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Utilisation des spermatozoïdes testiculaires en ICSI. Intérêt de la culture in vitro. Revue de la littérature

Testicular spermatozoa for ICSI: benefits of in vitro culture. A review

Andrologie volume 11, pages 9–20 (2001)Cite this article

Résumé

Au cours de ces dernières années les tentatives d’ICSI réalisées avec des spermatozoïdes testiculaires se sont considérablement accrues. Cependant, l’une des difficultés techniques tient au fait que la mobilité des spermatozoïdes est extrêmement réduite. Un accroissement de la mobilité avait été observé après une incubation des prélèvements testiculaires pendant quelques heures. Dans l’optique d’augmenter les chances de succès, une culture in vitro des spermatozoïdes, préalable à l’ICSI, a été envisagée. Nous rapportons ici la revue de la littérature sur ce sujet.

Dans les azoospermies obstructives, la culture in vitro présente peu d’intérêt puisque, excepté une éventuelle “maturation” des spermatozoïdes pendant cette période, un pourcentage appréciable de spermatozoïdes mobiles est souvent observé rapidement après le traitement de la biopsie.

Dans les azoospermies non obstructives la culture in vitro paraît justifiée, puisque lorsque l’on retrouve des spermatozoïdes dans la biopsie, ils sont généralement immobiles. Cependant, la plupart des auteurs s’accordent à reconnaître que les résultats restent aléatoires: au terme de la culture, soit il existe un gain de mobilité, soit au contraire la plupart des spermatozoïdes sont morts.

Quelque soit le type d’azoospermie, les meilleurs résultats sont obtenus après 3–4 jours de culture. La supplémentation des milieux de culture avec de la FSH recombinante s’avère aussi efficace.

La culture in vitro peut être associée à la congélation des spermatozoïdes et la séquence culture in vitro/congélation donnerait de meilleurs résultats que la séquence congélation/culture in vitro.

Les quelques travaux sur l’utilisation en ICSI des spermatozoïdes maintenus en culture in vitro pendant 1 à 2 jours rapportent des résultats satisfaisants en terme de taux de fécondation et de grossesse.

La culture in vitro de spermatozoïdes testiculaires peut constituer une voie de recherche intéressante pour améliorer les résultats en ICSI, dans les cas où la quantité de spermatozoïdes retrouvée et/ou leur mobilité sont très faibles. De plus, elle nous paraît être un bon modèle d’étude des mécanismes d’acquisition de la mobilité des spermatozoïdes.

Abstract

The number of ICSI cycles performed with testicular spermatozoa has increased dramatically over recent years. However, one of the technical limitations of this approach concerns the extremely reduced motility of testicular spermatozoa. However, increased sperm motility was observed after incubating testicular samples for several hours. Therefore, in order to improve ICSI success rates, several authors have tested the effect of previous in vitro culture. We present a review of the literature on this subject.

In vitro culture does not appear to be very useful in cases of obstructive azoospermia, as, apart from possible sperm “maturation” during this culture phase, a high proportion of motile spermatozoa is usually already observed prior to in vitro culture.

The benefits of in vitro culture appear to be greater in the case of non-obstructive azoospermia, as when spermatozoa are present on the biopsy, they are usually immobile. However, discordant results have been published: after in vitro culture, spermatozoa have been reported to be either motile or mostly dead.

Regardless of the type of azoospermia, the best results are obtained after 3–4 days of in vitro culture. Addition of recombinant FSH to the culture medium also appears to be effective.

Cryopreservation of testicular biopsies may also be associated with in vitro culture and the in vitro culture/freezing sequence appears to give better results than the freezing/in vitro culture sequence.

Very few studies have reported the results of ICSI using frozen in vitro cultured spermatozoa, as most published studies concern fresh spermatozoa, used after 1–2 days of in vitro culture with satisfactory fertilization and pregnancy rates.

In vitro culture of testicular spermatozoa may therefore constitute an interesting research approach to improve the results of ICSI when the number of spermatozoa and/or motility are very low. In addition, in vitro culture of testicular spermatozoa appears to be a good tool to study the mechanisms of acquisition of motility, which are still poorly understood.

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Authors and Affiliations

  1. Laboratoire de Biologie du Développement et de la Reproduction, CECOS, Hôtel-Dieu, Boulevard Léon Malfreyt, 63000, Clermont-Ferrand

    B. Schubert, G. Grizard & D. Boucher

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  2. G. Grizard
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  3. D. Boucher
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Correspondence to B. Schubert.

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Prix de DESS décerné par la Société d’Andrologie de Langue Française. Présentation au XVIlème Congrès de la SALF, 7–8 décembre 2000, Bordeaux.

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Schubert, B., Grizard, G. & Boucher, D. Utilisation des spermatozoïdes testiculaires en ICSI. Intérêt de la culture in vitro. Revue de la littérature. Androl. 11, 9–20 (2001). https://doi.org/10.1007/BF03034391

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Basic and Clinical Andrology

ISSN: 2051-4190