Zini Armand, Sigman Mark
Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada.
J Androl. 2009 May-Jun;30(3):219-29. doi: 10.2164/jandrol.108.006908. Epub 2008 Dec 4.
The advent of assisted reproductive technologies, particularly intracytoplasmic sperm injection (ICSI), has revolutionized the treatment of male-factor infertility. However, there are many unanswered questions regarding the safety of these techniques. These safety concerns are relevant because 1) these technologies often bypass the barriers to natural selection; 2) infertile men, particularly those with severe male-factor infertility, possess substantially more sperm DNA damage than do fertile men; and 3) experimentally, sperm DNA damage has been shown to adversely affect the developing embryo. This review discusses the etiology of sperm DNA damage, describes the individual tests of sperm DNA damage, and explores the relationship between sperm DNA damage and pregnancy outcomes. Based on a systematic review of the literature, sperm DNA damage is associated with lower natural, intrauterine insemination (IUI), and in vitro fertilization (IVF) pregnancy rates, but not with ICSI pregnancy rates. The literature also suggests that that sperm DNA damage is associated with an increased risk of pregnancy loss in those couples undergoing IVF or ICSI. Nonetheless, the true clinical utility of sperm DNA damage tests remains to be established, because the available studies are small and few in number and the study characteristics are heterogeneous. Although current data suggest that impaired sperm DNA integrity may have the greatest effect on IUI pregnancy rates and pregnancy loss by IVF and ICSI, further prospective studies are needed before testing should become a routine part of patient management.
辅助生殖技术的出现，尤其是卵胞浆内单精子注射（ICSI），彻底改变了男性因素所致不孕症的治疗方式。然而，关于这些技术的安全性仍存在许多未解决的问题。这些安全问题之所以重要，是因为：1）这些技术常常绕过自然选择的屏障；2）不育男性，尤其是那些患有严重男性因素不孕症的男性，其精子DNA损伤比可育男性要多得多；3）在实验中，精子DNA损伤已被证明会对发育中的胚胎产生不利影响。本综述讨论了精子DNA损伤的病因，描述了精子DNA损伤的各项检测方法，并探讨了精子DNA损伤与妊娠结局之间的关系。基于对文献的系统综述，精子DNA损伤与自然妊娠、宫内人工授精（IUI）和体外受精（IVF）的较低妊娠率相关，但与ICSI妊娠率无关。文献还表明，精子DNA损伤与接受IVF或ICSI的夫妇中流产风险的增加有关。尽管如此，精子DNA损伤检测的真正临床实用性仍有待确定，因为现有研究规模小、数量少且研究特征各异。虽然目前的数据表明精子DNA完整性受损可能对IUI妊娠率以及IVF和ICSI导致的流产影响最大，但在检测成为患者管理的常规部分之前，还需要进一步的前瞻性研究。
