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Syndrome de Klinefelter et microinjections intraovocytaires de spermatozoïdes (revue de la littérature)

Klinefelter’s syndrome and intracytoplasmic sperm injection (review)

Andrologie volume 13, pages 161–169 (2003)Cite this article

Résumé

Le syndrome de Klinefelter représente historiquement la forme clinique typique de l’azoospermie sécrétoire sans espoir d’obtenir une paternité biologique. Les méthodes de microinjection intraovocytaire d’un spermatozoïde, soit de l’éjaculât, soit extrait du parenchyme testiculaire, ont pu être appliquées à des patients présentant un syndrome de Klinefelter. Les publications que nous avons recensées jusqu’en juin 2002 font état de microinjections, soit à partir de spermatozoïdes éjaculés, dans 9 cas de syndrome de Klinefelter avec oligospermie extrême, avec pour résultats globaux: 79 ovocytes matures, 52 ovocytes fécondés, 31 embryons, 18 embryons transférés, 6 grossesses, 5 naissances, soit à partir de spermatozoïdes testiculaires, dans 93 cas, avec pour résultats globaux: 347 ovocytes, 193 ovocytes fécondés, 149 embryons, 78 embryons transférés sur 37 cycles, 24 grossesses cliniques et 2 grossesses biochimiques, et 32 naissances. Bien que l’on puisse tout à fait suspecter un biais de publication (les tentatives ayant donné lieu à des grossesses ayant été publiées, les échecs n’ayant vraisemblablement pas fait l’objet de publication), ces résultats sont tout de même inattendus si on se réfère au pronostic traditionnellement admis dans le syndrome de Klinefelter. Le taux de spermatozoïdes aneuploïdes semble lui aussi inférieur à ce que l’on pouvait craindre. La proportion réelle des cas de syndrome de Klinefelter pour lesquels on peut disposer de spermatozoïdes ayant un bon potentiel de dévelopement embryonnaire reste toutefois à établir et les moyens permettant de repérer ces patients restent à préciser.

Abstract

Historically, Klinefelter’s is the typical clinical form of secretory azoospermia with no hope of achieving biological paternity. However, ICSI, either from ejaculated sperm or following testicular sperm extraction, have been recently applied to patients with Klinefelter’s syndrome. Papers published until June 2002 have reported microinjections with ejaculated sperm in 9 cases of Klinefelter’s syndrome with extreme oligospermia with the following overall results: 79 mature oocytes, 52 fertilized oocytes, 31 embryos, 18 transferred embryos, 6 pregnancies, 5 births, or from testicular spermatozoa, in 93 cases, with the following results: 347 oocytes, 193 fertilized oocytes, 149 embryos, 78 embryos transferred out of 37 cycles, 24 clinical pregnancies and 2 positive pregnancy tests, and 32 births. Although a publication bias was very likely (successful attempts were published, failed attempts were probably not published), these results were unexpected based on the traditional view on Klinefelter’s syndrome. The rate of aneuploid spermatozoa also appeared to be lower than expected. The real proportion of Klinefelter patients in whom spermatozoa with a good potential for embryonic development can be retrieved and the means of identifying these patients remain to be established.

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  1. Département de Médecine de la Reproduction, Hôpital E. Herriot et Inserm-Inra u418, Hôpital Debrousse, Lyon

    Gérald Raverot & Hervé Lejeune

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  1. Gérald Raverot
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  2. Hervé Lejeune
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Correspondence to Hervé Lejeune.

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Raverot, G., Lejeune, H. Syndrome de Klinefelter et microinjections intraovocytaires de spermatozoïdes (revue de la littérature). Androl. 13, 161–169 (2003). https://doi.org/10.1007/BF03034431

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Basic and Clinical Andrology

ISSN: 2051-4190