Fertilité de l’homme en fonction de l’âge

The aim of this work was to analyse the evolution of sperm characteristics according to age. To this end we analysed the spermogram of 2,126 men aged 20 to 64 who came for consultation for feminine indications for in vitro fertilization at the Clermont-Ferrand Human Reproduction Unit during the period 1980 to 1994. A search for a link between the age of the patient at the time of the spermogram and 10 sperm parameters, by studying a linear regression, did not reveal any evidence of a significant correlation between the age and the parameters studied. The mean values for volume, concentration of spermatozoa, percentage of mobile forms (normal, diminished), percentage of typical and mobile forms and percentage of abnormal forms were compared for age classes covering 5 years. These values showed no significant difference according to the age classes. Between 20 and 60 years the essential parameters of the spermogram seem generally to be independent of age, from which it can be deduced that ejaculate quality remains the same until 50 years of age. However a bias in the recruitment of the population studied and a very wide spread for the values for a given age mean that we may not have detected fluctuations in sperm characteristics linked with age.     

Syndrome de Klinefelter et AMP à l’aube de l’an 2000

Material and Methods

The patient is a 33 year old male, with a 47, XXY karyotype (cytogenetical investigation of 16 metaphases). Semen analysis revealed a severe oligozoospermia. (spermatozoa ?1×106/mL) and asthenozoospermia (60% of decreased motiliy), for an ejaculate volume of 1.8mL. Three-colourIn Situ Hybridization was performed on spermatozoa recovered from his cryopreserved semen, in order to simultaneously detect the chromosome X, Y and one with specific appropriate probes. Semen from two 23 year old men were also analyzed as controls.

Results

502 spermatozoa were analyzed from the patient and about 10,000 from the controls. There was an increase of about ten times of the percentage of hyperhaploïd (24XY) spermatozoa in the semen of the Klinefelter patient compared to the controls.

Discussion and conlustion

In a general view of IVF-ICSI practice in Klinefelter patients, we also discuss here several practical points such as (i) is there any morphological criteria which may prevent from injecting an aneuploid spermatozoa, (ii) is the risk of aneuploidy higher when using testicular spermatozoa than when using ejaculated spermatozoa, (iii) what do we know about the offspring obtained by IVF-ICSI in Klinefelter patients and (iv) when should prenatal and/or preimplantatory genetical diagnosisbe proposed in this particular context.     

Contraception thermique de l’homme

Several characteristics of spermatogenesis are heat-dependent in mammals. A similar process does exist in man in whom a qualitatively and quantitatively normal spermatozoa out put occurs for a mean testicular temperature ranging between 33 and 34.5°C. As in many animal species, an induced increase in the testis temperature results in a decreased spermatozoa out put and quality, decrease which is a function of both the intensity and the duration of the increase in temperature as well as the heated target (whole body, scrotum, testes). A daily increase of 1 to 2°C in the testis temperature for at least the waking hours induces on spermatogenesis an inhibitory effect strong enough to temporarily suppress the fecundity, i.e. to achieve a male contraception, withtout any major side-effects as reported for 37 couples during 411 cycles of exposure. Both spermatogenesis and fecundity recover initial values within one year after the heatng is stopped.     

Le principe de l’anonymat du donneur de gamètes à l’épreuve de son contexte. Analyse des conceptions juridiques de l’identité

This study clarifies the lively debate surrounding the anonymity of gamete donors. This principle, which has not been challenged since 1994, is currently criticized by a number of people, who were conceived through medically assisted procreation technologies with donor and who now have reached adulthood. Their testimony has a very significant impact on French public opinion. Several official reports have already suggested that the anonymity of gamete donors may well be removed under certain circumstances. To understand why public opinion has evolved so dramatically, we must revisit the legal position of gamete donors in the specific context of less visible changes in the law. Indeed, the legal concepts of parenthood and identity have been reshuffled over time, and such changes have deeply affected the legal issues relating to the anonymity of gamete donors. Formerly, the law governing the identification of individuals was shaped by political and social objectives. Now it is more concerned with the sense of identity and personal fulfilment of people. This change, based on modern western notions of egalitarianism and individuality, has dramatically affected the outcome of parenthood trials. Moreover, biological tests have made the truth available like never before. The possibility of finding out the truth has shocked the practice of many areas of family law and has created a new set of challenges, especially when the secrecy of the genetic parents has been legally established. In France, women have traditionally been able to deliver their children anonymously. A deadlock has resulted, which may now be overcome by introducing a new concept of personal origins. Now the law is evolving to permit the children to demand their biological mothers’ identity under certain circumstances, but without affecting anyone’s rights. The concept of personal origins has been quite successful on the European scene and has also charged the debate. It is now recognized under French and European laws that individuals must have privileged access to their personal origins. Can the principle of anonymity of gamete donors remain immune from such a (r)evolution ?     

Application de la technique de PCR en temps réel à l’étude de l’ADN ancien

Real-time Polymerase Chain Reaction (PCR) for the study of ancient DNA. The properties of ancient DNA (aDNA) make difficult the retrieval of DNA sequence. The advantage of Real-Time PCR was exploited, for the first time, in the study of aDNA. We determined the optimal condition to amplify, in one round of PCR, aDNA, which should be directly sequenced. Beside the verification of aDNA authenticity, we compared two cleaning bone methods: scalpel and ethanol. The ethanol specimens showed the best DNA yield. The aDNA was extracted and amplified (mitochondrial hypervariable region I) from five skeletons exhumed from the archaeological site of Notre-Dame-du-Bourg (France), dated from 3rd to 17th century. To cite this article: R. Kefi et al., C. R. Palevol 2 (2003) 125–132.     

Effets de l’Oxygenation du Milieu d’Incubation des Cotyledons de Ricin sur les Flux de Protons et sur l’Absorption du Saccharose

Some of the effects of oxygen concentration in the external medium bathing castor bean cotyledons were investigated. At 700 μM O₂, the sucrose-dependent proton influx was dependent on external pH while sucrose influx was independent of pH between 4,5 and 6; proton influx and sucrose influx were both dependent on external sucrose concentration; both were saturated above 50 mM sucrose. The stoichiometry H+/S decreased with increasing pH and sucrose concentration. These data were consistent with the results obtained in stirred or aerated external medium. Oxygen consumption, acidification of the medium, sucrose-dependent proton influx and sucrose uptake increased with increasing oxygen concentration up to 700 μM where saturation was reached. Bubbling with air (O₂, 160 μM) resulted in the same increase despite lower oxygen concentration. It is suggested that not only O₂ concentration but also CO₂ concentration act on O₂ consumption, and proton and sucrose fluxes.

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Nouveaux sites paléolithiques de l’oasis de Djizak

The present paper is devoted to the study of Paleolithic settlements recently discovered in the territory of the Djizak Oasis. Some Paleolithic settlements such as Yangikichlak, Azimboulak, Gourdara 1, 2 and Shachmai-Doston were discovered at the roof of the Nourata mountain range in the Farich district. Their cultural layers are not conserved but the single discoveries testify to the presence of prehistoric human camps in the Upper Paleolithic period. The lithic assemblage from the sites of the Djizak Oasis has some similarities with the material coming from the Tachkent site complex and from the Samarkand drainage basin. The discovery of the settlements and their later studies fill gaps on the Paleolithic map of the region.     

Physiologie de l’interaction gametique: Revue de la litterature

Our knowledge of gamete interaction in vitro and in vivo has grown rapidly over the last century. Its importance has been reinforced by the development of in vitro fertilization and assisted conception procedures on one hand, and by research on the development of contraceptive vaccines on the other. This literature review synthesizes our current understanding of the successive steps in the fertilization process from sperm capacitation allthrough gamete fusion, including sperm interaction with the cumulus oophorus and the zona pellucida, as well as consideration on the mechanisms and timing of the acrosome reaction.     

Les théories de l’économie animale et l’émergence de la psychiatrie de l’Encyclopédie à l’aliénisme

The author analysesEncyclopédie’s articles devoted to nervous and mental functioning and disorders, showing that a new approach to lunacy as a mental illness, which is defined in some articles as a “general trouble of the animal economy”, progressively emerged. The term,animal economy, unified physical and moral aspects of the study of man. It was elaborated by XVIIIth century physiologists and was widely accepted by French physicians. This idea is based on the vitalistic thought of the Montpellier school, which equated life with sensibility, and on English medical conceptions of a nervous-centred organism. Later on Philippe Pinel’s work displayed the legacy of these conceptions. On one hand, the comprehensive view of physical and moral dimensions in theanimal economy neutralized the question of an organic or psychogenetic origin of madness. This enabled him to consider it as a determinate field of sensibility interactions and as a medical matter, and to legitimize the group of therapeutic practices that he namedtraitement moral. On the other hand, Pinel departed from the classical conception ofanimal economy by developing his concept of aprinciple of mania, which underlies the manifold symptoms and forms of madness, and which are only perceptible to a trained specialist (aliéniste). The historical development analysed in this article show how alienists were enabled to claim both the wholly medical nature of insanity as disease, and their specific competence as apart from the other medical disciplines. To this extent, Esquirol achieved Pinel’s scientific work.     

L’analyse combinée de la tomoscintigraphie myocardique de stress et de l’angioscanner coronaire pour identifier les artères responsables de l’ischémie

The identification of ischemia-related coronary artery by stress myocardial perfusion SPECT (SPECT-MPS) is difficult, but it is likely that this identification could be easier by fusionning the SPECT images with images from coronary CT angiography (CTA).ObjectiveTo assess the usefulness of the fusion of SPECT-MPS images with CTA images in the identification of ischemia-related coronary arteries.MethodSPECT-MPS and CTA, which had been recorded in a delay ≤ 3 months, were reanalyzed blindly to identify the coronary arterial vessels with (1) stress ischemia at SPECT-MPS and (2) significant coronary stenosis (> 70 %) at CTA. In case of discordance between the two techniques, an analysis was performed while fusioning the SPECT-MPS and CTA images.ResultsThe population included 38 patients, of whom 22 (58 %) had an ischemia at SPECT-MPS. The identification of the ischemia-related vessels was initially discordant between SPECT-MPS and CTA for 17 patients (45 %). After the fusion's analysis, nine out of these 17 patients (53 %) became totally concordant because of modifications in the CTA analysis in six patients and in the SPECT-MPS analysis in only three. A low severity of ischemia was the main correlate of persisting discordances after fusion: 58 % (7/12) of such low severity ischemia were observed in coronary vessels with persisting discordance, but only 24 % (5/27) with concordant coronary vessels (p = 0.02).ConclusionThe identification with SPECT-MPS of the ischemia-related coronary artery is rarely modified by a fusion analysis with CTA images. Discordances between the two techniques remain frequent, even after fusion, but especially in case of low severity SPECT-MPS ischemias.     

Prevention de l’infertilite d’origine infectieuse chez l’adolescent

Some causes of infertility can be prevented, as is the case for infertility of infectious origin. Genital infections represent a major source of infertility. Prostato-epididymitis consecutive to an urinary infection can be prevented by identifying and treating prostatic localizations at an early stage of urinary infection. The prevention of sexually transmitted diseases (STD), which cause male and female infertility, is, at the moment, accomplished by the prevention of the sexual transmission of the HIV. Teenagers represent a target of choice for the educational campaigns promoting condom use. The role of physicians, especially when teenagers are asking for a contraception, must be complementary to the public health campaign to decrease the spread of HIV and other STDs.     

Place de l’embolisation percutanée de la varicocèle dans le traitement de l’infertilité

Objectives

To describe percutaneous embolization of varicocele and to evaluate the effect on fertility disorders.

Materials and methods

One hundred nineteen patients, aged 11 to 48 years, underwent percutaneous embolization for varicocele indicated by a fertility disorder in 23% of cases. Correction of the varicocele and resolution of associated pain, improvement of testicular trophicity and the effect on fertility were studied and a review of the literature was performed.

Results

Percutaneous embolization was performed using neuroleptanalgesia on an outpatient basis. The technique combined venous sclerotherapy and placement of coils in the gonadal vein. The technique was successful in 95% of cases and one complication was observed. At 3 months, the varicocele and related pain had resolved in 98% of treated patients. According to previous reports in the literature, the relations between varicocele and fertility disorders are still unclear, but improvement of fertility (semen quality and conception rates) after varicocele repair has been established.

Conclusion

Although the consequences of varicocele on fertility have not been fully elucidated, treatment of varicocele appears to be beneficial. Percutaneous embolization of varicocele is a safe and effective alternative to surgery. This technique, based on a urological and radiological consensus, is the first-line treatment for varicocele in our institution.     

Commande nerveuse peripherique de l’erection

Local mechanisms causing penile erection and detumescence result from variation in tone of vascular and trabecular smooth muscles and in a lesser part of striated muscles around the crura penis. All these events are neurally mediated. We reviewed human and animal data concerning the functional peripheral neuroanatorny of erection. General organization of peripheral nervous system is recalled. Somatic efferents of the pudendal nerve, originating in the sacral spinal cord, innervate the striated musculature of the perineum. Somatic afferents of the penis are conveyed by the dorsal penile nerve, a branch of the pudendal nerve. Afferent terminations project into the spinal cord, their role is discussed. Parasympathetic pathways are involved in the reflexogenic erections. Sympathetic pathways destinated to the erectile structures are more complex. They are issued from thoracolumbar spinal cord and travel through the hypogastric nerve or the lumbosacral sympathetic chain. Sympathetic fibers originating in the sacral sympathetic chain are present in both pelvic and pudendal nerves. Inhibitory role on the erection of the sympathetic nervous system is well-known, it could be also responsible for psychogenic erections. Parasympathetic and sympathetic fibees are mixed in the pelvic plexus and the cavernous nerves which are described. Relations between the four sets of peripheral nerves (somatic efferents, penile afferents, thoracolumbar sympathetic sacral parasympathetic and sympathetic) are discussed.     

Mecanismes des phases de l’erection

The erectile phenomenon is scientifically described since the early 19 th century. During the last 10 years, new methodologies in experimental and clinical approaches added further details to our knowledge on the erectile process. Postaganglionic parasympathetic neurotransmitters as Acetyl-Choline, Vasoactive-Intestinal-Polypeptide or Calcitonine — Gene — Related — Peptide are identified; their information reaches the cavernous smooth muscle cells indirectly via the endothelium, mediated by Endothelium Derived Relaxing Factor. Sympathetic neurotransmitters as Norepinephrine seem to influence the smooth muscle cell directly, but recent studies suggest a role for endothelin, an endothelium derived contracting substance. The neurogenic information reaches the cavernous bodies probably via pace maker-cells that are connected with the other smooth muscle cells by gap junction. The balance between parasympathetic and sympathetic influences determines the state of erection.     

Prevention de l’infertilite d’origine infectieuse chez l’adolescent

Some causes of infertility can be prevented, as is the case for infertility of infectious origin. Genital infections represent a major source of infertility. Prostato-epididymitis consecutive to an urinary infection can be prevented by identifying and treating prostatic localizations at an early stage of urinary infection. The prevention of sexually transmitted diseases (STD), which cause male and female infertility, is, at the moment, accomplished by the prevention of the sexual transmission of the HIV. Teenagers represent a target of choice for the educational campaigns promoting condom use. The role of physicians, especially when teenagers are asking for a contraception, must be complementary to the public health campaign to decrease the spread of HIV and other STDs.     

Synthese de la Desamino 9’ Sinefungine

Abstract

La sinéfungine dont nous avons récemment achevé la synthèse (1) possède une activité antiparasitaire en particulier sur différentes souches de Leishmania (2) mais présente 1′inconvénient d'ine toxicité non négligeable; nous avons donc entrepris la synthèse d'analogues, en particulier du dérivé 9’ désamino è partir de l'adénosine et è partir du ribose.     

Optimisation de l’utilisation du PSA

PSA is a tumor marker usually determined for prostate cancer at diagnosis for its pronostic value and at therapy follow-up. But lack of specificity of PSA for prostate cancer and variability between assays demonstrated by the quality program survey make this marker not valuable in mass screening program. Market control of Afssaps on analysis devices of PSA showed a correct harmonization for total PSA. Biological tools available and easy to perform could improve ability of PSA for early detection of prostate cancer at a curable stage without induction of unnecessary biopsies prescribed because elevated total PSA values.