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Les prélèvements testiculaires dans les azoospermies sécrétoires: le point de vue du Biologiste de la Reproduction sur la lecture du prélèvement

The testicular sperm extraction in men with nonobstructive azoospermia: the reproduction biologist’s point of view on interpretation of biopsies

Andrologie volume 11, pages 127–132 (2001)Cite this article

Resume

Le pronostic des infertilités masculines sévères, dont les azoospermies sécrétoires, s’est considérablement amélioré ces dernières années avec la microinjection (ICSI). Le biologiste de la Reproduction participe activement, en collaboration avec le chirurgien à la recherche et l’extraction des spermatozoïdes à partir du tissu testiculaire (TESE).

La présence du biologiste au bloc opératoire est impérative pour guider le chirurgien et éviter des biopsies trop nombreuses. L’extraction des spermatozoïdes au laboratoire se fait le plus souvent par extraction mécanique en dilacérant le tissu en fins lambeaux à l’aide de pinces fines. L’extraction enzymatique à l’aide de collagénase de type IV pourrait être employée dans le cas des azoospermies sécrétoires afin de mieux dissocier les cellules et d’augmenter les chances de récupération de formes matures. La purification des spermatozoïdes sur fraction 50% de PureSperm permet de limiter la perte en spermatozoïdes sur des prélèvements qui sont souvent moins cellulaires que dans les cas d’azoospermie excrétoire. L’addition de stimulant de la mobilité (telle que la Pentoxifylline) ou la culture in vitro pendant 3 jours dans le cas d’akinésie, permet d’améliorer les résultats en AMP.

La cyropréservation des spermatozoïdes est obligatoire dans la prise en charge de ces cas d’azoospermie, permettant de programmer la TESE de manière asynchrone par rapport à la FIV-ICSI. Les résultats de cryoconservation des spermatozoïdes testiculaires obtenus ces dernières années sont satisfaisants. La congélation de plusieurs fractions spermatiques de petit volume serait à privilégier. II apparaît important de diminuer les interventions chirurgicales sur le testicule.

Nous présentons brièvement notre expérience sur 36 cas d’azoospermie sécrétoire, dans 13 cas la recherche de spermatozoïdes a été négative soit 36%; c’est le taux qui est retrouvé dans la littérature.

Abstract

The prognosis of severe male sterility (nonobstructive azoospermia) has considerably improved over recent years with the introduction of ICSI. The human reproduction biologist actively collaborates with the surgeon in the search for and extraction of sperm from testicular tissue (TESE).

The presence of the biologist during surgery is mandatory to guide exploration and to avoid an excessive number of biopsies. Sperm extraction is performed in the laboratory by mechanical extraction with fine forceps. Enzymatic extraction with collagenase IV can be used in cases of nonobstructive azoospermia to optimize tissue dispersion and to improve retrieval of mature cells. The use of only one fraction (50%) of Pure Sperm (JC Diffusion, Lyon France) limits the loss of spermatozoa. to optimize the results in cases of akinesia, it may be useful to induce sperm motility by pentoxifylline or perform in vitro culture for three days.

Sperm cryopreservation is compulsory in the case of nonobstructive azoospermia. This allows programming of TESE for a different time from that of ICSI. All results obtained with cryopreserved testicular sperm, in recent years, are encouraging. It is also recommended to freeze several small fractions of sperm in order to limit the number of surgical procedures on the testicle. This article presents the results of our experience in 36 cases of nonobstructive azoospermia. Extraction was negative in 13 cases (36%), similar to the rate reported in the literature.

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Authors and Affiliations

  1. Département de Médecine de la Reproduction, Hôpital E. Herriot, pavillon L, 5 place d’Arsonval, 69437, Lyon Cédex 03

    J. Lornage, S. Giscard D’estaing, H. Lejeune, M. Benchaib, D. Cottinet, B. Salle, V. Bied-Damon, S. Hadj & J. F. Guerin

  2. Service de Gynécologie, Hôpital Edouard-Herriot, Lyon

    D. Boulieu

Authors
  1. J. Lornage
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  2. S. Giscard D’estaing
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  3. H. Lejeune
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  4. M. Benchaib
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  5. D. Cottinet
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  6. B. Salle
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  7. D. Boulieu
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  8. V. Bied-Damon
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  9. S. Hadj
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  10. J. F. Guerin
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Additional information

Communication au XVIIème Congrès de la SALF, 7–9 décembre 2000, Bordeaux.

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Lornage, J., D’estaing, S.G., Lejeune, H. et al. Les prélèvements testiculaires dans les azoospermies sécrétoires: le point de vue du Biologiste de la Reproduction sur la lecture du prélèvement. Androl. 11, 127–132 (2001). https://doi.org/10.1007/BF03036636

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  • DOI: https://doi.org/10.1007/BF03036636

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Basic and Clinical Andrology

ISSN: 2051-4190