Hall J, Fishel S
Nottingham University Research and Treatment Unit in Reproduction, Department of Obstetrics and Gynaecology, University Hospital, Queens Medical Centre, UK.
Baillieres Clin Obstet Gynaecol. 1997 Dec;11(4):711-24. doi: 10.1016/s0950-3552(97)80008-9.
The first observation that in vitro fertilization (IVF) was useful for treating oligozoospermia and oligoasthenozoospermia was reported by Fishel and Edwards in 1982. This was followed by a series of cases indicating the value of IVF in such cases. Conventional IVF has been modified and refined to achieve increased rates of conception in cases of male factor infertility. Methods such as high insemination concentration IVF for the treatment of teratozoospermia and microscopic IVF for the treatment of oligozoospermia have had some impact on fertilization and pregnancy rates; however, reports of success are varied. The recent advent of micromanipulation and, in particular, intracytoplasmic sperm injection (ICSI) has overshadowed the use of these modified IVF procedures. Because of the high fertilization and pregnancy rates achieved with ICSI, other micromanipulation techniques (subzonal insemination and partial zona dissection) have been abandoned; there have also been suggestions that other more conventional techniques, i.e. IVF, should also be abandoned and that ICSI become the sole technique for the treatment of infertility. The rapid increase in the number of centres using ICSI has led to extreme pressure for individual units to achieve high fertilization and pregnancy rates and there is a temptation to assign all patients to ICSI treatment. It is important that, in this highly competitive environment, new techniques are not applied haphazardly and reduced to the mere injection of gametes and achievement of pregnancy regardless of the cause of infertility. In his 1986 IVF--Historical Perspective, Fishel quoted Auguste Comte: 'to understand science it is necessary to know its history'. IVF has much recent history in animal and also human work. Although ICSI is the most significant therapeutic advance in male infertility treatment, its application to human IVF is only 4 years old, with a paucity of animal studies on which to rely. For this reason IVF still plays a very important role in the treatment of male factor infertility and should only be ruled out when it has failed previously or the number of available sperm is limited.
1982年，费舍尔和爱德华兹首次报道了体外受精（IVF）可用于治疗少精子症和少弱精子症。随后有一系列病例表明IVF在这类病例中的价值。传统的IVF已得到改进和完善，以提高男性因素不孕症患者的受孕率。诸如用于治疗畸形精子症的高受精浓度IVF和用于治疗少精子症的显微IVF等方法对受精率和妊娠率产生了一定影响；然而，成功的报道各不相同。微操作技术，尤其是卵胞浆内单精子注射（ICSI）的出现，使这些改良的IVF程序的应用黯然失色。由于ICSI取得了较高的受精率和妊娠率，其他微操作技术（透明带下授精和部分透明带切开）已被摒弃；也有人建议其他更传统的技术，即IVF，也应被摒弃，ICSI应成为治疗不孕症的唯一技术。使用ICSI的中心数量迅速增加，给各个单位带来了极大压力，要求其实现高受精率和妊娠率，因此存在将所有患者都分配接受ICSI治疗的倾向。在这种竞争激烈的环境中，重要的是新技术不能随意应用，不能仅仅为了实现配子注射和妊娠而不顾不孕症的病因。费舍尔在其1986年的《IVF——历史视角》中引用了奥古斯特·孔德的话：“要理解科学，就有必要了解其历史”。IVF在动物和人类研究方面都有很多近期的历史。尽管ICSI是男性不育治疗中最重大的治疗进展，但其在人类IVF中的应用仅有4年历史，可供参考的动物研究很少。因此，IVF在男性因素不孕症的治疗中仍然起着非常重要的作用，只有在先前失败或可用精子数量有限时才应排除。
