Search

International audience; Study question: What are the motivations, experience, and acceptability of thermal male contraception (TMC) in men using TMC as the only couple contraceptive ? Summary answer: Men wished to share the role of providing contraception in a couple and to avoid the use of hormones. Sexual satisfaction was significantly improved.What is known already: Two male contraceptive methods inducing spermatogenesis suppression have achieved contraceptive efficacy, on a large population for hormonal contraception and a smaller one for thermalcontraception (TC). The suppression of sperm counts to below 1 million/mL results in fertility rates commensurate with female pills. TC is obtained by wearing 15 hours/day a contraceptive underwear (CU) inducing a 2C increase in testicular temperature (Mieusset & Bujan 1994). As no commercially available male thermal contraceptive exists, little information regarding the acceptability of this approach to men has been reported and only one publication analysed the hypothetical acceptability of TMC (Amouroux et al. 2018). Study design, size, duration: We contacted 72 men who had started the CU testing phase between June 2011 and September 2019. The participants completed an anonymous online survey of 93 questions exploring population characteristics, contraceptive histories, motivations for choosing TC, patient experience at the successive phases of use, relations with partner and environment, and satisfaction with TC. Sexual life was evaluated by rating (1 to 4): frequency and pleasure of sexual intercourse, sexual desire, morning and intercourse erections. Participants/materials, setting, methods: Among men who had reached the contraception use phase, the quality ratings of sexual life were compared over time, from the contraceptive method used before TC (“N-1” method) to the 2 previous methods (“N-2” and “N-3”)): “N-3” versus “contraception use phase”, “N-3” versus “CU testing phase,” and “CU testing phase” versus “contraception use phase.” These comparisons were made for all 5 sexual life parameters by a paired samples Wilcoxon signed rank test. Main results and the role of chance: Sixty-seven men responded (93% response rate);63 participated in the survey (94% participation rate). The median age was 31 [21-52], 30 men (48%) had a Master’s degree or more, 49 (78%) had no child and 24 (38%) no parental project. Among the men whose couple’s contraception method immediately before TC (N-1) was a female method (n ¼ 36/63, 57%), the 2 main reasons for switching to a male method were the wish to share the role of providing contraception in a couple (n ¼ 31/36, 86%) and the willingness to take responsibility for contraception (n ¼ 21/36, 58%). The main motivations for choosing TC were “not using hormones” (n ¼ 59/63, 94%) and using a method regarded as “natural” (n ¼ 49/63, 78%). Most of men (68%) adopted the method in less than 2 weeks. During the contraception use phase (n ¼ 59 men), they described: i) significantly improved sexual satisfaction (3,49§0,29/4) compared to that experienced with previous contraceptive methods (3,27§0,58/4;p

Resume Contexte Ces recommandations communes de l’Association Francaise d’Urologie (AFU) et de la Societe d’Andrologie de Langue Francaise (SALF) ont pour objectif de fournir des directives pratiques a la communaute urologique et andrologique Francaise concernant l’evaluation des hommes infertiles. Materiel et methodes Recherche bibliographique dans PubMed en utilisant les mots-cles «male infertility», «diagnosis», «management» et «evaluation» limitee aux articles cliniques en anglais et en francais anterieurs au 1/01/2020. Pour renseigner le niveau de preuves, le systeme de gradation de l’HAS (2013) a ete applique. Resultats Concernant l’evaluation des hommes infertiles, l’AFU et la SALF recommandent : (1) un interrogatoire systematique explorant les antecedents familiaux, les antecedents de fertilite de l’homme hors couple, les antecedents personnels du patient pouvant avoir un impact sur sa fertilite, ses habitudes de vie, ses traitements, ses symptomes et les eventuelles difficultes sexuelles du couple ; (2) un examen physique general pour evaluer les signes d’hypogonadisme et les caracteres sexuels secondaires ; (3) un examen physique scrotal par un urologue ou un andrologue pour evaluer (i) le volume et la consistance des testicules, (ii) les canaux deferents et les epididymes a la recherche d’une absence totale ou partielle ou des nodules, et (iii) la presence de varicocele ; (4) d’effectuer 2 spermogrammes, conformement aux recommandations de l’Organisation mondiale de la sante (OMS), si le premier presente au moins une anomalie ; (5) une echographie scrotale systematique, pouvant etre completee par une echographie pelvienne endorectale selon la clinique ; (6) un bilan hormonal comportant au moins une determination de la testosterone serique et de FSH ; si la testosterone est basse, la LH permettra de differencier hypogonadisme hypogonadotrope (central) et hypogonadisme peripherique ; (7) un caryotype chez les hommes infertiles ayant une concentration de spermatozoides ≤ 10,106/ml ; (8) l’evaluation des microdeletions du chromosome Y chez les hommes infertiles ayant une concentration de spermatozoides ≤ 1,106/ml ; (9) l’evaluation du gene CFTR en cas de suspicion d’agenesie bilaterale ou unilaterale des canaux deferents et des vesicules seminales. La place de l’analyse de l’integrite de l’ADN du sperme (SCSA, TUNEL par exemple) dans le bilan de l’homme infertile est encore en cours d’evaluation. Conclusion Ces recommandations peuvent etre appliquees en pratique clinique en routine chez tout homme infertile.

Congenital absence of the vas deferens (CAVD) may have various clinical presentations depending on whether it is bilateral (CBAVD) or unilateral (CUAVD), complete or partial, and associated or not with other abnormalities of the male urogenital tract. CBAVD is usually discovered in adult men either during the systematic assessment of cystic fibrosis or other CFTR-related conditions, or during the exploration of isolated infertility with obstructive azoospermia. The prevalence of CAVDs in men is reported to be approximately 0.1%. However, this figure is probably underestimated, because unilateral forms of CAVD in asymptomatic fertile men are not usually diagnosed. The diagnosis of CAVDs is based on clinical, ultrasound, and sperm examinations. The majority of subjects with CAVD carry at least one cystic fibrosis-causing mutation that warrants CFTR testing and in case of a positive result, genetic counseling prior to conception. Approximately 2% of the cases of CAVD are hemizygous for a loss-of-function mutation in the ADGRG2 gene that may cause a familial form of X-linked infertility. However, despite this recent finding, 10–20% of CBAVDs and 60–70% of CUAVDs remain without a genetic diagnosis. An important proportion of these unexplained CAVDs coexist with a solitary kidney suggesting an early organogenesis disorder (Wolffian duct), unlike CAVDs related to CFTR or ADGRG2 mutations, which might be the result of progressive degeneration that begins later in fetal life and probably continues after birth. How the dysfunction of CFTR, ADGRG2, or other genes such as SLC29A3 leads to this involution is the subject of various pathophysiological hypotheses that are discussed in this review.

Background: A mild increase in testicular and epididymal temperatures in men, bulls and rams (pendulous scrotum) inhibits spermatogenesis and increases the percentage of sperm with an abnormal morphology. However, the stages of spermatogenesis that are most sensitive to a mild increase in testicular temperature in men are unknown. The aim of the present study was to explore the effects of a mild induced increase in testicular and epididymal temperature (i.e., testicular temperature maintained below the core body temperature) on sperm morphology in humans depending on the physiological time of spermatogenesis and epididymal transit. Methods: Five healthy volunteers were enrolled in an experimental study in which testicular and epididymal temperatures were increased by maintaining the testes in a supra-scrotal position with a specially designed underwear worn 15±1 h a day for 120 consecutive days. Semen collection was scheduled on specific days depending on spermatogenic stages and epididymal transit. Results: Sperm morphology and the multiple anomalies index (MAI) were analysed before, during and after heating. This mild induced increase in testicular and epididymal temperatures resulted in a significant rise in the percentage of morphologically abnormal spermatozoa on day 34 of heating, which remained elevated throughout the heating period and persisted until 45 days after cessation of heating. The MAI was significantly increased on day 20 throughout the heating period and persisted 45 days after cessation of heating. An increase in the percentage of anomalies in the sperm head, acrosome or tail occurred on days 34 and/or 45 of heating. Abnormal sperm morphology and MAI reverted to control values 73 days after cessation of heating. Conclusions: A mild sustained increase in testicular and epididymal temperature in man leads morphological abnormalities in spermatozoa mainly due to an impairment of spermiogenesis and meiosis.

Background Congenital unilateral absence of vas deferens has been diagnosed in fertile and normozoospermic males and is associated with the risk of unilateral renal absence or cystic fibrosis transmembrane conductance regulator mutations; but no prediction model currently exists to diagnose this condition. Objectives The study aims to identify clinical and biological variables that may have a predictive value for the diagnosis of congenital unilateral absence of vas deferens in male partners of infertile couples MATERIALS AND METHODS: We designed a retrospective, cross-sectional, case-control study on electronic health records of a single tertiary-care andrological centre collected between 1998 and 2018. We included all subjects diagnosed with congenital unilateral absence of vas deferens using combined scrotal and transrectal ultrasounds. Controls were confirmed free of congenital unilateral absence of vas deferens by the same way. Both groups received standardised exploration procedures. Multivariable logistic regression model was built in a backward stepwise manner. Model performance and calibration were assessed. The study is reported according to TRIPOD statement. Results We included 69 congenital unilateral absence of vas deferens cases and 78 controls. Cases had a lower semen volume than controls. The congenital unilateral absence of vas deferens risk was associated with history of cryptorchidism and both levels of semen fructose and α-glucosidase. These predictors were confirmed by a random forest algorithm. The area under the curve was 0.886 (95% interval: 0.81-0.92). Calibration was performed with the Hosmer-Lemeshow test (p = 0.88). Discussion and conclusion History of cryptorchidism, semen fructose and α-glucosidase were identified as relevant and independent predictors for the diagnosis of congenital unilateral absence of vas deferens. The model enables to identify male patients with a high risk of congenital unilateral absence of vas deferens to whom a transrectal ultrasounds would be proposed to confirm the diagnosis, whatever their semen parameters. It will also help to address the risks of unilateral renal absence and of cystic fibrosis transmembrane conductance regulator mutations carrying during the management of infertile couples.

Study question Among health professionals involved in contraceptive prescribing, what are the knowledge, professional attitudes and training on male contraceptive methods? Summary answer The health professionals involved in prescribing contraception are not sufficiently trained in male contraception and almost all of them want more. What is known already The most recent large-scale studies show that 70% of couple contraception is provided by women and that the majority of men and women would be willing to adopt male contraception as couple contraception. The medicalization of contraception places the medical profession at the forefront of the acceptability of and information regarding a contraceptive method. However, only one study have evaluated health professionals’ knowledge of the various methods of male contraception (MC), including male hormonal contraception (MHC) and male thermal contraception (MTC). Study design, size, duration Between April 2020 and June 2020, we carried out a descriptive prospective multicentre study in a medical population of 2243 prescribers of couple contraception in France. Participants/materials, setting, methods The participants were obstetrician-gynaecologists, medical gynaecologists, general practitioners or midwives. They completed a three-part numerical questionnaire, including i) sociodemographic characteristics and personal experiences with contraception, ii) knowledge and professional attitudes about male contraception and iii) training on male contraception. Main results and the role of chance The overall participation rate was 19% (340/2243). Condoms and withdrawal were known by 98% and 89% of the population, respectively. Vasectomy was known by 75% of the population and significantly better known by obstetrician-gynaecologists than by medical gynaecologists and general practitioners (p = 0.026). Male hormonal contraception (MHC) and male thermal contraception (MTC) were known by 10% and 23% of the population, respectively, and were significantly better known by medical gynaecologists and general practitioners than by other specialties (p Limitations, reasons for caution The population was mainly representative of medical health practitioners of southeastern France. There was an over-representation of women in all medical specialties, except for midwives. Wider implications of the findings: Our study shows that health professionals involved in contraception have limited knowledge about MC and are eager to have more information about it. To advance the acceptability and dissemination of such contraceptive methods, it seems imperative to provide health professionals with an adapted training program on male contraception. Trial registration number 2020–01–23–03

International audience; Background. — The aim of these Association Franc ̧aise d’Urologie (AFU) and Sociétéd’Andrologie de Langue Franc ̧aise (SALF) common recommendations are to provide practiceguidelines for the French Urological and Andrological community regarding the evaluation ofinfertile men.Material and methods. — Literature search in PubMed using the keywords ‘‘male infertility’’, ‘‘diagnosis’’, ‘‘management’’ and ‘‘evaluation’’ limited to clinical articles in English and French prior to 01/01/2020. To inform the level of evidence, the HAS grading system (2013) was applied.Results. — Concerning the evaluation of infertile men, the AFU and the SALF recommend : (1)a systematic interview exploring the family history, the fertility history of the man outside thecouple, the patient’s personal history that may have an impact on his fertility, lifestyle habits,treatments, symptoms and possible sexual difficulties of the couple; (2) a general physical examination to assess signs of hypogonadism and secondary sexual characters; (3) a scrotal physical examination performed by an urologist or andrologist to assess (i) the testes for volume and consistency, (ii) vas deferens and epididymes for total or partial absence or nodules, and(iii) presence of varicoceles; (4) Performing two semen analyses, according to World HealthOrganization guidelines, if the first one has at least one abnormaly; (5) a scrotal ultrasoundas part of routine investigation, that can be completed with an endorectal pelvic ultrasound according to the clinic; (6) an endocrine evaluation with at least a Testosterone and FSH serum determination; (7) Karyotype analysis in infertile men with a sperm concentration ≤ 10 106/mL;(8) assessment of Yq microdeletions in infertile men with a sperm concentration ≤ 1 106/mL;(9) Cystic fibrosis trans membrane conductance regulator gene evaluation in case of suspicion for bilateral or unilateral congenital agenesis of vas deferens and seminal vesicles.; Contexte. — Ces recommandations communes de l’Association Française d’Urologie (AFU) et de la Société d’Andrologie de Langue Franc ̧aise (SALF) ont pour objectif de fournir des directives pratiques à la communauté urologique et andrologique Française concernant l’évaluation des hommes infertiles.Matériel et méthodes. —Recherche bibliographique dans PubMed en utilisant les mots-clés «male infertility», «diagnosis», «management» et «evaluation» limitée aux articles cliniques en anglais et en français antérieurs au 01/01/2020. Pour renseigner le niveau de preuves, le système de gradation de l’HAS (2013) a été appliqué.Résultats. — Concernant l’évaluation des hommes infertiles, l’AFU et la SALF recommandent :(1) un interrogatoire systématique explorant les antécédents familiaux, les antécédents de fertilité de l’homme hors couple, les antécédents personnels du patient pouvant avoir un impact sur sa fertilité, ses habitudes de vie, ses traitements, ses symptômes et les éventuelles difficultés sexuelles du couple ; (2) un examen physique général pour évaluer les signes d’hypogonadisme et les caractères sexuels secondaires ; (3) un examen physique scrotal par un urologue ou un andrologue pour évaluer (i) le volume et la consistance des testicules, (ii)les canaux déférents et les épididymes à la recherche d’une absence totale ou partielle ou des nodules, et (iii) la présence de varicocèle ; (4) d’effectuer 2 spermogrammes, conformément aux recommandations de l’Organisation mondiale de la santé (OMS), si le premier présente au moins une anomalie ; (5) une échographie scrotale systématique, pouvant être complétée par une échographie pelvienne endorectale selon la clinique ; (6) un bilan hormonal comportant au moins une détermination de la testostérone sérique et de FSH ; si la testostérone est basse, la LH permettra de différencier hypogonadisme hypogonatrope (central) et hypogonadisme périphérique ; (7) un caryotype chez les hommes infertiles ayant une concentration de spermatozoïdes ≤ 10,106/ml ; (8) l’évaluation des micro délétions du chromosome Y chez les hommes infertiles ayant une concentration de spermatozoïdes ≤ 1,106/ml ; (9) l’évaluation du gène CFTR en cas de suspicion d’agénésie bilatérale ou unilatérale des canaux déférents et des vésicules séminales. La place de l’analyse de l’intégrité de l’ADN du sperme (SCSA, TUNEL par exemple) dans le bilan de l’homme infertile est encore en cours d’évaluation. Conclusion. — Ces recommandations peuvent être appliquées en pratique clinique en routine chez tout homme infertile.

Resume S’il existe un spectre de 11 methodes contraceptives differentes pour les femmes, il n’y en a que 3 couramment utilisees par les hommes : le preservatif et le retrait, avec leur taux d’echecs eleves, ainsi que la vasectomie, consideree comme une methode irreversible. Depuis 40 ans, de nombreuses etudes ont ete realisees pour developper des contraceptifs masculins hormonaux et non hormonaux surs et efficaces. Bien qu’elles aient fait la preuve de leur efficacite, les contraceptions masculines hormonale et thermique restent encore peu utilisees. Les principes, protocoles, efficacite, reversibilite et acceptabilite de ces deux methodes sont presentees, ainsi que les elements pratiques, pour leur prescription et leur suivi. Nous decrivons egalement de nouvelles methodes en cours de developpement (contraceptifs hormonaux masculins oraux ou transdermiques, methodes d’occlusion deferentielle). D’autres recherches sont necessaires pour l’amelioration et la diffusion de methodes contraceptives masculines efficaces, reversibles et sures qui permettront aux hommes autant qu’aux femmes de jouer un role actif dans la planification familiale.

International audience

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; In mammals testicular and epididymal temperature increase impairs spermatogenesis. This experimental study investigates the effects of a mild testis temperature increase (i.e. testis temperature remains below core body temperature) on sperm aneuploidy in men. In 5 fertile volunteers a testicular temperature increase was induced by maintaining the testes at suprascrotal position using specially designed underwear for 15 ± 1 h daily for 120 consecutive days. After heating men were followed for next 180 days. A control group (27 men) was recruited. Semen samples were collected before, during and after heating period and analyzed for chromosomes X, Y and 18 for aneuploidy using FISH. A total of 234,038 spermatozoa were studied by FISH. At day 34 of heating, mean sperm aneuploidy values were not modified. From day 34 of heating until day 45 post heating, FISH evaluation was not possible due to the drastic fall of sperm count. At day 45 post-heating total sperm aneuploidy percentage was twice higher than before heating whereas. Sex disomy (sperm XY18), sex chromosome nullisomy (sperm 18) were significantly higher than controls. These effects were completely reversed at 180 days post heat exposure. Conclusion: A mild rise in testicular temperature significantly increases sperm aneuploidies, reflecting an effect on the meiosis stage of spermatogenesis. The effect of heating was reversible and suggests that recovery of aneuploidy to normal values requires at least two cycles of spermatogenesis. Nonetheless, the low number of volunteers was a limitation of this pilot study and warrants further research on larger population.

International audience; In 80% of infertile men with obstructive azoospermia caused by a congenital bilateral absence of the vas deferens (CBAVD), mutations are identified in the cystic fibrosis transmembrane conductance regulator gene (CFTR). For the remaining 20%, the origin of the CBAVD is unknown. A large cohort of azoospermic men with CBAVD was retrospectively reassessed with more stringent selection criteria based on consistent clinical data, complete description of semen and reproductive excurrent ducts, extensive CFTR testing, and kidney ultrasound examination. To maximize the phenotypic prioritization, men with CBAVD and with unilateral renal agenesis were considered ineligible for the present study. We performed whole-exome sequencing on 12 CFTR-negative men with CBAVD and targeted sequencing on 14 additional individuals. We identified three protein-truncating hemizygous mutations, c.1545dupT (p.Glu516Ter), c.2845delT (p.Cys949AlafsTer81), and c.2002_2006delinsAGA (p.Leu668ArgfsTer21), in ADGRG2, encoding the epididymal- and efferent-ducts-specific adhesion G protein-coupled receptor G2, in four subjects, including two related individuals with X-linked transmission of their infertility. Previous studies have demonstrated that Adgrg2-knockout male mice develop obstructive infertility. Our study confirms the crucial role of ADGRG2 in human male fertility and brings new insight into congenital obstructive azoospermia pathogenesis. In men with CBAVD who are CFTR-negative, ADGRG2 testing could allow for appropriate genetic counseling with regard to the X-linked transmission of the molecular defect.

To describe the presence of sperm in the prostatic urethra as a stand-alone ejaculation entity and to assess its characteristics.Thirty-three patients with anejaculation during sexual stimulation were enroled. Penile vibratory stimulations were carried out following bladder catherization and instillation of a pink buffering medium (Ferticult). Two-step catheterisation was then performed: a catheter was inserted through the urethral sphincter into the prostatic urethra to aspirate its content, and then bladder catheterisation was performed to collect the Ferticult. The procedure was repeated in some patients after at least 1 week. The characteristics of the semen collected from each organ were analysed and compared.A total of 42 trials were obtained from 22 patients. Sperms were found in the prostatic urethra in 21 samples (50%) from 12 patients (11 with spinal cord injury, 1 with diabetes). The colour of all 21 prostatic urethra sperm samples differed from the Ferticult. Sperm motility was greater in 8 samples, sperm count was higher in 10 and pH was different in 10, compared with the bladder samples. The higher overall quality of the sperm allowed cryopreservation in 10 prostatic urethra samples compared with only 5 bladder samples. Four of the five patients who underwent repeated trials had a reproducible pattern of prostatic urethra ejaculation.The presence of sperm in the prostatic urethra most probably results from 'ejaculation dyssynergia', a lack of coordination between bladder neck and external sphincter. Sperm from the prostatic urethra should be systematically sought to improve the outcome of assisted reproduction.

Background Spermatozoa acquire their fertilizing ability and forward motility properties during epididymal transit. Our knowledge of gamete physiology is based on studies conducted in laboratory and domestic species; our knowledge of these processes in humans is limited. Medical indications for assisted reproductive technologies (ART) have progressed to include male infertility. Surgical procedures allow collection of spermatozoa from all along the human excurrent ducts, and the former have been used with some success in reproductive medicine. This has raised questions over the role of the epididymis in human sperm physiology. Objective and rationale To reanalyze what we now know about epididymal physiology in humans and to assess the relevance of laboratory animal models for understanding human physiology and the pathophysiology of the epididymis. Search methods A systematic bibliographic search of PubMed for articles published in English before May 2015 was carried out using the search terms 'epididymis' and 'sperm maturation'. Literature on the consequences of vasectomy on the epididymis was also searched. Outcomes Whereas the proximal epididymis is almost exclusively occupied by efferent ducts, the sperm reservoir capacity is poorly developed in humans. At the molecular level, the human transcriptome and proteome show some segment specificity; conflicting results persist with regard to secretome variation along the tubule. The number of genes regulated along the excurrent ducts in men is lower when compared to rodent species, but remains significant. It is challenging to reconcile biochemical and physiological studies with clinical data obtained from men undergoing reanastomosis of the vas deferens at different points along the excurrent duct. We propose that vasectomy/vasovasostomy is a model to understand the consequences of obstruction on epididymis function in humans. Wider implications Despite the scarcity of biological material available, the interspecies variability of the male reproductive tract urges us to use modern molecular and cellular biology tools to better understand human epididymis physiology in order to apply ART in a more responsible manner.

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.

To evaluate the efficacy of anticholinergic agents in the treatment of neurogenic overactive bladder (NOAB) and neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients on clean intermittent catheterisation (CIC). Chronic suprasacral SCI patients on CIC presenting with at least one urinary leakage a day were included. Urodynamics and voiding diaries were performed at baseline and 1 month follow-up. In case of NDO at baseline, an anticholinergic drug was prescribed. The 231 SCI patients presented with one to five urinary leakages per day (mean 2.1). Urodynamics showed NDO in all patients. A new anticholinergic treatment was started in all, either in monotherapy (134 patients) or in association with the existing anticholinergic drug (oxybutynin+trospium bitherapy, 97 patients). The mean maximum bladder capacity significantly increased from 225 to 441 ml, and the mean involuntary detrusor contractions (IDC) significantly decreased from 67 to 41 cm H2O. Only 75 SCI patients (32%) were fully continent. However, 25 out of these 75 patients showed persistent NDO, with amplitudes of IDC above 40 cm H2O in 12 patients. Incontinence was still found in 156 SCI patients (67%), with an average of 1,2 leakages a day. In 100 patients, amplitudes of IDC remained above 40 cm H2O. There was no statistical difference between patients on anticholinergic monotherapy or bitherapy at follow-up. Anticholinergic treatment is not always satisfactory in terms of control of NDO and rarely allows full continence. Urodynamic follow-up is mandatory in all patients, even in those showing clinical continence.

Resume But Evaluation des dysfonctions erectiles et ejaculatoires des blesses du cone medullaire (BCM) et evaluation de l’efficacite de la prise en charge therapeutique. Patients Notre etude est retrospective et monocentrique portant sur une cohorte de 90 BCM stabilises. Tous les patients ont un examen clinique avec bilan neurologique du perinee, une evaluation des dysfonctions erectiles et ejaculatoires par l’International Index of Erectile Function (IIEF-15) ainsi qu’une mise en situation. Nous avons evalue l’erection par une echelle de cotation clinique de Schrameck. Soixante-dix-sept sur 90 (85,55 %) ont eu des tests therapeutiques pour retablir l’erection : prostaglandines (PGE1), inhibiteurs des phosphodiesterases de type 5 (IPDE5) et papaverine. Soixante-quatorze sur 90 (82,22 %) ont essaye le vibromassage penien (VM) plus ou moins associe a la Midodrine ® (alpha mimetique) pour provoquer une ejaculation avec une recherche systematique des spermatozoides dans les urines. Les donnees ont ete saisies et analyses au moyen du logiciel Microsoft office Excel. Resultats Quatre-vingt-dix patients presentant une lesion complete motrice des myelomeres S2-S3-S4 ont ete inclus. Ils ont ete repondeurs aux PGE1, IPDE5 respectivement a 81,63 % et 30,76 %. L’association VM/Midodrine ® ameliore l’ejaculation dans 52,63 % des cas. Les differents traitements donnes n’ont pas permis de retablir des sensations orgasmiques chez aucun des patients de cette serie. Conclusion Dans cette serie de patients BCM, nous avons observe une bonne efficacite des PGE1 et des IPDE 5 sur l’erection. Nous avons egalement observe des resultats favorables du vibromassage et des alpha-mimetiques pour obtenir l’ejaculation. Niveau de preuve 4.

Summary In cryptorchid boys, failures in germ cell development have been clearly established. Some studies reported some abnormalities in Sertoli cells morphology but the results regarding their endocrine secretion remain controversial. To compare testicular hormone levels in young boys with and without cryptorchidism, we performed a cross-sectional hospital-based study. From surgery appointment records, we identified a case group of boys with unilateral or bilateral cryptorchidism and a control group undergoing dental care, minor osteoarticular or dermal surgery. Blood samples were withdrawn during the surgical procedure to perform testosterone, inhibin B and anti-mullerian hormone (AMH) immunoassays. We included 27 cryptorchid boys and 27 controls aged of 26.6 vs. 24.2 months, respectively (p = 0.172) far from the post-natal mini-puberty and the corresponding hormonal surges. Age-adjusted AMH and inhibin B levels were significantly lower in cryptorchid than in control boys (AMH: 87 ng/mL vs. 135 ng/mL; p = 0.009, inhibin B: 97 pg/mL vs. 133 pg/mL; p = 0.019, respectively). Moreover, AMH and inhibin B levels were significantly lower in the bilateral cryptorchid subgroup, being 50% lower than in the controls (p = 0.011 and 0.019, respectively) and while both hormones levels were independent in controls, they became strongly correlated in bilateral cryptorchid boys (R² = 0.75, p = 0.001). In addition, testosterone levels were still detectable in some boys, with significantly lower levels in cryptorchid group than in controls. Overall, 2-year-old cryptorchid patients presented a simultaneous and significant drop in AMH and inhibin B levels, suggesting a functional defect of Sertoli cells. This deficiency appeared more pronounced in bilateral cryptorchidism and thus, regarding the pivotal role of Sertoli cells in germ cell development, it may explain the compromised fertility found later in men born with such a malformation.

Retrospective.The objective of the study was to describe the type of ejaculation in patients with cauda equina (CE) and conus medullaris (CM) lesions, and to analyse sperm quality.France.One hundred sixty-six patients with CE and CM lesions were included. Diagnosis was based on clinical (no motor responses, sensation or sacral reflexes) and urodynamic assessments (no detrusor activity). Vibromassage (VM) was used to induce ejaculation according to the recommendations for patients with spinal cord injury. If ejaculation did not occur, oral midodrine was administered in progressive doses. Retrograde ejaculation was systematically sought. Sperm parameters were analysed according to World Health Organisation recommendations (2010).Eighty-nine patients were included. Eleven ejaculated on the first VM trial (four anterograde (AE), six retrograde (RE) and one antero-retrograde (ARE)). Five patients continued trials of VM alone, two of whom ejaculated following a mean 1.9 trials (one RE, one ARE). Twenty-six patients underwent trials of VM+ midodrine, 18 of whom ejaculated following a mean 4.4 trials with a mean dose of 22.5 g of midodrine (2 AE, 13 RE and 5 ARE). Fifty-three ejaculates from 26 patients were analysed. Sperm concentration was low in 90.6% of samples; total necrospermia was found in 65% and asthenospermia in 95% of samples.Ejaculation is difficult to induce using VM in patients with CE and CM lesions, and requires high doses of midodrine. Sperm counts were generally low, and asthenospermia and necrospermia were found in the majority of specimens. Cryopreservation of sperm should be systematic in case of medically assisted procreation.

Contributing reviewersThe editor of Basic and Clinical Andrology would like to thank all of our reviewers who have contributed to the journal in Volume 25 (2015).

We evaluated midodrine as oral treatment for pharmacologically induced priapism in spinal cord injured patients.From 2004 to 2007 we treated 354 spinal cord injured patients with intracavernous injection of prostaglandin E1 to induce erection. Prolonged erection or priapism occurred in 14 cases (1.3% of intracavernous injections). High blood pressure and bradycardia (autonomic dysreflexia) were noted in 2 tetraplegic cases. Except in 2 patients oral midodrine was used as the only therapeutic approach to this event because of its alpha stimulant properties.All patients returned to the flaccid penile state within 30 to 45 minutes after midodrine administration. Oral midodrine was well tolerated with few side effects and without increasing the incidence of autonomic dysreflexia. At 6 months complete erection could be again induced by intracavernous injection in all treated patients.Midodrine administered orally is a simple and efficient treatment for the priapism induced by intracavernous injection of prostaglandin E1. It could be the first line therapeutic approach before more aggressive procedures.

Transient scrotal hyperthermia and levonorgestrel enhance testosterone-induced spermatogenesis suppression in men through increased germ cell apoptosis.

Resume Objectifs Faire l’etat d’avancee des differentes methodes contraceptives masculines (a l’exception des methodes deferentielles). Materiel et Methodes Une recherche bibliographique a ete realisee en utilisant les mots cles : male/contraception. Nous avons restreint la recherche aux articles originaux en anglais et en francais. Les articles portant sur la vasectomie et les autres methodes de contraception deferentielles ne seront pas consideres dans la presente revue. Resultats Actuellement les methodes de contraception masculine utilisees a large echelle restent encore au nombre de 3 : Le retrait, le preservatif masculin et la vasectomie, bien que d’autres types de contraception masculine aient fait la preuve de leur efficacite. Parmi celles-ci, la contraception hormonale apparait la plus prometteuse et fait d’ailleurs l’objet de la majorite des recherches. Les autres methodes contraceptives (immunologiques, thermiques …) pourraient constituer des alternatives possibles. Conclusion La contraception masculine reste sous-utilisee, et seul le preservatif masculin est d’utilisation courante (si on exclut le retrait et la vasectomie). En consequence, de nouveaux protocoles de recherche dans le champ de la contraception masculine doivent etre fortement encourages.

Objective To evaluate the percentage of couples achieving parenthood and the rate of separation 6 years after their first consultation for infertility. Study design Epidemiological study in the reproductive medicine department of a French university hospital. All first consulting couples (FCC) who had their first infertility consultation in the department in 2007 were contacted by phone and asked to respond to a questionnaire concerning their infertility treatments, parenthood and marital status 6 years after their first consultation. Results Of the 685 FCC, 94 could not be contacted, 34 refused to respond and 557 (86%) answered the questionnaire. Of 557 FCC who have responded, 361 (65%) have achieved parenthood: 166 (46%) after treatment, 98 (27%) after spontaneous conception, 38 (11%) after both spontaneous and treatment-induced conception and 59 (16%) through adoption. Parenthood was not influenced either by the causes or duration of infertility. Separation occurred in 53 (9.5%) of FCC, mainly in those without any children (28% vs 4% in FCC with at least one child; P Conclusion Six years after their primary consultation, 25% of couples remained childless and 28% of them were separated.

L’hypospadias est une anomalie du developpement dont la traduction la plus evidente est une position ectopique du meat uretral situe soit sur la face ventrale du gland ou du penis, soit en position scrotale ou perineale. La reparation chirurgicale a pour objectifs de permettre une miction en position debout, une pleine sexualite, et d’obtenir une apparence cosmetique de la verge aussi normale que possible. Les resultats d’une revue de la litterature sont presentes.

Bien que retrouvee chez des hommes feconds, la varicocele est consideree comme responsable de l'infecondite par de nombreux auteurs. L"hyperthermie' est l'un des mecanismes physiopathologiques evoques pour expliquer les alterations de la spermatogenese dues a la varicocele. A partir des resultats rapportes dans la litterature concernant a la fois des situations cliniques chez l'homme et des donnees experimentales chez l'animal, les constatations suivantes peuvent etre faites: dans les populations d'hommes porteurs de varicocele unilaterale, les temperatures moyennes testiculaires et scrotales sont augmentees de facon bilaterale dans la plupart des etudes. La bilateralite de la varicocele n'est pas associee a une augmentation plus importante de la temperature. L'effet de la cure chirurgicale sur la temperature testiculaire ou scrotale reste discute. Enfin, le modele animal de varicocele experimentale n'a pas jusqu'alors apporte des donnees supplementaires concernant les mecanismes par lesquels la temperature testiculaire est augmentee en cas de varicocele. En conclusion, s'il existe bien une association entre varicocele et temperature testiculaire, cette derniere n'est pas systematiquement augmentee.

Contributing reviewers The Editors of Basic and Clinical Andrology would like to thank all our reviewers who have contributed to the journal in Volume 23 (2013).

Testicular cancer is the most common neoplasia occurring in the young male population. The PEB (cisplatin, etoposide and bleomycin) adjuvant chemotherapy usually proposed after orchidectomy in non seminomatous tumours, and in metastatic seminomas, has improved the long-term survival of these patients. Following an azoospermic period, sperm cell recovery is generally observed after treatment delivery, but little is known about the genetic consequences on these new spermatozoa. To estimate the chromosomal consequences of this chemotherapy on sperm cells during the period of recovery of spermatogenesis, sperm cell aneuploidy was studied in testicular cancer patients, at 6-18 months after PEB adjuvant chemotherapy delivery, using fluorescence in-situ hybridization (FISH) of chromosomes 7, 16, 18, X and Y with specific DNA probes. A significant increase in the frequency of diploidy and disomy for chromosomes 16, 18 and XY was observed in treated patients compared with a healthy control group. Spermatozoa aneuploidy occurring during the spermatogenesis recovery period might be a possible side effect of the PEB regimen. Thus, practitioners should be advised to provide counselling about the need for an appropriate duration of contraception. Moreover, genetic counselling should be offered in cases of pregnancy occurring soon after the end of chemotherapy.

To evaluate relationships between the phenotypic and genotypic characteristics of patients with congenital bilateral absence of the vas deferens (CBAVD).Retrospective study.A university hospital urology-andrology department.Forty-one men with CBAVD.CBAVD was diagnosed during surgical and/or ultrasound exploration of the vasa deferentia (VD) (n = 39), or on the basis of impalpable scrotal VD (n = 2).History, clinical and seminal characteristics, and cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations including IVS-8 polyT analysis.A palpable scrotal vas deferens was present as a fibrous cord or nonpermeable duct in 13% of patients undergoing surgical exploration. Seminal vesicles were bilaterally absent in 28% of patients. No CFTR gene mutation or 5T allele was detected in 24.5% of the patients. Two CBAVD patients with renal agenesis carried a CFTR gene mutation (DeltaF508/5T-9T and R117G/7T-9T). CBAVD patients who have both a semen volume ofor =1.0 mL and a semen pH of7.0 have a significantly higher risk of severe CFTR gene mutation (OR = 9.12 [95% CI = 1.81-49.50]).A palpable scrotal vas deferens was found in 13% of CBAVD patients. Semen volume ofor =1.0 mL and semen pH of7.0 in CBAVD patients were associated with a higher risk of severe CFTR gene mutations. Patients with CBAVD and renal agenesis should be screened for CFTR gene mutations before assisted reproductive techniques are used.

Resume La detection de sperme peut etre une preuve indicielle de grande valeur apres une agression sexuelle ou un viol. Cet article reprend les differentes methodes cytologiques, biochimiques, immunologiques et de biologie moleculaire que les medecins legistes modernes ont a leur disposition pour affirmer un rapport sexuel recent.

The relationship between male occupational heat exposure and the time required to achieve a pregnancy [ TTP] was studied in a retrospective survey of 402 fertile couples. The TTP for the subgroups `exposure to heat' (median = 4.0 months; mean = 11.8; SD = 13.3) and `professional driver >3 h/day' (median = 4.5; mean = 14.4; SD = 28.5) was significantly longer (both p

The usual testicular location, either low or high in the scrotum, as well as testis ascent into suprascrotal position at least once a week from a usually scrotal position reported by the patient to occur spontaneously and regularly, were recorded in 85 fertile and 1014 infertile men, including 95 with a history of cryptorchism. The frequency of at least one testis being in a high scrotal location was similar in fertile (16.5%) and non-cryptorchid infertile (17%) men but higher in previously cryptorchid infertile men (27.2%), a difference probably due to cryptorchism. Testicular ascent was more frequent when scrotal location was high rather than low. An ascending testis was encountered more frequently in previously cryptorchid (30.4%) than in non-cryptorchid infertile men without any history of cryptorchism (18.3%) or in fertile men (11.8%). Moreover, in infertile men, spermatogenesis was more depressed in cases of testicular ascent than when both testes were never ascending, independently of a varicocele. Testis ascent could be a risk factor for spermatogenesis in infertile men without any history of maldescended testicle.

Basic and Clinical Andrology (BaCA) is a new scientific open access, international peer-reviewed journal covering all aspects of male reproductive and sexual health. BaCA has its roots in the journal formerly entitled Andrologie (Springer), the official journal of the French speaking Society of Andrology (SALF) for the past 25 years. BaCA is an evolution of this journal, adding an international dimension (publishing in English language) and is now the official journal of the SALF. Basic and Clinical Andrology aims to bring to light the various clinical advancements and research developments attained in andrology around the world and thus help the field move forward. BaCA publishes many article types [1] in many areas, from basic research and clinical studies in animal models and humans related to male fertility, infertility, contraception as well as sexual and genital health. The field of andrology cannot be simply reduced to spermatogenesis or spermatozoa, erection or erectile dysfunction. It also covers the development and maintenance of tissues, structures and functions at the molecular, cellular, tissue, organism levels to ensure male reproductive efficiency. As such, andrology should then be considered important enough in human life for knowledge not to be restricted to a small community. As sexuality and genital health, as well as male fertility and contraception, are important parts of individual well being, accessibility to knowledge in andrology is required for any scientific or medical teams working in this area. In this way, an open access journal such as Basic and Clinical Andrology is a window onto the andrological world, with the potential to reach a much larger set of readers than any subscription-based journal, in print and online format. This ensures that author’s work will be disseminated to the widest possible audience and, hopefully, will offer better indexing opportunities [2, 3].

Summary To determine whether the characteristics of Percoll-selected spermatozoa are more predictive of in-vitro fertilization (IVF) results than are those of native semen, 118 semen samples from patients undergoing an IVF attempt were studied. Motility, using computer-assisted sperm analysis, and morphology were recorded before and after sperm selection on a Percoll gradient. Percoll selection increased the percentage of morphologically normal spermatozoa (58.2 ± 19.9% versus 47.9 ± 17.9%; p

Out of 85 fertile and 1014 infertile men, two (2.4%) and 95 (9.4%) respectively had a history of cryptorchidism. Thus cryptorchidism appears to be a risk factor for fertility since this difference was significant. Further comparisons showed that the volume of a former cryptorchid testis was smaller than the contralateral normally descended one and that sperm output/concentration was more impaired in bilateral than in unilateral cryptorchidism. A retractile testis, defined as a testis reported by the patient to be spontaneously and regularly, i.e. at least once a week, ascending up into a supra-scrotal position, was more frequent in infertile men with a history of cryptorchidism than in fertile men. Retractility was more frequent on the cryptorchid side, and was found more frequently after hormonal than after surgical treatment. Independently of all epidemiological and clinical parameters studied, retractility was associated with a lower sperm output. Among the infertile men with a history of cryptorchidism, 45% had an abnormally high scrotal temperature. This abnormal temperature represented a pejorative risk factor for fertility in this group, since it was associated with a more severely impaired spermatogenesis and a higher incidence of primary infertility than in infertile men with a history of cryptorchidism but normal scrotal temperatures.

Sperm detection can be an important factor in confirming sexual assault in cases of rape. This paper compares two biochemical methods used in forensic medicine: the first detects the presence of zinc, the second detects acid phosphatase activity. The population studied was composed of 174 consenting women seen at the Male Infertility Center in Toulouse, France. The date of their last sexual intercourse was known accurately. Cytology was the reference test to confirm the presence of sperm in the vaginal samples. We studied the sensitivity, specificity, and positive and negative predictive value of the two biochemical methods. Acid phosphatase detection was the most valuable technique, but its use is limited in time. The zinc test gave disappointing results in our study and does not seem to be a useful reference method for the forensic physician.

Objective To evaluate rates and reasons for treatment discontinuation in couples with male factor infertility and who failed to conceive. Design Retrospective study. Setting Male Sterility Center, University Hospital. Patient(s) A total of 407 couples consulting for male factor infertility and who discontinued treatment without conceiving. Intervention(s) None. Main Outcome Measure(s) Treatment, reasons for dropout, and reproductive outcomes after discontinuation. Result(s) Of the 407 patients, 218 (54%) had had fertility treatment (medical or surgical), and 189 (46%) underwent assisted reproductive techniques (ART) (intrauterine insemination [IUI], in vitro fertilization [IVF], or intracytoplasmic sperm injection [ICSI]). The main reasons for dropout were painfulness of treatment (15% for patients with non-ART treatment vs. 32% for patients who had undergone ART), its ineffectiveness (12% vs. 26%), and separation of the couple (18% vs. 7%). Of the 407 patients, 27% consulted in another fertility center, 8% succeeded in having a child by ART with male partner sperm, 1% by ART with donor sperm, and 11% through adoption. Conclusion(s) About half of the couples consulting for male factor infertility discontinued fertility treatment, and of those who discontinued only a fifth finally succeeded in having a child. Although support is available to couples during fertility care, ART is a physical and psychological burden.

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.

De nombreux facteurs peuvent constituer un risque pour la fertilite chez l’homme. Parmi ceux-ci, les infections du sperme sont frequemment citees, et plus particulierement les infections du sperme a chlamydia et celles a mycoplasmes. Nous avons revu les principaux resultats rapportes dans la litterature concernant les infections a mycoplasmes et a chlamydia, et essaye de degager leurs effets potentiels sur la fecondance du sperme. Pour chacun de ces deux agents infectieux, seront successivement envisages, les effets sur les parametres du sperme, sur le taux de fecondation, et sur le developpement de l’embryon.