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Azoospermie et microinjection

Azoospermia and intracytoplasmic sperm injection

Andrologie volume 11, pages 142–148 (2001)Cite this article

Résumé

Dans les azoospermies, le prélèvement chirurgical de spermatozoïdes testiculaires, associé à la congélation, permet la mise en oeuvre de l’ICSI dans de bonnes conditions. Les auteurs présentent leur expérience dans ces azoospermies en insistant sur trois aspects:

  • - Prélèvement chirurgical ou à l’aiguille: dans les azoospermies obstructives, 40 patients ont eu un prélèvement chirurgical épididymaire ou testiculaire et 37 patients une biopsie testiculaire percutanée à l’aiguille: tous les prélèvements sont positifs. Dans les azoospermies non obstructives, 133 patients ont eu une biopsie testiculaire percutanée et 50 prélèvements ont montré la présence de spermatozoïdes mobiles (38%)

  • - La congélation est réalisée avec un milieu sans jaune d’oeuf, après dilacération des biopsies testiculaires à l’aide de lames de verre. Les résultats des ICSI avec ou sans congélation préalable sont rapportés et ne montrent pas de différence significative: Dans les azoospermies obstructives, sans congélation 41 cycles ont permis l’obtention de 13 grossesses (31%) et avec congélation préalable 115 cycles ont permis l’obtention de 24 grossesses (20%). Dans les azoospermies non obstructives, 31 cycles avec spermatozoïdes frais ont permis d’obtenir 6 grossesses (19%) et 33 cycles avec spermatozoïdes congelés 12 grossesses (36%)

  • - Après décongélation, le pourcentage de spermatozoïdes testiculaires dits mobiles est très faible, de l’ordre de 4%, et de plus cette mobilité est très diminuée (spermatozoïdes frémissants) ce qui rend la recherche de ces spermatozoïdes difficile et longue. L’adjonction de pentoxifyline (3mM) augmente en 15mn la mobilité qui passe à 30%, dont plus d’ 1/3 de progressifs, la recherche de spermatozoïdes mobiles devient plus aisée et rapide, les taux de fécondations et de grossesses étant par ailleurs équivalents.

Aucune malformation n’a été observée sur les 51 enfants nés vivants.

Abstract

In cases of azoospermia, testicular biopsy combined with cryopreservation of spermatozoa allows ICSI to be performed under good conditions. In this study, the authors present their results by emphasizing three major aspects:

  • - Retrieval of testicular spermatozoa by open biopsy or percutaneous needle aspiration: 40 patients with obstructive azoospermia underwent epididymal or testicular retrieval by open biopsy and 37 by percutaneous needle aspiration. All biopsies were positive. 133 patients with nonobstructive azoospermia underwent percutaneous needle aspiration and spermatozoa were successfully retrieved from 50 patients (38%).

  • - The freezing process was performed with a cryoprotective medium devoid of egg yolk after dilaceration of the testicular tissue using two sterile glass slides. No significant difference in the outcome of the ICSI procedure was observed between fresh and frozen-thawed spermatozoa. In cases of obstructive azoospermia, 13 pregnancies out of 41 ICSI cycles (31%) were obtained with the use of fresh testicular or epididymal spermatozoa and 24 pregnancies out of 115 ICSI cycles (20%) were obtained with the use of cryopreserved spermatozoa. In cases of non-obstructive azoospermia, 6 pregnancies out of 31 ICSI cycles (19%) were obtained with the use of fresh testicular spermatozoa and 12 pregnancies out of 33 ICSI cycles (36%) were obtained with the use of frozen-thawed spermatozoa.

  • - After the freezing-thawing process, the percentage motile testicular spermatozoa is very low (about 4%), with a weakly shaking motility making selection of live spermatozoa very long and difficult. The addition of pentoxifylline (3 mM) significantly increases this motility within 15 minutes, as 30% of spermatozoa have a progressive motility. Selection of viable motile spermatozoa is therefore easier and more rapid. Fertilization and pregnancy rates are comparable to those generally reported. No malformation was observed on 51 live births.

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Authors and Affiliations

  1. Unité de Biologie de la Reproduction-CECOS, I bis rue de la Cochardière, 35000, Rennes

    D. Le Lannou & J. F. Griveau

  2. Service de Gynécologie, CHR Hopital-Sud, Rennes

    M. C. Laurent

  3. Service d’Urologie, CHR Pontchaillou, Rennes

    B. Lobel

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  1. D. Le Lannou
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  2. J. F. Griveau
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  3. M. C. Laurent
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  4. B. Lobel
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Le Lannou, D., Griveau, J.F., Laurent, M.C. et al. Azoospermie et microinjection. Androl. 11, 142–148 (2001). https://doi.org/10.1007/BF03036638

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Basic and Clinical Andrology

ISSN: 2051-4190