Oehninger S, Alexander N J
Eastern Virginia Medical School, Norfolk.
Curr Opin Obstet Gynecol. 1991 Apr;3(2):182-90.
Few systemic approaches for treatment of the infertile male are available. Therefore, the focus has shifted to studies of sperm maturation in the female tract, tests of sperm function, and assisted reproduction. New methods of sperm evaluation allow a better determination of those samples that will and will not fertilize ova. These methods include the strict morphology examination, biochemical approaches such as evaluation of creatine kinase levels, and the hemizona assay. Computer assisted semen analysis has not yet proved important for diagnosis but has provided important research information. For example, the drug pentoxifylline significantly increases velocity and has also been shown to enhance in vitro fertilization. The term subfertile is extensively used in the literature but its clear definition and the prognosis for subfertile men have not been established. Approaches that may increase fertilization rates include reducing the gamete culture volume and removal of cumulus oophorus. Assisted reproductive technologies for patients with ejaculatory dysfunction have also been expanded. The use of improved semen processing techniques, advanced oocyte retrieval, and well-timed intrauterine insemination are enabling physicians to use decreasing numbers of viable sperm to achieve pregnancies.
目前针对男性不育的系统性治疗方法很少。因此，研究重点已转向女性生殖道内精子成熟的研究、精子功能测试以及辅助生殖。新的精子评估方法能更好地确定哪些样本能够使卵子受精，哪些不能。这些方法包括严格的形态学检查、生物化学方法（如评估肌酸激酶水平）以及半透明带试验。计算机辅助精液分析尚未被证明对诊断有重要意义，但已提供了重要的研究信息。例如，药物己酮可可碱能显著提高精子速度，还被证明可增强体外受精能力。文献中广泛使用“亚生育力”一词，但尚未明确其定义，也未确定亚生育力男性的预后情况。可能提高受精率的方法包括减少配子培养液体积以及去除卵丘。针对射精功能障碍患者的辅助生殖技术也有所扩展。使用改进的精液处理技术、先进的卵母细胞采集方法以及适时的宫内授精，使医生能够使用数量越来越少的活精子来实现妊娠。
