Les anomalies spermatiques responsables des infertilités masculines à Yaoundé : aspects épidémiologiques et biochimiques.

Abstract

The use of data relating to the health situation of populations around the world and their importance in the development of protocols and strategies for treatment and prevention are currently the subject of great interest. In Cameroon, the increase in the prevalence of male infertility continues to markedly. It is the consequence of a radical change in the way of life of citizens and a decline in sperm parameters over the years. The objective of this study was to determine the frequency of sperm abnormalities responsible for male infertility in Yaoundé and their epidemiological and biochemical etiologies. An analytical cross-sectional study with a control group, and multicenter carried out among 240 men followed-up in public and private health establishments in the city of Yaoundé. Patients were recruited from three public hospitals (Yaoundé Central Hospital, Yaoundé Hospital and University Center, Yaoundé General Hospital) and three private laboratories in the city of Yaoundé (Bethanie Laboratory, Center Medical Analysis Laboratory and GTAB Laboratory). After obtaining informed consent and completing the questionnaire, we subsequently performed biological analyzes on both the serum and the semen. The blood and semen samples, as well as the sperm culture and the spermogram were carried out according to the Guide for the Good Execution of Medical Biology Analyzes (GBEA). The assay of fructose, FSH and Inhibin B hormones, screening for Chlamydia, Mycoplasma, Syphilis, HIV, hepatitis B, hepatitis C infections and the assay of stress markers was done using Enzyme Immunoassay, Immuno -chromatographic, colorimetric and kinetic. At the end of these studies, the data were coded and entered in Excel 2013, then analyzed using the XLSTAT 2014 software. The work received the approval of the national ethics committee for research in human health. Cameroon under the reference 015/04/572 / CE / CNERSH / SP. The epidemiological approach shows that secondary infertility was the most prominent reason for consultation (55%) in our population and the majority marital status was that of married. The majority of our patients had an advanced age of paternity (37.1 ± 7.37 years) and a mean BMI of 25.26 ± 6.8 kg / m2. The study of the association between infertility and risk factors supports conventional notions. Indeed, male infertility appears to be strongly linked to cryptorchidism, mumps, chickenpox, varicocele, abdominal / pelvic surgery and testis removal (OR> 1). Regarding risk behaviors and eating habits, the most predisposing to infertility were the phone in the pocket of the pants, the use of the computer on the knees, the wearing of tight clothes, the heavy consumption of Fast -Foods, sweets and fatty foods (OR>1). The prevalence of sperm abnormalities is high in our population (64.86%). Cases had lower values for volume (p> 0.05), sperm concentration (p <0, 0001), total sperm count (p <0,0001), progressive mobility (p <0, 0001), vitality (p <0, 0001) and the total percentage of normal forms (p> 0.05). They had higher values of pH (p = 0.020) and viscosity (p> 0.05). About 67% of cases had multiple sperm abnormalities, the most common association being the combination of Oligospermia + Asthenospermia Necrospermia. Clinical history, surgery, occupation, risk behaviors were significantly associated with a decrease in sperm count (OR>1). Evaluation of the various biochemical parameters indicates that the vast majority of the population had a normal level of fructose (> 13μM / ejaculate). Compared to controls, the Case population had a significantly higher level of fructose (p = 0.004). In our population, the abnormalities in the spermogram were not due to a fructose deficiency. Assessment of serum Inhibin B and FSH concentrations indicated that Case had lower concentrations of Inhibin B (p = 0.216) and higher concentrations of FSH (p = 0.964). Inhibin B was positively correlated with percent normal forms, sperm concentration and volume, and negatively correlated with vitality, mobility, viscosity, and pH. FSH, on the other hand, was positively correlated with Percent of normal forms, volume and pH; it was negatively correlated with vitality, mobility, count and viscosity. In addition, Inhibin B was negatively correlated with FSH (r = -0.509; p<0.0001). The evaluation of the concentrations of oxidative markers indicates the cases had lower concentrations of antioxidants including Catalase (p = 0.880), reduced Glutathione (p =0.558) and Glutathione peroxidase (p <0.0001) compared to controls. In addition, the concentrations of total peroxides (p = 0.162), MDA (p = 1), and nitrites (p = 0.899) were higher in the Case group compared to controls. Volume, count, vitality, mobility and percentage of normal forms were positively correlated with antioxidant markers. Regarding oxidative markers, MDA and total peroxides were negatively correlated with semen parameters. With the exception of FRAP, fructose was inversely proportional to antioxidant markers. As for the hormones Inhibin B and FSH, we observed inverse and opposite correlations with respect to antioxidant markers. Indeed, Inhibin B was positively correlated with Glutathione Peroxidase, Catalase and SOD and negatively correlated with Reduced Glutathione, FRAP and Vitamin E. We can conclude that the quality of the sperm of our patients is decreasing. This decrease is the consequence of a radical change in the way of life observed among citizens. It is also the consequence of a plethora of other factors set out in this work. However, their negative effects can be overcome to a large extent by behavior modification, early diagnosis of sperm abnormalities, and careful management.