精子总数的阈值是多少,精子浓度,渐进运动,在进行生育力评估的夫妇中,总的进行性活动精子计数(TPMC)与较早的受孕时间有关?
值远高于世界卫生组织(WHO)的精子总数参考,浓度,和渐进的运动,TPMC的价值高达1亿,始终与较早的受孕时间和较高的受孕率有关。
虽然个别精液参数通常无法区分有生育能力的男性和不育男性,它们可以为寻求生育治疗的患者提供有关怀孕时间的临床有用信息。与常规精液参数相比,TPMC可能是评估男性不育严重程度的更好指标。
我们使用了2002年至2017年对低生育能力男性进行的纵向队列研究的数据,并在研究中纳入了6061名进行初始精液分析(SA)的男性。
纳入了在研究期间接受SA的低生育夫妇的男性,收集5年随访数据以获取受孕数据.夫妇被进一步分为两个亚组:自然受孕(n=5126),在分离使用ART或IUI实现受孕的人之后;没有主要女性因素的自然受孕(n=3753),在分离那些患有严重女性因素的不孕诊断后。通过将精液体积(ml)乘以精子浓度(百万/ml)和逐渐运动的精子百分比(%)来计算TPMC。Cox比例风险模型用于报告在调整男性年龄之前和之后具有95%CI的风险比(HR)。第一个SA之前的孩子数量,和收入。使用回归树方法,我们计算了精子总数的阈值,精子浓度,渐进运动,和TPMC可以最好地区分那些在第一次SA后5年内更有可能怀孕的人和那些不太可能怀孕的人。我们还绘制了精液参数的连续值,以预测5年受孕率和受孕时间。
总的来说,中位受孕时间为22个月(95%CI:21-23).已知共有3957对(65%)夫妇在第一次SA的5年内实现了受孕。这些患者较年轻,精子浓度值较高,渐进运动,和TPMC。在整个队列中,由5千万分化最好的男性组成的TPMC,他们更有可能在5年内生孩子。在调整模型中,TPMC≥5000万的男性伴侣在5年内受孕的机会增加了45%(HR:1.45;95%CI:1.34-1.58),并且与TPMC<5000万的男性相比,怀孕时间更早(中位数为19个月(95%CI:18-20)与36个月(95%CI:32-41))。在自然受孕队列中观察到类似的结果。对于没有主要女性因素的自然受孕队列,TPMC的截止日期为2000万。在连续精液参数值的图形的视觉评估中,5年受孕率和受孕时间在精子浓度较高时始终稳定,精子总数,渐进运动,和TPMC与WHO参考水平和我们计算的阈值进行比较。对于TPMC,在曲线的视觉评估中,高达100-1.5亿的值仍然与更好的受孕率和受孕时间相关。
关于女性伴侣的信息有限,并且在捕获不太严重的女性不孕症诊断方面可能存在不准确。此外,我们缺乏有关在我们的医疗保健网络之外获得的辅助怀孕的详细信息(在我们的队列中可能会误码为“自然概念”)。我们只使用最初的SA和精子形态,另一个潜在的重要参数,不包括在分析中。我们没有关于怀孕尝试/意图连续性的信息,这可能会影响受孕时间数据。最后,大多数夫妇在开始生育治疗之前已经尝试怀孕超过12个月,所以我们很可能低估了受孕时间。重要的是,我们的数据可能缺乏对其他人群的普适性.
我们的结果表明,5千万精子的TPMC阈值提供了最好的预测能力,可以估计男性因素不育症夫妇的早期受孕时间。精子数较高,超过WHO参考的浓度和进行性运动仍与更好的受孕率和受孕时间相关.这为根据WHO参考值优化精液值低但不异常的精液参数提供了机会。当SA结果用于患者咨询时,这些数据可用于更好地告知患者每年受孕的机会。
无。
不适用。
What thresholds for total sperm count, sperm concentration, progressive motility, and total progressive motile sperm count (TPMC) are associated with earlier time-to-conception in couples undergoing fertility evaluation?
Values well above the World Health Organization (WHO) references for total sperm count, concentration, and progressive motility, and values up to 100 million for TPMC were consistently associated with earlier time-to-conception and higher conception rates.
Although individual semen parameters are generally not able to distinguish between fertile and infertile men, they can provide clinically useful information on time-to-pregnancy for counseling patients seeking fertility treatment. Compared to the conventional semen parameters, TPMC might be a better index for evaluating the severity of male infertility.
We used data from a longitudinal cohort study on subfertile men from 2002 to 2017 and included 6061 men with initial semen analysis (SA) in the study.
Men from subfertile couples who underwent a SA within the study period were included, and 5-year follow-up data were collected to capture conception data. Couples were further categorized into two subgroups: natural conception (n = 5126), after separating those who achieved conception using ART or IUI; natural conception without major female factor (n = 3753), after separating those with severe female factor infertility diagnoses. TPMC was calculated by multiplying the semen volume (ml) by sperm concentration (million/ml) and the percentage of progressively motile sperm (%). Cox proportional hazard models were used to report hazard ratios (HRs) with 95% CIs before and after adjusting for male age, the number of previous children before the first SA, and income. Using the regression tree method, we calculated thresholds for total sperm count, sperm concentration, progressive motility, and TPMC to best differentiate those who were more likely to conceive within 5 years after first SA from those less likely to conceive. We also plotted continuous values of semen parameters in predicting 5-year conception rates and time-to-conception.
Overall, the median time to conception was 22 months (95% CI: 21-23). A total of 3957 (65%) couples were known to have achieved conception within 5 years of the first SA. These patients were younger and had higher values of sperm concentration, progressive motility, and TPMC. In the overall cohort, a TPMC of 50 million best differentiated men who were more likely to father a child within 5 years. Partners of men with TPMC ≥50 million had a 45% greater chance of conception within 5 years in the adjusted model (HR: 1.45; 95% CI: 1.34-1.58) and achieved pregnancy earlier compared to those men with TPMC < 50 million (median 19 months (95% CI: 18-20) versus 36 months (95% CI: 32-41)). Similar results were observed in the natural conception cohort. For the natural conception cohort without major female factor, the TPMC cut-off was 20 million. In the visual assessment of the graphs for the continuous semen parameter values, 5-year conception rates and time-to-conception consistently plateaued at higher values of sperm concentration, total sperm count, progressive motility, and TPMC compared to the WHO reference levels and our calculated thresholds. For TPMC, values up to 100-150 million were still associated with a better conception rate and time-to-conception in the visual assessment of the curves.
There was limited information on female partners and potential for inaccuracies in capturing less severe female infertility diagnoses. Also we lacked details on assisted pregnancies achieved outside of our healthcare network (with possible miscoding as \'natural conception\' in our cohort). We only used the initial SA and sperm morphology, another potentially important parameter, was not included in the analyses. We had no information on continuity of pregnancy attempts/intention, which could affect the time-to-conception data. Finally, most couples had been attempting conception for >12 months prior to initiating fertility treatment, so it is likely that we are underestimating time to conception. Importantly, our data might lack the generalizability to other populations.
Our results suggest that a TPMC threshold of 50 million sperm provided the best predictive power to estimate earlier time-to-conception in couples evaluated for male factor infertility. Higher values of sperm count, concentration and progressive motility beyond the WHO references were still associated with better conception rates and time-to-conception. This provides an opportunity to optimize semen parameters in those with semen values that are low but not abnormal according to the WHO reference values. These data can be used to better inform patients regarding their chances of conception per year when SA results are used for patient counseling.
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