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Quelle valeur attribuer à l’analyse morphologique des spermatozoïdes en microscopie optique?

What is the value of light microscopy sperm morphological examination?

Resume

La morphologie des spermatozoïdes reste le paramètre qui suscite le plus de contradictions dans la littérature lorsque l’on veut tenter d’en apprécier la valeur prédictive. Il est cependant clair qu’actuellement on ne peut pas écarter la morphologie des spermatozoïdes comme critère d’appréciation de la qualité de ces cellules, cet examen reste d’une grande importance dans le bilan d’une infertilité masculine ou du couple. Par ailleurs, les nouvelles technologies, qui permettent de voir et donc de sélectionner sur leur morphologie les spermatozoïdes avec des grossissements supérieurs à ceux utilisés jusqu’ici, améliorent considérablement les résultats des fécondationsin vitro.

Plusieurs systèmes de classification détaillée des anomalies des spermatozoïdes ont été proposés depuis une cinquantaine d’années. Ces classifications deviennent de plus en plus strictes à chacune de leurs révisions. Trois parmi ces classifications servent le plus fréquemment de référence: la classification de Kruger/Tygerberg et la classification de David, redéfinie avec un soin particulier dans le souci de la démarche d’assurance en qualité en biologie de la reproduction par Auger et Eustache. Les résultats de ces analyses sont très hétérogènes en ce qui concerne le pourcentage global d’anomalies morphologiques et les fréquences respectives des différentes anomalies. Il est donc important de souligner qu’il est indispensable d’apporter un soin particulier à la réalisation technique de cet examen, à l’établissement de critères stricts d’appréciation de chaque anomalie et à l’harmonisation de ces critères entre les divers observateurs d’un même laboratoire et entre les laboratoires.

L’impact de la tératozoospermie isolée sur les résultats de la FIV et de l’ICSI fait l’objet de nombreuses études dont les résultats sont là encore parfois contradictoires. Cependant, la majorité des études montre que le pourcentage de spermatozoïdes morphologiquement normaux est positivement corrélé avec les résultats de l’ICSI, et de nombreux auteurs admettent qu’un pourcentage de spermatozoïdes morphologiquement normaux inférieur à 5% est prédictif d’un taux faible de fécondation et de grossesse en FIV et en ICSI.

Au cours de ces dix dernières années, on a montré que les taux d’aneuploïdies dans le sperme des populations d’hommes infertiles présentant une oligospermie sévère ou modérée étaient plus élevés que ceux des hommes fertiles avec spermogramme normal, et que les taux de disomies des spermatozoïdes étaient environ 20 fois plus élevés dans les ICSI que dans les FIV. Cependant, les résultats de ces différentes études ne permettent pas d’établir un lien évident entre la tératozoospermie polymorphe et la fréquence des disomies et des aneuploïdies dans le sperme.

Globalement, on peut conclure que l’analyse morphologique des spermatozoïdes en microscopie optique, au grossissement habituellement utilisé pour la réalisation des spermocytogrammes (x2000), n’est donc pas un bon indicateur des anomalies chromosomiques dans le sperme humain, excepté dans quelques cas rares d’anomalies monomorphes. Il n’en est pas de même des liens entre la morphologie des spermatozoïdes et l’apoptose. En effet, un nombre croissant de travaux établissent une corrélation positive entre l’infertilité masculine et la présence de marqueurs apoptotiques sur les spermatozoïdes, et le paramètre morphologie semble particulièrement lié à l’apoptose. Enfin, il est important de souligner l’absolue nécessité d’une standardisation des procédures employées et de tous les résultats de l’analyse morphologique du sperme.

Abstract

The value of sperm morphology to predict the sperm fertilizing capacity is a subject of ongoing debate. However, it is clear that sperm morphological examination is essential to determine sperm quality as part of the assessment of male or couple infertility. Moreover, application of a new high-power magnification method, which allows the choice of spermatozoa with a preferred nuclear morphology, is positively correlated with a dramatic increase in IVF-IMSI pregnancy rates. Several detailed classification systems of sperm abnormalities have been proposed over the last fifty years and each revision of these classifications introduces stricter criteria. Three of these classifications are generally used as reference classifications: the Kruger/Tygerberg classification and the David classification, carefully revised by Auger and Eustache to ensure quality assurance in reproduction biology. However, the results of sperm analyses are very heterogeneous in terms of the overall percentage of morphological abnormalities and the respective frequencies of the various abnormalities. This examination must therefore be performed very carefully based on strictly defined criteria for the assessment of each abnormality with harmonization of these criteria between the various observers in the same laboratory and between laboratories.

Various studies have examined the impact of isolated teratozoospermia on the results of IVF and ICSI, but once again with sometimes contradictory results. However, most studies show that the percentage of morphologically normal sperm is positively correlated with the results of ICSI, and many authors agree that a percentage of morphologically normal sperm less than 5% is predictive of low fertilization and pregnancy rates in IVF and ICSI. Over the last ten years, it has been shown that aneuploidy rates in the semen of populations of infertile men with moderate or severe oligospermia were higher than those in fertile men with normal sperm counts, and that sperm disomy rates were about 20-fold higher in ICSI than in IVF. However, the results of these various studies fail to demonstrate an obvious link between polymorphic teratozoospermia and the frequency of disomy and aneuploidy in sperm.

Consequently, light microscopy sperm morphological examination, at the magnifications generally used for sperm counts (x 2000), is therefore not a good indicator of chromosomal abnormalities in human semen, except in the rare cases of monomorphic abnormalities. However, this is not the case for the link between sperm morphology and apoptosis, as a growing number of studies establish a positive correlation between male infertility and the presence of apoptotic markers on spermatozoa, and morphological parameters appear to be closely correlated with apoptosis. Finally, standardization of examination procedures and reporting of the results of sperm morphological examination is absolutely essential.

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Correspondence to Marie -Roberte Guichaoual or Jeanne Perrin or Cendrine Geoffroy-Siraudin or Mireille Papadaccu.

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Guichaoual, M.-., Perrin, J., Geoffroy-Siraudin, C. et al. Quelle valeur attribuer à l’analyse morphologique des spermatozoïdes en microscopie optique?. Androl. 18, 18–25 (2008). https://doi.org/10.1007/BF03040376

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Mote clés

  • morphologie de spermatozoïdes
  • infertilité
  • anomalies chromosomiques
  • apoptose
  • FIV
  • ICSI

Key words

  • sperm morphology
  • infertility
  • chromosomal abnormalities
  • apoptosis
  • IVF
  • ICSI