Alexandre C
Nouv Presse Med. 1976;5(27):1678-82.
Study of 1303 cases of male sub-fertility led to a certain number of practical conclusions: - From a diagnostic viewpoint, the "fertility" of an individual, which is difficult to assess, depends more on the motility than the number of spermatozoa. This is most faithfully reflected in the crossed penetration test which defines the quality of penetration of a control mucus. The value of electron microscopic cytological study in the case of total asthenospermia or major monomorphous teratospermia, reflecting an irreversible constitutional abnormality of the ultrastructure of the spermatozoon, is emphasised. - From a therapeutic viewpoint, recent progress has involved the technique of surgical treatment for varicocoele as well as hormone therapy. It is essential not to neglect empirical "minor aids" indicated in the case of unexplained abnormalities (homologous artifical insemination in the case of abnormalities in the volume of the ejaculate, retard androgen therapy in the case of polyzoospermia). - From a prognostic viewpoint. The distinction must be drawn between aetiologies of good prognosis (80% of our success) responsible for transient abnormalities in spermatogenesis (infections, metabolic disturbances, varicocoele) and aetiologies with an unfavourable prognosis since they cause tubulopathies of greater or lesser severity with a lesional impairment of spermatogenesis.
对1303例男性不育病例的研究得出了一些实际结论:——从诊断角度来看,个体的“生育能力”难以评估,其更多取决于精子活力而非数量。这在交叉穿透试验中体现得最为明显,该试验可确定对照黏液的穿透质量。强调了电子显微镜细胞学研究在完全弱精子症或重度单形性畸形精子症病例中的价值,这反映了精子超微结构不可逆的体质异常。——从治疗角度来看,近期进展涉及精索静脉曲张的手术治疗技术以及激素疗法。对于不明原因异常情况所指出的经验性“小辅助手段”(如射精量异常时的同种人工授精、多精子症时的延迟雄激素疗法)绝不可忽视。——从预后角度来看。必须区分预后良好的病因(我们80%的成功案例),这些病因导致精子发生的短暂异常(感染、代谢紊乱、精索静脉曲张),以及预后不良的病因,因为它们会导致不同程度的小管病变以及精子发生的损伤性损害。