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Anti-sperm antibodies (ASA) have been shown to reduce male fertility but consensus about the precise situations in which tests should be carried out are lacking. In infertility investigations, should the mixed antiglobulin reaction (MAR) test be a first-line test? Should it be carried out systematically before assisted reproductive technology (ART)? What are the risk factors for ASA?All infertile patients (n = 1364) were tested with SpermMar (modified MAR test) between July 2013 and June 2017. Intra-patient variability of the MAR test was also assesed by comparing two tests within the same year in selected patients (n = 101).The main factor that influenced the percentage of ASA was the presence or absence of sperm agglutination. In the presence of agglutinations, 27 out of 72 (37.5%) patients were positive for ASA compared with 33 out of 1292 (2.6%) in the absence of agglutinations (P0.0001). When one risk factor was present (spontaneous sperm agglutination, history of scrotal trauma or inguinal surgery), 33 out of 179 (18.44%) tests were positive for ASA (≥50% coated spermatozoa), whereas only 27 out of 1242 (2.2%) were positive when no risk factor was present (P0.0001).ASA detection should not be systematically recommended in investigations of fertility status and before ART but reserved for when sperm agglutination is found during conventional sperm examination, or if the patient has a history of scrotal trauma or has undergone inguinal surgery.

Background Men with congenital unilateral absence of vas deferens were reported to be mainly azoospermic, with both unilateral renal absence and mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) but some have neither. Objectives To assess whether in infertile couples the male partners with congenital unilateral absence of vas deferens are mainly azoospermic men. Material and methods Retrospective study in a unique university hospital; reproductive, clinical, CFTR analysis and seminal data of male partners of infertile couples (from 1998 to 2018) were analysed. Diagnosis of congenital unilateral absence of vas deferens was based on transrectal ultrasounds (TRUS): complete or partial absence of one vas deferens with complete contralateral vas deferens confirmed in 63 men. Distribution of sperm count in three classes: azoospermia, oligozoospermia or normozoospermia. Ultrasound determination of renal status; seminal biomarkers assays; and search for CFTR mutations. Results Among the 63 men, 39.7% displayed azoospermia, 27% oligozoospermia and 33.3% normozoospermia; 42% of the non-azoospermic men (16/38) had previously obtained a natural pregnancy. We found unilateral renal absence in 17/59 patients (29%). Among 50 men with CFTR testing, five carried an allele associated with cystic fibrosis belonging to the 29 men without renal anomalies, indicating a high allelic frequency (8.6%). The 63 patients displayed high rates of surgical histories for undescended testicles or inguinal hernia, low values of semen volume and of total seminal glycerophosphocholine. Conclusions Our results indicate that men with congenital unilateral absence of vas deferens mainly display oligozoospermia or normozoospermia and that they were previously fertile. They clearly confirm, first, that CFTR testing is recommended in congenital unilateral absence of vas deferens men and it should be mandatory for those with normal kidneys; and, second, that TRUS is needed for the diagnosis of congenital unilateral absence of vas deferens. As congenital unilateral absence of vas deferens may be present whatever the sperm count, biological warnings are represented by semen volume and seminal epididymal markers and clinical warnings by surgical histories of undescended testes or inguinal hernia.

International audience; Background: While reproductive technologies are increasingly used worldwide, epidemiologic, clinical and genetic data regarding infertile men with combined genital tract and renal abnormalities remain scarce, preventing adequate genetic counseling. Methods: In a cohort-based study, we assessed the prevalence (1995-2014) and the clinical characteristics of renal disorders in infertile males with genital tract malformation. In a subset of 34 patients, we performed a detailed phenotype analysis of renal and genital tract disorders. Results: Among the 180 patients with congenital uni- or bilateral absence of vas deferens (CU/BAVD), 45 (25 %) had a renal malformation. We also identified 14 infertile men with combined seminal vesicle (SV) and renal malformation but no CU/BAVD. Among the 34 patients with detailed clinical description, renal disease was unknown before the assessment of the infertility in 27 (79.4 %), and 7 (20.6 %) had chronic renal failure. Four main renal phenotypes were observed: solitary kidney (47 %); autosomal-dominant polycystic kidney disease (ADPKD, 0.6 %); uni- or bilateral hypoplastic kidneys (20.6 %); and a complex renal phenotype associated with a mutation of the HNF1B gene (5.8 %). Absence of SV and azoospermia were significantly associated with the presence of a solitary kidney, while dilatation of SV and necroasthenozoospermia were suggestive of ADPKD. Conclusion: A dominantly inherited renal disease (ADPKD or HNF1B-related nephropathy) is frequent in males with infertility and combined renal and genital tract abnormalities (26 %). A systematic renal screening should be proposed in infertile males with CU/BAVD or SV disorders.

In which cases is freezing of ejaculated sperm indicated before ICSI?Sperm freezing should be performed only when out of two analyses at least one total sperm count in the ejaculate is lower than 10(6).Due to variations in individual sperm parameters, in cases of severe oligozoospermia there is a risk of absence of spermatozoa on the day of ICSI, leading to cancellation of the attempt. Sperm freezing can avoid this problem but little is known of the parameters governing the decision to freeze sperm or not.This retrospective study included 247 men who underwent sperm cryopreservation to prevent the risk of azoospermia on the day of ICSI, from 2000 to 2012.Receiver operating characteristic curve analysis was used to define the threshold value. The lowest total sperm count per ejaculate was studied as a predictive factor for the use of frozen sperm in a total of 593 ICSI attempts. Moreover, 2003 patients who had at least 4 semen analyses for andrological diagnosis have been studied to evaluate the reproducibility of sperm count. To evaluate the psychological impact of sperm freezing, a questionnaire was administered to 84 men who attended for sperm cryopreservation between June and December 2014. The cost of sperm freezing was analysed according to the French prices.When at least one total sperm count was10(5) the risk of azoospermia in at least one ICSI attempt was 52% (34/66) versus 3% (5/181) when all counts were ≥10(5) (P0.0001). However, the study of the reproducibility of pre-ICSI semen analyses has shown wide variations among ejaculates, and therefore sperm freezing is recommended when one analysis from at least two, showed a sperm count10(6). Such a policy could allow a saving of about €70 000 by avoiding unnecessary sperm freezings. The psychological impact of sperm freezing was good since70% of men had positive feelings about this technique.This was a fairly short-term study and preservation of future fertility was not assessed. It appeared impossible to find a threshold that would predict the risk of azoospermia with 100% accuracy. Therefore there is still a risk of absence of spermatozoa on the day of ICSI despite a good negative predictive value when no total sperm count was lower than 10(5).These data suggest that sperm freezing should be proposed when total sperm count is lower than 10(6) to avoid cancellation of the ICSI attempt due to azoospermia.

In non-azoospermic patients with low semen volume (LSV), looking for partial retrograde ejaculation (PRE) by searching sperm in the postejaculatory urine (PEU) is required. The use of a retro-ejaculatory index (R-ratio) was suggested to define PRE, but none of the studies indicated a specific threshold above which PRE must be considered. Our objective was to propose a threshold value for the R-ratio as indicative of PRE in patients with LSV selected to be devoid of any known causes or risk factors for retrograde ejaculation or LSV. Among our data base (2000–2009) including 632 patients with PEU, 245 male patients from infertile couples who had had a first semen analysis with LSV (< 2mL) and a second semen analysis associated with PEU, were selected on the previous criteria. A prospective control group was randomly constituted (2007–2008) of 162 first consulting male patients from infertile couples, with a normal semen volume (≥ 2mL) on a first semen analysis and who accepted to collect PEU with their usual second semen analysis, selected on the previous criteria. To define an R-ratio threshold indicative of PRE, we used a ROC curve analysis and a regression tree based on a classification and regression tree (CART) algorithm. Of the 245 LSV patients, 146 still presented low semen volume (< 2 mL) on the second semen analysis. From the use of the CART algorithm, two low (1.5% and 2.8%) and two high R-values (7.1% and 8.3%) were defined, according to the lower reference limit for semen volume of 2.0 mL (WHO 1999) or 1.5 mL (WHO 2010) respectively. As only one or no patient with normal semen volume was observed above the two high R-values, we suggest an R-value higher than the range of [7.1–8.3]% as indicative of PRE until confirmation by a prospective multicenter study.

Treatment of differentiated thyroid cancer usually consists of a total thyroidectomy followed by one or several courses of radioiodine ((131)I). (131)I is known to have deleterious effects on radiation sensitive tissues and irradiation to the testes has been shown after its administration. We investigated effects of such treatment on sperm DNA in a patient with differentiated thyroid carcinoma.The patient, a 32-year-old male with differentiated thyroid carcinoma treated by total thyroidectomy and radioiodine therapy, performed 6 semen samples in total, 3 for sperm banking and 3 for semen exploration, that were analysed for classic semen parameters. DNA integrity was analysed by flow cytometry: sperm DNA fragmentation index (DFI) and high DNA stainability (HDS) were analyzed by sperm chromatin structure assay, DNA fragmentation was analyzed by terminal deoxynucleotidyl transferase dUTP nick end labeling assay.Moderate oligozoospermia was observed as early as 3 months after a first dose of (131)I and became severe at 5 months. Total sperm count was reduced up to 12 months after the second dose of (131)I. Sperm DFI was increased 3.25 months after the first dose of (131)I. All parameters returned to normal values 28 months after the second (131)I dose.Treatment with (131)I induces alterations in sperm chromatin as well as in sperm parameters a short time (3 months) after a first dose of (131)I with persistence of sperm alterations until 12 months after a second dose. Sperm banking should be recommended before treatment.Le traitement du cancer différencié de la thyroïde consiste en général en une thyroïdectomie totale suivie d’un traitement par l’iode radioactif (Le patient est un homme de 32 ans présentant un cancer différencié de la thyroïde traité par thyroïdectomie totale puis traitement par iodothérapie. Il a réalisé 6 prélèvements de sperme, 3 pour de l’autoconservation et 3 pour le suivi après traitement, dont les caractéristiques spermatiques ont été étudiées suivant les méthodes classiques. L’analyse de l’intégrité de la chromatine a été réalisée par cytométrie en flux : l’index de fragmentation de l’ADN (DFI) et la haute colorabilité de l’ADN (HDS) ont été analysés par le sperm chromatin structure assay (SCSA), la fragmentation de l’ADN a été évaluée par la technique de terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL).Une oligozoospermie modérée a été observée dès 3 mois après une première dose deLe traitement parTraitement par iode radioactif, SCSA, fragmentation de l’ADN du spermatozoïde, cancer différencié de la thyroïde, paramètres spermatiques.

background: Most studies assessing the outcome of assisted reproductive technologies (ARTs) have reported live birth rates in couples by taking mainly the female factor into account. However, infertility is a couple’s concern, and the majority of publications do not take into consideration the true impact of male infertility on having the desired number of children. methods: We carried out a follow-up study to evaluate the probability of having a child during treatments at the Toulouse Male Sterility Centre and after discontinuation from 2000 through 2008. Couples were followed for at least 4 years until discontinuation of treatment or delivery of a live infant. results: We were able to contact 65% of the 1735 male partners by telephone. Of the 1131 respondents, 56% had become parents (60% if adoption is included), 28% after ART, 16% by natural pregnancy, 8% after non-ART treatment and 4% after ART in another centre. The cumulative rates of success reached 64% [95% confidence interval (CI), 60 –67] for men ≤35 years and women ≤35 years after 9 years, and 31% (95% CI, 24–39) in older patients. With optimistic analysis, which assumes that patients for whom no information was available have the same chance of success in having a child as those whose reproductive outcome was known, the cumulative rate of success was 48% (95% CI, 45–50) in the 1735 couples. conclusions: More than half of couples consulting for male infertility succeeded in having a child. Male age over 35 years old appears as a key risk factor as well as the woman’s age, and these findings should encourage couples to attempt parenthood earlier.

Objectifs Preciser la frequence des anomalies a l’examen clinique des hommes consultant pour infertilite masculine, et les orientations etiologiques apportees par l’examen clinique. Methodes Cohorte retrospective de 1672 patients venus consulter dans notre centre pour infertilite masculine entre 2000 et 2004. La consultation andrologique comportait un interrogatoire et un examen clinique suivant une grille standardisee. Les analyses de sperme ont ete faites dans le meme laboratoire et seul le premier echantillon de sperme a ete pris en compte. Nous avons egalement etudie la relation entre l’examen andrologique et l’examen de sperme par analyse factorielle des correspondantes multiples, arbre de regression et regression polytomique. Resultats Sur les 1672 hommes, au moins 85 % presentaient une anomalie a l’examen andrologique ; 21 % presentaient un antecedent d’infection urogenitale, 13 % un antecedent de cryptorchidie, 9 % un antecedent chirurgical et 4 % un antecedent de traumatisme testiculaire ; 23 % avaient une evaluation anormale des epididymes, 22 % une varicocele, 20 % une evaluation anormale du scrotum et 4 % une anomalie des canaux deferents. L’oligospermie etait principalement liee a un antecedent de cryptorchidie ou a la presence d’une varicocele alors que l’azoospermie etait uniquement associee a une evaluation epididymaire anormale. Les hommes presentant une evaluation anormale des volumes testiculaires quelle que soit l’evaluation des canaux deferents avaient un risque accru d’oligospermie ou d’azoospermie. Conclusion Une evaluation clinique standardisee (antecedents et examen) de l’homme permet souvent de poser un diagnostic etiologique aux anomalies spermatiques et permet ainsi de mettre en place la prise en charge la plus appropriee a l’homme et au couple infecond.