Structure of defects in sperm quality in men in the infertile couples and the algorithm for their management in level 3 healthcare facilities


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Abstract

Aim. To identify the structure of defects in sperm quality in men in infertile couples and to develop the algorythm for management of such patients. Materials and methods. Clinical laboratory testing of4088 infertile couples (I) without established female factor; the control group - 365fertile men (F), whose spouses became pregnant in the natural cycle for the last 12 weeks. Research type - analytical one-stage multicenter study. Results. The defects in sperm quality in group I were observed more often than in group F: cases of azoospermia - 4,2% and 0% (р<0,001), cryptozoospermia - in 1,6% and 0% (p<0,01), oligozoospermia - 17,4% and 2,2% (р<0,001), asthenozoospermia - 45,5% and 22,1% (р<0,001), teratozoospermia - 27,5% and 11,3% (р<0,001), oligospermia - 5,3% and 1,7% (p<0,05), antisperm antibodies(MAR-IgG>50%) - 12,3% and 4,8% (р<0,001), pyospermia - 17,1% and 8,1% (р<0,001), normal zoospermia - 47,0% and 70,0% (р<0,001) respectively. The medians and ranges of all the parameters of spermogram in group I were significantly worse than in group F (p <0.001), except for the volume and percentage of abnormal forms (p>0,05). In group I, the men with normal zoospermia had defects in sperm function: increased DNA fragmentation (51%), oxidative stress (50%), abnormal acrosomal reaction (46%) andprotamination (30%). Conclusion. In 2/3 of cases, a decrease in male fertility is a consequence of functional disorders of spermatozoa. According to WHO-2010, in fertile men normozoospermia was observed in 70% of cases; this indicates that the ranges reference values vary among the regions. An algorithm for management of patients with various sperm disorders in level 3 healthcare facilities was proposed.

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About the authors

Vladimir A. Bozhedomov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University; Medical Scientific and Educational Center, M.V. Lomonosov Moscow StateUniversity; Polyclinic №3, Administration of the President of the Russian Federation

Email: vbojedomov@mail.ru
Doctor of Medical Sciences, Professor, Leading Researcher

Marina A. Nikolaeva

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: nikolaeva_ma@mail.ru
Candidate of Biological Sciences, Leading Researcher, Laboratory of Clinical Imunology

Irina V. Ushakova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: irisun77@mail.ru
PhD, embryologist of 1-st gynecology department

Galina E. Bozhedomova

Medical Scientific and Educational Center, M.V. Lomonosov Moscow StateUniversity; Polyclinic №3, Administration of the President of the Russian Federation

Email: bozhiedomova@bk.ru
Medical Technologist,”Men’s Health” Clinic, Medical Scientific and Educational Center

Natalia A. Lipatova

Polyclinic №3, Administration of the President of the Russian Federation

Email: li_nal328@mail.ru
Candidate of Medical Sciences, Clinical Laboratory Diagnosis Physician

Rimma A. Kamarina

Polyclinic №3, Administration of the President of the Russian Federation

Email: kamarina.rim@yandex.ru
Clinical Laboratory Diagnosis Physician

Dmitry A. Okhobotov

Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University; Medical Scientific and Educational Center, M.V. Lomonosov Moscow StateUniversity

Email: l4072003m@gmail.com
Candidate of Medical Sciences, Associate Professor of the Department of Urology and Andrology, Faculty of Fundamental Medicine, Urologist, ”Men’s Health” Clinic, Medical Scientific and Educational Center

Armais A. Kamalov

Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University; Medical Scientific and Educational Center, M.V. Lomonosov Moscow StateUniversity

Email: priemnaya@mc.msu.ru
Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Director of the Medical Research and Education Center and Head of the Department of Urology and Andrology

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