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Tests de Selection des Spermatozoïdes avant Assistance Médicale à la Procréation

Selection Procedures of spermatozoa before assisted reproductive technologies

Resume

Les techniques de sélection des spermatozoïdes humains sont nombreuses et souvent spécifiques du centre d’andrologie qui les pratique. Nous ne faisons pas ici l’inventaire de toutes ces techniques mais reprenons les principales, le lavage-centrifugation, les méthodes de filtration («SpermPrep»), la migration ascendante ainsi que les gradients de densité avec des solutions colloïdales («Percoll», «PureSperm» et «Isolate») ou avec de nouvelles molécules iodées non colloïdales («OptiPrep»). Nous tentons de faire une synthèse de la littérature afin de dégager des méthodologies standardisées par technique et nous discutons les avantages et les inconvénients de chacune d’elle. La France étant un pays où les milieux utilisés pour une assistance médicale à la procréation doivent avoir été agréés d’un point de vue microbiologique, certains milieux décrits ici («Percoll») n’ont pas reçu cet agrément et ne doivent pas être utilisés en thérapeutique alors qu’un usage diagnostique est possible.

Certaines anomalies du sperme nécessitent un type de préparation particulière. Nous décrivons les techniques les plus consensuelles pour traiter les spermes avec anticorps anti-spermatozoïdes, avec présence de leucocytes ou suspects d’infection, les spermes hypervisqueux, ou encore le recueil des spermatozoïdes dans l’urine quand il existe une éjaculation rétrograde. Nous décrivons plus en détail une technique de préparation des spermes cryoconservés en s’inspirant des résultats de recherches fondamentales sur la congélation-décongélation des gamètes mâles humains.

Enfin, nous proposons une conduite à tenir pour le choix d’une technique d’AMP à proposer à un couple en tenant compte des caractéristiques du sperme, du résultat du test de sélection spermatique ainsi que de la survie des gamètes.

Abstract

There are many procedures to select spermatozoa but those procedures are often specific of each andrology centre. This review that is not an exhaustive review of the numerous methods published is rather devoided to focus on the main techniques, the sperm washing, the filtration methods («SpermPrep»), the swim-up, and the discontinuous density gradients with colloïdal solutions («Percoll», PureSperm” and «Isolate») including iodinated organic molecule as ‘OptiPrep». The first part presents a synthesis of literature in order to bring out standardized procedures, and a summary of the advantages and disadvantages of each step of these procedures.

Some specific anomalies of sperm need particular treatments. There is a consensus on the validated techniques to prepare semen samples in the presence of antisperm antibodies, leukocytes, bacterial contaminants, and also semen samples exhibiting hyperviscosity or in case of retrograde ejaculation. Cryopreserved sperm preparation is also described with references to experimental results in freezing-thawing human spermatozoa. The second part proposes guidelines for the therapeutic choice of the appropriate assisted reproductive technologies (i.e.: intra uterine artificial insemination, in vitro fertilization or intracytoplasmic sperm injection) according to semen parameters, and to the outcome of sperm selection and survival.

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Correspondence to C. Mathieu.

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Mathieu, C., Lucas, H. Tests de Selection des Spermatozoïdes avant Assistance Médicale à la Procréation. Androl. 9, 286–296 (1999). https://doi.org/10.1007/BF03035240

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Mots clés

  • Sperme humain
  • préparation du sperme
  • test de migration survie
  • gradients de densité
  • Percoll
  • migration ascendante

Key-words

  • Human semen
  • sperm preparation
  • swim-up
  • density gradients
  • Percoll
  • filtration methods