Irvine D S, Aitken R J
Medical Research Council Reproductive Biology Unit, Centre for Reproductive Biology, Edinburgh.
Endocrinol Metab Clin North Am. 1994 Dec;23(4):725-48.
The diagnosis of male infertility is a rapidly developing field of investigation. The traditional descriptive approach to semen analysis is still at the heart of the diagnostic workup of male patients and important advances have been made in the standardization of the procedures used to construct the conventional semen profile, as embodied in the WHO handbook. Significant improvements have also been made in the techniques used to assess the quality of sperm motility. While this was once an entirely subjective exercise, the introduction of CASA systems to take objective measurements of the trajectories of human spermatozoa has revolutionized this form of analysis. The speed and accuracy of such systems has permitted detailed analyses of the relationships between sperm movement and sperm function, which has greatly enhanced the diagnostic power of this form of descriptive analysis. Notwithstanding the importance of the descriptive approach to semen analysis, it has also been recognized that to achieve an accurate diagnosis of male infertility such criteria should be supplemented with assays designed to reveal the functional competence of the spermatozoa. Bioassays have therefore been developed to measure such functions as the penetration of cervical mucus, sperm-zona interaction, the acrosome reaction, and sperm-oocyte fusion. All of these assays have been shown to generate information predictive of the fertilizing potential of human spermatozoa in vivo and in vitro. Despite their diagnostic value, the time, expense, and expertise required to run such functional assays has meant that they have not been widely used by infertility specialists. These functional assays are of value, however, in fundamental studies designed to elucidate the biochemical basis of defective sperm function. The first fruits of this research effort are now beginning to appear in the identification of a number of cytoplasmic markers for defective sperm function and the realization that lipid peroxidation plays a key role in the etiology of male infertility. In the wake of these fundamental studies will flow a new generation of biochemical tests for the diagnosis of defective sperm function and, it is hoped, the development of rational therapies with which to treat this condition.
男性不育的诊断是一个快速发展的研究领域。传统的精液分析描述性方法仍然是男性患者诊断检查的核心，并且在构建传统精液图谱所使用程序的标准化方面取得了重要进展，这体现在世界卫生组织手册中。在评估精子活力质量的技术方面也有显著改进。虽然这曾经完全是一项主观操作，但引入计算机辅助精子分析（CASA）系统以客观测量人类精子轨迹，彻底改变了这种分析形式。此类系统的速度和准确性使得能够对精子运动与精子功能之间的关系进行详细分析，极大地增强了这种描述性分析的诊断能力。尽管精液分析的描述性方法很重要，但人们也认识到，要准确诊断男性不育，此类标准应辅以旨在揭示精子功能能力的检测方法。因此，已经开发出生物检测方法来测量诸如宫颈黏液穿透、精子 - 透明带相互作用、顶体反应和精子 - 卵母细胞融合等功能。所有这些检测方法都已证明能够生成预测人类精子在体内和体外受精潜力的信息。尽管它们具有诊断价值，但进行此类功能检测所需的时间、费用和专业知识意味着不育症专家尚未广泛使用它们。然而，这些功能检测在旨在阐明精子功能缺陷生化基础的基础研究中具有价值。这项研究工作的初步成果现在开始显现，即确定了一些精子功能缺陷的细胞质标志物，并认识到脂质过氧化在男性不育病因中起关键作用。随着这些基础研究的开展，将涌现出新一代用于诊断精子功能缺陷的生化检测方法，并且有望开发出合理的治疗方法来治疗这种病症。
