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Approche clinique d'une OAT

Resume

L'oligozoospermie (ou OAT) est un tableau biologique souvent observé chez les hommes inféconds. Cette OAT peut être la conséquence de différents facteurs mis en évidence par l'anamnèse, l'examen clinique et le spermogramme. L'anamnèse révèle les antécédents infectieux, de cryptorchidie, de cure chirurgicale d'hydrocèle ou de hernie inguinale, facteurs potentiels d'OAT. L'examen clinique peut montrer l'existence d'un varicocèle dont le traitement est à envisager en cas d'association avec une OAT. Enfin l'infection du sperme est un tableau dont le diagnostic et le traitement restent difficiles. En l'absence de ces facteurs potentiels d'OAT, le diagnostic d'OAT idiopathique est facilement posé, comme le montrent trois exemples d'OAT faussement idiopathiques: les obstructions unilatérales des épididymes ou des déférents, les obstructions partielles des canaux éjaculateurs et les pathologies thermiques des testicules. L'examen clinique de l'homme infécond reste un élément indispensable avant toute indication d'assistance médicale à la procréation.

Abstract

The clinical approach of the male partner of infertile couples seems to be still a problem. Indeed, clinical history and examination are too often lacking. Such an attitude induces that the treatment of male infertility tends to be based for most part on the examination of seminal fluid alone. With the consequence that the treatment of the semen rather the man is the focus of attention. Oligozoospermia (OAT) is a common finding among infertile men. This OAT can be due to factors that may be found through anamnesis, clinical examination and semen analysis. Anamnesis indicates history of cryptorchidism, urogenital infections, surgery for inguinal hernia. One of the most studied factors that can be found during clinical examination is varicocele, and recent data indicate that the surgical treatment of varicocele when associated with OAT could be beneficial to fertility of infertile men. Semen infection, a difficult diagnosis mainly based on bacteriospermia and leukospermia, could benefit from other diagnosis tools such as echography of the male reproductive tract and biochemical markers of the seminal plasma.

Finally, when no potential factors responsible for an OAT are found, such an OAT is named “idiopathic”. However, some of these “idiopathic OAT” are false idiopathic OAT, as shown through three examples, such as unilateral testicular obstruction, partial ejaculatory duct obstruction and thermal pathologies of the testes, when anamnesis and clinical examination are adequately associated with semen analysis.

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Mieusset, R., Bujan, L., Daudin, M. et al. Approche clinique d'une OAT. Androl. 6, 154–163 (1996). https://doi.org/10.1007/BF03034445

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Mots clés

  • Oligozoospermie
  • Anamnèse
  • Examen clinique
  • Infection du sperme
  • OAT faussement idiopathiques

Key words

  • Oligozoospermia
  • Anamnesis
  • Clinical examination
  • Semen analysis
  • Infertility