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《世界卫生组织人类精液分析实验室技术手册》第5版中低正常精子形态值的临床意义

国际生殖健康／计划生育杂志 2010年第3期29卷 168-177页

作者： menkveld r 甄威刘建兵姚康寿 Andrology Laboratory Department of Obstetrics and GynaecologyTygerberg Academic Hospital and University of StellenboschTygerberg 7505South Africa

第5版《世界卫生组织人类精液分析实验室技术手册》中提出4%这一非常低的正常精子形态临界值与近期发表的数值和报道中正常精子形态平均值下降趋势一致。导致正常形态精子比例下降的可能原因很多。首先是引进了评估精子形态的严格标准... 详细信息

第5版《世界卫生组织人类精液分析实验室技术手册》中提出4%这一非常低的正常精子形态临界值与近期发表的数值和报道中正常精子形态平均值下降趋势一致。导致正常形态精子比例下降的可能原因很多。首先是引进了评估精子形态的严格标准。其他的原因可能包括采用另外的标准定义精子形态异常,诸多负面环境因素导致的精液参数下降。虽然同原先使用的严格评估精子形态的标准一样,新引入的非常低的正常值本身并不能提供强有力的预测值来评价男性生殖潜能,但是如果将全面、严格的评价精子形态的方法与其他可行的精子形态参数一起应用,仍然可得到一个良好的预测值,已知有一些形态参数对精子异常有很强的预测与预后判断作用。此外,更好的方法学国际标准化,精子形态评估标准解释的一致性及标准的国际室间质量控制(EQC)计划对保证精子形态预测值的精确性极为重要。

关键词：男性生殖潜能正常临界值精液分析精子形态学评估严格标准世界卫生组织手册

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Clinical significance of the low normal sperm morphology value as proposed in the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen

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Asian Journal of Andrology 2010年第1期12卷 47-58页

作者： roelof menkveld Andrology Laboratory Department of Obstetrics and Gynaecology Tygerberg Academic Hospital and University ofStellenbosch Tygerberg 7505 South Africa

The very low cut-off value for sperm morphology of 4% morphologically normal spermatozoa, as proposed in the new edition of the World Health Organization （WHO） manual on semen analysis, is in agreement with recently published values and reflects the trend of a decline in reported mean values for normal sperm morphology. The reduced value for morphologically normal spermatozoa over the years may be due to several factors. The first is the introduction of strict criteria for the evaluation of sperm morphology. Other reasons may include the introduction of additional criteria for sperm morphology abnormalities and the suggested decrease in semen parameters because of increasing negative environmental influences. Although on its own the newly proposed very low normal value may not provide the strong predictive value for a males＇ fertility potential, as originally reported for sperm morphology evaluated according to strict criteria, a good predictive value can still be obtained if the holistic, strict approach for sperm morphology evaluation is followed together with additional sperm morphology parameters now available, because certain morphology patterns and sperm abnormalities are now known to be of strong prognostic value. In addition, better international standardization of the technical methodology, consensus on the interpretation of sperm morphology evaluation criteria and standardized international external quality control （EQC） schemes, are of utmost importance to maintain the good predictive value of sperm morphology.

关键词： male fertility potential normal cut-offvalues semen analysis sperm morphology evaluation strict criteria WHO manual

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Measurement and significance of sperm morphology

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Asian Journal of Andrology 2011年第1期13卷 59-68页

作者： roelof menkveld Cas AG Holleboom Johann PT rhemrev Andrology Laboratory Department of Obstetrics and Gynaecology Tygerberg Academic Hospital and University of Stellenbosch Tygerberg 7505 South Africa Department of Obstetrics and Gynecology Bronovo Hospital The Hague 2597AX The Netherlands

The measurement or evaluation and clinical significance of human sperm morphology has always been and still is a controversial aspect of the semen analysis for the determination of a male＇s fertility potential. In this review the background of the development of the evaluation criteria for sperm morphology will be discussed. Aspects of criticism on the strict criteria definition and use of the criteria for sperm morphology evaluation will be discussed as well as possible reasons for the decline in normal sperm morphology values and how we can compromise for this phenomenon resulting in the very low normal reference value as published in the 2010 WHO manual for the Examination and Processing of Human Semen. One of the possible solutions may be to give more attention to a limited number of abnormal sperm morphology categories and the inclusion of sperm morphology patterns. It is concluded in this review that if done correctly and with care and with strict application of existing guidelines as outlined in the 2010 WHO manual, sperm morphology measurement still has a very important role to play in the clinical evaluation of male fertility potential.

关键词： human sperm morphology male fertility potential strict criteria traditional or liberal criteria WHO manual for semen analysis

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精液分析和精子功能测试

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Asian Journal of Andrology 2012年第1期14卷 6-13,174页

作者： Daniel r Franken Sergio Oehninger Department of Obstetrics and Gynaecology Tygerberg Hospita Tygerberg Cape Town 7505 South Africa Department of Obstetrics and Gynaecology Eastern Virginia Medical School Jones Institute for Reproductive Medicine Norfolk VA 23507 USA

Despite controversy regarding the clinical value of semen analysis, male fertility investigation still relies on a standardized analysis of the semen parameters. This is especially true for infertility clinics in both developing and developed countries. Other optional tests or sophisticated technologies have not been widely applied. The current review addresses important changes in the analysis of semen as described in the new World Health Organization （WHO） manual for semen analysis. The most important change in the manual is the use of evidence-based publications as references to determine cutoff values for normality. Apart from the above mentioned changes, the initial evaluation and handling methods remain, in most instances, the same as in previous editions. Furthermore, the review evaluates the importance of quality control in andrology with emphasis on the evaluation of sperm morphology. WHO sperm morphology training programmes for Sub-Saharan countries were initiated at Tygerberg Hospital in 1995. The external qualitY control programme has ensured that the majority of participants have maintained their morphological reading skills acquired during initial training. This review reports on current sperm functional tests, such as the induced acrosome reaction, and sperm-zona pellucida binding assays, as well as the impact of sperm quality in terms of DNA integrity, and the relationship of sperm function tests to sperm morphology.

关键词： male infertility quality assurance semen analysis spermatozoa sperm concentration sperm function sperm morphology sperm motility

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