Accuracy of sperm-cervical mucus penetration tests in evaluating sperm motility in semen: a systematic quantitative review.
BACKGROUND
Our objective was to determine the accuracy of in-vitro sperm penetration into cervical mucus or substitutes in evaluating sperm motility in semen.


METHODS
This was a systematic quantitative review of test accuracy studies. The Cochrane library (2000:4), Medline (1966-2001), Embase (1988-2001) and SciSearch (1981-2001) were searched, in addition to manual searches of conference papers and bibliographies of known primary and review articles. Primary studies measuring in-vitro sperm penetration into cervical mucus, or substitutes (i.e. sperm-mucus penetration test, SMPT) and comparing results with sperm motility in semen were included.


RESULTS
There were 18 primary diagnostic studies published in 17 papers, involving a total of 2580 samples. Fourteen primary diagnostic tests used vanguard distance as diagnostic criteria (SMPT(vd)) and the pooled likelihood ratio (LR) for positive (LR+) and negative (LR-) tests were 2.29 (1.82-2.87) and 0.52 (0.44-0.63) respectively. Four studies used diagnostic criteria based directly or indirectly on swim-up sperm count per high power field (SMPT(sc)) instead. Their pooled LR+ and LR- were 5.24 (3.36-8.18) and 0.15 (0.06-0.39) respectively.


CONCLUSIONS
SMPT(vd) has a low accuracy in the evaluation of sperm motility in semen. However, SMPT(sc) was found to be more accurate. This method of using sperm concentration, instead of vanguard distance, as diagnostic criteria of in-vitro SMPT has potential as a useful laboratory-based sperm function test.
The Assisted Conception Unit and Education Resource Centre, Birmingham Women's Hospital, Birmingham B15 2TG, UK. BolarindeOla@aol.com
Bolarinde
B
Ola
Masoud
M
Afnan
Spyros
S
Papaioannou
Khaldoun
K
Sharif
Lars
L
Björndahl
Aravinthan
A
Coomarasamy
D002582:Cervix Mucus / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D012661:Semen / Q000502:physiology*; D013081:Sperm Motility; D013094:Spermatozoa / Q000502:physiology*