Sharpe R M
MRC Human Reproductive Sciences Unit, Centre for Reproductive Biology, 37 Chalmers Street, Edinburgh EH3 9ET, UK.
Br Med Bull. 2000;56(3):630-42. doi: 10.1258/0007142001903436.
This chapter is an overview of recent developments in our understanding and thinking about the importance and nature of environmental effects on sperm counts and fertility in the human male. This area is plagued by imperfect studies, not necessarily because of imperfect design but because of other 'uncontrollable' constraints. The available data, therefore, need to be placed in context and account taken of the limitations of our understanding or, more correctly, our ignorance. As we enter the new millennium, one of the saddest scientific aspects of human reproduction and infertility is our persisting ignorance about the causes and treatment of male infertility. With one notable exception (Y chromosome microdeletions) there has been little advance in our understanding of the causes of male infertility and its direct treatment over the past 20 years. Although most infertile men can now be offered the chance of fertility via ICSI, it is largely ignored that this does not represent treatment of the patient's infertility (which will persist unchanged), but is a means of circumventing the problem and leaving it for the next generation to tackle. There are many reasons for our ignorance about the causes of infertility, and some of these are outlined below in order to emphasise how this limits our ability to establish whether or not specific lifestyle and environmental factors do, or do not, affect human male reproductive function.
本章概述了我们对环境因素对男性精子数量和生育能力的重要性及本质的理解和思考方面的最新进展。这一领域受到不完善研究的困扰，不一定是因为设计不完善，而是由于其他“无法控制”的限制因素。因此，现有数据需要放在特定背景下考量，并考虑到我们理解上的局限性，或者更确切地说，我们的无知。进入新千年之际，人类生殖与不育领域最令人悲哀的科学现状之一，就是我们对男性不育的原因和治疗方法仍然一无所知。除了一个显著的例外（Y染色体微缺失），在过去20年里，我们对男性不育原因及其直接治疗方法的理解几乎没有进展。尽管现在大多数不育男性都有机会通过卵胞浆内单精子注射（ICSI）实现生育，但很大程度上被忽视的是，这并不代表对患者不育问题的治疗（不育问题将依然存在），而只是一种规避问题的手段，把问题留给下一代去解决。我们对不育原因无知有诸多原因，下面将概述其中一些，以强调这如何限制了我们判断特定生活方式和环境因素是否影响男性生殖功能的能力。
