男性不育患者精液分析和精子形态学分析

目的：回顾性分析助孕门诊男性不育患者精液分析与精子形态学检测，为防止临床对女方过度治疗提供依据。方法：选择2007年10月1日～2008年2月29日在本院助孕门诊就诊的不孕夫妇，男方至少行精液分析2次，在第一次精液分析即进行精子形态学分析。精液分析采用清华同方精液分析系统，精子形态学分析采用改良巴氏法染色，应用Microsoft Excel进行分析。结果：进行精液分析共1206人次，进行精子形态学分析共517人次。精子密度0-180^★10^9／L，平均55．3±32．2^★10^9／L，75．1％的病例精液密度为20-100^★10^9／L，仅13．3％为少精症，无精症占1．5％；a级精子为14．0％±9．9％，b级精子为10．6％±7．8％，a级＋b级〉50％者仅占0．6％，超过半数的为30％-50％（51．1％），精子形态学分析，仅有20．5％病例是正常的（〉14％）。结论：除无精症显然与不育相关外，精液密度可能不是评估男性不育的一个很好的指标，精子活动力低下或精子畸形率过高更能预示不孕因素，精液分析和精子形态学分析可以作为助孕门诊男性不育的首要筛查手段，防止对女方的过度治疗。

Semen Analysis and Sperm Morphology Analysis of Infertile Males

Objective Retrospective analysis of semen and sperm morphology analysis, to prevent excessive clinical treatment for infertile couples. Methods Chose the infertile couples of out-patient department from Oct 1^st 2007 to February 29^th 2008. All males underwent semen analysis for at least 2 times and sperm morphology analysis for 1 time. Microsoft Excel was used for statistic analysis. Results Totally 1206 cases of semen analysis and 483 cases of sperm morphology were analyzed. Sperm concentration was 0-180^★10^9/L, with an average of 55.3± 32.2^★10^9/L, 75.1% were within 20-100^★10^9/L, only 13.3% were oligozoospermia, and azoospermia accounted for 1.5%; 51.1% of the cases had 30% -50% rapid progressive sperms （a grade＋b grade）, and only 0.6% were normal according to the WHO standard （a grade＋b grade〉 50%）. Only 20.5% of the cases had 〉 14% normal sperm morphology. Conclusion Except azoospermia which were obviously related to infertility, sperm concentration may not be a good indicator for assessment of infertility, but sperm activity and morphology may predict the infertility factors. Analysis of semen and sperm morphology should be used as the first screening method for out-patient infertile couples to prevent excessive treatment for the women.