Computer-aided texture analysis combined with experts' knowledge: Improving endoscopic celiac disease diagnosis

AIM: To further improve the endoscopic detection of intestinal mucosa alterations due to celiac disease(CD).METHODS: We assessed a hybrid approach based on the integration of expert knowledge into the computerbased classification pipeline. A total of 2835 endoscopic images from the duodenum were recorded in 290 children using the modified immersion technique(MIT). These children underwent routine upper endoscopy for suspected CD or non-celiac upper abdominal symptoms between August 2008 and December 2014. Blinded to the clinical data and biopsy results, three medical experts visually classified each image as normal mucosa(Marsh-0) or villous atrophy(Marsh-3). The experts' decisions were further integrated into state-of-the-arttexture recognition systems. Using the biopsy results as the reference standard, the classification accuracies of this hybrid approach were compared to the experts' diagnoses in 27 different settings.RESULTS: Compared to the experts' diagnoses, in 24 of 27 classification settings(consisting of three imaging modalities, three endoscopists and three classification approaches), the best overall classification accuracies were obtained with the new hybrid approach. In 17 of 24 classification settings, the improvements achieved with the hybrid approach were statistically significant(P < 0.05). Using the hybrid approach classification accuracies between 94% and 100% were obtained. Whereas the improvements are only moderate in the case of the most experienced expert, the results of the less experienced expert could be improved significantly in 17 out of 18 classification settings. Furthermore, the lowest classification accuracy, based on the combination of one database and one specific expert, could be improved from 80% to 95%(P < 0.001).CONCLUSION: The overall classification performance of medical experts, especially less experienced experts, can be boosted significantly by integrating expert knowledge into computer-aided diagnosis systems.

Regionalization of epididymal duct and epithelium in rats and mice by automatic computer-aided morphometric analysis

Aim： To establish a rat and mouse epididymal map based on the use of the Epiquatre automatic software for histologic image analysis. Methods： Epididymides from five adult rats and five adult mice were fixed in alcoholic Bouin＇s fixative and embedded in paraffin. Serial longitudinal sections through the medial aspect of the organ were cut at 10 jam and stained with hematoxylin and eosin. As determined from major connective tissue septa, nine subdivisions of the rat epididymis and seven for the mouse were determined, consisting of five sub-regions in the caput （rat and mouse）, one （mouse） or three （rat） in the corpus and one in the cauda （rat and mouse）. Using the Epiquatre software, several tubular, luminal and epithelial morphometric parameters were evaluated. Results： Statistical comparison of the quantitative parameters revealed regional differences （2-5 in the rat, 3-6 in the mouse, dependent on parameters） with caput regions 1 and 2 being largely distinguishable from the similar remaining caput and corpus, which were in turn recognizable from the cauda regions in both species. Conclusion： The use of the Epiquatre software allowed us to establish regression curves for different morphometric parameters that can permit the detection of changes in their values under different pathological or experimental conditions. （Asian J Androl 2005 Sep; 7： 267-275）

Semen analysis and sperm function testing

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.

Semen analysis in 21st century medicine： the need for sperm function testing

Sperm function testing, once commonly performed for the infertile couple before employing assisted reproductive technology （ART）, has fallen out of favour in many reproductive medicine centers throughout the world. Indeed, the most recent addition of the ＇World Health Organisation （WHO） Laboratory Manual for the Examination and Processing of Hu- man Semen＇ now groups many of these procedures into a section termed Research Procedures. In large part, this reflects the current clinical practice of bypassing the in-depth evaluation of the male partner, while assuming that if a spermatozoon can be found for intracytoplasmic sperm injection （ICSI）, it must be a healthy cell capable of achieving fertilization. Never- theless, sperm function testing can provide valuable clinical insights into defects causing male infertility. Admittedly, in some cases, functional sperm deficiencies can be overcome using an ART. In other cases, couples will be empowered by the knowledge of the cause of their infertility, and for some couples, perhaps even the likelihood of ICSI success （relative to the spermatozoa）. The knowledge allows them to make truly informed reproductive decisions, including （perhaps） the de- cision to seek donor insemination, to adopt or to remain childless. Knowledge of the cause of their infertility may provide closure for couples and a sense of confidence regarding their choice of reproductive treatment.

Semen analysis with regard to and functional aspects sperm number, sperm morphology

The new World Health Organization （WHO） Manual for Semen Analysis contains several improvements. One is that the 20 million spermatozoa per mL paradigm has been ousted in favour of proper calculations of lower reference limits for semen from men, whose partners had a time-to-pregnancy of 12 months or less. The recommendation to grade the progressive motility as described in the third and fourth editions of the WHO manual was not evidence-based, and WHO was therefore motivated to abandon it. However, the new recommendation is not evidence-based either, and it is difficult to understand the rational for the new assessment. It may have been a compromise to avoid returning to the rather robust system recommended in the first edition （1980）. The unconditional recommendation of the ＇Tygerberg strict criteria＇ is not evidence-based, and seems to be the result of an unfortunate bias in the composition of the Committee in favour of individuals known to support the ＇strict criteria＇ method. This recommendation will have negative effects on the develop- ment ofandrology as a scientific field. Given the importance of the WHO manual, it is unfortunate that the recommenda- tions for such important variables, as motility and morphology, lack evidence-based support.

Optimal analysis conditions for sperm motility parameters with a CASA system in a passerine bird, Passer montanus

Background:Sperm motility parameters,which can be measured objectively and repeatedly by a computer-assisted sperm analysis(CASA)system,are important indicators of sperm quality.However,the sperm motility parameters assessed by a CASA system can be affected by various factors,including instrument components and settings,sperm preparation or analysis procedures.To date,no standardized protocol is available that would permit to assess sperm kinetic characteristics in passerine birds and this lack precludes any comparison of sperm swimming ability and sperm quality across species.Methods:In this study,we chose the Tree Sparrow(Passer montanus)as the object to evaluate sperm motility parameters,including sperm motility,sperm velocity and sperm movement trajectory,at different analysis time,temperatures and pH using the WLJY-9000 CASA system.Results:Sperm motility parameters remained statistically unchanged at 1‒9 min.Progressive motility was similar at 38℃ and 40℃,but a greater percentage of slow progressive sperm was detected at 38℃ compared to 40℃ and 42℃.Additionally,progressive motility was lower and immotility was higher at 42℃than 38℃and/or 40℃(close to the body temperature of the Tree Sparrow).The percentages of rapid progressive sperm,progressive sperm and immotile sperm were statistically similar at pH 7.0,7.5 and 8.0 with the exception of lower percentage of progressive sperm at pH 7.0 compared to pH 7.5.In addition,slower sperm velocity and worse sperm movement trajectory were found at pH 6.0 and 9.0 than those at pH 8.0,7.5 or 7.0.Conclusions:Our study indicates that the ideal conditions for sperm motility parameters assessment in Tree Sparrow are obtained between 1 and 9 min after dilution,an environment at body temperature(40℃)and a pH around 7.5-8.0.The results of this study provide a reference for the evaluation of sperm characteristics and sperm quality using a CASA system in passerine birds.

Differential Proteomic Analysis of Carbon Ion Radiation in Sheep Sperm

This study is first to investigate proteomic changes in sheep sperm induced by carbon ion radiation using two-dimensional electrophoresis （2-DE） analysis in the project of breeding a new variety of sheep. Differential expression proteins were detected using the PDQuest 8.0 software after staining with Coomassie blue. Valid spots were then analyzed through liquid chromatography tandem mass spectrometry （LC-MS/MS）. Among the 480 total protein spots displayed in 2-D gels, 6 specific protein spots were observed in sperm gels. A search against protein sequences in the National Center for Biotechnology Information databases （NCBI） indicated that differentially expressed proteins correspond to two proteins, identified to be enolase and transcription factor AP-2-alpha （TFAP-2c0. The two proteins were up-regulated in the irradiated sperm. To the best of our knowledge, this study is the first to identify proteomic changes induced by carbon ion radiation in sheep sperm. The analysis of differential expression protein may be useful in identifying new breeding markers in sheep reproduction and in clarifying the mechanisms involved in irradiation or space breeding.

Practical semen analysis： from A to Z

Accurate semen analysis is critical for decisions about patient care, as well as for studies addressing overall changes in semen quality, contraceptive efficacy and effects of toxicant exposure. The standardization of semen analysis is very difficult for many reasons, including the use of subjective techniques with no standards for comparison, poor technician training, problems with proficiency testing and a reluctance to change techniques. The World Health Organization （WHO） Semen handbook （2010） offers a vastly improved set of standardized procedures, all at a level of detail that will preclude most misinterpretations. However, there is a limit to what can be learned from words and pictures alone. A WHO- produced DVD that offers complete demonstrations of each technique along with quality assurance standards for motility, morphology and concentration assessments would enhance the effectiveness of the manual. However, neither the manual nor a DVD will help unless there is general acknowledgement of the critical need to standardize techniques and rigorously pursue quality control to ensure that laboratories actually perform techniques ＇according to WHO＇ instead of merely reporting that they have done so. Unless improvements are made, patient results will continue to be compromised and comparison between studies and laboratories will have limited merit.

Evaluation of trend in semen analysis for 11 years in subjects attending a fertility clinic in India

Aim: The data on semen analysis of subjects attending the Fertility Clinic at NIHFW (National Institute of Health and Family Welfare) Munirka, New Delhi for the last 11 years were analyzed to verify the claims and speculations on declining sperm counts in men. Methods: Approximately 10 % of the records every year starting from 1990 to 2000 (numbering 1176 in total) were randomly selected for analysis. Subjects with azoospermia or severe oligozoospermia were excluded from analysis. Results: The average age of the men attending the infertility clinic was 31.2 years. The average semen volume and sperm count were found to be (2.6 ±0.1) mL and (60.6 ± 0.9) × 106/mL, respectively. No significant decline in sperm counts was observed in any year during the entire study period. Only 1.8 % of the total number of sperm counts in the random sampling were less then 20 × 106/mL. On the basis of WHO criteria on motility, the total percentage of non-progressive and non-motile sperm in the ejaculate was higher (63 %) as compared to the combined categories of slow and rapid linear progressive. Conclusion: The present study has confirmed similar findings from other different countries that declining sperm counts in humans is not a global phenomenon.

Semen analysis from an epidemiologic perspective

The fifth edition of the World Health Organization （WHO） manual for semen analysis includes for the first time reference values for human semen characteristics. This paper considers whether such values will help to resolve the intensely debated data indicating temporal and geographical shifts in sperm counts and hypotheses that anthropogenic activities that result in the release of chemicals into the environment are detrimental to male reproductive health. The reasons that these reference values will not fulfil these purposes are also explained. Although established reference values for semen characteristics are of limited value in analytical epidemiologic research, the WHO guidelines are of utmost importance for supporting the development of appropriate research protocols. Moreover, in spite of its limitations, semen analysis is still a useful research tool in epidemiological research, and no superior alternatives are on the horizon.

A comparison of conventional and computer-assisted semen analysis.（CRISMAS software） using samples from 166 young Danish men

The aim of the present study was to compare assessments of sperm concentration and sperm motility analysed by conventional semen analysis with those obtained by computer-assisted semen analysis （CASA） （Copenhagen Rigshospitalet Image House Sperm Motility Analysis System （CRISMAS） 4.6 software） using semen samples from 166 young Danish men. The CRISMAS software identifies sperm concentration and classifies spermatozoa into three motility categories. To enable comparison of the two methods, the four motility stages obtained by conventional semen analysis were, based on their velocity classifications, divided into three stages, comparable to the three CRISMAS motility categories： rapidly progressive （A）, slowly progressive （B） and non-progressive （C＋ D）. Differences between the two methods were large for all investigated parameters （P〈0.001）. CRISMAS overestimated sperm concentration and the proportion of rapidly progressive spermatozoa and, consequently, underestimated the percentages of slowly progressive and non-progressive spermatozoa, compared to the conventional method. To investigate whether results drifted according to time of semen analysis, results were pooled into quarters according to date of semen analysis. CRISMAS motility results appeared more stable over time compared to the conventional analysis; however, neither method showed any trends. Apparently, CRISMAS CASA results and results from the conventional method were not comparable with respect to sperm concentration and motility analysis. This needs to be accounted for in clinics using this software and in studies of determinants of these semen characteristics.

Assessment of solidification characteristics of carbon-inoculated Mg-3%Al melt by thermal analysis

The Mg-3%Al melt was inoculated by carbon with different holding time.The effect of holding time on grain refining efficiency was evaluated.The solidification characteristics of the carbon-inoculated Mg-3%Al melt with different holding time were assessed by computer-aided cooling curve analysis.The results showed that Mg-3%Al alloy could be effectively refined by carbon inoculation.Slight fading phenomenon occurred with increasing the holding time to 60 min.Carbon inoculation could significantly influence the shape of cooling curves of Mg-3%Al melt.The nucleation starting and minimum temperatures increased.The recalescence undercooling and duration decreased to almost zero after carbon inoculation.The grain refining efficiency of carbon inoculation could be assessed by the shape of the cooling curve and solidification characteristic parameters including nucleation starting and minimum temperatures,recalescence undercooling and duration.

Joint Angle Correction in Rheumatoid Arthritis and Its Reliability Analysis Based on Phase Dispersion Quantification

Background: Rheumatoid arthritis is a form of autoimmune disease characterized by synovitis that can ultimately cause joint deformities and impaired functioning. The cartilage destruction is one of the most important indicators for diagnosis and treatment of rheumatoid arthritis, and it is radiographically manifested as joint space narrowing. Issue: In the literature, the joint space narrowing progression between a baseline and its follow-up finger joint images can be quantified by using image registration algorithm. We found that the inconsistencies of joint angles may lead to characteristic mismatches and thus severely affect the accuracy of joint space narrowing quantifications. Methods: In this work, we introduce a rotation invariant phase only correlation in joint space narrowing quantification for the joint angle correction. Further, we propose a confidence index to quantify the quantification reliability of phase only correlation based on phase dispersion in phase difference spectrum. Conclusion: In our clinical experiments, the proposed quantification method can effectively overcome and manage the mismatch due to the inconsistency of joint angles. Additionally, the confidence index shows a high consistency with the joint space narrowing progression examinations manually done by a trained radiologist and one radiological technologist.

补肾生精法治疗特发性少、弱精子症的Meta分析

目的应用Meta分析研究补肾生精法治疗特发性少、弱精子症的疗效。方法检索中国知网、维普、万方、中国生物医学文献数据库、PubMed等数据库建库至2023年10月收录的采用补肾生精法治疗特发性少、弱精子症的临床随机对照试验文献。运用方法学质量评价,使用RevMan 5.4软件进行统计分析,并进行偏倚分析。结果共纳入7篇文献。Meta分析结果显示:采用补肾生精法治疗特发性少、弱精子症患者的总有效率(RR=1.26,95%CI:1.10~1.43,P=0.0006)、精子密度(WMD=23.83,95%CI:21.87~25.78,P<0.00001)、配偶妊娠率(RR=1.89,95%CI:1.56~2.29,P<0.00001)均显著优于对照组。结论补肾生精法治疗特发性少、弱精子症具有较好的临床疗效,可以显著提高精子密度、精子活动率及配偶妊娠率,且无明显不良反应报道,安全性及有效性均较高。

康乐黄公鸡早期体重与繁殖性状的相关性分析

为了揭示康乐黄公鸡早期体重与繁殖性状之间的相关性,试验测定了102只康乐黄公鸡出生和2,4,6,8,10,12,14,16周龄体重及22周龄繁殖性状指标[睾丸质量指标(左侧睾丸重、右侧睾丸重、总睾丸重、左侧睾丸指数、右侧睾丸指数、总睾丸指数)和精液品质指标(精液体积、精子密度)],并分析各性状指标间的相关性。结果表明:康乐黄鸡公鸡各周龄体重的变异系数在3.68%~12.84%之间,繁殖性状指标的变异系数在42.41%~68.43%之间。不同周龄体重间的相关性均达到显著水平(P<0.05),相关系数在0.345~0.958之间;睾丸质量指标(左侧睾丸重、右侧睾丸重、总睾丸重、左侧睾丸指数、右侧睾丸指数、总睾丸指数)间均呈极显著相关(P<0.01),相关系数在0.854~0.979之间;精液体积与8周龄、10周龄、12周龄、14周龄体重呈显著或极显著相关(P<0.05或P<0.01),相关系数在0.313~0.373之间。精子密度与左侧睾丸重、右侧睾丸重、总睾丸重、左侧睾丸指数、右侧睾丸指数、总睾丸指数均呈显著相关(P<0.05),相关系数在0.310~0.350之间。说明康乐黄鸡8周龄、10周龄、12周龄、14周龄体重与部分繁殖性状之间存在相关性。

IVF/ICSI-ET中胚胎实时监测系统与常规形态学评估选择性单胚胎移植累积活产率分析

目的:分析胚胎实时监测(TLM)系统和常规形态学评估(CMA)在体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)中选择性单胚胎移植的临床应用价值,并初步探讨拉曼光谱分析胚胎培养液对临床妊娠率的预测价值。方法:本研究为前瞻性随机对照临床研究,选择2019年4月至2020年7月在苏州市立医院生殖与遗传中心行IVF/ICSI-ET助孕的139例患者,随机分为TLM组和CMA组,分别选择最优胚胎行单胚胎移植(新鲜周期和复苏周期),患者第1次胚胎移植未获临床妊娠,则进行第2次,比较两组患者移植后的累积活产率和其他妊娠结局差异。同时收集IVF/ISCI受精后第3天胚胎培养液15μl,进行拉曼光谱分析。结果:TLM组与CMA组的累积活产率、累积临床妊娠率、累积早产率、累积早期自然流产率、累积异位妊娠率、累积早产率、小于胎龄儿或大于胎龄儿差异均无统计学意义(P>0.05)。TLM组新生儿性别比低于CMA组,但差异无统计学意义(P>0.05)。胚胎培养液拉曼光谱分析预测临床妊娠率的准确度为67.21%。结论:在卵巢储备功能良好的年轻女性中,进行选择性单胚胎移植时TLM评估胚胎优势不明显,需警惕基于动力学参数的胚胎选择可能影响性别比。拉曼光谱分析胚胎培养液尚不能很好地预测胚胎的种植能力。

《世界卫生组织人类精液检查与处理实验室手册》版本演变及临床意义

精液分析是男性生育力评估的基石,《世界卫生组织人类精液检查与处理实验室手册》是公认的精液分析指南,为全世界精液检查程序的标准化和参考值提供了基础。自第1版问世以来已经过去了40余年,期间用于评价精液质量的实验室方法发生了显著变化,检测的精确度和准确性得到了提高。随着男科学和生殖医学的不断进步及辅助生殖技术的出现和进展,该手册不断更新并引入新的、基于循证医学的检测方法,除了进行精液常规分析,还可以评估精子功能以满足临床需要。2021年第6版发布,提供了满足评估男性生殖功能、生育保健、不育症的诊断与治疗所需实验室程序的最新循证信息。本文对手册的演变进行了梳理和分析,并强调了更新之处及其临床应用价值,希望其能够获得广泛接受和应用。

计算机辅助精子分析用精液样本的稀释条件及标准化研究

目的探讨计算机辅助精子分析(CASA)系统检测高浓度精液样本的稀释条件及标准。方法当精子浓度<50×10^(6)/mL时不稀释;当≥50×10^(6)/mL时,按1:[n/(50×10^(6))]的比例[n为精子浓度,n/(50×10^(6))向下取整]用生理盐水稀释至50×10^(6)/mL以下。采用CASA系统和10μm深度一次性计数板检测精液样本,分为未稀释组(组1:精子浓度<50×10^(6)/mL).50×10^(6)/mL≤精子浓度<100×10^(6)/mL组(组2)、精子浓度≥100×10^(6)/mL组(组3),稀释前后分析各组精子浓度、前向运动精子百分率(PR)、非前向运动精子百分率(NP)精子活动率(PR+NP)和不活动精子百分率(IM)等,比较稀释前后结果的一致性。采用ROC曲线预测最佳稀释阈值。结果随着精子浓度的增加,稀释前后各参数差异逐渐增大。ROC曲线分析结果显示,分别用精子浓度、PR+NP、PR、NP、IM預測时,精液标本的最佳稀释阈值分别为133.05×10^(6)/mL.101.75×10^(6)/ml.118.60×10^(6)/mL.90.90×10^(6)/m111.83×10^(6)/mL.结合高浓度精液样本未稀释检测时对精子浓度和NP的影响最大,确定最佳稀释固值为125.08×10^(6)/ml。结论建议当精子浓度>125×10^(6)/mL时,应对精液样本进行生理盐水稀释。

SARS-CoV-2感染对男性精液质量影响的研究及meta分析

目的通过meta分析和回顾性研究探讨SARS-CoV-2感染对男性精液质量的影响。方法检索PubMed、中国知网、万方数据库及CBM中国生物医学文献数据库,运用Stata15.0进行meta分析。选取本院就诊并符合meta分析纳入标准的男性为研究对象,统计其一般人口学资料和精液参数,采用GraphPad Prism9.5.1对精液参数进行单因素方差分析和制图。检验水准为0.05。结果Meta分析共纳入9项研究,267例患者。精子浓度和存活率在感染前后差异均无统计学意义(P>0.05)。感染后1~3个月,精液量和正常形态精子百分率均增加(P=0.005,P=0.010),精液量于感染后>3个月恢复至感染前水平(P>0.05)。精子活动率和前向运动精子百分率于感染后>3个月增加(P=0.046,P=0.045),并恢复至感染前水平(P=0.099,P=0.098)。精子DNA碎片化指数于感染后3个月内可短时增高,>3个月后逐渐降低。回顾性研究8例,各阶段精液参数与感染前比较差异无统计学意义(P>0.05),但感染后<1个月均呈现负向变化,>3个月恢复至感染前水平。结论本实验室研究结果与meta分析基本一致。男性感染SARS-CoV-2后仅对精子形态、活力及DNA完整性产生短暂负面影响,但一般于感染后>3个月恢复至感染前水平。由于本研究对象人群和数量有限,SARS-CoV-2感染对男性精液质量影响仍需长期前瞻性大规模研究观察证实。

多因素对宫腔内供精人工授精临床妊娠率的影响分析

目的:探究多种因素与宫腔内供精人工授精(AID-IUI)临床妊娠率的相关性,寻求进一步提高中心妊娠率的方法。方法:回顾性分析本中心2015年1月至2022年12月257对夫妇在本中心行AID-IUI的440个治疗周期,按女方年龄分为<30岁、30~35岁、>35岁三组;按女方体重指数(BMI)分为<18.5、18.5~24、24~28、≥28四组;输卵管分为单侧通畅和双侧通畅两组;按治疗方案分为自然周期组和促排周期组;处理后前向运动精子总数(PTMS)分为(10~30)×106、(30~40)×106、≥40×106三组;按精液处理后孵育时间分为0~10min、10~40min、≥40min三组;分别对各因素进行单因素和多因素回归分析。结果:女方年龄<30岁、30~35岁、>35岁三组临床妊娠率分别是33.62%、27.11%、26.19%(P>0.05)。单侧输卵管通畅组临床妊娠率33.7%高于双侧输卵管通畅组的29.6%(P>0.05)。促排周期组临床妊娠率32.16%高于自然周期组的27.39%(P>0.05)。体重指数(BMI):<18.5、18.5~24、24~28、≥28四组临床妊娠率分别为35.48%、31.27%、30.26%、15.38%(P>0.05)。PTMS各组临床妊娠率差异无统计学意义(P>0.05)。精液处理后孵育时间10~40min组妊娠率33.82%高于0~10min组的23.53%和≥40min组的28.57%(P>0.05)。Logistic回归分析BMI是AID-IUI临床妊娠率的重要影响因素。结论:建议行AID-IUI治疗的女方将BMI控制在28以内有利于提高临床妊娠率;无论输精1次或2次只要PTMS超过10×106即可获得良好的成功率;人工授精妊娠结局一定程度上受到精液优化处理后孵育时间影响,提倡优化处理后孵育时间10~40min内进行手术,利于提高妊娠率。