[Spermatogenesis protection: myth or reality?]

Cytotoxic agents used in various therapies (anticancer treatments in particular) 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 various possibilities to protect male reproduction? Sperm cryo-storage, prior to the beginning of chemotherapy and/or radiotherapy, is one possibility. However this possibility can only be offered to a relatively limited number of patients, due to the fact that the disease itself often causes gonadal abnormalities. Another possibility is the substitution 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 various protective agents appears to be necessary. Of all the agents so far tested (anti-oxidants, GnRH analogs, FSH, steroids), the combination of medroxyprogesterone acetate and testosterone (MPA+T) is the one which has been the most studied both in men (contraception) and in rodents (contraception and protection). From a series of experiments using MPA+T in male rats, it appears that both qualitative and quantitative protection of fertility can be achieved against chemo- and radiotherapy. Progress in this field should be the prelude of clinical trials. This transfer from animals to men, should result as one of the activities of a pluri-disciplinary group supported by INSERM and entitled "Prosperm". 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.(ABSTRACT TRUNCATED AT 250 WORDS)