SPERMATOGENESIS PROTECTION - MYTH OR REAL ITY

Cytotoxic agents used in various therapies (anticancer treatments in p articular) are known to be very deleterious to male fertility In these situations, both quantitative (oligo and azoospermia) and qualitative alterations of the male reproductive system occur. What are the vario us possibilities to protect male reproduction? Sperm cryostorage, prio r to the beginning of chemotherapy and / or radiotherapy, is one possi bility. However this possibility can only be offered to a relatively l imited number of patients, due to the fact that the disease itself oft en causes gonadal abnormalities. Another possibility is the substituti on of the most cytotoxic drugs by less deleterious agents, as well as, the reduction of the doses used in the therapeutic regimens. Progress in this field however remains very slow. Therefore, the use of variou s protective agents appears to be necessary. Of all the agents so far tested (anti-oxydants, GnRH analogs, FSH, steroids), the combination o f medroxyprogesterone acetate and testosterone (MPA + T) is the one wh ich has been the most studied both in men (contraception) and in roden ts (contraception and protection). From a series of experiments using MPA + T in male rats, it appears that both qualitative and quantitativ e protection of fertility can be achieved against chemo- and radiother apy. Progress in this field should be the prelude of clinical trials. This transfer from animals to men, should result as one of the activit ies of a pluridisciplinary group supported by INSERM and entitled << P rosperm >>. The dialogue established in this group between researchers and physicians offers new perspectives in the domain of protection of spermatogenesis, at a time when this is most needed. In fact, recent epidemiological studies have revealed the increase incidence of reprod uctive abnormalities in the human male, which may be caused by environ mental factors.