计算机辅助精液分析与人工常规精液分析的比较

目的探讨计算机辅助精液(computer-aided semen analysis,CASA)和人工常规精液分析(sperm routine analysis,SRA)两种方法对精液分析主要指标存在的差异,以提高实验室精液标本质量分析的准确性,为临床提供准确的报告结果。方法采用CASA系统和SRA对不育男性1018列(剔除无精子标本)精液标本进行分析,对两种方法检验结果进行比较。结果两种方法在精液质量分析中存在一定的差异,在分析精子活动率、精子活力、精子形态、精子密度过高(50×109/L)和过低密度(20×109/L)的标本及其他细胞方面存在差异(P0.05),而对密度在(20~50×109/L)范围内标本浓度检测结果较理想,无显著性差异(P0.05)。结论 CASA作为一种新的检测技术具有高效客观、高精度的特点,但也存在许多影响因素和局限性,不能盲目依赖其结果,应在CASA分析的方法上结合SRA,从而提高结果的准确性。     

提高计算机辅助精液分析复查结果稳定性方法的研究

目的探讨提高计算机辅助精液分析(computer-assisted sperm analysis,CASA)复查结果稳定性的方法。方法对40位初次检查精液参数异常的患者,按照规范要求复查,精液分析根据WHO男科实验室手册第五版的质控方法执行精子浓度和体积的质量控制,然后将两次检查结果中精液体积、精子浓度、活力等参数进行t检验,并对浓度值进行相关性分析,分析两次检查结果的稳定性。结果两次检查结果精液参数比较差异无统计学意义,浓度值的相关系数为0.9518。结论在按照规范要求并严格执行精液分析质控后,是可以保证精液检查结果稳定性的。     

男性不育就诊者解脲脲原体（Uu）检测结果与精子质量关系分析

目的进一步探讨精液中Uu感染与精子质量的关系。方法取2125例男性不育就诊者的精液标本,应用套式聚合酶链反应（nPCR）技术和《伟力彩色精子质量检测系统》进行解脲脲原体（Uu）检测和计算机辅助精液分析（CASA）,并对Uu阳性组和Uu阴性组的精子质量进行比较分析。结果通过对首次来我院男性科门诊的2125例男性不育就诊者进行Uu培养和CASA,Uu阳性组的精子密度为64.3×10^6ml,精子活率为67.1%,精子活力：a级精子为18.9%,b级精子为28.0%,c级精子为20.0%;Uu阴性组的精子密度为72.2×10^6ml,精子活率为66.7%,精子活力：a级精子为18.5%,b级精子为28.7%,c级精子为18.9%。经卡方检验后两组比较,Uu阳性组与Uu阴性组的精子活率、活力无显著性差异（P〉0.05）,精子密度Uu阳性组高于Uu阴性组（P〈0.01）,有统计学意义。结论Uu感染与精子质量低下不一定成正比关系,精子质量低下可能与Uu感染量的多少和时间长短及其他病原微生物混合感染等有关。     

两种稀释液在精液常规分析中的应用比较

目的探索通过计算机辅助分析（CASA）能较真实反映高密度精子质量的精液稀释液。方法对64份高密度精液（粘稠标本30份，非粘稠标本34份）均予以生理盐水和自体精浆等比稀释，后用CASA分析原液、生理盐水稀释液、精浆稀释液。并对生理盐水稀释液人工计数精子密度及活力。结果非粘稠精液：经CASA分析，原液密度明显高于精浆稀释液（P=0．003）或生理盐水稀释液（P=0．001）的密度，两种稀释液的密度相近（P=0．076）；原液活力明显低于精浆稀释液（P=0．001）或生理盐水稀释液的活力（P〈0．001），生理盐水稀释液的活力明显高于精浆稀释液的活力（P〈0．001）；CASA分析和人工计数生理盐水稀释液的密度（P=0．372）和活力（P=0．060）相似。粘稠精液：经CASA分析，原液和精浆稀释液的密度相近（P=0．054），二者均较生理盐水稀释液的密度明显增高（P〈0．001），原液和精浆稀释液的活力相似（P=0．288），二者均明显低于生理盐水稀释液的活力（P〈0．001）；CASA分析和人工计数生理盐水稀释液的密度（P=0．073）和活力（P：0．161）相似。结论行精液常规分析时，非粘稠的高密度精液，用自体精浆稀释后，CASA分析的参数能较真实反映患者精子质量；粘稠的高密度精液，生理盐水是相对较好的稀释液。     

解脲支原体感染精液的精子动态分析

目的采用计算机辅助的精液分析(CASA)研究解脲支原体(UU)感染的精了各项参数的影响.方法应用荧光定量PCR的方法对228例男性不育患者的精液进行UU检测,同时采用CASA分析其精子的动态参数.结果UU感染对精液的密度无影响,而对精子的活率、精子活率、A、B、C、D级精子的百分率和密度均有非常显著性差异(P0.01;代表精子运动的参数VCL、VSL、VAP、BCR均有非常显著性差异(P＜0.01),ALH、WOB、LIN、STR均有显著性差异(P＜0.05).结论解脲支原体感染可明显降低精子活率、精子活力、精子运动速度等,并改变精子运动方式,是造成男性不育的重要原因之一.     

司机职业对男性精液质量的影响

目的探讨司机职业与男性精液质量的相关性.方法422例不育男性(司机63例、非司机359例)和61例生育男性精液进行计算机辅助分析(CASA)和精子形态学分析.结果(1)不育组和生育组比较,不育组精子密度、活动率、前项运动级别显著性降低,畸形率显著性升高(P＜0.01).(2)不育司机组和不育非司机组比较,不育司机组精子密度、活动率和前项运动级别显著性降低,畸形率显著性升高(P＜0.05).不育司机组精子密度、活动率和前项运动级别与驾龄之间呈显著性负相关,畸形率与驾龄之间呈显著性正相关(P＜0.01).结论司机职业可能对男性精液质量有不良影响.     

厦门地区332例男性不育患者精液常规结果分析

目的对厦门地区男性不育患者的精液进行常规分析,了解厦门地区男性不育患者精液质量的现状。方法采用SQA-V全自动精子质量分析仪对332例不孕不育中心就诊的男性不育患者及107例正常生育者进行精液常规项目分析及统计。结果精子密度、a+b级精子活动率比例、正常精子形态百分率三项指标与正常对照组差异有统计学意义(P<0.05)。结论男性不育症患者的精液精子密度、a+b级精子活动率比例、正常形态精子百分率三项指标与正常对照组均较正常者低。     

自动化精液分析仪检测结果的分析

目的 对西班牙SCA,上海北昂和北京伟力三台精子分析仪进行评估.方法 分别使用三台仪器和显微镜对精液标本进行精子密度和活力检测,比较不同精液分析仪的重复性、线性等.结果 三种仪器的重复性均较好,变异系数CV均小于15％;三台仪器和显微镜检测结果相关性接近,相关系数(r)分别是0.60,0.57和0.56;配对t检验三台分析仪的P值均小于0.001.结论 建议针对不同仪器建立相应的的参考值区间.     

青岛市工业区婚龄男子精液状况分析

目的为了解青岛市工业区婚龄男子精液质量,促进本地区优生优育工作.方法按照,使用清华同方产CASAS-QH-Ⅲ仪器,对1000名婚龄男子完整精液标本进行分析.结果①我市工业区婚龄男子精液质量处于较低水平.②精液异常主要是精子活力降低,其余依次为体积减少、精子存活率降低、白细胞计数增多、精子密度降低及pH值降低.③精液体积、pH值、a级、a b级活动精子百分率、精子密度、总精子计数、精子存活率、正常精子形态率、白细胞计数、生精细胞计数的主要分布范围(不包括范围上限)分别在2～2.5ml、7.6～7.8、15%～20%、35%～40%、30～60×106/ml、0～100×106、60%～70%、60～70%、0.5～～1×106/ml、0～0.5×106/ml.结论工业区婚龄男子精液质量较差,应当引起有关部门重视;在婚前保健中应重点针对精子活力降低状况,开展保健服务,同时建议开展精液常规检查,以促进优生优育工作.     

石河子地区6178例男性精液质量评估及其与年龄的相关性探讨

目的了解本地区就诊男性患者的精液质量状况,初步探讨男性年龄对精液质量的影响,为临床诊治提供参考。方法对2012年1月至2016年8月来我院就诊男性患者的6178例精液标本进行回顾性分析和统计,并按照年龄分为30岁、30-39岁及≥40岁3个年龄组,分析比较各组精液参数,分析指标主要包括pH值、精液量、精子密度、精子活率及前向运动率等。结果 6178例精液标本中,正常精液占27.57%,异常精液占72.43%,其中无精症占3.19%。异常精液主要以精子活率低为主,其次是前向运动率低及液化时间异常等。pH值在30-39岁年龄组高于其余2个年龄组,组间差异有统计学意义(P0.05),精液量在≥40岁年龄组均显著低于30岁年龄组及30-39岁年龄组,差异有统计学意义(P0.01);另外随着年龄的增加,精子活率和前向运动率呈递减趋势而精子密度呈递增趋势,组间差异有统计学意义(P0.01)。不同年龄组男性异常精液发生率不同,精子活率异常发生率在30-39岁组最高,精液量、前向运动率及液化时间异常发生率在≥40岁年龄组最高,组间差异有统计学意义(P0.01)。结论?石河子地区男性精液质量异常主要表现为精子活率低,且随着年龄的增长男性精液质量除pH值及精子密度外呈逐渐下降趋势。通过对本地区男性精液质量分析可初步评估本地男性的生育能力,对临床的诊治也具有重要的意义。     

Results of the American Association of Bioanalysts national proficiency testing programme in andrology

Proficiency testing samples for antisperm antibodies (ASAB), sperm count, morphology and vitality were mailed to participating laboratories. The majority participating utilized Immunobead ASAB procedures (81 versus 14% mixed antiglobulin reaction and 5% 'other'), and there was 95.6 +/- 1.2% agreement on the presence or absence of ASAB. The majority of laboratories utilized manual (79%) versus computer assisted semen analysis (CASA; 15%) methods. Approximately 64% used the haemocytometer and 26% used the Makler counting chambers for manual counts. Coefficients of variation (CV) in sperm counts ranged from 24 to 138%, with CASA displaying lower overall CV (53 +/- 8%) than manual methods (80 +/- 9%). A wide variation in the reports of percent normal morphology was noted (CVs calculated from arc sin transformed means ranged from 15 to 93%). Participants using American Society of Clinical Pathologists (ASCP) criteria reported sperm morphology values that were clustered in the 'normal' range (11 out of 12 samples), while those using strict criteria were clustered in the 'abnormal' range (10 out of 12 samples). Good agreement was observed in sperm vitality (overall mean CV = 18%). These data highlight the urgent need for improvement in overall quality of andrology testing and indicate that practical proficiency testing programmes can be made available on a large scale.     

Diagnostic accuracy of computer-assisted sperm motion analysis

One retrospective and two prospective studies were conducted among 218 couples treated with in-vitro fertilization (IVF) to establish the reproducibility and diagnostic accuracy of computer-assisted sperm analysis (CASA) with swim-up spermatozoa for the prediction of the fertilization rate of oocytes in vitro. Based on the results of a preliminary retrospective analysis in 49 patients, the 'curvilinear velocity' (VCL) was chosen as the most distinctive motion parameter of sperm function and the median was used to represent the entire sperm population. The number of inseminated motile spermatozoa was then adjusted to median VCL during two subsequent prospective studies with clinical IVF. Whereas in the first prospective study (90 couples) the threshold values of VCL with regard to the number of spermatozoa inseminated were based on the results of the preliminary retrospective study (49 couples), in the second prospective study (79 couples) the settings were based on the results of the first prospective study. The reproducibility of CASA was tested by analysing the motion characteristics of spermatozoa at different intervals after termination of swim-up, by repeated analysis of the same video-recording of the incubated spermatozoa by different observers, and by the repeated video- recording of the freshly prepared sperm samples and analysis of both video-recordings by the same observer. Under these conditions the frequency of disagreement between two measurements varied between 2.0 and 8.2%. In both prospective studies the sensitivity of CASA for the prediction of fertilization was high (74.0%), whereas the specificity was low (40.0%). In contrast to successful fertilization, unsuccessful fertilization of oocytes in vitro could not be predicted reliably with CASA. However, the pregnancy rate per cycle among patients with predicted low fertilization rates was significantly lower (5.3%) than in couples with high predicted fertilization rates (24.3%, P < 0.001). Therefore, CASA of washed spermatozoa may still help to identify couples who would benefit more from intracytoplasmic sperm injection (ICSI) than from IVF. A definite threshold level could not be identified for any of the motion parameters to distinguish the motion characteristics of fertilizing and non-fertilizing spermatozoa. Using various algorithms for hyperactivated motility, the percentage of hyperactivated spermatozoa was significantly higher among the successfully fertilizing patients than among the nonfertilizing group. However, the absolute number of hyperactivated spermatozoa added to the oocytes was higher in non-fertilizing couples. Therefore, the lack of fertilization in some patients may be caused by a generalized defect in sperm function rather than by insufficient hyperactivation.      

Time to pregnancy in relation to semen quality assessed by CASA before and after sperm separation.

BACKGROUND: In order to provide a reference for infertile men, we defined normal values of semen quality in a population of fertile men, using computer-assisted semen analysis (CASA) before and after sperm separation. Additionally, we investigated the relationship between semen quality and time to pregnancy (TTP). METHODS AND RESULTS: Semen samples were obtained from 315 proven fertile men. The median sperm concentration in fresh samples was 107 x 10(6)/ml (5-95 percentiles: 16-322 x 10(6)/ml), the median percentage of motile sperm cells was 65% (14-87%) and the median percentage of progressively motile cells was 37% (5-64%). After density gradient sperm separation, the median total sperm count was 46 x 10(6) (4-350 x 10(6)), the median percentage of motile sperm cells was 77% (16-95%) and the median percentage of progressively motile cells was 63% (11-84%). No significant associations were found between TTP and sperm counts or sperm motility, either before or after sperm separation. This may be due in part to the fact that the study comprised couples with proven fertility. CONCLUSION: We have defined semen parameters, including the results of density gradient separation, in a population of normal fertile men which may be of interest in the evaluation of semen samples from infertile men.     

The effects of cryopreservation on sperm morphology, motility and mitochondrial function

BACKGROUND: The effects of cryoinjury were determined simultaneously on the mitochondrial function, motility, morphology and viability of ejaculated human sperm. METHOD: Rhodamine 123 (R123) uptake (% of sperm) and stain intensity were used to determine sperm mitochondrial activity before and after cryopreservation from the semen of 50 men attending for infertility investigation. Morphology was assessed using Tygerberg's strict criteria and viability was assessed by eosin Y. Sperm motility was measured using computer-assisted semen analysis (CASA). RESULTS: Freeze-thawing caused a 37% (P = 0.001) reduction in normal morphological forms of sperm. All CASA sperm motility parameters except amplitude of lateral head displacement were similarly reduced. R123 uptake and intensity within sperm mitochondria decreased by 36 and 47% respectively (both P = 0.001). In addition, there was a similar significant decrease (31%, P = 0.001) in the viability of the sperm. CONCLUSIONS: Sperm morphology, motility, mitochondrial activities and viability are equally susceptible to cryopreservation-induced damage. R123 intensity is a novel and robust indicator of mitochondrial function before and after such trauma.     

Andrology: Implementing comprehensive quality control in the andrology laboratory

Comprehensive quality control procedures were integrated intothe routine semen analysis workload of a large university-basedandrology laboratory. Methods were chosen to match as far aspossible those which have been used successfully for many yearsin disciplines such as clinical chemistry. Levey—Jenningsand cusum charts were plotted in order to monitor the immunobead-bindingtest for antisperm antibodies and a video-taped control samplefor computerized semen analysis. A cryopreserved semen controlwas also charted. Daily manual sperm counts were plotted againstthe corresponding computer-assisted semen analysis (CASA) value.Multiple readings of 30 slides were used to monitor morphologyassessments. Monthly means for morphology were also calculatedregularly. Coefficients of variation were calculated for allvariables and were found to be more appropriate for some aspects,such as CASA, than for others, such as morphology, when differencefrom the previous reading of the same slide was found to bemore useful. These integrated quality control procedures hada direct influence on the production of results from the laboratory.Together with a high standard of technician training, comprehensiveroutine quality control based on repeated analyses of controlsamples is an effective way of assuring the validity of semenanalysis results.     

金属硫蛋白（MT）与男性不育患者精浆铅镉及精子参数的研究

目的探讨金属硫蛋白（Metallothionein,简称MT）与男性不育精浆铅镉、精子参数的关系。方法采用钨舟原子吸收光谱法检测患者口服金属硫蛋白前、后精浆铅Pb镉Cd的浓度;采用（computer aided semen anlysis,CASA）方法检测精子质量,分析各组数据间有无统计学意义。结果服用MT1-2个疗程前后进行统计学配对t检验：精子活率检测,密度、活率达到正常参考值的分别为46.8% P〈0.05统计学上有显著差异、34.78% P〈0.001统计学上有极显著差异。精子密度、精子活率的改善率分别为58.69% P〈0.05统计学上有显著差异、56.52%〈0.05统计学上有显著差异。结论口服MT后精子参数有不同程度的改善,对方怀孕11人占19.64%。     

2570例男科就诊患者精液质量分析

目的对成都地区男科就诊患者精液质量进行调查研究.方法严格按照WHO技术规范,对2570例不育门诊男性精液进行常规分析.结果精液质量异常者共2272例,占受检总数的88.4%,其中无精子症患者193例,占7.5%,严重少精子症患者66例,占2.5%;而精液完全正常者只有298例,仅占受检总数的11.6%.结论精液质量的准确分析,是正确判断男性生育力的重要检测手段之一,尤其是将计算机辅助精液分析与染色法观察精子形态相结合,更能为男性不育症的诊治提供可靠而有力的依据.     

Antioxidant intake is associated with semen quality in healthy men

BACKGROUND: We seek to determine whether dietary and supplement intake of specific micronutrients (zinc and folate) and antioxidants (vitamins C, E and beta-carotene) is associated with semen quality. METHODS: Ninety-seven healthy, non-smoking men provided semen and were interviewed. Average daily nutrient intake from food and supplements was derived from a self-administered food frequency questionnaire. Intake levels were summarized as low, moderate and high. Semen volume, sperm concentration, total sperm count, motility, progressive motility and total progressively motile sperm count (TPMS) were measured. RESULTS: After controlling for covariates, a high intake of antioxidants was associated with better semen quality but, in almost all cases, there was no clear dose relationship in that moderate intake groups had the poorest semen quality. For example, positive associations were observed between vitamin C intake and sperm number as reflected in the higher mean count (P=0.04), concentration (P=0.05) and TPMS (P = 0.09); between vitamin E intake and progressive motility (P = 0.04) and TPMS (P = 0.05); and between beta-carotene intake and sperm concentration (P = 0.06) and progressive motility (P = 0.06). Folate and zinc intake were not associated with improved semen quality. CONCLUSIONS: In a convenience sample of healthy non-smoking men from a non-clinical setting, higher antioxidant intake was associated with higher sperm numbers and motility.     

Influence of co-culture with established human endometrial epithelial and stromal cell lines on sperm movement characteristics

The effects of co-culture of human spermatozoa with human immortalized endometrial cells - epithelial or stromal - on sperm movement characteristics, including hyperactivation, were studied using computer- assisted sperm analysis (CASA). Epithelial and stromal cell types could be separated following 8-10 days of culture of endometrial cells originating from human biopsies. Both cell types were immortalized by the SV 40 large T antigen. Co-incubation of sperm with epithelial and stromal monolayers enhanced the rate of hyperactivation: 24.9% (P <0.05) and 17.8% (P = 0.05) versus 9.5% as control, respectively, whereas the majority of motility parameters remained unchanged. Conditioned media had no effect upon sperm parameters, including hyperactivation. Co-incubation with either monolayer was able to maintain sperm motility over a longer period than incubation in control medium alone. In four patients whose spermatozoa did not exhibit hyperactivation, co-incubation with epithelial cells, but not conditioned medium, allowed normal rates of hyperactivation (range: 6.9- 15.6%).      

Does the potential for selection bias in semen quality studies depend on study design? Experience from a study conducted within an infertility clinic

BACKGROUND: The low participation rates in human semen quality studies raises concern for the potential of differential participation based on semen quality (or a surrogate). To explore the potential for differential participation, we compared semen analysis results from study subjects with those of non-study subjects. METHODS: We obtained semen analysis results from 235 study subjects and retrospectively obtained results from a subset of 235 infertility clinic patients that were not study subjects but met the same eligibility criteria. The study was conducted at the Massachusetts General Hospital Infertility Clinic. All semen samples (study subjects and non-study subjects) were analysed for sperm concentration and motility by computer-aided semen analysis (CASA), and morphology was assessed using strict criteria. Semen analysis parameters for the non-study subjects were compared with the semen analysis results from study subjects. RESULTS: For all semen characteristics (sperm concentration, total sperm count, sperm motility and morphology), there were only marginal (non-significant) differences between study subjects and non-study subjects. CONCLUSIONS: Among men from an infertility clinic, we found no strong evidence of differential participation based on semen quality. This is reassuring since the potential for selection bias is of concern in semen quality studies. However, the potential for selection bias in other study designs remains unclear.