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

Difficulties in differential diagnosis between obstructive and non-obstructive azoospermia

Introduction. The difference between obstructive and non-obstructive azoospermia (OA and NOA) is important for the choice of treatment tactics and adequate counseling of a married couple.Objective. To describe, analyze, and classify possible challenges in differentiating between two types of azoospermiaMaterials and methods. The retrospective review of database on surgical sperm retrieval attempts performed our hospital (n = 754). A subpopulation of 216 patients who were preliminary diagnosed with OA, was selected for further analysis. All patients had testicular pathology data following sperm retrieval attempt. Rate of reclassification was assessed as a primary outcome. Reclassified cases were further analyzed to find a possible reason for incorrect differential diagnosis.Results. Among 216 patients with initially suspected OA, 131 (60.6%) had evidence of spermatogenic dysfunction on pathological examination of seminiferous tubules. Multivariate regression analysis showed that only regular exposure to high temperatures was an independent predictor of NOA detection in patients with normal endocrine and clinical parameters (OR = 1.989; 95% CI = 1.101 – 3.595). Analysis of the decision tree showed that patients with inhibin B levels below 93 pg/ml had the highest risk of an incorrect initial diagnosis (82.6%).Conclusions. Differential diagnosis of OA and NOA is not such a simple task. Any case of azoospermia against the background of normal semen volume by default should be considered as a case of NOA if there is no anamnestic or clinical data clearly indicating obstruction. Regular exposure to high temperature is likely to cause azoospermia in men with initially severe disorders of spermatogenesis. Finally, the reference values of inhibin B offered by most laboratories are not intended to assess reproductive function

Lipidomic profile of seminal plasma in non-obstructive azoospermia with sperm maturation arrest

Introduction. The difference between obstructive and non-obstructive azoospermia with sperm maturation arrest is important for the choice of treatment tactics and adequate counseling of a married couple.Purpose of the study. The study aimed to assess the semen lipid profile in patients with sperm maturation arrest. Materials and methods. Samples of seminal plasma for lipid composition of 24 men with normozoospermia and 64 men with azoospermia were studied. Patients with azoospermia underwent microdissection testicular biopsy followed by the detection of testicular tissue pathology. Lipid extracts were analyzed by liquid chromatography with mass spectrometry. Lipid data were compared with the results of pathomorphological studies.Results. Comparison of two groups revealed a statistically significant concentration differences for 22 lipids detected in positive-ion mode and 11 lipids detected in negative-ion mode. Those lipids mainly belong to the classes hexosylceramides, sphingomyelins and phosphatidylcholines — simple ethers and oxidized lipids. In multivariate analysis, the following lipids were found to be statistically significant predictors of sperm maturation arrest: PC 16: 0_22: 6 lipid (β-coefficient: -0.73; 95% confidence interval (95% CI): -1.42 to -0.27; odds ratio (OR): 0.48; OR CI: 0.24 to 0.76; Wald's test: -2.58; p = 0.01), SM d20: 1/22:2 lipid (β-coefficient 4.96; 95% CI 2.29 to 9.13; OR: 142.31; OR CI: 9.90 to 9.22^103; Wald's test: 2.93; p = 0.003); PG 20:3_22: 6 lipid (β-coefficient 2.52; 95% CI 1.13 to 4.49; OR: 12.37; OR CI: 3.10 to 89.27; Wald's test: 3.02; p = 0.002); PC O- 16: 1/16:0 lipid (β-coefficient 1.96; 95% CI -4.12 to 0.27; OR: 0.14; OR CI: 0.02 to 0.76; Wald's test: -2.05; p = 0.04). The prediction model characteristics of sperm maturation arrest, obtained during cross-validation in the positiveion mode composed: sensitivity 91%, specificity 85%; in negative-ion mode: sensitivity 75%; specificity 81%.Conclusions. Even though early stages of spermatogenesis are equally preserved in both fertile men and men with homogeneous sperm maturation arrest, the semen in the studied group of patients differed in its lipid profile. Patients with non-obstructive azoospermia, associated with meiosis arrest, may have unique lipidomic characteristics of seminal plasma, which in the future will make it possible to differentiate various variants of severe male infertility using non-invasive methods

Erectile dysfunction and cardiovascular disease: old problem, new approaches

More and more experimental and clinical data confirm that typically, arteriogenic form of erectile dysfunction (ED) is not a late complication of cardiovascular disease (CVD), but an early manifestation of systemic vascular pathology. One important mechanism, common for both ED and CVD, is endothelial dysfunction, affecting various vascular basins, including penis corpus cavernosus. The latter effect results in decreased synthesis and/or bioavailability of NO – the main erection mediator. Systemic character of vascular pathology in arteriogenic ED patients is confirmed by associated large artery endothelial dysfunction, and explains previously demonstrated increased risk of latent coronary heart disease in ED males. This emphasizes the importance of aggressive early ED diagnostics not only by urologists, but also cardiologists and therapeutists. ED presence points to the need for more detailed examination and early intervention

Method of the Cyclotorsion Error Compensation for Myopic Astigmatism during SMILE Surgery

Purpose: to develop an effective and safe method of cyclotorsion compensation, to improve the clinical and functional results of the of myopic astigmatism correction with SMILE surgery.Patients and methods: Two equivalent groups of 30 people (30 eyes) were formed with cyclotorsion from ±5 degrees («Standard» and «Verion»). The correction for cyclotorsion was carried out only in the «Verion» group. Before the laser-refraction surgery, all eyes were examined using «Verion» image guided system (Alcon, USA) to determine cyclotorsion. In the «Verion» group, the obtained cyclotorsion data was used to aligement the astigmatism axis by Introducing into the «Visumax» femtolaser system. Further, the operation was carried out according to the standard protocol. At 3 months after SMILE surgery, all patients were examined by a UDVA, CDVA, objective refraction. Furthermore, efficiency and safety, as well as vector analysis of corneal astigmatism according to Alpins were calculated indices at 3 months after surgery.Results: The mean and standard deviation of cyclotorsion of the «Standard» and «Verion» groups was 6.16 ± 1.31 D and 6.30 ± 1.36 degrees, respectively (p > 0.05). The increasement of 1 or more UDVA lines was noted at 20 % and 7 %, respectively after 3 months in the «Standard» and «Verion» groups. The safety index (postoperative UDVA / preoperative UDVA) in both groups was not statistically significantly different (p > 0.05). The predictability of the spherical equivalent within ±0.5 D relative to the target refraction (emmetropia) in the «Standard» and «Verion» groups was 70 % and 100 %, respectively. The predictability of the cylindrical component of refraction within ±0.5 D relative to the target refraction (emmetropia) was 40 % and 90 % for the «Standard» and «Verion» groups, respectively (p < 0.05). Difference vector was 1.01 ± 0.59 D in the group «Standard» and 0.64 ± 0.33 D in the «Verion» group (p < 0.05). Correction index was 0.80 ± 0.43 in the «Standard» group and 0.99 ± 0.04 in the «Verion» group (p < 0.05).Conclusions: Сyclotorsion compensation using the «Verion» image guided system is a safe method. It improves the efficiency and predictability of correction myopic astigmatism in patient undergoing to SMILE surgery. This method recommended for patients with cyclotorsion from ±5 degrees and myopic astigmatism from –0.75 D

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

Surgical correction of urinary incontinence associated with orgasm (climacturia) using a compression graft (clinical cases)

Climacturia is a rarely discussed functional complication of radical prostatectomy. Various methods of medical and surgical treatment of climacturia have been described. In this article we present two clinical cases of successful surgical treatment of climacturia which involved three-piece penile prosthesis implantation and placement of compression graft made of porcine dermal collagen on urethra

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