Contraception épididymaire: état des recherches et perspectives

The development of new contraceptive strategies is a major economic challenge. The epididymis, the site of post-testicular maturation of spermatozoa, has recently become the subject of research as a target organ for the development of new contraceptive approaches in mammals. The epididymis, which transports and stores spermatozoa (in most mammals), is a key organ, due to its various funtions, in the acquisition of the fertilizing property of male gametes. Although the complex phenomena of secretion and reabsorption leading to remodelling of spermatozoa and acquisition of their capacity to recognize and fertilize the ovum are far from being fully elucidated, major progress has been made concerning the physiology of the mammalian epididymis. After a brief review of the activities of epididymal epithelium, the authors discuss the main lines of research for the development of future post-testicular contraceptive strategies with particular emphasis on the cases of infertility encountered in recent generations of various models of transgenic mice.     

Sarcoïdose épididymaire

The Sarcoidosis or Besnier Boeck Schaumann's disease is a systemic granulomatous disorders. Multiple organs but specially lungs and skin may be affected. We describe an uncommon case of genital localisation in one patient with epididymal sarcoidosis, regarding on the heterogeneous clinic presentations of this affection. References show differents hypotesis about the pathogenesis: mycobacterial, viruses, imunologic or genetic factors. There are also a race predominance in black population. The patient was referred to us for testicular pain associated with a palpable epididymal node, subcutaneous thoracic and limbs, painless nodes, and rhinorrea. With the first clinic approach we attempted the diagnosis of epididymal tuberculosis, which was corrected after to sarcoidosis with the conjunction of several items on a score disease basis. The biopsy confirmed the diagnosis of sarcoidosis, so we began the medical treatment including chloroquine: 300 mg/day during 3 years (to avoid recurrences). As the usual surgical treatment, we submitted our patient to an epididymal node resection. After a 4 years follow-up, there are no evidences of disease.     

Grossesses obtenues par Fécondation In Vitro avec sperme épididymaire

Excretory azoospermia, or rather some of its anatomoclinical forms, represents a new indication of IVF using epididymal semen are reported (our overall statistics concerns 15 attempts). Practical applications of the method are discussed.     

Dysfonction érectile et traitement antihypertenseur

Fifteen to 20% of hypertensive patients suffer from erectile dysfunction prior to initiation of antihypertensive therapy and the frequency of erectile dysfunction increases to 40–50% after initiation of antihypertensive therapy. Clinical studies conducted according to a rigorous methodology have shown that diuretics are the main cause of erectile dysfunction. Antihypertensive combination therapy is an aggravating factor. Phosphodiesterase-5 inhibitors can be used in hypertensive patients with erectile insufficiency in the absence of any contraindications.     

Origine et évolution des saurischiens

We propose here a short synthesis of the saurischian evolutionary history. Our knowledge of the diversity and evolution of the saurischian non-avian dinosaurs has increased during the past decade. The generalized use of cladistics has led to various phylogenetic hypotheses, some of them in agreement on the evolution of saurischians, even if some controversy remains. The saurischian evolution is closely linked to two of the five great mass extinctions, which punctuated life history, but probably also to a third, less important, extinction event at the end of the Early Jurassic.     

Etats épididymaire,prostatique et vésiculaire en relation avec les paramètres du spermogramme chez les hommes consultant pour infertilité

The semen results from the mixture on ejaculation of various secretions from the testicle, the genital tract and the adnex glands. It consists on a cellular phase: spermatozoa and a liquidian phase: the seminal plasma. The spermogram is the first exam to make in order to set diagnosis of male infertility. It is completed with a biochemical study of the semen to find an excretory origin to infertility. In this work, we have studied the frequences of prostatic, vesicular and epididymious anomalys, through dosage of their markers in the semen, in 146 males consulting for infertility and eventual relationships between these markers and the characteristics of the spermogram. We found out that the prostate is the most hurt portion of the genital tract in infertile males and presents a dysfunctioning in 32,26% of cases, most often resulting in an inflammatory states of this gland. The epididymious obstruction is detected in 35% of azoospermia cases. In all the cases, we found out significant statistical correlation between the semen volume and the activity of alpha 1–4 glucosidase and also the pH of the semen and the seminal citric acid. For patients having a high leucospermia we didn’t find any relationship between the leucocytes rate in the semen and the different biochemical markers. If the seminal fructose rate has no effect on the initial mobility of spermatozoa, it has a statistically significant effect on their survival. In fact, the diminution of seminal fructose coincides with a bad survival of spermatozoa, which shows the importance of this spermatic substrate on the maintaining of spermatozoa mobility.     

Taxonomie, écologie et lutte biologique

Summary It is impossible to study modern taxonomy without taking into consideration the population genetic and ecology. Thé Linnean concept of monotypic species should be replaced by the biometric study of the frequency of the variability of the biological characters (particularly morphological) used in taxonomy. The study of populations offers a larger scientific interest than the one of isolated types. It gives the possibility of caracterizing the evolution stability of the species. So, Taxonomy can help considerably in biological control. By revealing large variability species, it gives a criterion of their adjusting plasticity. But, by definition, the biological control is based on the adjusting capacity of the entomophagous insects either to a new host or to a new environment. Information given by the taxonomist on the species stability has consequently a great value in the choice and use of the Entomophagous insects. — Ecologists using biological control, expect from the taxonomist to lie more than a label, which implies the use of biometric analysis methods in Entomophagous taxonomy.      

Régulation des fonctions de l’épithélium épididymaire des mammifères: état des lieux

Male gametes formed in the testis, the site of spermatogenesis, continue their maturation outside of the gonad in the genital tract. The epididymis is at the centre of this process of post-testicular maturation of spermatozoa, responsible for acquisition of their mobility and their ability to recognize and penetrate an oocyte, essential events for fertilization. During their transit in the epididymal ducts, gametes evolve in a perpetually changing luminal environment due to complex interactions of secretion and reabsorption activities of the epididymal epithelium. These numerous secretion and reabsorption activities are closely regulated in space and time, which makes this epididymal epithelium a very complex tissue subject to an elaborate network of cross-regulations. Apart from classical endocrine and paracrine regulations, the proximal part of the epididymis is also subject to lumicrine regulation by testicular factors which increase the complexity of the regulation networks involved. The present study tries to present an exhaustive review of the factors demonstrated in the literature to exert a modulation of epididymal activity.     

Le courant,facteur écologique et éthologique de la vie aquatique

Résumé Nous avons exposé dans ce travial l'état de nios connaissances sur le facteur courant, du double point de vue écologique et éthologique. Nous avons recherché les problèmes que pose cette étude et les moyens mis à notre disposition pour les résoudre.Avant d'entreprendre toute étude biologique sur le courant, il convient de bien étudier les caractéristiques mécaniques de l'eau en mouvement.Le courant est caractérisé le plus souvent par sa vitsse. Celle-civarie beaucoup suivant les points où on la mesure. Elle diminue vers la surface de l'eau et surtout contre le fond. Dans la végétation et derrière les obstacle, le courant est très faible: ces régions constituent les eaux-mortes. Ambhul (1959) a également en évidence une couche-limite presque immobile contre le fond.Le courant raréfie la nourriture des organismes, leur rend l'oxygène plus facilement utilisable.Au point de vue écologique, le courant est le facteur reposable de nombreuses adaptations. Le problème pour les animaux rhéophiles est de ne pas ne laisser emporter. Les animaux vivant en pleine eau (Poissons) ont une forme hydrodynamique, qui offre la moindre résistance. Le animaux benthiques, aplatis, sont plaqués contre le fond par une composante verticale de la poussée du courant (théorie de la poussée de Steinamann), ou évitent les effects mécaniques de courant, par leur taille petite ou leur forme, en se plaçant dans les eaux-mortes ou les couches-limites (Nielsen, Ambuhl).Les animaux se répartissent donc sur le fond suivant possibilitités par rapport au courant. On évalue quatitativement cette répartition en comptant le nombre d'individus se trouvant dans chaque zone de vitesse et en construisant le polygone de fréquence correspondant.Au point de vue éthologique, le courant est le fateur physique responsable du rhéotropisme. Beaucoup d'espéces s'orientent contre le contre le courant (rhéotropisme positif). Le déterminisme de cette orientation est mal connu. Des processus mécaniques et phisiologiques entrent en jeu suivant le cas. Le fait même de résiter au courant constitute aussi un genre de réponse à ce stimulus. On peut mesurer ce comportements par l'évaluation de la vitesse maximale supportée et des déplacements des organismes dans le courant.Nous avons affaire à un biotope complexe. son étude au laboratoire permet de sérier les questions, en simplifiant et contrôlant plus étroitement les conditions de milieu. Pour ce fai9re nous avons utilisé un appareillage spécial. Deux sortes de bacs à courant sont décrits:Des appareils à courant circulaire, pour lesquels nous avons établi une carte des vitesses aux aux différents point du fond. Un tableau de probabilité permet se savior si un animal fréquentee de préférence les zones à courant fort ou les zones à courant faible. Ces appareils permttent donc un choix organismes.Des appareils à courant retiligne oùle courant est plus régulier. Ils permettent des expériences sur la résistance au courant et la mesure des déplacements des organisme dans le courant.La vitesse du courant se mesure à l'aide de différents appareils souvent trop encombrants pour le laboratoire. Les principaux sont le tube de Pitot, utilisable pour les courant moyens à trés rapides, et le micromoulinet Beauvert, précis de 0 à 250 cm/s, utilisable surtout sur le terrain. Nous avons construit un balancier à curseur, muni d'une palette plongeant dans le courant. Un étalonnage permet de mesurer la vitesse de 0 à 60 cm/s dans toutes les parties des appareils utilisés au laboratoire. I1 permet également la mesure de la poussée du courant sur un objet plongé dans l'eau.Enfin Ambuhl (1959) utilise une méthode photographique valable au laboratoire pour les courants lents et trés lents.Nous avons enfin complété personnellement l'étude du courant en envisageant s aforce de poussée. Nous avons démontré que la larve de Micropterna testacea (Gmel.) (Trichoptera Limnophilidae) et son étui sont assimilables à un cylinder plongé dans le courant, de diamètre égal au diamètre antérieur de l'étui. Le régime d'écoulement de l'eau est toujours turbulent. Une formule donne la force F de poussée du courant en fonction de la vitesse V du courant et de la section S du cylindre plongé dans l'eau. Elle est voisine de la forme F = kSV². Les courbes données sur la figure 7 permettent de conaître la force supportée par une larve de Trichoptère plongée dans un courant de vitesse connue.Nous verrons dans une étude ultérieure que cette force semble constituer le stimulus actif dans le rhéotropisme de la larve de Micropterna testacea.

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Summary We have exposed in the preceding study what we know of the current as a factor, from the point of view both ecological and ethological. We have tried to make evident the problems which this study brings up and the means at our disposal for their solution.Before beginning a biological study of the current, it is necessary to make a thorough study of the mechanical characteristics of water in motion.The current is, as a rule, characterised by its speed, or velocity. The velocity is variable with the places of measure. It decreases near the surface and specially close to the bottom. In vegetation and behind obstacles the current is very slow. Dead water happens in these places. Ambuhl has also established the existence of a boundary layer almost motionless close to the bottom.The food of organisms is made scarce by the current which also makes oxygen easier to utilize.From the ecological point of view, the current is the factor responsible for many adaptations, specially of rheophilous animals which must resist being carried away. The swimming species (fishes) hydrodynamic shape allows them to resist the current. The benthic species are flattened against the bottom by a vertical component of the shove in the current (shove theory by Steinmann) or they may avoid the mechanical action of the current through their smallness or their shape and by placing themselves in the dead waters or the boundary layers (Nielsen, Ambuhl).The animals scatter themselves on the bottom proportionately to their capacity to resist the current. This distribution is quantitatively estimated by counting the number of organisms found in each zone of velocity and by drawing the corresponding polygone of frequency.From the ethological point of view, the current is the physical factor responsible for rheotropism. A great number of species set themselves against the current (positive rheotropism). The determinism of this orientation is little known. Mechanical and physiological proceedings come into play according to the particular case. The very resistance to the current is also a sort of answer to this stimulus. This behaviour can be estimated by evaluating the maximum velocity borne by the organisms and their moving about inside the current.We have to deal with a complex biotope, the study of which in the laboratory allows taking problems in their logical order, simplifying and controlling more narrowly the properties of the medium. For that study we have used special fittings. Two sorts of troughs or channels are described:An equipment for circular current, for which we have drawn up a chart indicating the velocity of each successive place on the bottom. A table of probabilities shows the prefered location of the animals, whether in zones where the current is strong, or in zones where it is slow. This equipment leaves to them the possibility of a choice.An equipment for rectolinear current. In these channels, the current is more regular. They allow of experiments on the resistance to the current, and appreciating the moving about of the organisms in the current.The velocity of the current is measured with the help of several appliances, often too cumbrous in the laboratory. The main ones are: the Pitot tube, useful in the case of mean to very rapid currents, and the Beauvert micromoulinet, shaped like small mill-wheel, with an accuracy of 0 to 250 cm/s, specially serviceable in natural surroundings. We have built a scale-beam fitted out with a traveller, and equipped with a paddle immersed in the current. Velocity, from 0 to 60 cm/s, is measured in all parts of the fittings used in the laboratory, by means of standardizing. The shove of the current on an object immersed in the water can also be measured.Lastly, Aambuhl makes use a photographic method sufficient in the laboratory for slow and very slow currents.We have personally supplemented our study of the current by an examination of its shove or thrust. We have showed that the larva of Micropterna testacea (Gmel.) (Trichoptera Limnophilidae) and its case are comparable to a cylinder in the current, the diameter of which is equal to the diameter of the forepart of the case. The waterflow is always turbulent. A formula supplies the force F of the shove, which force is a variable dependent on the velocity V of the current and on the section S of the immersed cylinder. The formula is very nearly F = kSV². The curves showed on figure 7 define the force that is borne by a larva of Trichoptera immersed in a current whose velocity is given.We shall see in a subsequent study that this force seems to form the active stimulus in the rheotropism of the larva of Micropterna testacea.

     

Intérêt de la ponction épididymaire et de la biopsie testiculaire systématique dans la prise en charge de l’azoospermie obstructive

Introduction

In obstructive azoospermia (OA), even if spermatozoa recovery rate are high, pregnancy rates could be lower as expected. When almost surgeons stop if they could find motile spermatozoa in the epididymis after microsurgical epididymal sperm aspiration (MESA), in our center, we add systematically a testicular biopsy with testicular sperm extraction (TESE). What are our sperm extraction rates in MESA or TESE? Are pregnancy and miscarriage rates different regarding the sperm origin?

Material and methods

A retrospective study including 48 infertile couples with ICSI because of OA. Between 2003 and 2011, each patient had a complete aetiological exploration and a surgery with the association of MESA and TESE. ICSI were asynchronous. Each time it was possible, ICSI was realized first with epididymal spermatozoa.

Results

For 48 couples, 99 ICSI were realized. Fifteen couples had 24 ICSI-TESE because no spermatozoon was found in MESA. Eleven couples had 20 ICSI-TESE because of bad quality of sperm recovered with MESA. Twenty-two couples had 22 ICSI-MESA in first intention. If failed, 11 couples had continued with 12 ICSI-MESA and 10 with 20 ICSI-TESE. Although the number of injected oocytes (7,1±4,1 vs 6,9 ±3,6 P: 0,8) and embryos (4,5±3,0 vs 4,7±2,7; P: 0,7) were not significantly different in the two ICSI groups, the number of top quality embryos (2,4±1,9 vs 3,6±2,0 P: 0,005) and frozen embryos (0,9±1,8 vs 1,7±1,9 P: 0,04) were higher in the ICSI-TESE group. Pregnancy rate per punction (58,5% vs 26,5%, P: 0,002) was higher when testicular spermatozoa were used.

Conclusion

Our approach is original with the systematic association of MESA and TESE for each OA man, when others stop surgery when they can find spermatozoa with MESA. We found that more than the half of epididymal explorations were not useful because negative or of bad quality. Embryo quality and per punction pregnancy rate were better with testicular spermatozoa. Association of MESA and TESE could improve the management of these infertile men without exposing them to an over surgical risk.     

Évolution de la composante lipidique de la membrane plasmique des spermatozoïdes durant la maturation épididymaire

One aspect of mammalian post-testicular sperm maturation is the progressive change in their plasma membrane lipid composition. These modifications in lipids allow sperm cells to fuse with oocytes during fertilization. A significant share of these sperm lipid changes occurs during their descent through the epididymal tubule. It then continues within the female genital tract during the capacitation process, an essential prerequisite for acrosomic reaction and hence fertilization. This review presents what is known concerning the sperm plasma membrane lipid changes during epididymal maturation in various mammalian models. In the first section, after a brief presentation of the classic eukaryotic cell plasma membrane lipid organization, the emphasis is on the particularities of sperm plasma membrane lipids. The second section presents the different changes occurring in the three major classes of lipids (i.e. phospholipids, sterols and fatty acids) during the sperm’s epididymal descent. The final section briefly describes the mechanisms by which these lipid changes might happen in the epididymal lumen environment. The role played by lipid-rich vesicles secreted by the epididymal epithelium via apocrine secretory processes is highlighted.