Laboratory of Testicular Physiology and Pathology, Center for Research in Endocrinology, National Research Council, Endocrinology Division, Buenos Aires Children's Hospital, Argentina.
Asian J Androl. 2012 Jan;14(1):14-23. doi: 10.1038/aja.2011.168. Epub 2011 Dec 26.
This article presents an update on the variable prognostic significance of different sperm pathologies in patients with severe male factor infertility due to morphology and motility disorders. Severe asthenozoospermia is one of the leading causes of male infertility as spermatozoa cannot reach the oocyte and/or penetrate normally. Identifying structural causes of sperm immotility was of great concern before the advent of intracytoplasmic sperm injection (ICSI), because immotility was the limiting factor in the treatment of these patients. In these cases, in vitro methods are used to identify live spermatozoa or stimulate sperm motility to avoid selection of non-viable cells. With these advances, fertilization and pregnancy results have improved dramatically. The identification of genetic phenotypes in asthenozoospermia is important to adequately inform patients of treatment outcomes and risks. The one sperm characteristic that seriously affects fertility prognosis is teratozoospermia, primarily sperm head and neck anomalies. Defects of chromatin condensation and acrosomal hypoplasia are the two most common abnormalities in severe teratozoospermia. The introduction of microscopic methods to select spermatozoa and the development of new ones to evaluate sperm quality before ICSI will assure that ultrastructural identification of sperm pathologies will not only be of academic interest, but will also be an essential tool to inform treatment choice. Herein, we review the differential roles played by sperm components in normal fertilization and early embryo development and explore how assisted reproductive technologies have modified our concepts on the prognostic significance of sperm pathologies affecting the head, neck, mid-piece and tail.
本文介绍了由于形态和运动障碍导致严重男性因素不育症患者不同精子病变预后意义的变化。严重的弱精子症是男性不育的主要原因之一，因为精子无法到达卵子和/或正常穿透。在胞浆内单精子注射 (ICSI) 出现之前，识别精子不动的结构原因非常重要，因为不动是这些患者治疗的限制因素。在这些情况下，体外方法用于识别活精子或刺激精子运动，以避免选择非存活细胞。随着这些进展，受精和妊娠结果得到了显著改善。在弱精子症中识别遗传表型对于充分告知患者治疗结果和风险非常重要。严重畸形精子症严重影响生育预后的一个精子特征是畸形精子症，主要是精子头部和颈部异常。染色质浓缩和顶体发育不全缺陷是严重畸形精子症中最常见的两种异常。引入显微镜方法选择精子和开发新方法在 ICSI 前评估精子质量，将确保精子病变的超微结构鉴定不仅具有学术意义，而且将成为告知治疗选择的重要工具。在此，我们回顾了精子成分在正常受精和早期胚胎发育中所起的不同作用，并探讨了辅助生殖技术如何改变了我们对影响头部、颈部、中段和尾部的精子病变预后意义的概念。
