ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil.
Department of Surgery (Division of Urology), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
Nat Rev Urol. 2018 Sep;15(9):535-562. doi: 10.1038/s41585-018-0051-8.
Intracytoplasmic sperm injection (ICSI) has become the most commonly used method of fertilization in assisted reproductive technology. The primary reasons for its popularity stem from its effectiveness, the standardization of the procedure, which means that it can easily be incorporated into the routine practice of fertility centres worldwide, and the fact that it can be used to treat virtually all forms of infertility. ICSI is the clear method of choice for overcoming untreatable severe male factor infertility, but its (over)use in other male and non-male factor infertility scenarios is not evidence-based. Despite all efforts to increase ICSI efficacy and safety through the application of advanced sperm retrieval and cryopreservation techniques, as well as methods for selecting sperm with better chromatin integrity, the overall pregnancy rates from infertile men remain suboptimal. Treating the underlying male infertility factor before ICSI seems to be a promising way to improve ICSI outcomes, but data remain limited. Information regarding the health of ICSI offspring has accumulated over the past 25 years, and there are reasons for concern as risks of congenital malformations, epigenetic disorders, chromosomal abnormalities, subfertility, cancer, delayed psychological and neurological development, and impaired cardiometabolic profile have been observed to be greater in infants born as a result of ICSI than in naturally conceived children. However, as subfertility probably influences the risk estimates, it remains to be determined to what extent the observed adverse outcomes are related to parental factors or associated with ICSI.
卵胞浆内单精子注射（ICSI）已成为辅助生殖技术中最常用的受精方法。它之所以如此流行，主要有以下几个原因：一是其有效性，二是该程序的标准化，这意味着它可以很容易地被纳入全球生育中心的常规实践，三是它几乎可以用于治疗所有形式的不孕。对于克服无法治疗的严重男性因素不孕，ICSI 是明确的首选方法，但在其他男性和非男性因素不孕情况下过度使用 ICSI 则没有证据支持。尽管通过应用先进的精子采集和冷冻技术以及选择染色质完整性更好的精子的方法，尽了一切努力来提高 ICSI 的效果和安全性，但不孕男性的总体妊娠率仍然不理想。在 ICSI 之前治疗潜在的男性不育因素似乎是改善 ICSI 结果的一种有前途的方法，但数据仍然有限。有关 ICSI 后代健康的信息在过去 25 年中积累了起来，人们对此感到担忧，因为与自然受孕的儿童相比，通过 ICSI 出生的婴儿出现先天性畸形、表观遗传紊乱、染色体异常、生育力低下、癌症、延迟的心理和神经发育以及受损的心脏代谢特征的风险更高。然而，由于生育力低下可能会影响风险估计，因此仍需确定观察到的不良后果在多大程度上与父母因素有关，或者与 ICSI 有关。
