Real-life users of hormonal or thermal male contraception: An analysis of female partners' motivation, experience, and satisfaction.

BACKGROUND: Two male contraceptive methods that inhibit spermatogenesis currently exist: thermal male contraception and hormonal male contraception. Only five studies have been conducted on the acceptability of these methods among men; among women, only the hypothetical acceptability of such a male contraceptive approach as the sole contraception method used by a couple has been evaluated. OBJECTIVES: To evaluate the motivation, experience, and satisfaction of female partners in couples using hormonal male contraception or thermal male contraception as the sole contraception. MATERIALS AND METHODS: In this cross-sectional study, 123 male users of hormonal male contraception or thermal male contraception as the couple's sole contraception method were asked to invite their female partner to participate in an anonymous online survey. The questionnaire included 95 questions exploring population characteristics, contraceptive and pregnancy history, motivations for choosing hormonal male contraception or thermal male contraception, the experience of the women in the successive phase of use, relationships with their partner, and satisfaction with the contraception method. RESULTS: The response rate among participating women was 69% (59/86). The two main reasons for choosing male contraceptive were the desire to share the contraception role in the couple (65%) and the desire of the man to take charge of the contraception (61%). The sexual satisfaction score increased significantly between the contraceptive methods used before hormonal male contraception or thermal male contraception and the phase of contraceptive use (p < 0.01). The overall satisfaction level with thermal male contraception or hormonal male contraception was rated at 3.7 ± 0.6 out of 4. Women mostly recommended hormonal male contraception or thermal male contraception because of the share of contraceptive responsibility and mental load (n = 23/54, 43%). DISCUSSION: This population of women seemed to have struggled to find a contraceptive method that suited them, but most took advantage of thermal male contraception or hormonal male contraception and trusted their male partner to take charge of contraception use. CONCLUSION: The positive evaluation from women in partnerships using thermal male contraception and hormonal male contraception should encourage the development of these methods.

Case Report: Abnormalities of sperm motility and morphology in a patient with Leber hereditary optic neuropathy: Improvement after idebenone therapy.

Case: We report the sperm characteristics of a male patient who developed, when he was 18 years old, a Leber hereditary optic neuropathy, a hereditary optic neuropathy due to mtDNA mutation as well as variants in the nuclear DNA. At the age of 30 years-old, he complained of infertility lasting for 2 years. Semen analyses showed low motility spermatozoa and a high percentage of morphological or ultrastructural abnormalities. Levels of epididymal markers were strongly atypical. Idebenone was prescribed as treatment of his Leber hereditary optic neuropathy in order to improve his visual acuity. After 5 months of this treatment, motility of spermatozoa increased, and their vitality improved. A natural conception occurred. Outcome: This case is the first description of an anomaly of spermatozoas and of the epididymis epithelium in a patient with Leber hereditary optic neuropathy. It draws attention to sperm pathologies in patients with mitochondrial disorders. The role of the mtDNA mutations must be suspected since it plays an important role in the development and motility of spermatozoa. In addition, idebenone can by-pass the complex I and transfer electrons to complex III. It has been suspected to have a favorable effect on spermatogenesis. Conclusion: This case confirms the possibility of sperm dysfunction in Leber hereditary optic neuropathy and the interest of idebenone as a treatment for infertility due to mtDNA mutations in human.

Hormonal, chemical and thermal inhibition of spermatogenesis: contribution of French teams to international data with the aim of developing male contraception in France.

Since the 1970s, international research on male contraception has been actively pursued. Hormonal and non-hormonal methods (thermal, chemical) have been tested, leading to clinical trials of interest to thousands of men and couples. The results showed that it was possible to develop methods of male contraception that inhibited spermatogenesis with good contraceptive efficacy. However, their side effects (mainly loss of libido), poorly accepted modes of administration, and the high frequency of poor responders prevented their widespread use. Based on earlier initiatives, new avenues were explored and significant progress was achieved, allowing the reasoned use of male contraception. For 40 years, several French teams have played an important role in this research. The aim of this paper is to outline the history and the progress of the experimental and clinical works of these teams who addressed hormonal, chemical and thermal approaches to male contraception. These approaches have led to a better comprehension of spermatogenesis that could be useful in fields other than male contraception: effects of toxic compounds, fertility preservation.

Depuis les années 1970, il existe une recherche internationale active sur la contraception masculine. Des méthodes hormonales ou non-hormonales (thermique, chimique) ont été testées, aboutissant à des essais cliniques pouvant intéresser des milliers d'hommes et de couples.Leurs résultats ont prouvé qu'il était possible de créer des méthodes de contraception masculine inhibant la spermatogenèse avec une bonne efficacité contraceptive. Toutefois, leurs effets secondaires (essentiellement perte de libido), des modalités d'administration mal acceptées, la fréquence élevée de mauvais répondeurs n'autorisaient pas leur diffusion.A partir de mises au point ébauchées dans le passé, de nouvelles pistes ont été explorées avec des progrès significatifs permettant une pratique raisonnée de la contraception masculine. Depuis 40 ans, plusieurs équipes françaises ont joué un rôle important dans cette recherche. Le présent article a pour objectif de dresser l'historique et les progrès des travaux expérimentaux et cliniques de ces équipes qui se sont intéressées aux approches hormonale, chimique et thermique. Celles-ci ont permis une meilleure compréhension de la spermatogénèse pouvant être utile dans d'autres domaines que celui de la contraception masculine : effets d'agents toxiques, protection de la fertilité.

CFTR p.Arg117His associated with CBAVD and other CFTR-related disorders.

BACKGROUND: The high frequency of the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) gene mutation p.Arg117His in patients with congenital bilateral absence of the vas deferens (CBAVD) and in newborns screened for CF has created a dilemma. METHODS: Phenotypic and genotypic data were retrospectively collected in 179 non-newborn French individuals carrying p.Arg117His and a second CFTR mutation referred for symptoms or family history, by all French molecular genetics laboratories, referring physicians, CF care centres and infertility clinics. RESULTS: 97% of the patients had the intronic T7 normal variant in cis with p.Arg117His. 89% patients were male, with CBAVD being the reason for referral in 76%. In 166/179 patients with available detailed clinical features, final diagnoses were: four late-onset marked pulmonary disease, 83 isolated CBAVD, 67 other CFTR-related phenotypes, including 44 CBAVD with pulmonary and/or pancreatic symptoms and 12 asymptomatic cases. Respiratory symptoms were observed in 30% of the patients, but the overall phenotype was mild. No correlation was observed between sweat chloride concentrations and disease severity. Five couples at risk of CF offspring were identified and four benefited from prenatal or preimplantation genetic diagnoses (PND or PGD). Eight children were born, including four who were compound heterozygous for p.Arg117His and one with a severe CF mutation. CONCLUSIONS: Patients with CBAVD carrying p.Arg117His and a severe CF mutation should benefit from a clinical evaluation and follow-up. Depending on the CBAVD patients' genotype, a CFTR analysis should be considered in their partners in order to identify CF carrier couples and offer PND or PGD.

Normal spermatogenesis in a man with mutant luteinizing hormone.

Men with mutations in LHB, the gene encoding the beta subunit of luteinizing hormone (LHB), have azoospermia with absent or few fetal Leydig cells. We report a mutation in LHB in a man and his sister. The man presented with absence of virilization, undetectable luteinizing hormone, and a low serum testosterone level. He had complete spermatogenesis with a normal sperm count. The mutant luteinizing hormone had a low level of partial activity in vitro. We concluded that the residual luteinizing hormone activity, resulting in the expression of steroidogenic enzymes in few mature Leydig cells producing small amounts of intratesticular testosterone (20.2 ng per gram), was sufficient for complete and quantitatively normal spermatogenesis.

Paradoxical increase of sperm motility and seminal carnitine associated with moderate leukocytospermia in infertile patients.

OBJECTIVE: To examine the relationship between seminal polymorphonuclear (PMN) granulocytes and sperm functions (particularly sperm motility) in infertile men. DESIGN: A prospective clinical study. SETTING: Assisted fertilization program in an academic research environment in France. PATIENT(S): Infertile men (n = 138) evaluated and classified as follows: group A with no detectable PMN in semen, group B with less than 0.5 x 10(6)/mL, group C with 0.5-1 x 10(6)/mL, and group D > 1 x 10(6)/mL. INTERVENTION(S): Seminal PMN, elastase concentrations, and sperm characteristics were analyzed. Seminal biochemical markers (free L-carnitine, citrate, zinc, acid phosphatase, and fructose) were measured. MAIN OUTCOME MEASURE(S): Relation between seminal markers and sperm motility. RESULT(S): Grade "b" motility and epididymal carnitine were statistically significantly increased in group C. Acid phosphatase was the only seminal marker to be statistically significantly impaired in group D. Elastase was proportional to the degree of leukocytospermia. CONCLUSION(S): These results suggest that sperm PMN originate from two regions: [1] the epididymis, where in small numbers and activated they may play a favorable role in sperm quality, and the [2] prostate, where their presence in large numbers, reflecting prostatitis, induces decreased secretion, especially of acid phosphatase.

Detection of cystic fibrosis transmembrane conductance regulator (CFTR) gene rearrangements enriches the mutation spectrum in congenital bilateral absence of the vas deferens and impacts on genetic counselling.

BACKGROUND: Mutations in the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) gene have been widely detected in infertile men with congenital bilateral absence of the vas deferens (CBAVD). Despite extensive analysis of the CFTR gene using varied screening methods, a number of cases remain unsolved and could be attributable to the presence of large gene rearrangements, as recently shown for CF patients. METHODS: We carried out a complete CFTR gene study in a group of 222 CBAVD patients with strict diagnosis criteria and without renal anomaly, and searched for rearrangements using a semi-quantitative assay in a subgroup of 61 patients. RESULTS: The overall mutation detection rate was 87.8%, and 82% of patients carried two mutations. Ten out of the 99 different mutations accounted for 74.6% of identified alleles. Four large rearrangements were found in patients who already carried a mild mutation: two known partial deletions (exons 17a to 18 and 22 to 23), a complete deletion and a new partial duplication (exons 11 to 13). The rearrangements accounted for 7% of the previously unknown alleles and 1% of all identified alleles. CONCLUSIONS: Screening for rearrangements should be part of comprehensive CFTR gene studies in CBAVD patients and may have impacts on genetic counselling for the patients and their families.

[Phyllodes tumour of the prostate in a 28-year-old man]. / Tumeur phyllode de la prostate chez un homme de 28 ans.

Phyllodes tumours of the prostate are very rare tumours, as less than 40 cases have been reported in the literature. The authors report the case of a 28-year-old man managed for a phyllodes tumour of the prostate diagnosed in a context of haemospermia. The diagnosis was established by ultrasound, CT MRI and prostatic biopsies. Radical prostatectomy was performed after multidisciplinary discussion. Thirty six months after the operation, the patient was in complete remission, with spontaneous erections and had fathered a child conceived by medically assisted procreation. The authors stress the importance of nerve-sparing radical surgery and early sexual rehabilitation.