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The worldwide incidence of prostatic cancer derived from data pub­ lished by the Union Internationale contre Ie Cancer and the Interna­ tional Red Cross Committee has been estimated to be 200 000 new cases each year. Cases occur predominantly in the USA (75 per 100 000) and in northern Europe (40 per 100 000), whereas the incidence is low in Asia. Comparison of clinical series and autopsies confirms the high incidence of cancer in older age groups, although not all cases are seen clinically. Mortality increases more slowly than the incidence of the disease, indicating that diagnosis and treatment are increasingly effec­ tive. Aetiological factors remain the subject of much discussion, without any criteria appearing to be dominant. L'incidence du cancer prostatique dans Ie monde, selon les publica­ tions de I'Union Internationale contre Ie Cancer et Ie Comite Interna­ tional de la Croix-Rouge (International Red Cross Committee) a ete es­ timee a200 000 nouveaux cas par an avec une predominance aux Etats­ Unis (75 par 100 000) et en Europe du nord (40 par 100000), les pays asiatiques se voyant epargnes. La comparaison de series cliniques et d'autopsies confirme la haute incidence de ce cancer chez les personnes plus agees, bien que tous les cas n'aient pas ete verifies en pratique c1inique.La mortallte croit moins vite que I'incidence de la maladie, ce qui traduit une meilleure performance du diagnostic et du traitement. Les donnees etiologiques restent tres controversees sans critere domi­ nant.

The treatment of clinically localized prostate cancer is based on total prostatectomy, radiotherapy or surveillance. The adverse effects of these treatments have led to an increasing interest in alternatives with decreased morbidity. Brachytherapy consists of placing radioactive sources in the prostatic tissue. High doses can therefore be delivered to the cancer while avoiding excessive irradiation of the bladder and rectum. Brachytherapy generally uses permanent implants (Iodine 125 or Palladium 103). The so-called Seattle technique requires planning before implantation, while, in the "ProCeed" technique, the position of the grains is determined at the time of treatment, with the help of a computer programme which determines the dosimetry. Brachytherapy is a reliable and reproducible technique with minimal morbidity, providing 10-year results comparable to those of total prostatectomy.

The objective of this study was to analyse all attempts of ICSI performed in our centre between 1995 and 1997 with surgically harvested sperm for the treatment of secretory and excretory azoospermia.71 infertile couples, in which the man suffered from secretory (n = 8) or excretory azoospermia (n = 63), were managed with 94 attempts of ICSI.ICSI was able to be performed 85 times with 82 embryo transfers resulting in 29 clinical pregnancies. The clinical pregnancy rate per ICSI attempt was comparable with sperm obtained on the day of ICSI or previously harvested and frozen (30.5% and 31.4% respectively). The clinical pregnancy rate per ICSI attempt was 33.3% for testicular sperm (n = 18), and 30.3% for epididymal sperm (n = 76). Twenty-seven clinical pregnancies (32.1%) were obtained for men with excretory azoospermia (47.2% for vas deferens agenesis and 20.8% for acquired urinary tract obstruction, p = 0.01), and 2 (20%) for men with secretory azoospermia.ICSI can achieve pregnancy in infertile couples in whom no other solution can be considered. Cryopreservation allows surgical harvesting to be dissociated from ICSI without decreasing the pregnancy rate, justifying freezing of sperm during any surgical procedure on the seminal tract. The better results obtained in congenital excretory azoospermia compared to acquired obstructions, usually post-infectious, suggest a harmful effect of infection on the quality of sperm.

International audience

International audience

The pregnancy rate after ICSI with surgically retrieved spermatozoa varies according to the etiology and to the level of sperm retrieval in the genital tract. The use of testicular sperm in all cases is discussed.