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Les traitements médicaux de l’oligoasthénozoospermie idiopathique

Revue de la littérature

Medical treatment of idiopathic oligoasthenozoospermia

Literature review

Resume

Dans un nombre élevé de cas, l’infertilité d’un couple résulte d’une oligoasthénozoospermie dont aucune étiologie ne peut être reconnue. Différentes thérapeutiques médicales ont été proposées dans la littérature pour accroître la numération et la mobilité des spermatozoïdes. Nombre d’études observent une amélioration des paramètres spermiologiques sans prendre en compte les variations physiologiques et sans les comparer à des patients traités par un placebo. Pour d’autres, le but final du traitement n’est pas précisé c’est-à-dire l’obtention d’un enfant par le couple.

Dans cette revue de la littérature, seules les études randomisées précisant les taux de grossesses ont été prises en compte. Différentes hormones de l’axe hypothalamo-hypophyso-testiculaire ont été utilisées, le GnRH et ses analogues, les gonadotrophines et leurs formes purifiées, les anti-estrogènes, les androgènes et les inhibiteurs de l’aromatisation. Parmi ces molécules, des effets positifs ont été sporadiquement observés. Ainsi, la mestérolone stimulerait la spermatogenèse dans une étude sur cinq. L’undécanoate de testostérone et la FSH auraient des effets bénéfiques sur le pouvoir fécondantin vitro. Deux anti-estrogènes ont été testés, le clomifène et le tamoxifène avec des taux de grossesse significativement augmentés mais cependant des effets paradoxaux ont été observés. D’autres molécules, non hormonales, ont également fait l’objet de travaux. La plus étudiée est la kallicréine, une glycoprotéine impliquée dans la libération des kinines à partir du kininogène. Des résultats contradictoires ont été obtenus avec cette thérapie. La pentoxifylline, un inhibiteur de la phosphodiestérase est activein vitro mais n’a pas encore fait ses preuvesin vivo. D’autres substances comme l’arginine, la carnitine, les α bloqueurs, les bloqueurs des mastocytes, l’acide folinique, les vitamines, etc, font l’objet de publications sporadiques et aucune conclusion ne peut être tirée.

En conclusion, l’oligoasthénozoospermie idiopathique semble toujours rebelle à la plupart des traitements dont nous disposons à ce jour. Dans ce cas, le choix d’une thérapie est empirique et devrait en cas d’échec être rapidement abandonné afin d’orienter le couple vers la procréation médicalement assistée.

Abstract

In number cases, couple infertility results of an oligoasthenozoospermia without any recognized etiology. Various medical therapies have been proposed in the literature to increase sperm count and their mobility. Some studies demonstrate an improvement of spermatic parameters without taking physiological variations into consideration and without comparing the results with those obtained in patients treated with a placebo. For others, the final aim of the treatment is not specified, that means to get a pregnancy by the couples.

In this review of literature, only randomized studies giving the pregnancy rate, were taken into account. Various hormones of the hypothalamo-hypophyso-testicular axe have been used. GnRH and its analogs, gonadothropins and their purified forms, antiestrogens, androgens and aromataze inhibitors. Among these molecules, positive effects have been sporadically observed. Mesterolone stimulated spermatogenesis in one on five studies. Testosterone undecanoate and FSH have a benefic effect onin vitro fertilization. Two antiestrogens have been tested for a couple of years. Clomiphene and tamoxifen induce a sifnificant increase in the pregnancy rates with however, some paradoxical effects. Other non hormonal molecules have also been studied. The oldest studied medication is kallicrein, a glycoprotein implicated in the release of kinins from kininogens. Contradictory results have been obtained with this therapy. Pentoxifyllin, a phosphodiesterase inhibitor is active on spermatozoa mobilityin vitro, but its activityin vivo is not demostrated.

Other medicators as arginin, carnitin, mast cell blockers, α-blockers, vitamins etc have also been tested. Publications are sporadic and any conclusion can be drawn.

In conclusion, idiopathic oligoasthenozoospermia seems still unamenable to treat. Choice of a therapy is empirical and must be leaved for trying a medically assisted treatment

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Demoulin, A. Les traitements médicaux de l’oligoasthénozoospermie idiopathique. Androl. 8, 47–56 (1998). https://doi.org/10.1007/BF03034761

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Mots clés

  • Infertilité masculine
  • idiopathique
  • traitements médicaux

Key-words

  • Idiopathic male
  • infertility
  • medical treatments