[Analysis of risk factors for the development of infertility in men from infertile couples, depending on age.]

According to the Russian Society of Urologists, the frequency of infertility in marriage in the Russian Federation is 8-17,2%; half of the cases are associated with the male factor. Among the risk factors for the development of male infertility, there are mainly medical reasons, lifestyle factors and negative environmental factors. Despite the fact that the problem of infertility is addressed by men of different ages, from youth to the elderly, the correction of risk factors is usually carried out without taking into account the age of the patient, which makes it difficult to develop a personalized strategy for the treatment or prevention of infertility. The aim of the study was to study the structure of the leading risk factors for the development of infertility in men from infertile couples, to identify and characterize their age-associated features. The analysis of the medical histories of 1 198 men from infertile couples and the collection of information on all available risk factors for infertility were carried out. The analysis of age features was performed by dividing the sample into 5 age groups: 1st (n=271) - men ≤29,9 years; 2nd (n=415) - 30-34,9 years; 3rd (n=291) - 35-39,9 years; 4th (n=141) - 40-44,9 years; 5th (n=80) - ≥45 years. It was shown that in the general sample of medical causes, factors associated with chronic inflammation predominate: sexually transmitted infections (STIs) - 54%; prostatitis - 32%; obesity - 27%; from non-medical: alcohol - 73%; stress - 47%; smoking - 41%. With increasing age, the frequency of obesity, STIs, prostatitis, hepatitis B/C, mumps increases statistically significantly, while the most unfavorable group of men is 40-45 years old for factors such as STIs, hepatitis B/C and mumps, and the group of men over 45 years old for factors such as obesity and prostatitis.

[Hydrophilic and lipophilic nutrients for the treatment of male idiopathic infertility: a randomized, comparative, open-label, multicenter, prospective, controlled study].

INTRODUCTION: the efficiency of nutrient therapy for idiopathic male infertility remains controversial. In particular, it is not unclear if hydrophilic or lipophilic nutrients are more effective. AIM: to compare the efficiency of a complex containing hydrophilic components (L-carnitine, zinc, selenium, vit. C, etc.) with a complex of lipophilic nutrients (docosahexaenoic and other omega-3 acids, vitamin E) in men with idiopathic subfertility. MATERIALS AND METHODS: a randomized, comparative, open-label, prospective, controlled, multicenter study was carried out. A total of one hundred and sixty patients with idiopathic oligo-, and/or astheno-, and/or teratozoospermia aged 18-45 years were randomized into three groups. In the group 1, patients received a complex of mainly hydrophilic nutrients (BESTFertil dietary supplement, 4 capsules per day), while in group 2 lipophilic nutrients (dietary supplement "BrudiPlus", 3 capsules per day) were prescribed. In the group 3 (control) patients didnt receive any treatment. All participants were given recommendations for a healthy lifestyle. Sperm analysis, sperm DNA fragmentation, and achievement of pregnancy were evaluated at baseline and after 3 months. RESULTS: 27 patients did not have a follow-up visit due to pregnancy achievement or other reasons, or were excluded from the study since pyospermia was detected or compliance was poor. Patients of group 1 (n=46) who remained in the protocol had an increase in sperm concentration by 16 million/ml (+ 41% vs. baseline; p=0.046), in comparison to 3 million/ml (+ 7% vs. baseline; p>0.05) in group 2 (n=45) and a slight decrease by 0.5 million/ml in the group 3 (n=42; - 1.2% vs. baseline; p>0.05). Positive changes were seen in 63, 58 and 52% of cases, respectively (in all cases, p>0.05). DNA fragmentation in all groups changed in similar fashion. In group 1 (n=31) it decreased by 6% (-33% vs. baseline; p=0.002), compared to - 5% in group (n=29; -29% vs. baseline; p=0.002) and -11% in group 3 (n=15; -48%; p<0.001). Positive changes were seen in 65% (p>0.05), 79% (p<0.01) and 73% (p>0.05) cases, respectively. Over a 3-month period, other sperm indices in all groups changed in different directions and there was no significant difference (p>0.05). There were 6 pregnancies in group 1 and 2 (11%), compared to 2 pregnancies in group 3 (4%; p>0.05). Intergroup comparison between the groups for all the values assessed did not reveal significant differences (p>0.05). CONCLUSIONS: 3-month therapy with hydrophilic or lipophilic antioxidant nutrients in men with idiopathic oligo-, and/or astheno- and/or teratozoospermia does not have significant effect on sperm analysis, sperm DNA fragmentation, and pregnancy rate. There is an urgent need to carry out additional comparative randomized trials to clarify indications for nutritional therapy. Statistical power of maximum 0.69 does not allow to exclude the type II error, non-rejection of a false null hypothesis.

[Hormonal feature of the androgen status in different-aged males.]

The examined males (n=374) aged from 20 to 69 years were divided into five age groups: the 1st - 20-29 years; the 2nd - 30-39 years; the 3rd - 40-49 years; the 4th - 50-59 years; the 5th - 60-69 years. There was 16,1±7 nmol/l total testosterone level in serum of all aged group. Hormonal signs of androgen deficiency, increased elderly aged groups, were revealed in males of the 2nd group as compared with males of the 1st group. The frequency of androgen deficiency (total testosterone level less than 12,1 nmol/l) in the 1st group was 26,9%; in groups 2, 3 and 4 this index was similar, composed 30,6-33,9%. However, the frequency of androgen deficiency increased and amounted to 44% in the 5th group. The frequency of hypogonadism hormonal signs (total testosterone level less than 8 nmol/l) did not significantly differ in groups 1-4 (6,2-9,3%), and only in group 5 it increased and amounted to 28%. The age-related androgenic deficiency in males was associated with decrease in androgenic function both the gonads, and the adrenal glands, increased level of sex steroid-binding globulin, increased metabolism of testosterone in estradiol and was accompanied by compensatory increase of luteinizing hormone synthesis in the pituitary gland.

[The use of nutrient complexes in idiopathic male infertility associated with asteno- and/or teratozoospermia: the search of predictors of treatment efficiency (preliminary results)].

BACKGROUND: Nutrient complexes (dietary supplements) containing various vitamins, minerals, enzymes are popular substances for treatment of male infertility. However, the use of such complexes often does not lead to an improvement of ejaculate analysis and the restoration of fertility. AIM: To determine the predictors of efficiency of treatment with a complex of nutrients. MATERIAL AND METHODS: An open, uncontrolled study which included 102 men from infertile couples aged 25-45 years with idiopathic asteno-, and/or teratozoospermia was conducted. All man received the complex of nutrients (4 capsules of 410 mg per day) containing L-arginine (720 mg), L-carnitine (240 mg), L-carnosine (92 mg), coenzyme Q10 (10 mg), glycyrrhetinic acid (6 mg), zinc (4,8 mg), vitamin (3,2 mg), vitamin (0,36 mg), selenium (0,034 mg), which is from 12% to 80% of recommended level of daily intake for these substances. The ejaculate analysis was done in accordance to WHO recommendations, including the assessment of the production of reactive oxygen species (ROS). RESULTS: After 3 months of treatment the proportion of sperm cells with progressive motility increased in 59% patients in the average by 4 % (<0.05) due to an increase in the proportion of rapidly progressive sperms with grade "A" motility by 4 % (<0,05) and a decrease in the proportion of non-progressive sperms (-2 %; <0.05). The improvement was more often observed in patients with baseline lower sperm motility (<0,05) and had phasic dependence on the ROS level. It was more pronounced (+24 % in relative values for motility "A"; <0.05) in patients with moderate elevation of ROS level (2-4 IU), and insignificant at the normal (< 2 IU) and marked elevated (4-7 >7 IU) ROS level. The standardized effect with an increase of ROS for motile spermatozoa of category A was 0.16, 0.47, 0.34 0.22, respectively, i.e., it was weak in all cases. The changes of sperm concentration and morphology were insignificant (>0.05), but the improvement of sperm morphology was more often observed in patients with pathologic forms greater than 95 % (<0.05). CONCLUSION: The increase in the proportion of sperm cells with progressive motility while taking nutrient complex had dependence on the baseline level of oxidative stress and it was more pronounced in patients with moderate elevation of ROS level. The further, more powerful studies to assess the influence of dietary of this supplement on the other ejaculate indicators.

[Andrological status of adolescents and its connection to anthropometric and hormonal descriptions in the students of technical college group].

The purpose of this investigation was to study the interrelation of andrological status with anthropometric and hormonal descriptions for age-specific features discovery of male sexual system pathological states at technical college students. 147 adolescents aged 15-17 years old were examined. Only 41 of them were found to have no abnormalities in their genital system development; in 35 adolescents sexual development was delayed; and 97 adolescents were found to have various andrological diseases (varicocele, phimosis, gynecomastia, testicular asymmetry, etc.) or clinical signs for development of these diseases. In 26 adolescences delayed sexual development was combined with the andrological pathology. The normal andrological status was usually accompanied with the highest frequency of low values of anthropometric indicators and indices that reflect the influence of various hormonal systems on the bodily constitution, as well as expressed anthropometricheterogeneity. In adolescents with andrological pathology or clinical signs for its development, in all anthropometric parameters the higher values were seen more frequently than low values against the background of highest group anthropometric homogeneity. Summative anthropometric characteristics of the adolescents group with delayed sexual development were between those of the adolescents groups with normal andrological status and andrological pathology The number of correlational relationships of anthropometric and hormonal indicators with the levels of cortisol and dehydroepiandrosteronesulphate was the lowest in the group of adolescents with normal andrological status as compared to their peers with delayed sexual development and andrological pathology. Only in the group of adolescents with normal andrological status the correlation analysis of data showed physiological influence of sexual hormones on anthropometric indicators. Thus, lower influence of sexual system hormones during this ontogenesis stage contributes to slowing down the process of sexual maturation both with the development of andrological pathology in adolescents.