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Panorama de l’infertilité masculine

Overview of male infertility

Résumé

Cette revue fait le point sur l’épidémiologie, l’étiologie et la thérapeutique de l’infertilité masculine en insistant sur les données nouvelles. Le progrès thérapeutique majeur que constitue la microinjection amène à considérer les causes d’infertilité masculine en fonction de l’état de santé des enfants qui seront obtenus. Les études concernant l’intervention possible de xénobiotiques perturbant le contrôle hormonal des fonctions testiculaires sont en cours. Des causes génétiques d’infertilité ont été identifiées, il s’agit d’une part des microdélétions du bras long du chromosome Y responsables d’une part non négligeable de troubles de la spermatogénèse, et d’autre part d’altération du gène CFRT faisant de l’agénésie vésiculo-déférentielle une forme fruste de mucoviscidose. Ces anomalies génétiques ainsi que les anomalies chromosomiques, classiquement reconnues comme responsables de troubles de la spermatogénèse, ont des implications dans la possible transmission de troubles de la reproduction, voire de pathologies plus générales, aux enfants qui peuvent être obtenus grâce à la microinjection de spermatozoïdes recueillis dans l’éjaculat, les voies excrétrices ou le testicule luimême.

Abstract

This paper reviews new epidemiological, etiological and therapeutic aspects of male infertility. Because of the great improvement in the efficacy of assisted reproductive techology due to ICSI, the recently discovered genetic causes of male infertility have to be considered. While studies concerning the role of xenobiotics in disrupting endocrine regulation of testicular functions are in progress, genetic causes of male infertility has been discovered. Microdeletions of the long arm of the Y chromosome account for a substantial part of unexplained spermatogenic failures. Mutations of CFTR gene are involved in bilateral agenesis of vas deferens. This condition might be considered as a mild form of cystic fibrosis. These genetic defects together with chromosmal abnormalities, which are known to be responsible for spermatogenic failures, should be considered as potential sources of reproductive abnormalities of more global pathology transmissible to children who can be obtained by ICSI with ejaculated, epididymal or testicular sperm.

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Correspondence to H. Lejeune.

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mots-clés

  • Spermatogénése
  • génétique
  • microinjection

Key-words

  • Spermatogenesis
  • genetic
  • intracytoplamic sperm injection