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Etiologie de 350 cas de stérilité masculine. Effet de divers traitements sur la qualité du sperme et analyse de leur rôle dans la survenue de 100 grossesses

Etiologic factors of male sterility evaluated in 350 men — efficiency of treatments

Resume

Des facteurs étiologiques de stérilité masculine et l'effet de différents traitements sur la qualité du sperme ont été évalués chez 350 patients consultant pour une stérilité primaire ou secondaire de plus d'un an. Des facteurs d'environnement ont été mis en évidence dans 12% des cas, des maladies acquises telles que prostatite, varicocèle ou auto-immunité dans 36.8%, une insuffisance testiculaire dans 23%, une azoospermie obstructive dans 7,4% et une endocrinopathie dans 1,4% des cas. Dix-neuf % des cas étaient idiopathiques.

Un traitement conventionnel a pu être proposé dans 50% des cas et évalué chez 101 patients. Une normalisation du sperme (définie par un NTSM de plus de 16 millions) a été observée dans le % de cas suivants: 80% après hormonothérapie, 41% après antibiothérapie pour prostaties, 37% après cure de varicocèle et 30% après un traitement anti-inflammatoire de diclofénac.

Sur 100 grossesses, 39% sont survenues spontanément ou après traitement inducteur d'ovulation, 32% à la suite de traitement andrologique conventionnel et 26% à la suite de procréation médicalement assistée telle que fécondation in vitro classique (FIV), injection intracytoplasmique de spermatozoïdes (ICSI) ou insémination intra-utérine (IIU). L'efficacité relative de ces divers traitements en fonction du NTSM et l'utilité de l'investigation de I'homme infertile sont discutées. Les risques encourus par la femme lors de traitement par ICSI sont soulignés.

Abstract

Etiologic factors of male sterility and the effect of different treatments on sperm quality have been evaluated in 350 men consulting for primary or secondary infertility of more than one year. Environmental factors represent 12% of the etiologies, acquired diseases such as varicoele and prostatitis 36.8%, testicular failure 23%, endocrinopathy 1,4%, sexual dysfunction 1,4%, abnormality of sperm transport 7,4%. and idiopathic cases 19%. A conventionnal treatment has been tempted in 50% of the cases and evaluated in 101 patients. A normalisation of the sperm (defined by a total motile sperm count (TMS) higher than 16 millions) has been observed in a variable proportion of the cases: 80% after hormonotherapy, 37% after varicocelectomy, and 30% after antiinflammatory treatment.

Among 100 pregnancies, 39% occurred either spontanously or after ovulation induction, 32% after classical andrological treatment and 26% after assisted reproductive techniques (ART) such as in vitro fertilization, intracytoplasmic sperm injection or intrauterine insemination. The efficiency of these different treatments according to the TMS and the utility of the clinical investigation of the infertile male are discussed. The risk faced by the wife because of ART are underlined.

References

  1. Skakkebaek N.E., Giwercman A., de Kretser, D.: Pathogenesis and management of male infertility. Lancet 1994; 343: 1473–1478.

    Article  PubMed  CAS  Google Scholar 

  2. Palermo G.D., Cohen J., Alikani M., Adler A., Rosenwaks Z.: Intracytoplasmic sperm injection: a novel treatment for all forms of male factor infertility. Fertil Steril 1995; 63: 1231–1240.

    PubMed  CAS  Google Scholar 

  3. Nagy Z.P., Liu J., Joris H., Verheyen G., Tournaye H., Camus M., Derde M.-P., Devroey P. andVan Steirteghem A.C.: The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters. Hum. Reprod. 1995a; 10: 1123–1129.

    PubMed  CAS  Google Scholar 

  4. Cummins J.M. andJequier A.M.: Treating male infertility needs more clinical andrology, not less. Hum Reprod 1994; 9: 1214–1219.

    PubMed  CAS  Google Scholar 

  5. Baker H.W.G.: Male infertility. In: de Groot L.J., ed. Endocrinology, 3 rd ed. 1995 Orlando: Saunders p. 2402–2433.

    Google Scholar 

  6. Rowe P.J., Comhaire F.H., Hargrave T.B., Mellows H.J.: WHO Manual for the Standarized Investigation and diagnosis of the infertile Couple. Cambridge University Press,Cambridge, UK. 1993.

    Google Scholar 

  7. Soldati G., Piffaretti Yanez A., Campana A., Marchini M., Luerti M. andBalerna M.: Effect of peritoneal fluid on sperm motility and velocity distribution using objective measurements. Fertil Steril 1989; 52: 113–119.

    PubMed  CAS  Google Scholar 

  8. World Health Organization: WHO Laboratory Manuel for the examination of human semen-cervical mucus interaction. 2nd. 1987. ed. Cambridge University Press, Cambridge.

    Google Scholar 

  9. Tournaye H., Liu J., Nagy Z., Camus M., Goossens A., Silber S., Van Steirteghem A., Devroey P.: Correlation between resticular histology and out-come after intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod 1996; 11: 127–132.

    PubMed  CAS  Google Scholar 

  10. Comhaire F.H., Rowe P.J. andFarley T.M.M.: The effect of doxycycline in infertile couples with male accessory gland infection: a double blind prospective study. Int J Androl 1995; 9: 91–98.

    Article  Google Scholar 

  11. Nieschlag E., Hertle L. andBehre H.M.: Treatment of varicocele; counselling as effective as occlusion of the vena spermatica. Hum. Reprod. 1995; 10: 347–353.

    PubMed  CAS  Google Scholar 

  12. Arny M., Quagliarello J.: Semen quality before and after processing by a swim-up method: reletionship to outcome of intrauterine insemination. Fertil Steril 1987; 48: 643–647.

    PubMed  CAS  Google Scholar 

  13. Martin-Du Pan R.C., Bourrit B., Biondo, M.: Traitement de la stérilité masculine par fécondation in vitro. Schweiz Med Wochenschr 1987, 117: 804–809.

    PubMed  CAS  Google Scholar 

  14. Martin-Du Pan R.C., Sakkas D., Stalberg A., de Boccard P.G., Campana A.: Traitement de la stérilité masculine par injection intra-ovocytaire de spermatozoide: évaluation critique. Schw. Med. Wochenschr 1995a; 125: 1483–1488.

    CAS  Google Scholar 

  15. Martin-Du Pan R.C., Bischof P., Campana A., Morabia A.: Relationship between etiological factors and total motile sperm count in 350 infertile patients. (soumis à Andrologia, 1997).

  16. Dubin L. andAmelar R.D.: Etiologic factors in 1,294 consecutive cases of male infertility. Fertil Steril 1971; 22: 496.

    Google Scholar 

  17. Nieschlag E., Behre H.M.: Male infertility due to testicular dysfunction In Drife, J.O. and Templeton, A.A. (eds). Infertility Procedings of the 25th Study Group of the Royal College Obstetricians and Gynecologists. Springer London 1992, pp. 65–80.

    Google Scholar 

  18. Barratt C.L.R., Naeeni M., Clements S., Cooke I.D.: Clinical value of sperm morphology for invivo fertility: comparison between World Health organization criteria of 1987 and 1992. Hum Reprod 1995; 10: 587–593.

    PubMed  CAS  Google Scholar 

  19. Matorras R., Corcostegui B., Perez C., Mandolia M., Mendoza R., Rodriguez-Escudero F.J.: Sperm Morphology analysis (strict criteria) in male infertility is not a prognostic factor in intrauterine insimination with husband's sperm. Fertil Steril 1995; 63: 608–611.

    PubMed  CAS  Google Scholar 

  20. Ayala C., Steinberger E., Smith D.P.: The impact of the male factor on fertility rates in infertile couples; an analysis of large population. 20-th Annual Meeting for American Society of Andrology. J Androl. (Suppl. January–February 1995) Abstr. 24: 9.

  21. Silber S.J.: The relationship of abnormal semen parameters to male fertility. Hum Reprod 1989; 4: 947–953.

    PubMed  CAS  Google Scholar 

  22. Brasch J.G., Rawlins R., Tarchala S., Radwanska E.: The relationship between total motile sperm count and the success of intrauterine insemination. Fertil Steril 1994; 62: 150–154.

    PubMed  CAS  Google Scholar 

  23. Ben-Chetri A., Senoz S., Greenblatt E.M. andCasper R.F.: In vitro fertilization outcome in the presence of severe male factor infertility. Fertil Steril 1995; 63: 1032–1037.

    Google Scholar 

  24. Ord T., Patrizio P., Balmaceda J.P., Asch R.H.: Can severe male factor infertility be treated without micromanipulation?. Fertil Steril 1993; 60: 110–115.

    PubMed  CAS  Google Scholar 

  25. Baker H.W.G. andKovacs G.T.: Spontaneous improvement in semen quality: regression toward the mean. Int J Androl 1985; 8: 421–426.

    Article  PubMed  CAS  Google Scholar 

  26. Wolff H.: The biologic significance of white blood cells in semen. Fertil Steril 1995; 63: 1143–1157.

    PubMed  CAS  Google Scholar 

  27. Branigan E.F. andMuller C.H.: Efficacy of treatment and recurrence rate of leukycytospermia in infertile men with prostatitis. Fertil Steril 1994; 62: 580–584.

    PubMed  CAS  Google Scholar 

  28. Yanushpolsky E.H., Politch J.A., Hill J.A. andAnderson D.J.: Antibiotic therapy and leukocytospermia: a prospective, randomized, controlled study. Fertil Steril 1995; 63: 142–147.

    PubMed  CAS  Google Scholar 

  29. Schlesinger M.H. andHarris M.: Treatment out-come after varicocelectomy. Urol Clin North Am 1994; 21: 517.

    PubMed  CAS  Google Scholar 

  30. Madgar I., Weissenberg R., Lunenfeld B., Karasik A., Goldwasser B.: Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil. Steril. 1995; 63: 120–123.

    PubMed  CAS  Google Scholar 

  31. O'Donovan P.A., Vandekerckhove P., Lilford R.J. andHughes E.: Treatment of male infertility: is it effective? Review and meta-analyses of published randomized controlled trials. Hum. Reprod. 1993; 8: 1209–1222.

    PubMed  Google Scholar 

  32. Moskovitz B., Lin R., Nassar S. andLevin D.R.: Effect of Diclofenac Sodium (Voltaren) on Spermatogenesis of Infertile Oligospermic Patients. Eur. Urol. 1988; 14: 395–397.

    PubMed  CAS  Google Scholar 

  33. Schoysman R.: Epididymal causes of male infertility: pathogenesis and management. Int J Androl 1981; suppl. 5: 120–133.

    Article  Google Scholar 

  34. Hauser R., Temple-Smith P.D., Soudhwick G.J., McFarlane J. andde Kretser D.M.: Pregnancies after microsurgical correction of partial epididymal and vasal obstruction. Hum Reprod 1995; 10: 152–1155.

    Google Scholar 

  35. Martin-Du Pan, R.C., Bischof, P., de Boccard G., Campana A.: Is diclofenac helpful in the diagnosis of partial epididymal obstruction? (sous prese, Human Reprod. 1997; 123).

  36. Silber J.S., Nagy Z., Liu J., Tournaye H., Lissens W., Ferec C., Liebaers I., Devroey P. andVan Steirteghem A.C.: The use of epididymal and testicular spermatozoa for intracytoplasmic sperm injection: the genetic complications for male infertility. Human Reprod 1995; 10: 2031–2043.

    Article  CAS  Google Scholar 

  37. Campana A., Sakkas D., Stalberg A., Bianchi P.G., Comte I., Pache T., Walker D.: Intrauterine insemination: evaluation of the results according to the woman's age, sperm quality, total sperm count per insemination and life table analysis. Hum Reprod 1996; 11: 732–736.

    PubMed  CAS  Google Scholar 

  38. Kirbi C.A., Flaherty S.P., Godfrey B.M., Warnes G.M., Matthews C.D.: A prospective trial of intrauterine insemination of motile spermatozoa versus time intercourse. Fertil Steril 1991; 56: 102–107.

    Google Scholar 

  39. Silverberg K., Johnson J., Olive D., Burns W., Schenken R.S.: A prospective, randomized trial comparing two different intrauterine insemination regiments in controlled ovarian hyperstimulation cycles. Fertil Steril 1992; 57: 357–361.

    PubMed  CAS  Google Scholar 

  40. Rosenberg S., Yuzpe A.A., Alken M., Dunn R.C., Gantt P., Gianfortoni J.G., Maxson W.S., Webster B.: A randomized comparative multicenter trial of ovulation induction (OI) using FSH/hCG vs. intrauterine insemination (IUI) vs. combined OI and IUI for couples with male factor infertility. The American Fertility Society. 1993; Montreal 11–14 oct. 1993. Abstract P-183.

  41. Crosignani P.G., Walters D.E.: Clinical pergnancy and male subfertility; the ESHRE multicentre trial on the treatment of male subfertility. Hum Reprod 1994; 9: 1112–1118.

    PubMed  CAS  Google Scholar 

  42. Hinting A., Comhaire F., Vermeulen L., Dhont M., Vermeulen M., Vandekerckhove D.: Possibilities and limitations of techniques of assisted reproduction for the treatment of male infertility. Human Reprod 1990; 5: 544–548.

    CAS  Google Scholar 

  43. Schlegel P.N.: Is varicocelectomy a cost-effecetive treatment for male infertility in the ICSI era? 51 st Meeting American Society of Reproductive Medecine 1995; 7–12 October, Seattle, USA. Abstr.0-177, pp 87.

  44. Reijo R., Alagappan R.K., Patrizio P., Page D.C.; Severe oligozoospermia resulting from deletions of azoospermia factor gene on Y chromosome. Lancet 1996; 347: 1290–1293.

    Article  PubMed  CAS  Google Scholar 

  45. Schenker J.G. andEzra Y.: Complications of assisted reproductive techniques. Fertil Steril 1994; 61: 415–418.

    Google Scholar 

  46. Callahan T.L., Janet J.E., Ettner S.L., Greene M.F., Crowley W.F.: The economic impact of multiple-gestation pregnancies and the contribution of assisted-reproduction techniques. New Engl J Med 1994; 331: 244–249.

    Article  PubMed  CAS  Google Scholar 

  47. Neumann P.J., Gharib, S.D. andWeinstein M.C.: The Cost of a Successful delivery with in Vitro Fertilization. N Eng J Med 1994; 331: 239–243.

    Article  CAS  Google Scholar 

  48. Dor J., Seidman D.S., Ben-Shlomo I., Levran D., Ben-Rafael Z., Mashiach S.: Cumulative pregnancy rate following in-vitro fertilization: the significance of age and fertility aetiology. Hum Reprod 1996; 11: 424–428.

    Google Scholar 

  49. Collins J.A., Wrixon W., Janes L.B. andWilson E.H.: Treatment-independent pregnancy among infertile couples. N Engl J Med 1983; 309: 1201–1206.

    PubMed  CAS  Google Scholar 

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Martin-Du Pan, R.C., Campana, A. Etiologie de 350 cas de stérilité masculine. Effet de divers traitements sur la qualité du sperme et analyse de leur rôle dans la survenue de 100 grossesses. Androl. 7, 199–211 (1997). https://doi.org/10.1007/BF03034933

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