse pregnancy rates. We would recommend that prior to IUI, couples are screened using the SMT.
本研究的目的是前瞻性评估精子迁移试验（SMT）在接受宫内人工授精（IUI）的夫妇中的鉴别作用。
在三年期间，261对夫妇接受了797个涉及促性腺激素刺激的IUI治疗周期。所有患者均诊断为不明原因不孕症。在女性伴侣接受控制性卵巢刺激之前，所有男性伴侣均接受了重复的标准精液分析和SMT。
尽管转诊前精液分析看似正常，但22份样本中的精子浓度、活力或形态异常（WHO标准）。其中，20对夫妇接受了109个周期的治疗，获得了2次妊娠，每个周期的妊娠率为1.8%，每对夫妇的累积妊娠率为10%。在其余精液分析正常的夫妇中，71例SMT<500万/mL，168例SMT>500万/mL。SMT欠佳组接受了276个周期的治疗（每对夫妇3.89个周期），获得了18次妊娠，每个周期的妊娠率为6.5%，累积妊娠率为25.4%。SMT正常组接受了412个周期的治疗（每对夫妇2.45个周期），获得了60次妊娠，每个周期的妊娠率为14.6%，累积妊娠率为35.7%。
我们证实精液分析异常会导致IUI的妊娠率较低。然而，尽管精液分析正常（WHO标准），但SMT<500万/mL也会导致明显更差的妊娠率。我们建议在IUI之前，使用SMT对夫妇进行筛查。
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