Desde su descripción inicial por Stein y Leventhal en 1935, el síndrome de ovarios poliquísticos (SOP) ha visto evolucionar su definición. Desde 2003, tras la conferencia de consenso de Rotterdam, la definición se ha basado en la presencia de criterios clínicos, de laboratorio y ecográficos, tras descartar otras etiologías que pudieran producir cuadros clínicos similares. La fisiopatología de este síndrome sigue siendo objeto de mucha controversia en la comunidad científica, pero la mayoría de los especialistas parecen estar de acuerdo en que el hiperandrogenismo de origen ovárico es el elemento «fundador». El tratamiento, tanto en lo que respecta al hiperandrogenismo como a la infertilidad y los trastornos del ciclo, está cada vez mejor codificado. La frecuente asociación de la resistencia a la insulina con este síndrome debería llevar a su detección ante el diagnóstico de SOP. En efecto, en este caso, las medidas higiénico-dietéticas y el uso de agentes sensibilizantes a la insulina, cuyo lugar queda por definir, parecen potenciar la acción de los diversos tratamientos.

Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia (NOA) in adulthood. Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism, previous studies have only described small cohorts or inhomogeneous population. Consequently, we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA, and compared testicular sperm extraction (TESE) outcomes between men with bilateral versus unilateral cryptorchidism. Our results show no difference in follicle-stimulating hormone (FSH) levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism (median: 21.3 IU l-1 vs 19.3 IU l-1, P = 0.306; and 7.2 ml vs 7.9 ml, P = 0.543, respectively). In addition, sperm retrieval rates were similar (66.2% vs 60.0%, P = 0.353). Using multivariate analysis, we have found that only a low inhibin B level (above the assay's detection limit) was positively associated with successful sperm retrieval (P < 0.05). Regarding intracytoplasmic sperm injection outcomes, we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups (17.4% vs 27.8%, P = 0.070; and 16.1% vs 26.4%, P = 0.067, respectively). Unexpectedly, there was no significant difference in hormonal profiles (FSH, luteinizing hormone [LH], testosterone, and inhibin B levels) and TESE outcomes between unilateral versus bilateral cryptorchidism. This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment. Interestingly, inhibin B level might be a predictor of successful TESE.

STUDY QUESTION:Is the negative correlation between the numbers of 2-5 and 6-9 mm follicles influenced by ovarian and/or metabolic parameter(s) in young control women and in patients with polycystic ovarian syndrome (PCOS)?SUMMARY ANSWER:Our study confirmed that the negative correlation between numbers of follicles sized 2-5 and 6-9 mm was stronger in PCOS than in young control women and was not linked to any ovarian or metabolic parameter.WHAT IS KNOWN ALREADY:Previous reports described a direct negative correlation between the number of small antral follicles (2-5 mm) and large antral follicle (6-9 mm) during the early follicular phase (cycle Days 2-5) in normal and PCOS women. Numerous factors, that could be either intrinsic to the ovary or secondary to metabolic influence and/or gonadotropin regulation, might account for this.STUDY DESIGN, SIZE, DURATION:Six hundred and thirty-nine patients with PCOS according to Rotterdam Criteria and 157 control women were recruited in this retrospective cross-sectional study from January 2009 to January 2016.PARTICIPANTS/MATERIALS, SETTING, METHODS:Data were obtained from a database of clinical, hormonal and ultrasound (U/S) features recorded consecutively in a single reproductive medicine centre. Univariate correlations between the various parameters were analysed by the Spearman's correlation test. All variables significantly related to the 2-5 and/or 6-9 mm follicle numbers were included in a principal component analysis (PCA) in order to structure the data and to obtain collections of uncorrelated variables, called principal components (PC), which are linear combinations of the original variables.MAIN RESULTS AND THE ROLE OF CHANCE:By univariate analysis, the 2-5 and 6-9 mm follicle numbers were strongly but negatively correlated in both populations. Many other variables were correlated to the 2-5 and/or 6-9 mm follicle numbers and to each other. By PCA, these relationships were gathered into four independent PCs in each population. In both groups, the 2-5 and 6-9 mm follicle numbers correlated strongly and inversely to a specific PC. Among the other variables tested, only serum oestradiol level correlated weakly to this PC in the control group. Two other uncorrelated PCs gathered relationships between variables linked to the metabolic status and the gonadotropin regulation both in control and PCOS women. Lastly, a fourth PC included relationships which linked to ovarian ageing in controls and to follicle dysregulation in patients with PCOS.LIMITATIONS, REASONS FOR CAUTION:Our controls did not represent the general population since they were recruited in an ART centre; we used a modified Rotterdam classification for PCOS using follicle count and/or serum AMH level with in-house thresholds to define the follicle excess; the AMH assay used is no longer commercially available.WIDER IMPLICATIONS OF THE FINDINGS:Factor(s) regulating specifically the equilibrium between the 2-5 and 6-9 mm follicle numbers still need(s) to be identified. More attention should be paid to the oocyte.STUDY FUNDING/COMPETING INTEREST(S):None.

Background Maternal virilization during pregnancy is a rare phenomenon. Polycystic ovary syndrome (PCOS), luteoma and luteinic cysts are the most frequent and benign etiologies. This article presents two cases of recurrent maternal virilization during pregnancy. Clinical cases Our reported cases were young women with Afro-Caribbean and Nigerian origins. Data were collected by history-taking, clinical examination, laboratory investigations, transabdominal ultrasonographic examination and Magnetic Resonance Imaging. Both patients were diagnosed with PCOS according to the Rotterdam criteria. During each of their pregnancies they both developed an explosive hirsutism, a deepening in the voice, a clitoromegaly. Gestational diabetes occurred during pregnancies. There was no fetal virilization, despite raising androgen levels, more than tenfold to normal. Improvement of hirsutism and normalization of androgens were described in postpartum. Conclusion Only few cases of maternal virilization during pregnancy were reported in literature and even fewer concern recurrent and bilateral ovarian etiology. Hyperplasia of ovarian theca cells seems to be the most likely explanation, which would suggest that PCOS belongs to a spectrum of abnormal reactivity of the ovary to human Chorionic Gonadotrophin (hCG) stimulation along with luteoma and luteinic cyst of pregnancy. Insulin resistance could worsen hyperandrogenism but is not enough to explain virilization. Treatment should focus on protecting the fetus of possible virilization as well as its mother, but also on preserving the subsequent fertility in both.

De nombreuses études existent sur le retentissement de l’âge féminin sur la fertilité naturelle, sur les chances de succès en assistance médicale à la procréation et sur les risques obstétricaux, fœtaux et néonataux. Les paternités tardives semblent banalisées notamment dans les médias… Pourtant, il existe des données scientifiques fiables qui confirment la baisse de la fertilité liée à l’âge masculin, mais aussi une augmentation du risque de pathologies génétiques pour la descendance. L’objectif de cet article est de faire une synthèse des données de la littérature sur ce sujet.

OBJECTIVE: Insulin resistance is known to worsen polycystic ovarian syndrome (PCOS). The management of insulin resistance is crucial in the treatment of PCOS and insulin- sensitizing molecule as myo-inositol (MYO) seems to have promising effects. The aim of our pilot study was to study whether supplementation with MYO can improve patients' sensitivity to clomiphene citrate (CC) in terms of ovulation and pregnancy rates.PATIENTS AND METHODS: This study included 26 patients with PCOS, eligible to ovulation induction with CC. All of them received MYO in combination with CC and folic acid, following the usual protocol. Results concerning ovulation and pregnancy rates were compared to those from our historical cohort of PCOS patients treated with CC alone.RESULTS: Ovulation rate was significantly higher with MYO+ CC than with CC alone (65.5% vs. 42%, p=0.0001). The number of patients sensitive to 50 mg/d was 54% with MYO vs. 40% in our reference cohort (NS). The total resistance rate was 19% vs. 27% in the reference cohort (NS). Cumulative pregnancy rate with MYO+ CC was 53.8% vs. 42.2% with CC alone (NS). Pregnancy rates per initiated cycle were 16.1% with MYO vs. 12.6% in the historical cohort (NS).DISCUSSION: Although the differences were not significant for most outcomes, probably due to the small number of patients, our pilot study seemed to show a benefit of supplementation with MYO during ovulation induction with CC in PCOS patients. CONCLUSIONS: This study proves the great interest of a RCT and re-opens the possibilities of insulin-sensitizing agents in the treatment of anovulatory patients with PCOS, such as natural products like MYO.

This review describes necrospermia, its diagnosis, causes and management. Sperm vitality is commonly assessed in the laboratory of reproductive biology, with the eosin test or with the hypo-osmotic swelling test. Necrospermia is defined by a percentage of living spermatozoa inferior to 58%, and can be related to male infertility. Several pathological mechanisms may be involved and can be classified either in testicular causes (hyperthyroidism, local hyperthermia, varicocele), or post-testicular causes (epididymal necrospermia, dysregulation of seminal plasma, adult polycystic kidney disease, vasectomy reversal, anti -sperm antibodies) or both (infection, toxic, age, spinal cord injury). The first treatment is to correct the underlying cause, if possible. Repetitive ejaculation has demonstrated to be effective as well. Many drugs would also improve the sperm vitality (antioxidants, non-and-steroidal anti-inflammatory drugs) but there is currently no guideline to recommend their use. With necrospermia, fertilization rates are lower but in vitro fertilization (IVF) with Intracytoplasmic sperm injection (ICSI) improves the chances of conception. (C) 2017 Elsevier Masson SAS. All rights reserved.

Cette revue de la littérature fait le point sur la nécrozoospermie, son diagnostic, ses étiologies possibles et sa prise en charge. L’évaluation de la vitalité spermatique est une technique courante au laboratoire de biologie de la reproduction. Elle s’effectue le plus souvent grâce à un test à l’éosine ou un test hypo-osmotique d’enroulement flagellaire. La nécrozoospermie est définie par un pourcentage de spermatozoïdes vivants inférieurs à 58 % et peut être observée dans l’infertilité masculine. Plusieurs mécanismes pathologiques peuvent être responsables d’une nécrozoospermie. Ils peuvent être d’origine testiculaire (hyperthyroïdie, varicocèle, hyperthermie), post-testiculaire (nécrozoospermie épididymaire, anomalie du plasma séminal, polykystose rénale, post vaso-vasostomie, anticorps anti-spermatozoïdes) ou mixte (infection, toxiques, âge, blessé médullaire). Le traitement est avant tout étiologique lorsque cela est possible. Par ailleurs, l’augmentation de la fréquence des éjaculations a démontré son efficacité. Plusieurs traitements médicamenteux permettraient également d’améliorer la vitalité spermatique (antioxydants, anti-inflammatoires stéroïdiens ou non), mais il n’existe actuellement aucune recommandation concernant leur utilisation. Les taux de fécondation sont faibles en cas de nécrozoospermie, mais les techniques de fécondation in vitro avec micro-injection intracytoplasmique de spermatozoïdes permettent d’améliorer les chances de conception.

Many studies exist on the impact of female age on fertility, success of assisted reproductive technologies and on obstetric, fetal and neonatal adverse outcomes. Late paternity seems commonplace especially in the media… But there are reliable scientific data which confirm decline of fertility related to male age but also an increased risk of genetic diseases for the offspring. The objective of this article is to make a synthesis of the literature on this subject.