Experience in the use of docosahexaenoic acid (BrudiPlus) in patients with increased sperm DNA fragmentation index in Acad. V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology

Male factor is the reason of infertility in almost half of marriages. Infertile men have the percentage of sperm with violations of DNA integrity of over 30 %; with that, healthy fertile men have that indicator of less than 15 %. Understanding of importance of damages of sperm DNA is growing with distribution ofauxiliary reproductive technologies. As of today, these consequences have not been studies yet, and the therapeutic effect of intake of antioxidants has not direct correlation with the sperm DNA fragmentation level. Docosahexaenoic acid is one of the most valuable omega-3 polyunsaturated fatty acids for human health. Docosahexaenoic acid is the main component of the brain gray matter, retina, testes, and sperm cell membranes. In connection with that, a study was held the purpose of which was to assess the effect of the nutraceutical enzymatic docosahexaenoic acid triglyceride (BrudiPlus) in high concentrations on damaged sperm DNA of patients with idiopathic pathozoospermia. 40 patients with idiopathic pathozoospermia and the level of DNA fragmentation over the statutory value took part in this study. The following positive results were received: intake of BrudiPlus allowed decreasing sperm DNA damages and improving of antioxidant system of sperm

Sperm oxidative stress: clinical significance and management

Oxidative stress is one of the leading causes of sperm dysfunction. Excessive amounts of reactive oxygen species can damage sperm membranes and disrupt their DNA integrity, which affects not only the likelihood of getting pregnant naturally, but also the clinical outcomes of assisted reproductive technologies and the risk of miscarriage. Sperm cells are extremely vulnerable to oxidative stress, given the limited functional reserve of their antioxidant systems and the DNA repair apparatus. Lifestyle factors, most of which are modifiable, often trigger generation of reactive oxygen species.  Both the lifestyle modification and use of antioxidant dietary supplements are adequate and compatible ways to combat male oxidative stress-associated infertility. The search for other internal and external sources of reactive oxygen species, the identification of the etiology of oxidative stress and treatment of respective diseases are necessary for the successful regulation of redox processes in the male reproductive system in clinical practice, which is required not only to overcome infertility, but also to prevent induced epigenetic disorders in subsequent generations. The article presents the analysis of the molecular mechanisms of male idiopathic infertility. The authors provide an overview of how to prevent oxidative stress as one of the causes of subfebrile fever. The article provides an overview of modern therapeutics, as well as the options for eliminating the consequences of the effect of reactive oxygen species on spermatogenesis and male reproductive system in general

New aspects of the use of sildenafil in the treatment of erectile dysfunction

Currently, there are many effective methods of drug-based treatment of erectile dysfunction (ED). The choice of treatment is determined by its invasiveness. In case of poor effectiveness, a less invasive technique is replaced by a more invasive one. Thus, most clinicians start treatment with oral phosphodiesterase type 5 inhibitors (PDE-5), and if the treatment fails, other oral drugs are prescribed, as well as intracavernous injections or vacuum erectile device. Combination treatment is also possible. If the techniques fail, the patient may be assigned for a surgical procedure

Male infertility: before and after the era of SARS-CoV-2

It has been found that men are infected with the coronavirus 1.5 times more often than women, but at the same time 95% of them have mild infection.There are questions that require a scientific explanation: why are men infected more often and more susceptible than women, does the virus cross the blood-testicular barrier, can it be found in the seminal fluid, does SARS-CoV-2 have an effect on the production of androgens, is the testicle affected and what are the consequences of this damage, what is the direct effect of a virus and virus-associated problems (such as social problems, isolation, quarantine, psychological problems, sedentary lifestyle, etc.) primarily on sexual function, sexual behaviour and reproduction in general?The review article examines the SARS-CoV-2 pandemic-associated situation in 2020 and its effect on the men’s health. The article provides data on epidemiology, aspects of pathogenesis, features of new coronavirus infection in men. The authors announced the international reproduction associations (ASRM, ESHRE, RAHR) recommendations for the implementation of assisted reproductive technology (ART) programs in the era of the pandemic. Different points of view on the effect of testosterone on the disease incidence in men are presented. The importance of sperm oxidative stress and antioxidant therapy for male infertility has been shown. The tasks of an international project for the study of SARS-CoV-2 coronavirus infection and its consequences on men’s health are outlined. An invitation to collaboration with domestic and foreign specialists in the field of urology and andrology under the aegis of the National Medical Research Center of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Health of the Russian Federation has been published

ANTIOXIDANT THERAPY IS THE KEY TO THE TREATMENT OF IDIOPATHIC MALE INFERTILITY

Idiopathic infertility (II) accounts for up to 30% of male infertility. Antioxidants were empirically used in the treatment of II based on their ability to improve reproductive function suppressed by oxidative stress (OS), which was often found in these patients. The review article was aimed to report the validity of available data confirming the use of antioxidants. Antioxidants such as glutathione, vitamins E and C, carnitines, coenzyme Q10, N-acetylcysteine, selenium, zinc, folic acid and lycopene have been shown to reduce sperm damage caused by OS. Although rigorous scientific evidence in the form of double-blind, placebo-controlled clinical trial is limited, recent systematic reviews and meta-analyses showed a positive effect of antioxidants on sperm parameters and fertility rates. There is, however, a need for further investigation with randomised controlled studies to confirm the efficacy and safety of antioxidant therapy in the medical treatment of idiopathic male infertility as well as the need to determine the effective dose of each compound to improve semen parameters, fertilisation rates and healthy pregnancy outcomes

EFFECT OF MICROSURGICAL VARICOCELECTOMY ON SEXUAL FUNCTIONS OF INFERTILE MALES.

Varicosity of testicular veins is a widespread urological disease and one of the most common reasons of male infertility. In 40-80% changes in sperm parameters may be the only clinical sign of varicocele. Some literature data report on the fact that varicocele leads to the decrease of testosterone level and worsening of erectile function, and varicocelectomy contributes to testosterone levels elevation and improvement of erection. We compared the effect of microsurgical varicocelectomy and stimulation of spermatogenesis on the sperm parameters, sexual function and hormonal levels in males with varicocele suffering from sexual disorders and infertility.Microsurgical varicocelectomy leads to testosterone elevation by 47.2%, decrease of estradiol by -3.1%, of progesterone by -2.3% by the end of the 12th month after operation, and stimulation of spermatogenesis increases testosterone levels by 10.8%, decreases estradiol by -8%, progesterone by -2.8% during the same period. In the group of surgical treatment concentration of spermatozoa increased 2.5 –fold as much, and in the group of stimulation 1.5-fold only. Questionnaire data demonstrated that the mean index “erectile function” in operated patients increased by 46.2%, “orgasm” increased by 21.5%, index “general satisfaction” by 39.3%, index “satisfaction with sexual act” by 35%, index “libido” improved by 26.6%. In the group of stimulation of spermatogenesis similar indexes were as follows: erectile function improved by 20.6%, orgasm by 7.4%, general satisfaction by 8%, satisfaction with sexual act by 13.6%, libido by 8.9%. According to AMS questionnaire in the group of varicocelectomy summarized scores decreased by 8%, in stimulation group only by 2%. Moreover a summarized enlargement of testicular volume was by 41.1% better in the group of operative interventions and by 5.2% in the group of spermatogenesis stimulation

Varicocele and non-obstructive azoospermia – where to start?

Background. Male etiology is responsible for nearly half of cases of infertility. Frequency of azoospermia in infertile men reaches 30 %; varicocele is diagnosed in almost 40 % of the patients. Varicocele- associated infertility has traditionally been considered an indication  for surgical treatment. At the same time, the main method of sperm  retrieval in azoospermia is testicular biopsy (testicular sperm  extraction, TESE).Objective: to assess the efficacy of surgical treatment in patients with non-obstructive azoospermia (NOA) and varicocele.Materials and methods. The study included 327 patients with NOA and varicocele aged between 22 and 48 years treated in the Department of Andrology and Urology at the V. I. Kulakov National  Medical Research Center of Obstetrics, Gynecology, and Perinatology  in 2012– 2016. Study participants were divided into two comparable  groups. Patients in the first group underwent microsurgical  varicocelectomy (Marmara procedure) on the first stage and  testicular biopsy (micro-TESE) on the second stage. Patients in the  second group underwent micro-TESE with no surgical correction of varicocele prior to it.Results. In the first group, the appearance of spermatozoa in ejaculate was observed in 84 (44.4 %) patients 6 month post microsurgical varicocelectomy. Upon micro-TESE, spermatozoa  suitable for use in assisted reproductive technologies were obtained  in 60 (56.7 %) men. Treatment was effective in 144 (76.2 %)  patients from the first group. In the second group, spermatozoa  were retrieved in 66 (47.8 %) men upon micro-TESE.Conclusion. Microsurgical varicocelectomy increases treatment efficacy in males with NOA and varicocele. In the absence of severe degeneration of the seminiferous epithelium, 72.6 % of patients had  the opportunity of becoming a genetic parent, avoiding in some  cases testicular biopsy

Assessment of influence of “BESTFertil” supplement on semen analysis parameters, oxidative stress markers and sperm DNA fragmentation index in infertile males

Background. Idiopathic male infertility remains an important problem in andrology and reproduction, despite steady advances in diagnostics and treatment of conditions associated with impaired fertility in men. Only available option of conservative treatment for idiopathic male infertility is an empiric antioxidant therapy.Materials and methods. Fifty five men from infertile couples without any identifiable cause of male infertility who received “BESTFertil” supplement were enrolled in this study. Semen analysis parameters (sperm density, percentage of sperm with progressive motility (categories A and B), sperm morphology, leukocyte concentration), MAR-test results, reactive oxygen species concentration as measured by chemiluminescence assay and sperm DNA fragmentation index evaluated using TUNEL method were registered and compared with baseline values after 90 days of treatment. Patient compliance was assessed by a number of capsules taken throughout the study period.Results. There was a significant difference in percentage of sperm with normal morphological features (median 2 % vs 4 %; p <0.001) and in percentage of A + B motile sperm (medium 31.2 % vs 41.15 %; p <0.001). Also, a statistically significant decrease in sperm DNA fragmentation index (median 17.8 % vs 15 %; p <0.001) and reactive oxygen species concentration in seminal plasma (median 0.7 mV/s vs 0.5 mV/s; p = 0.002). Forty-three (78.2 %) patients were fully compliant, 11 (20 %) patients had compliance over 90 %, and 1 patient was 89 % compliant. No treatment-related adverse events were observed.Conclusion. “BESTFertil”supplement may be used in empiric therapy of idiopathic male infertility and has a good safety profile. Separate intake of morning and evening supplement doses increases efficacy of multicomponent antioxidant therapy by preventing possible interaction between biochemically incompatible components. Treatment with “BESTFertil”supplement leads to a decrease in reactive oxygen species seminal concentration and sperm DNA fragmentation index

ROLE OF MALE INFERTILITY IN ASSISTED REPRODUCTIVE TECHNOLOGY PROGRAMS (A LITERATURE REVIEW)

Тhe literature review is devoted to the most important medical and social problem of modern medicine — the male infertility. Nowadays the assessment and treatment of male infertility can identify a number of problems: the lack of standard tests for assessing fertility, incomplete knowledge of the pathophysiology of infertility, a shortage of specialists in the field of andrology and male infertility, as well as a lack of necessary technical resources. The lack of proven methods of pharmacotherapy can be added to this list. In comparison with the successes in the detection and treatment of female infertility, the diagnosis and therapy of male, especially idiopathic, remain ineffective and are largely empirical in nature. It is difficult to identify at what rates of spermogram the most frequent failures of the ART program occur, to compare the indicators of failures of ART with the parameters of pathozoospermia to reveal the regularity. Not all pathological mechanisms of fertility disorders in men have developed correct diagnostic tests at the present time, this significantly reduces the prognostic value of the spermogram and makes the question of assessing the disturbances in the character of the spermogram and its effect on the effectiveness of ART procedures extremely topical. There will be discussed the development and effectiveness of ART in the world and in Russia, the role of unfavorable lifestyle factors in infertile couples, the role of male infertility factors and the dependence of the effects of spermogram indices on the results of ART

The role of surgical sperm retrieval techniques in patients with azoospermia in assisted reproductive technology programs (literature review)

This literature review is dedicated to surgical sperm retrieval techniques, such as percutaneous and microsurgical epididymal sperm aspiration, testicular sperm aspiration, testicular sperm extraction (standard, microdissection, multifocal). Those methods allow men with azoospermia to achieve biological parenthood, because gametes retrieved from testis or epididymis are usable for assisted reproduction. After laboratory processing of surgical specimen the sperm may be used for intracytoplasmic injection and/or cryopreservation. In this article we discuss historical and technical aspects of such procedures and provide critical analysis of their advantages, disadvantages and limitations. Existing laboratory techniques for processing of surgically retrieved sperm are mentioned. We discuss possible future directions for development of testicular biopsy technique aimed at improving sperm retrieval outcomes