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대한생식의학회지 제29권 제1호 2010년
남성 불임의 진단 및 체외수정의 예후인자로서 정자 형태의 정밀 분석과 정자 첨체반응 및 햄스터 난자 침투 분석의 비교 연구
서울대학교 의과대학 산부인과학교실1, 서울대학교 의학연구원 인구의학연구소2
문신용, 류범용2,방명걸2,오선경1,2,이재훈1,서창석1,2,김석현1,2,최영민1,2·김정구1,이진용
Comparison of Sperm Morphology Evaluation Using Strict Criteria, Acrosome Reaction Following Ionophore Challenge and Zona-free Hamster Ova Sperm Penetration Assay as Prognostic Factors in Diagnosis of
SY Moon
Institute of Reproductive Medicine and Population, Medical Research Center2, Seoul National Univ
(영문 제목) Comparison of Sperm Morphology Evaluation Using Strict Criteria, Acrosome Reaction Following Ionophore Challenge and Zona-free Hamster Ova Sperm Penetration Assay as Prognostic Factors in Diagnosis of Male Infertility and In Vitro Fertilization (영문 초록) Objective: This study was designed to investigate the interrelationship and clinical usefulness of sperm morphology by strict criteria (SM), acrosome reaction following ionophore challenge test (ARIC) and sperm penetration assay (SPA) using zona-free hamster ova as prognostic factors in in vitro fertilization. Materials and Methods: Semen samples were provided by 83 patients undergoing IVF. We first evaluated the differences between normal fertilization group and poor fertilization group on three andrologic tests. Secondly, we analyzed the relationship between the three andrologic tests and in vitro fertilization on IVF settings. Finally, we evaluated the effectiveness of the three andrologic tests as the prognostic indicators for fertilizing ability. Results: The fertilization rate of all men in the poor fertilization group was less than 30%; but there was no evidence that this poor fertilization was due to oocyte defects. The results of three andrologic tests were significatly higher in normal fertilization group. Fertilization rate (%) in vitro was highly correlated (p<0.001) with % normal sperm by SM, ARIC value (%), and SPA result. By using Receiver-Operator-Characteristic curve (ROC), we evaluated the effectiveness of these three tests. The sensitivity and specificity of SM, ARIC test and SPA in predicting fertilization potential in IVF setting were 76% and 75%, 84% and 90%, and 76% and 95%, respectively. Conclusion: Our data suggest that the three andrologic tests can be reliable tools as prognostic factors of sperm fertilizing ability. Among these test, ARIC test and SPA gave more accurate information on fertilizing capacity. ARIC test was shown to have a predictive value for fertilizing ability comparable to that of SPA that appears to be a simple and cost-effective addition to current andrology laboratory. Combined application of these three tests may give more information on predicting sperm fertilizing capacity.
키워드 : Sperm, Strict morphology, ARIC, SPA, IVF
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