Chlamydiae, Mycoplasmes

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Chlamydiae, Mycoplasmes IVIALADIES SEXUELLEMENT Andrologie (1994), 4, 406-413 TRANSMISSIBLES ET FERTILITI~ Germes tropisme cellulaire (Chlamydive, Mycoplasmes) et perturbation de la f6condance du sperme Roger MIEUSSET Centre de Stdrilitd Masculine et Laboratoire d'Hislologie-Embryologie, CHR - Toulouse RESUME rieure a celle des hommes f6conds (88 % versus 26 %) par GNARPE & FRIBERG [2]. De nombreux facteurs peuvent consti- Cependant (Tableau 1), les 6tudes sui- tuer un risque pour la fertilit4 chez vantes prenant en compte ~ la lois des l'homme. Parmi ceux-ci, les infections populations d'hommes f6conds et inf6conds du sperme sont fr4quemment cit4es, et [3, 4] ou des hommes inf6conds seuls [5-7] plus particuli~rement les infections du rapportent en fait des taux beaucoup plus sperme ~ chlamydia et celles ~ myco- faibles chez les inf6conds (31 ~ 47 %) et plasmes. Nous avons revu les princi- peu diff6rents de ceux observ6s chez les paux r6sultats rapport6s dans la litt6- f6conds (32 %). Quoi qu'il en soit, les r6sul- rature concernant les infections tats de GNARPE & FRIBERG [2], confort6s mycoplasmes et ~ chlamydia, et essay4 par la mise en 6vidence, en microscopie de d6gager leurs effets potentiels sur 61ectronique ~ balayage, d'images 6vo- la f~condance du sperme. Pour chacun quant une adh6sion de UU ~ la membrane de ces deux agents infectieux, seront de spermatozoides [8], furent suivis successivement envisag4s, les effets d'6tudes des effets des infections sperma- sur les param~tres du sperme, sur le tiques a mycoplasmes sur la fertilit6 chez taux de f~condation, et sur le d6velop- l'homme. pement de l'embryon. Mots-cl4s : Mycoplasmes, Chlamydim, Sperma- 1. Effets sur les param~tres du sperme tozoides, Fertilit6. a) Volume de l'djaculat et concentra- MYCOPLASMES tion de spermatozo~des Parmi les 5 esp6ces de mycoplasmes Le volume de l'6jaculat et le nombre de connues pour ~tre pr6sentes dans le trac- spermatozo~'des/ml ne semblent pas modi- tus urog6nital de l'homme, Mycoplasma fi6s par la pr6sence de mycoplasmes dans le hominis (MH), Mycoplasma urealyticum sperme : en effet, si quelques auteurs rap- [appel6 aussi plus g6n6ralement Ureaplas- portent une augmentation de la frSquence ma urealyticum (UU)], Mycoplasma ferr- des 6jaculats > 6 ml [9] ou une diminution nentans, Mycoplasma primatum et Myco- de la concentration de gam6tes en cas de plasma genitalium, les trois derni6res sont Mycoplasmes positifs [10, 11], ces modifica- rarement isol6es, et donc peu recherch6es tions n'ont pas 6t6 retrouv6es par d'autres [1]. Par contre, les deux premi6res esp6ces auteurs, en ce qui concerne le volume [10, (MH et UU) sont retrouv6es dans le sper- 12, 13] ou la concentration de spermato- me des hommes inf6conds avec une fr6- zo~des, que ce soit avant traitement [12-15] quence qui avait 6t6 rapport6e bien sup6- ou apr6s traitement antibiotique [16]. 406 Tableau 1 : Fr~quence des mycoplasmes dans le sperme des hommes f~conds (F) et infdconds (I). Auteurs Population (n) MH (%) UU (%) Total MH+UU (%) GNARPE 8~ FRIBERG, [2] F (23) 0 26 26 I (36) 5 83 88 DE LouvoIs et al., [3] F (38) 0 32 32 I (120) 8,5 38,5 47 MATTHEWS et al., [5] I (105) 2 33 35 TOTH • LESSER, [39] F (30) 13 I (100) 26 WITK~N & TOTH, [40] I (100) 11 NAESSENS et al., [11] I (120) 9,2 33,3 42,5 HELLSTROMet al., [37] I (52) 5,7 30,7 36,4 JACQUESet al., [41] I (100) 10 29 39 EGGEST-KRUSE et al., [42] I (623) 2,6 17 19,6 WOLFF et al., [13] I (209) 16 ISUS [4] F (60) 4,6 6,1 10,7 I (286) 3,0 18,5 21,5 MH : Mycoplasma hominis ; UU : Ureaplasma urealyticum. b) Mobilitd des spermatozofdes la mobilit6, ph6nom~ne consid6r6 comme un artefact par les auteurs. L'effet n6gatif La pr6sence d'une infection spermatique de UU porterait essentiellement sur les mycoplasme est sans influence sur le pour- spermatozoa'des alt6r6s du sperme [19]. centage de spermatozo~des mobiles pour plusieurs auteurs [10, 12-15]. 9Par contre, apr~s une nuit d'incubation, le pourcentage de spermatozo~des mobiles Ces r6sultats sont toutefois en contradiction est diminu6, ainsi que deux param~tres avec d'autres donn~es plus completes, qualitatifs : v61ocit6 moyenne (> 35 puisque portant /~ la fois sur les aspects gm/sec) et d6placement lat6ral de t6te quantitatif (pourcentage de spermatozo~des [20]. mobiles) et qualitatif (mobilit~ progressive) de la mobilit6, qui montrent soit une r6duc- En conclusion, il semble d'apr~s les r6sul- tion en cas d'infection [9, 11, 17] soit une tats des 6tudes in vivo et in vitro, que la am61ioration de ces aspects apr~s traite- pr6sence de Mycoplasmes dans le sperme ment antibiotique [16, 18]. retentisse sur la mobilit6 des spermato- zo~des, avec une atteinte portant pr6f6ren- Dans deux ~tudes r~centes, le sperme non tiellement sur les aspects qualitatifs de infect6 d'hommes f6conds a 6t6 incub6 avec cette mobilit6, atteinte qui nScessite route- diff6rents s6rotypes d'UU ou de MH pen- fois d'6tre confirm6e par d'autres 6tudes. dant 45 min [19] soit pendant route une nuit [20] : c) Morphologie des spermatozofdes 945 min. d'incubation n'entra~nent aucun En ce qui concerne la morphologie des effet sur le pourcentage de spermato- spermatozo~des, les effets d'une infection zoides mobiles, mais semblent am~liorer du sperme par mycoplasmes ne sont pas certaines caract~ristiques qualitative de clairement 6tablis. En cas de spermes 407 infect6s, FOWLKES et al [9] retrouvent une dant contradictoires avec l'absence d'effet distribution diff6rente des diff6rents types rapport6 sur le taux de grossesse lors du d'anomalies morphologiques des sperma- traitement de l'homme dans une 6tude tozoides portant essentiellement sur une ant6rieure [22]. augmentation des anomalies de la t6te. b) Etudes in vitro (fdcondation in vitro) Ces modifications ont 6t6 indirectement confirm6es par TOTH & LESSER [18] qui I1 ne semble pas exister d'effet de la pr6sen- rapport6rent une augmentation du pour- ce de mycoplasmes dans le sperme lors de la centage de t~tes normales apr6s traite- tentative de FIV sur le taux de f6condation. ment antibiotique en cas de sperme infec- HILL et al. [14] retrouvent chez 135 patients t6. Plus r6cemment, des auteurs ont mon- 55 (39 %) avec UU et 16 (12 %) avec MH : tr6 que l'incubation de spermes normaux pas de diff6rence dans les taux de f6conda- avec des mycoplasmes pendant une nuit tion entre patients positifs et n6gatifs. A entrainait une diminution du pourcentage noter toutefois que les auteurs rapportent de flagelles normaux [20]. Par contre, plu- une 6radication par lavage du sperme, de sieurs auteurs n'ont retrouv6 aucune UU dans 71% des cas, mais dans aucun des modification du pourcentage de spermato- cas de MH. Ces r6sultats, montrant une zoides de formes normales en cas de absence d'effet des mycoplasmes du sperme spermes infect6s [10, 12-15] ou aucune sur le taux de f6condance en FIV, ont 6t6 am61ioration de ce pourcentage apr6s trai- r6cemment confirm6s par des auteurs [15] tement antibiotique de spermes infect6s qui ont compar6 197 hommes UU n6gatif et [16]. 12 UU positif le jour de la FIV. d) En conclusion g~ndrale de cette partie c) En conclusion concernant les effets des mycoplasmes sur I1 semble donc, d'apr6s les donn6es les param6tres du sperme, il semble que actuelles, que la pr6sence d'un sperme seule l'alt6ration de la qualit6 de la mobilit6 infect6 par des mycoplasmes le jour de la des spermatozoides puisse ~tre retenue FIV soit sans effet sur le taux de f6conda- comme un effet potentiel des mycoplasmes. tion; en reproduction naturelle cette affir- Toutefois les m6canismes mis en jeu sont mation n6cessite d'autres 6tudes que les encore inconnus, m4me s'il a 6t6 clairement deux 6tudes aux r6sultats contradictoires montr6 en microscopic 61ectronique que les dont on dispose aujourd'hui. Toutefois une mycoplasmes T (Ureaplasma urealyticum) 6tude plus ancienne [23] avait montr6 adh6raient aux spermatozoides au niveau qu'apr6s incubation avec des mycoplasmes de la t6te et de la pi6ce interm6diaire du (UU ou MH), les spermatozoides avaient flagelle [8, 21]. une capacit6 diminu6e a p6n6trer des ovo- 2. Effets sur la capacit4 des spermato- cytes de hamster d6pellucid6s ; cette 6tude zoides ~ f6conder l'ovule montrait surtout que cette r6duction 6tait variable selon le s6rotype de UU, le s6roty- a) Etudes cliniques in vivo pe 1 6rant sans effet, les s6rotypes 4, 6 et 8 TOTH & LESSER [18] rapportent un effet de ayant des effets drastiques. Les auteurs l'infection du sperme a UU sur la survenue avanqaient ainsi, comme hypoth6se explica- de grossesse deux ans apr6s la fin d'un trai- tive de la divergence des r6sultats rapport6s tement antibiotique chez 122 couples inf6- dans la litt6rature concernant les effets des conds : sur les 28 hommes avec UU positif mycoplasmes sur la fertilit6 chez Pnomme, apr6s la fin du traitement, une grossesse l'existence d'une sp6cificit6 d'action de cer- deux ans (4 %) ; sur les 94 hommes avec UU tains s6rotypes. I1 est a noter que les s6ro- n6gatif apr6s le traitement, 67 grossesses types ne sont jamais 6tudi6s dans les 6tudes (71%) a deux ans. Ces r6sultats sont cepen- cliniques. 408 3. Effets sur le d~veloppement embryon- du traitement peuvent choisir de traiter soit naire syst6matiquement, soit de fa~on s~lective les patients positifs". Nous n'avons aucune notion associant une plus grande fr~quence de fausse couche Cependant, une autre explication a 6t6 plus chez les couples dont l'homme est porteur r~cemment avanc6e, qui consid~re que la de mycoplasmes [24]. Une seule 6tude quantit6 de germes presents dans le sperme ~voque un effet des mycoplasmes du sperme aurait d'autant plus d'effet que le hombre sur le d~veloppement de l'embryon, mais la de spermatozo~des est plus faible [25].
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