Shushan A, Eisenberg V H, Schenker J G
Department of Obstetrics and Gynecology, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel.
Fertil Steril. 1995 Sep;64(3):459-69. doi: 10.1016/s0015-0282(16)57777-2.
To review the major changes that have occurred during the last decade of assisted reproduction technology (ART) practice, looking at the various conditions that cause subfertility.
A short review describing the progress that has been made during the last decade of ART practice, analyzing the various conditions that cause subfertility, is presented. The efficacy of ART as a treatment of these conditions is discussed.
Assisted reproductive technology currently is used for a wide range of indications and has become an acceptable tool in the treatment of subfertile couples. Yet, there is an ongoing debate regarding the effectiveness of ART versus conventional treatment for the various conditions that cause subfertility. The effectiveness of IVF in terms of pregnancy rate (PR) was demonstrated only for patients with severe bilateral tubal disease and male subfertility. For couples with other causes of infertility the differences in PRs do not reach statistical significance, and the efficacy of IVF has not been demonstrated clearly to date. Moreover, much of the discussion about management of subfertility has centered on costs of ART and the cost-benefit of ART versus conventional therapy for subfertility. It has been shown that, in women with unexplained infertility, menotropin treatment is as successful, less expensive, and carries a smaller risk than the surgical approach used in ART. However, the exact role of ART in the management of polycystic ovarian syndrome, immunological infertility, and endometriosis still is to be determined. Yet, as embryo implantation after ART still is considerably lower than that of fertile couples who conceive naturally, we expect that the next major thrust improving the effectiveness of ART will occur after future elucidation of factors influencing embryonic implantation.
回顾辅助生殖技术（ART）实践过去十年间发生的主要变化，审视导致生育力低下的各种情况。
本文呈现了一篇简短综述，描述了ART实践过去十年取得的进展，分析了导致生育力低下的各种情况，并讨论了ART作为这些情况治疗方法的疗效。
辅助生殖技术目前用于广泛的适应症，已成为治疗不育夫妇的可接受工具。然而，关于ART与传统治疗方法对各种导致生育力低下情况的有效性仍存在争议。仅在严重双侧输卵管疾病和男性不育患者中证明了体外受精（IVF）在妊娠率（PR）方面的有效性。对于其他不孕原因的夫妇，PR的差异未达到统计学意义，并且IVF的疗效迄今尚未得到明确证明。此外，关于生育力低下管理的许多讨论都集中在ART的成本以及ART与传统生育力低下治疗方法的成本效益上。研究表明，在不明原因不孕的女性中，促性腺激素治疗同样成功，成本更低，且风险小于ART中使用的手术方法。然而，ART在多囊卵巢综合征、免疫性不孕和子宫内膜异位症管理中的确切作用仍有待确定。然而，由于ART后的胚胎着床率仍远低于自然受孕的可育夫妇，我们预计在未来阐明影响胚胎着床的因素后，提高ART有效性的下一个主要突破将会出现。
