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L’AMP chez les blessés médullaires: quelles indications pour quels résultats?
Strategy and management of assisted reproductive techniques in men with spinal cord injury
Andrologie volume 10, pages 412–416 (2000)
Résumé
Le traitement de l’infertilité de l’homme blessé médullaire a bénéficié de progrès réalisés dans différents domaines: techniques d’éjaculation provoquée, assistance médicale à la procréation, prélèvement micro-chirurgical de spermatozoïdes.
La dégradation rapide de la fertilité de ces patients nécessite d’envisager très précocement après le traumatisme médullaire une congélation de sperme. En cas d’anéjaculation, le sperme pourra très souvent être obtenu par des techniques de stimulation. C’est uniquement en cas d’échec du traitement de l’éjaculation que nous aurons recours au prélèvement micro-chirurgical de spermatozoïdes dans les voies génitales.
Les techniques d’assistance médicale à la procréation ne sont indiquées qu’en cas d’impossibilité ou d’échec d’une auto-insémination intra-conjugale. Leurs indications ne sont pas différentes de celles des autres couples infertiles. Cependant, le sperme recueilli est en général pauvre et nous devons très souvent avoir recours à la fécondation in vitro et parfois à la micro-injection.
Abstract
The fertility of men with spinal cord injury (SCI) is severely impaired because of ejaculatory dysfunction and poor semen quality.
Only a few patients are able to ejaculate during either sexual intercourse or masturbation. Fortunately, ejaculation can usually be obtained either by penile vibratory stimulation as first treatment option or electroejaculation as the second option. When assisted ejaculation techniques fail because of lack of response or complications such as autonomic dysreflexia, spermatozoa can be retrieved from the vas deferens or epididymis or directly from the testes.
Motivated couples with adequate semen quality can be offered penile vibratory stimulation combined with self-insemination at home before resorting to assisted reproductive technology.
However, most couples require an assisted reproduction technique. When semen quality is consistently good, up to three or four intrauterine inseminations can be initially recommended. However, this technique achieves only modest pregnancy results andin vitro fertilization techniques are often required. We perform standardin vitro fertilization (IVF) when semen quality is considered to be sufficient, otherwise we perform intracytoplasmic sperm injection (ICSI).
With the new techniques now available, the majority of spinal cord injured men stand a fair chance of fathering a child. Availability of ICSI is important to maximize the probability of success for men with very poor semen quality. There are also a number of concerns about the safety of ICSI and the potential risks for the offspring. This new technique must therefore be used very cautiously and requires further surveillance.
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Wagner, L., Costa, P. L’AMP chez les blessés médullaires: quelles indications pour quels résultats?. Androl. 10, 412–416 (2000). https://doi.org/10.1007/BF03034497
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DOI: https://doi.org/10.1007/BF03034497