Significance of sperm characteristics in the evaluation of male infertility
Significance of sperm characteristics in the evaluation of male infertility
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DOI：
10.1016/j.fertnstert.2005.08.024
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发表时间：
2006-03-01
影响因子：
6.7
通讯作者：
Agarwal, A
中科院分区：
文献类型：
--
作者：
Nallella, KP;Sharma, RK;Agarwal, A
目的：比较接受不育评估的患者、男性因素不育（MFI）患者、健康精子捐献者和已证实生育力的男性的精子特征，以检查所有四组中精子特征的重叠;并在精子特征中识别生育力与不育的良好判别因素。设计：回顾性研究。设置：三级保健医院的男性不育诊所。患者：正常生育男性（n = 56），正常供精者（n = 91），不孕症评估男性（n = 406）和MFI患者（n = 166）。干预：无。主要结果测量：常规精液分析。结果：使用世界卫生组织（世卫组织）现行参考值，大部分MFI患者表现出较高的精子浓度（27.5 × 10（6）至99.2 × 10（6）），导致与有生育能力的男性有更广泛的重叠，并且敏感性较差（0.48）。同样，使用Tygerberg严格标准的正常形态百分比（%）在大多数MFI患者中较低（敏感性0.83），几乎一半的生育男性也存在异常形态（特异性0.51）。在所有检查的变量中，精子活力（%）是上级的，具有最小的重叠范围（下限和上限截止值分别为46%和75%）和高灵敏度（0.74）和特异性（0.90）。曲线下面积（0.90）和精子浓度（0.84）均高于形态学（WHO标准0.65和Tygerberg严格标准0.74）。重新定义精液浓度和形态的参考值可能会显著增加常规精液分析的重要性。
Objective: To compare sperm characteristics among: patients undergoing infertility evaluation, patients with male factor infertility (MFI), healthy sperm donors, and men with proven fertility to examine the overlap of sperm characteristics in all four of these groups; and to identify good discriminators of fertility versus infertility among sperm characteristics.Design: Retrospective study.Setting: Male infertility clinic at a tertiary care hospital.Patient(s): Proven fertile men (n = 56), normal donors (n = 91), men presenting for infertility evaluation (n = 406), and MFI patients (n = 166).Intervention(s): None.Main Outcome Measure(s): Routine semen analysis.Result(s): Using current World Health Organization (WHO) reference values, a large group of MFI patients presented with higher sperm concentration (27.5 X 10(6) to 99.2 X 10(6)), resulting in broader overlap with fertile men and poor sensitivity (0.48). Similarly, percentage normal morphology (%) using Tygerberg's strict criteria was low in most of the MFI patients (sensitivity 0.83), almost half of the fertile men also presented with abnormal morphology (specificity 0.51). Of all the variables examined, sperm motility (%) was superior, having minimum overlap range (lower and upper cut-off values 46% and 75%) and high sensitivity (0.74) and specificity (0.90). Areas under curve were higher for, motility (0.90) and concentration (0,84) compared with morphology, (WHO 0.65 and Tygerberg's strict criteria 0.74).Conclusion(s): Sperm, motility and concentration provide more accurate information than morphology (WHO and Tygerberg's criteria) during infertility evaluation. Redefining the reference values for concentration and morphology may significantly increase the importance of routine semen analysis.