Schlegel P N
James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center, New York.
Urol Clin North Am. 1994 Aug;21(3):477-86.
Techniques such as PZD, SZI, and ICSI are advantageous in cases of extreme male factor infertility. They are adjunctive techniques, applicable in the laboratory only during an IVF cycle. They can be used either simultaneously on sibling oocytes or, if indicated, individually. The present results demonstrate a lack of correlation between quantitative sperm parameters and outcome of assisted fertilization procedures. Preliminary results strongly suggest that ICSI will replace SZI and PZD for treatment of severe male factor infertility. Hundreds of viable pregnancies have been established well below the normal cut-off values for regular assisted conception procedures. Fertilization and pregnancy occurred following the use of spermatozoa without progressive motility and without normal morphology. In some patients sperm counts were correspondingly reduced and spermatozoa could be visualized only after centrifugation of the semen specimen. The current results provide evidence that spermatozoa from extremely oligoasthenoteratozoospermic men can produce normal offspring after the application of micromanipulation techniques, even when fertilization previously failed following standard IVF. Currently, investigators have not been able to identify, on the basis of conventional semen evaluations, subgroups of patients who would not benefit from microsurgical techniques. Findings published to date suggest approximately 24% clinical pregnancy rates per cycle when SZI and PZD are used together, but 35% clinical pregnancy rate per cycle for ICSI. Preliminary results suggest that the application of these techniques does not increase the risk of birth defects for subsequent offspring. However, continued observation of the potential effects of these procedures on progeny will be required.
诸如卵胞浆内单精子注射（PZD）、透明带下精子注射（SZI）和卵胞浆内单精子显微注射（ICSI）等技术在严重男性因素不育的情况下具有优势。它们是辅助技术，仅适用于体外受精周期中的实验室操作。这些技术既可以同时用于姐妹卵母细胞，也可以根据具体情况单独使用。目前的结果表明，精子数量参数与辅助受精程序的结果之间缺乏相关性。初步结果强烈表明，ICSI将取代SZI和PZD用于治疗严重男性因素不育。在远低于常规辅助受孕程序正常临界值的情况下，已经成功建立了数百例存活妊娠。使用无进行性运动能力且形态不正常的精子后实现了受精和妊娠。在一些患者中，精子计数相应减少，只有在对精液标本进行离心后才能看到精子。目前的结果证明，即使在标准体外受精先前失败后，应用显微操作技术，来自极度少弱畸精子症男性的精子也能产生正常后代。目前，研究人员尚未能够根据传统精液评估确定哪些患者亚组无法从显微手术技术中获益。迄今为止发表的研究结果表明，SZI和PZD联合使用时每个周期的临床妊娠率约为24%，但ICSI每个周期的临床妊娠率为35%。初步结果表明，应用这些技术不会增加后续后代出生缺陷的风险。然而，需要持续观察这些程序对后代的潜在影响。
