[Assisted procreation for male indication].

Abstract

Strategy for male infertility looks like a compromise between diagnosis methods with their efficacy and complexity and treatment with their own risks, cost, efficacy. Infertility duration as well as woman's fertility play a key role for such a strategy. Definitive infertility without any correction (secretory azoospermia) will be proposed for alternate projects. Some situations may benefit from specific therapy (hypogonadotropic hypogonadism, anejaculations or retrograde ejaculation). More frequently male hypofertility is suspected with non specific sperm alterations, then assisted reproductive technologies will be discussed. Intra-cervical way artificial insemination with husband semen may be proposed in case of hypospadias, anejaculation, retrograde ejaculation, small volume ejaculate or self-cryostored semen, however negative post-coital test, positive crossed penetration test and positive post-insemination test need to be confirmed. Intrauterine way enhance fertilizing probability by discarding cervical step. It will be justified in case of negative post-coital test as well as crossed penetration test except that sperm preparation allowed to inseminate 500,000 to 1 million motile spermatozoa. Both rigorous monitoring and synchronism between insemination and ovulation enhance the efficacy of IU AIH which allowed a two to four fold increase in the pregnancy rate on a total of six cycles. In vitro fertilization for male factor represent around 15% of all IVF attempts. Both decrease in the fertilization rate and the increase in the pregnancy rate by transfer as compared with tubal factor are well accepted. The fertilization failure remain difficult to explain and need to be cautiously confirmed. Thus IVF represent an actual fertilization test but remain limited by the heterogeneity of parameters under "male factor".(ABSTRACT TRUNCATED AT 250 WORDS)