男性不育的辅助生殖技术治疗  

Treatment with Assistant Reproductive Technology for Male Infertility

作　　者：滕晓明[1] 韩毅冰[1] 黄文强[1] 陈振文[2] 

机构地区：[1]同济大学附属第一妇婴保健院,上海200040 [2]国家人口计生委科学技术研究所

出　　处：《国际生殖健康／计划生育杂志》2012年第5期378-380,共3页Journal of International Reproductive Health/Family Planning

摘　　要：男性不育的辅助生殖技术(ART)治疗应该是从夫精人工授精开始的,早期常规体外受精-胚胎移植(IVF-ET)主要是针对治疗女性因素特别是输卵管因素引起的不孕,男性因素引起的不育治疗效果相对较差,原因是精子活动力过于低下IVF的受精率低。1988年Gordon与Talansly采用生化方法在透明带上打孔、Cohen采用机械方法切除部分透明带技术获得妊娠。这些方法部分克服了受精障碍,但是单精受精率低,多精受精率高;临床妊娠率偏低,仅10%左右,大大限制了这些技术的推广。直到1992年比利时Palermo等将单个精子直接注射到成熟的MⅡ期卵细胞的胞浆内获得了妊娠,才迎来了男性不育治疗的革命性突破。ART已成为治疗男性不育的重要手段,但不应作为男性不育治疗的首选,而是常规治疗方法无效时的备选方案。在不同ART方法的选择上,也应遵循安全的原则,首先考虑损伤小的技术,其次才选择风险大、费用高的技术。采用ART治疗男性不育,应该在客观评估男性生育能力的基础上进行。选择ART方法还要结合女方因素综合考虑,制定最佳治疗方案。Treatment of male infertility started from the intrauterine insemination with husband＇s semen （IUH）. In the early stage, assisted reproductive technology （ART） was mainly for female patients with infertility, specifically for the tubal factor infertility. The outcome of ART treatment of male factor infertility was not good as that of female factor infertility, because of the low in vitro fertilization rate due to the low spermatozoa motility. To get clinical pregnancies, Gordon and Talansly in 1988 successfully developed ＇zona drilling （ZD）＇, and Cohen developed ＇partial zonal dissection （PZD）＇. Although these techniques partially overcome the difficulties of fertilization, they were not widely applied due to the low monospermie fertilization rate （15%-25%）, the high polyspennic fertilization rate,the relative high requirement for sperm number and motility, and the low clinical pregnancy rate （10%）. In 1992, Palermo successfully developed the intracytoplasmic sperm injection （ICSI） technique for the creative treatment of male infertility. ART should never be the first choice for the treatment of male infertility,it is a important backup choice after routine treatment. The good treatment for male infertility should be evaluated overall factors, including male fertility function, fertility ability of female panner, selectable ART methods,safety and low-invasiveness and low cost.

关 键 词：不育 男(雄)性 生殖技术 辅助 受精 体外 胚胎移植 精子注射 细胞质内 

分 类 号：R714.8[医药卫生—妇产科学]