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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
Andrologie volume 7, pages 199–211 (1997)
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.
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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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DOI: https://doi.org/10.1007/BF03034933