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Les différentes anomalies de la reproduction masculine sont-elles en augmentation ? Faits et controverses, possibles facteurs en cause: une analyse actualisée des données de la littérature et des registres

Are abnormalities of male reproductive function becoming increasingly common? Facts and controversies, possible causative factors: an up to date analysis of the literature and of disease registers

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Résumé

Au cours des dernières décennies, de nombreuses observations dans la faune sauvage d’anomalies relatives à l’appareil génital et à la fonction de reproduction mâle, certaines évoquant les données de la toxicologie expérimentale, ont conduit à s’interroger sur la toxicité de facteurs environnementaux pour la reproduction de l’homme. De plus, un certain nombre d’études suggère une augmentation de la prévalence des troubles de la reproduction de l’homme adulte au cours des dernières décennies dans de nombreux pays développés. Les données les mieux documentées concernent le cancer du testicule, son rythme de croissance suggérant le rôle de facteurs environnementaux et/ou de mode de vie. Toutefois, des différences régionales et ethniques considérables dans les taux d’incidence absolue pourraient impliquer des facteurs génétiques concomitants. Parallèlement, il semble que la qualité du sperme a diminué dans de nombreux pays, à en juger aussi bien par des méta-analyses que par des analyses statistiques de données d’un seul centre. Au début des années 2000, Skakkebæk et al. à Copenhague ont formulé l’hypothèse d’une origine commune à ces différentes anomalies lors du développement du testicule durant la gestation. Existe-t-il pour ces différentes conditions des données indiquant un lien de causalité avec une exposition environnementale/professionnelle à des composés reprotoxiques ? Ne serait-ce plutôt l’exposition chronique à de très nombreux composés chimiques à faible dose qui pourrait être impliquée ? Les facteurs de style de vie jouent-ils un rôle ? L’ensemble de ces questions se fondant sur une somme d’études, dont les résultats sont loin d’être univoques, a été la source de nombreux débats aussi bien au sein de la communauté scientifique que dans les médias. Les meilleures réponses possibles à ces questions complexes sont naturellement fondamentales pour les instances en charge de l’évaluation du risque et les politiques de santé publique qu’il convient d’adopter. La présente revue donne un état des lieux actualisé de ces questions.

Abstract

In recent decades, numerous observations in wildlife of various anomalies of the male reproductive functions-some being reminiscent of experimental toxicology data-have raised questions about the possible role of environmental pollutants. A number of studies suggest an increased prevalence of reproductive disorders in adult humans in recent decades in many (but not all) Western countries. The best documented data concern testicular cancer, its increasing rate suggesting that environmental factors and/or changes in lifestyle may come into play. However, considerable regional and ethnic differences exist in absolute incidence rates, suggesting in turn the concomitant role of the genetic background. Finally, several studies suggest that semen quality has declined in many countries. In the early 2000’s, Skakkebæk’s group in Copenhagen postulated a common origin to these different abnormalities — the so-called testicular dysgenesis syndrome (TDS) — all possibly related to abnormal testis development during gestation. Is there a causal link between these different conditions and deleterious environmental and/or lifestyle factors? The answer is far from being unequivocal, and the subject, a potential major public health problem, remains a source of hot debate both within the scientific community and in the media. The present review aims to provide an updated synthesis of these complex issues.

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Auger, J. Les différentes anomalies de la reproduction masculine sont-elles en augmentation ? Faits et controverses, possibles facteurs en cause: une analyse actualisée des données de la littérature et des registres. Basic Clin. Androl. 21, 7–23 (2011) doi:10.1007/s12610-010-0115-y

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Mots clés

  • Cancer du testicule
  • Cryptorchidie
  • Environnement
  • Expositions multiples
  • Faibles doses
  • Hypospadias
  • Infertilité masculine
  • Perturbateurs endocriniens
  • Qualité du sperme
  • Style de vie
  • Reprotoxiques
  • Testicule non descendu

Keywords

  • Cryptorchidism
  • Endocrine disruptors
  • Environment
  • Lifestyle
  • Low doses
  • Hypospadias
  • Male infertility
  • Multiple exposures
  • Semen quality
  • Reproductive toxins
  • Testicular cancer
  • Undescended testicle