- Revue
- Azoospermies Sécretoires et Fécondation Assistée
- Published:
Azoospermies non obstructives; facteurs prédictifs du prélèvement testiculaire et risques de la fécondation assistée
Nonobstructive azoospermia: predictive factors of testicular sperm retrieval and risks of assisted fertilization
Andrologie volume 14, pages 34–44 (2004)
Resume
Le prélèvement chirurgical de spermatozoïdes a révolutionné le traitement des azoospermies et plus particulièrement des azoospermies non-obstructives. Grâce à la microinjection intracytoplasmique (ICSI) qui permet à des spermatozoïdes défectueux de féconder l’ovocyte, des hommes naturellement inféconds peuvent engendrer. Ces techniques appliquées sans investigation préalable sur l’animal, ont soulevé un énorme enthousiasme et se pratiquent à grande échelle. Pour augmenter l’efficacité de ces traitements, les cliniciens cherchent, sans trop de succès, à mettre en évidence des facteurs de réussite qui leur permettraient de mieux conseiller les couples avec azoospermie non-obstructive, tributaires de ces techniques et d’éviter des interventions testiculaires inutiles et traumatisantes. Les recherches sur l’animal, entreprises après coup, soulèvent des réserves sur l’innocuité de l’ICSI et le bien-fondé d’une utilisation de ces spermatozoïdes, souvent à haut risque génétique. Plus encore, des travaux cliniques soulignent la fréquence inhabituelle de problèmes divers chez des enfants d’ICSI mais aussi de toute technique d’assistance à la reproduction. Ces observations troublantes ne sont pourtant pas corroborées par des suivis cliniques bien menés d’enfants d’ICSI. Ce paradoxe soulève une polémique vive.
Abstract
Surgical sperm retrieval has revolutionized the treatment of azoospermia. Intracytoplasmic sperm injection (ICSI) allows naturally infertile men to have children by allowing defective sperm cells to fertilize oocytes. These techniques, applied without any preliminary animal experimentation, raised an enormous enthusiasm and are performed on a large-scale. To increase the efficiency of these treatments, the clinicians are now trying, without success, to identify factors predictive of success allowing better patient selection and counselling of couples dependent on these techniques in order to avoid useless and harmful interventions. Animal research, conducted after introduction of these techniques, has raised serious doubts about the safety of ICSI and the legitimacy of using defective spermatozoa from genetically high-risk patients. Some studies have also emphasized the unusual frequency of obstetric and neonatal problems as well as rare diseases and malignancies in ICSI-born children and ART-born children. However, these disturbing findings are not specifically related to the ICSI procedure, as demonstrated by well-conducted large-scale follow-up studies in ICSI-born children. This paradox raises a lively debate. ICSI-children follow-up studies should continue until sound data taking into account the genetic and all other parental background are obtained. In conclusion, non obstructive azoospermic patients should be informed of the limits of sperm retrieval and genetic screening tools as well as all risks common to ICSI and ART.
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Soffer, Y. Azoospermies non obstructives; facteurs prédictifs du prélèvement testiculaire et risques de la fécondation assistée. Androl. 14, 34–44 (2004). https://doi.org/10.1007/BF03035466
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DOI: https://doi.org/10.1007/BF03035466
Mots clés
- infécondité masculine
- azoospermies non-obstructives
- prélèvements testiculaires
- ICSI
- techniques d’assistance à la reproduction
- facteurs de succès
- risques génétiques