[Results of surgical testicular sperm extractions (TESE) in a population of azoospermic patients with a history of cryptorchidism based on a 10-year experience of 142 patients]. / Résultats des extractions chirurgicales testiculaires de spermatozoïdes (TESE) dans une population de patients azoospermiques avec antécédent de cryptorchidie : à propos d'une expérience sur dix ans auprès de 142 patients.

INTRODUCTION: Cryptorchidism is a common and possible etiology of male infertility. OBJECTIVES: This is a retrospective study of 142 azoospermic men with history of cryptorchidism. A testicular sperm extraction (TESE) was performed for each of them, between 1995 and 2005, to realize in vitro fecundation with intracytoplasmic sperm injection (ICSI). MATERIAL AND METHODS: We studied the clinical pattern (age at the treatment, unilateral or bilateral cryptorchidism), hormonal levels (total testosterone and FSH) and ultrasound examinations in this population. Then, we studied the rates of successful TESE according to these various characteristics. RESULTS: The main origin of azoospermia is non obstructive (secretory). A great majority of the patients (71.8%) has benefited of an orchidopexy before the age of 10 years which does not seem to represent a factor of better forecast of surgical extraction of sperm cells. In the subgroup of the bilateral cryptorchidy, the rate of extraction was 63% (55/87). In the subgroup of the one-sided cryptorchidy, it was 61.9% (36/42). CONCLUSION: For us, history of cryptorchidism is an etiology of good prognosis for azoospermia, since the rate of TESE with positive sperm retrieval is 65%. In our population, the subgroups of patients whose FSH is normal and/or whose testicular volume is higher than 10 cm3 are those whose forecast is still better, because the rate of TESE with positive sperm retrieval is 75%.

[Unilateral partial deferential agenesia and CFTR gene composite heterozygoty (deltaF508/V938G)]. / Agénésie déférentielle partielle unilatérale et hétérozygotie composite du gène CFTR (DeltaF508/V938G).

This is a case report of a thirty-year-old-man consulting for a primary infertility that was diagnosed four years ago. Andrologic exam was normal. Two spermograms found normal spermatic parameters. An uro-genital echography with a RMI showed that a unilateral agenesia of the left vas deferens in the pelvic portion. Then, a composite heterozygoty of the CFTR gene (DeltaF508/V938G) was found. This is the first time that the association of these two mutations has been described. This case also makes it possible to wonder about the need for realizing, or not, a systematic basis imagery (ultrasound examination in first), in the event of infertility of the couple. In this context, the discovery of an echographic anomaly made it possible to identify CFTR mutations, whose physiopathological implication in the infertility can be discussed (CFTR related disorders)...

[Necrozoospermia: From etiologic diagnosis to therapeutic management]. / La necrozoospermie : du diagnostic étiologique à la prise en charge thérapeutique.

This review describes necrospermia, its diagnosis, causes and management. Sperm vitality is commonly assessed in the laboratory of reproductive biology, with the eosin test or with the hypo-osmotic swelling test. Necrospermia is defined by a percentage of living spermatozoa inferior to 58%, and can be related to male infertility. Several pathological mechanisms may be involved and can be classified either in testicular causes (hyperthyroidism, local hyperthermia, varicocele), or post-testicular causes (epididymal necrospermia, dysregulation of seminal plasma, adult polycystic kidney disease, vasectomy reversal, anti-sperm antibodies) or both (infection, toxic, age, spinal cord injury). The first treatment is to correct the underlying cause, if possible. Repetitive ejaculation has demonstrated to be effective as well. Many drugs would also improve the sperm vitality (antioxidants, non-and-steroidal anti-inflammatory drugs) but there is currently no guideline to recommend their use. With necrospermia, fertilization rates are lower but in vitro fertilization (IVF) with Intracytoplasmic sperm injection (ICSI) improves the chances of conception.

Extreme spermatogenesis failure: andrological phenotype and intracytoplasmic sperm injection outcomes.

Patients with very low sperm count through direct sperm examination can exhibit extreme oligozoospermia or cryptozoospermia (after centrifugation). The management of these patients is a real challenge for both clinicians and biologists. In this retrospective and comparative cohort study, we compared the andrological phenotype of patients with extreme alterations of spermatogenesis and assessed whether the origin of spermatozoa (testicular or ejaculate) had any influence on intracytoplasmic sperm injection (ICSI) outcomes. A total of 161 ICSI cycles were performed using ejaculated spermatozoa from 75 patients with extreme oligozoospermia (EOS) or cryptozoospermia (CS) and 150 ICSI cycles using extracted testicular spermatozoa from 74 patients with non-obstructive azoospermia (NOA). Physical, hormonal, ultrasound assessments, and ICSI outcomes were performed in each group. Cryptorchidism was significantly more frequent in the NOA group (60.8% vs. 22.6%, p = 0.001). FSH levels were significantly higher [18.9 IU/L (5.9-27.0) vs. 15.3 IU/L (9.0-46.5), p = 0.001] and the majority of inhibin B levels measured were found mostly undetectable in the NOA group as compared to EOS/CS group (31.1% vs. 10.7%, p = 0.0004). Moreover, we found no significant differences in the respect to the fertilization rates (48.9% and 43.3%, p = 0.43), implantation rates (17.4% and 15.9%, p = 0.77), and percentage of top quality embryo (22.4% and 20.4%, p = 0.73) between the two groups. The clinical pregnancy rates per embryo transferred were comparable in both groups (28.3% and 27.4%, p = 0.89). In this study, we showed for the first time a different andrological phenotype between EOS/CS and NOA groups. Indeed, cryptorchidism was significantly more frequent with more severe endocrine parameters found in the NOA group. These results reflect a more profound alteration in spermatogenesis in NOA patients. However, there was no difference in ICSI outcomes between NOA and EOS/CS groups.

Transition protein 1 mRNA expression is not related to pregnancy rate in azoospermic men undergoing TESE-ICSI.

Our laboratory has previously reported significantly low levels of protamine (PRM) gene expression in infertile men. This drop was correlated with a low pregnancy rate, suggesting that PRMs may be useful as predictive factors for the outcome of testicular sperm extraction and intracytoplasmic sperm injection (TESE-ICSI) in azoospermic men. Transition nuclear proteins (TPs) are expressed earlier in spermatogenesis than protamines and are required for normal sperm development. In the present study, we examined the expression of the transition nuclear protein 1 gene (TNP1) in azoospermia and its relationship with TESE-ICSI outcomes. The cellular expression of TNP1 mRNA in spermatids was quantified by in situ hybridisation on paraffin sections of testis biopsies from 21 men with obstructive azoospermia and 23 men with non-obstructive azoospermia. Cases of non-obstructive and obstructive azoospermia did not differ significantly in terms of TNP1 expression. Furthermore, TNP1 mRNA expression was similar in non-pregnant and pregnant couples. Hence, the pregnancy rate was not related to TNP1 mRNA expression levels in azoospermia. Our results emphasise the value of TNP1 as a reliable predictive marker for the presence of spermatids/spermatozoa in the testis biopsies used for TESE but also indicate that expression of the TNP1 gene (believed to be a major player in spermiogenesis and required for production of normal sperm) may not be a predictive factor for successful post-ICSI embryonic development.

Optimal management of extreme oligozoospermia by an appropriate cryopreservation programme.

BACKGROUND: Severe oligozoospermia is characterized by sperm count fluctuations that may result in insufficient quantities of motile sperm for ICSI on the day of oocyte retrieval, thus necessitating testicular biopsy. To avoid this, we proposed that patients, with transient azoospermia or repeatedly low sperm counts, make a safety pool of frozen spermatozoa before ICSI attempts. METHODS: Seventy cryptozoospermic (<10(3) spermatozoa/ml) and 46 oligozoospermic patients (10(3)-10(5)/ml) were included. Although all oligozoospermic patients succeeded in sperm banking, only 44 of 70 cryptozoospermic patients were successful. Others underwent testicular extraction of spermatozoa. The ICSI results for frozen sperm from cryptozoospermic patients were compared with those obtained with fresh sperm from a group of normal patients (>10(5) spermatozoa/ml). RESULTS: In this prospective matched, controlled study, five cryptozoospermic, but no oligozoospermic, patients failed to produce sperm on the ICSI day, and frozen sperm was used instead. Although fertilization and pregnancy rates (per attempt) using fresh (49% and 5/44, respectively) and frozen sperm (54% and one-fifth, respectively) were similar for this cryptozoospermic group, the results for fresh sperm were significantly lower when compared with the control group (66% and 16/43, P < 0.0001, P < 0.001, respectively). In contrast, results for the oligospermic and control groups were similar. CONCLUSIONS: Banking of ejaculated sperm is helpful for cryptozoospermic patients.