Silber S J
St Luke's Hospital, St Louis, Missouri 63017.
Reprod Fertil Dev. 1994;6(1):93-103; discussion 103-4. doi: 10.1071/rd9940093.
It is archaic to view male factor infertility today separately from in vitro fertilization (IVF) and treatment of the female partner. Oligoasthenozoospermia may be an inherited condition (most likely on the Y chromosome), and is refractory to any treatment of the male including hormones and varicocelectomy. IVF technology is the only justifiable approach for achieving a pregnancy in these couples. The reasons for this view and the suggested modern approach to couples with oligoasthenozoospermia are outlined in this review. However, obstructive azoospermia is different as it can be successfully corrected with microsurgery in over 90% of men. When it cannot be corrected, as in congenital absence of vas, microsurgical sperm retrieval combined with IVF can still be highly effective in producing pregnancy with sperm from the husband. The most important arena for research into male infertility in the next decade will be to map out the deletions on the Y chromosome that might result in defective spermatogenesis, and which probably cause most cases of non-obstructive male factor infertility.
如今，将男性因素不育与体外受精（IVF）及女性伴侣的治疗分开看待已过时。少弱精子症可能是一种遗传性疾病（最有可能位于Y染色体上），对包括激素和精索静脉曲张切除术在内的任何男性治疗均无效。IVF技术是这些夫妇实现妊娠的唯一合理方法。本综述概述了持此观点的原因以及针对少弱精子症夫妇建议的现代治疗方法。然而，梗阻性无精子症则不同，因为超过90%的男性可通过显微手术成功矫正。当无法矫正时，如先天性输精管缺如，显微取精结合IVF仍可非常有效地利用丈夫的精子实现妊娠。未来十年男性不育研究最重要的领域将是绘制Y染色体上可能导致精子发生缺陷的缺失图谱，这些缺失可能是大多数非梗阻性男性因素不育的病因。
