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Background. Not all pathological mechanisms of fertility disorders in men are currently the correct diagnostic tests, this significantly reduces the prognostic value of the spermogram and makes the question of assessing spermogram character disorders and its impact on the effectiveness of assisted reproductive technologies (ART) procedures extremely relevant. In our study, we retrospectively evaluated the parameters of ejaculate and their effect on ART outcomes.Aim. To assess the effect of sperm agglutination and ejaculate liquefaction time on in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) results.Materials and methods. The selection of married couples was carried out on the basis of the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia. The study included 6,416 married couples who sought IVF-ICSI in the period from December 2012 to December 2016. Ages of men varied between 23 and 74 years, ages of women between 17 and 53 years. Examination data of the patients were extracted from the BABE software. In the study, sperm analysis parameters were evaluated during preparation to the IVF program, IVF-ICSI, and on the day of transvaginal ovarian puncture. Using univariant and regression analysis, prognostic factors of clinical pregnancy and childbirth after IVF-ICSI were determined.Results. Sperm agglutination rates adversely affect the incidence of clinical pregnancy (probability ratio (PR) 0.701; 95 % confidence interval (CI) 0.589–0.834; p

Introduction. Inflammation and fibrosis may have a significant role in pathogenesis of benign prostatic hyperplasia and associated lower urinary tract symptoms. Moreover, those factors may compromise the outcomes of surgical interventions for bladder outlet obstructions, such as transurethral resection of the prostate (TURP). Additional measures, such as administration of anti-fibrotic agents, may decrease the incidence of certain complications (e.g. bladder neck stenosis, urethral stricture) and improve overall outcomes of TURP. Bovhyaluronidase azoximer is an enzyme combined with high molecular mass copolymer which may inhibit surgery-related tissue remodeling and prevent excessive fibrosis.Materials and methods. Sixty-five patients undergoing monopolar TURP were enrolled in this prospective randomized open-label study. Patients in Group 1 (n = 34) received 5 intramuscular injections of bovhyaluronidase azoximer (3000 IU) on days 3, 6, 9, 12 and 15 after TURP in addition to standard therapy. Patients in Group 2 (n = 31) received conventional peri-operative therapy. All patients routinely underwent uroflowmetry and post-void residual volume measurement on follow-up 3 months after TURP. Incidence of fibrosis-associated complications was compared using Fisher’s exact test. Uroflowmetric parameters were compared using Mann-Whitney U-test.Results. One patient in Group 1 was excluded from the study due to mild allergic reaction after second injection of bovhyaluronidase azoximer. There were three cases of clinically significant fibrosis-associated complications in Group 2 which were confirmed on imaging (9.7 %). One case of stricture in bulbar urethra was later successfully managed with anastomotic urethroplasty, and two cases of bladder neck stenosis were managed with transurethral incision. No such complications were observed in Group 1 (0 %). However, the difference was not statistically significant (p = 0.1079). Otherwise, there were no adverse events in both groups. Median Qmax in Groups 1 and 2 was 24 ml/s and 22 ml/s, respectively (p = 0.08). Median Qave in Groups 1 and 2 was 15 ml/s and 9 ml/s, respectively (p

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.

Benign extratestinal lesions, including spermatic cord lipomas, are often incidental findings on palpation of the scrotum. There are frequent cases of detection of lipomas both when performing hernioplasty of inguinal hernias, and during other surgical interventions in the inguinal canal or in the scrotum. Lipomas of the spermatic cord can accompany the hernia of the inguinal canal, and in some cases, and proceed independently.Some authors have described cases of erroneous diagnosis of huge extratesticular lipomas as inguinal hernias, while suggesting that the lipoma of the spermatic cord be recognized as an important clinical unit necessary in conducting a thorough urological differential diagnosis in order to avoid unnecessary hernioplasty. It is not always easy to determine the correct tactical and technical techniques, their sequence, adequacy for each specific case. This is due to the limited time for decision-making and the high emotional burden that the doctor bears when examining and deciding treatment tactics at the time of surgery. This fact prompted us to share our clinical observations and suggest step-by-step surgical tactics that we use.

Differential diagnosis between obstructive and non-obstructive azoospermia is an important task in clinical management of infertile patients. Chances of extracting sperm in obstructive azoospermia are high enough to inform the couple about favorable outcome of assisted reproductive technologies without resorting to donor sperm. Some forms of seminal tract obstruction can be corrected by microsurgical interventions or endoscopic resection of the ejaculatory ducts. Therefore, one of the objectives standing before imaging methods in reproductive andrology is the detection of these cases. In this literature review we present a detailed analysis of how to suspect and diagnose this form of azoospermia using imaging.

Introduction. Direct influence of novel coronavirus infection (COVID-19) on male fertility is still unproven. However, through prolonged fever, hypoxia, systemic inflammation and other yet incompletely described factors this disease may apparently cause not only “long COVID” syndrome, but also transitory non-specific impairment of spermatogenesis. The study objective is to evaluate the effectiveness of administration of Russian complex with unique composition BESTFertil in case of decreased fertility and asthenic syndrome in males after new coronavirus infection.Materials and methods. We performed a non-blinded randomized prospective controlled trial which included 60 male patients with a history of COVID-19 not earlier than 6 months prior to enrollment from couples planning to have children. Patients were included if they had pre-disease semen analysis results available. They were divided into two equal groups. Group 1 (main group) received BESTFertil complex for 12 weeks, while Group 2 (comparison group) received no additional treatment. At baseline and 12-week follow-up all patients underwent semen analysis, MAR test, sperm DNA fragmentation test, serum sex hormone profiling and completed the “Asthenic condition scale” questionnaire. Student's t-test, Wilcoxon test, Mann-Whitney U-test and McNemar test were used for statistical analysis.Results. When comparing retrospective and baseline values we found no critical influence of COVID-19 on semen parameters, though a moderate decrease of percentage of sperm with progressive motility could be observed (40.5 % vs 30 %, p = 0.008). Group 1 had a stronger tendency toward recovery of semen parameters. Patients receiving BESTFertil had median total motile sperm count increased from 48.5 million to 76.8 million (p = 0.032), while in comparison group it increased from 39.8 million to 49.2 million (p = 0.317). BESTFertil antioxidant complex had no negative influence on endocrine profile. Moreover, there was a statistically significant decrease of sperm DNA fragmentation index from 21.2 to 13.9 % (p = 0.007) in Group 1. Lower rate of asthenic symptoms was observed in Group 1 which received BESTFertil.Conclusion. Men with a recent history of COVID-19 had a moderate decrease of surrogate fertility markers, most probably due to non-specific mechanisms. Patients receiving BESTFertil had a more pronounced recovery of semen parameters and improvement in post-COVID asthenic syndrome.

The prevalence of erectile dysfunction (ED) among men over 50 years is 31-51 %. By 2025, the prevalence of ED is expected to increase to 322 million men worldwide. In Russia, according to academician D.Yu. Pushkar', ED suffers up to 89.9 %.In this regard, it seems very important to establish the causes of this condition. The purpose of this review is to assess the current state of the literature on the issue of risk factors leading to or associated with the development of ED.The presented works show that well-known factors play a role in the occurrence of ED: unfavorable environmental conditions, harmful lifestyle factors, chronic intoxication, obesity, genetic predisposition, deficiency of sex hormones and vitamins, diseases of the cardiovascular system, prostate and urethra, as well as drugs for their treatment. Also, new indicators in laboratory and instrumental studies that change with ED are considered.Among the well-known data, there are also some very original works devoted to this topic. The relationship between ED and reproductive disorders, psoriasis, periodontitis, human immunodeficiency virus infection and some drugs use is now being investigated, which is presented in this review.

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.

Varicocele is a common disease that occurs in 35–40% of men with primary infertility and in 80% of men with secondary infertility Disturbance of microcirculation in the testicles, which occurs during varicocele, lead to ischemia and hypoxia of the testicles, which provoke degenerative changes in all testicular cell populations. Retrograde blood flow from the testicular vein and the external spermatic vein into pampiniform venous plexus leads to an increase of hydrostatic pressure in the testicular vascular system and rise of temperature, and it also contributes to the development of sterile inflammation. Oxidative stress, nitrosative stress, and hypoxia are generally recognized elements of the pathogenesis of infertility associated with varicocele. It is known that when the supraphysiological level of reactive oxygen species in the ejaculate is reached, their concentration disrupts the structure and function of spermatozoa. Nitric oxide (NO) is involved in the regulation of body temperature, NO-dependent mechanisms may contribute to the increased scrotal temperature during varicocele. The physiological concentration of NO pro duced by testicular macrophages stimulates steroidogenesis in Leydig cells. However, in the presence of certain reactive oxygen species, NO can transform into peroxynitrite and other strong cytotoxic metabolites, which lead to dysregulation of testosterone synthesis involved in spermatogenesis. Also, manifestations of varicocele among infertile men have decreased expression levels of the testis-specific heat-shock protein, HSPA2, and abnormal methylation of sperm DNA. Therefore, the use of combined anti oxidant supplements as part of adjuvant therapy after surgical treatment or as an independent application in some clinical cases appears to be an adequate strategy to optimize fertility in patients with varicocele. In this review, we evaluated the importance of various antioxidants, such as vitamin E, folic acid, carnitine, inositol, arginine, acetylcysteine, zinc, selenium in spermatogenesis and their effect on reproductive function during varicocele.

Introduction. According to research, seminal plasma is a rich source of biomarkers in male infertility including biomarkers of residual spermatogenesis in males with azoospermia. In many cases, extraction of seminal plasma does not require invasive procedures. Therefore, non-invasive test for identification of males with azoospermia and residual focal spermatogenesis can improve selection of patients for microdissection testicular sperm extraction (microTESE) and become a useful tool for patient consultation.The study objective is to evaluate capabilities of proteomic analysis of seminal plasma for identification of males with azoospermia and residual focal spermatogenesis in the testes who have higher chance for sperm extraction using the microTESE procedure.Materials and methods. Samples of seminal plasma of 36 males between 21 and 45 years of age (mean age 33.3 ± ± 3.9 years) were tested for proteomic composition. For proteomic analysis, proteins were hydrolyzed with trypsin. The obtained peptides were analyzed using chromatography-mass spectrometry complex composed of liquid chromatograph nano-HPLC Agilent 1100 and high-resolution mass spectrometer 7Т LTQ-FT Ultra. Proteomic analysis data were compared with results of the microTESE procedure.Results. In this study, proteomic composition of seminal plasma in azoospermia was assessed. Semi-quantitative analysis without markers using bottom-up approach identified 405 different proteins, and 174 of them were detected in all samples. The obtained quantitative parameters were sufficient to identify patients with focal spermatogenesis.Conclusion. Seminal plasma is a potential source of biological markers for prediction of sperm extraction success in patients with azoospermia. The presented results are preliminary, and further studies are needed to confirm the identified protein panel.

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.

Purpose of the study. To determine the practical value of puncture methods for obtaining spermatozoa in azoospermia. Patients and methods. The results of 127 puncture biopsies of testis (TESA) and testicular appendage (PESA) in patients with azoospermia of presumably obstructive origin were analyzed. The sperm production frequency (SPF) was calculated, as well as the frequency of transition to an open testicular biopsy. Was built a logistic regression model to analyze factors influencing the result, TESA / PESA, which included as independent variables the following parameters: patient age, duration of involuntary infertility, the level of sex hormones (testosterone, estradiol, luteinizing hormone, follicle-stimulating hormone, prolactin, progesterone, inhibin B), the total volume of testes, presence of varicocele, the presence of chemotherapy or radiation therapy, a history of alcohol abuse, Smoking, regular violation of the thermal mode, surgery in the inguinal and scrotal region. Indicators of the probability ratio (PR) with a 95% confidence interval (95% CI) were obtained. Results. 92 biopsy attempts out of 127 were successful, and the NPV was 72.4%. Independent statistically significant predictors of PESA / TESA success were testicular volume (PR = 1.113; 95% CI = 1.026–1.207) and inhibin b level (PR = 1.026; 95% CI = 1.011–1.041). In 35 patients whose spermatozoa were not found during the puncture biopsy, conversion to open microsurgical biopsy was performed. Conclusion. PESA and TESA have only limited effectiveness in azoospermia. We believe that puncture biopsy of the testicles and epididymis is justified only in patients with normal testicular volume and high levels of inhibin B. PESA / TESA should be performed in conditions that allow immediate transition to an open biopsy in case of failure.

Empirical therapy of male infertility is used as a stand-alone type of treatment in idiopathic infertility, and in other situations can complement basic therapy. There are well-known pathogenetic methods of male infertility treatment applied in case of reproductive gland infection, hypogonadotropic hypogonadism, ejaculation disorders. However, the prospects of empirical treatment of male infertility are not fully clear. Combined antioxidant drugs are very popular, which include a wide range of similar substances. However, their molecules significantly differ from each other in structure, chemical properties and set of biological functions, therefore, there is a number of questions that deserve separate discussion regarding their compatibility with each other. Antioxidants such as various water-soluble and fat-soluble vitamins, coenzyme Q10, zinc and carnitines are widely used in its composition to reduce sperm damage caused by oxidative stress. They are widely available and inexpensive compared to other methods of treatment. Although there are no results of large randomized controlled trials yet, there is some evidence that taking oral antioxidoidants improves the basic parameters of sperm and increases the frequency of childbirth. There are many antioxidant supplements in different dosage forms, with different compositions and modes of use. In this article, we have analyzed the effect of the main antioxidant substances used on semen parameters, the need for their combined use and the role of these substances in the body.

This paper addresses the background of phosphodiesterase-5 inhibitors use in erectile dysfunction and lower urinary tract symptoms, as well as a special position which is held by tadalafil as an only drug from its class suitable for daily intake. Tadalafil pharmacodynamics and hypotheses concerning its mechanism of action on prostatic tissue are discussed. Special attention is paid to drug»s efficacy and safety in elderly men, who often require therapy for benign prostatic hyperplasia with lower urinary tract symptoms. It is mentioned that tadalafil may be used in penile rehabilitation programs in men who underwent radical prostatectomy.

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.

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

Patients with erectile dysfunction require special approach. Any therapy should be prescribed with patient’s individual features, comorbidities and concominant medication in mind. Considering good efficacy and safety profile of tadalafil, together with appearance of its generic forms on the market, making such treatment more accessible for our patients, soon it may become the most commonly prescribed drug from phosphodiesterase-5 inhibitors class. Therefore, evidence on its use in special groups of men with specific anamnestic features should be systematized. In this article we discuss the use of 20 mg tadalafil on demand in specific categories of patients suffering from erectile dysfunction: in men with metabolic syndrome, benign prostate diseases, neurological conditions and, finally, in men who express wish to become fathers.

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.

Abstract. This study was aimed to evaluate the role of power Doppler imaging in diagnosis of prostate cancer and prediction of its aggressiveness. This study included 118 patients with prostate cancer suspected due to elevation of prostate specific antigen (PSA) values to > 4.0 ng/ml. All patients underwent transrectal prostate biopsy with ultrasound guidance for histological verification. Prostate was scanned in power Doppler mode and one of vascularization patterns was assigned, as described by Zhao et al. Power Doppler imaging results and biopsy results were compared. Forty eight patients had normal results of power Doppler imaging. Fifty five patients had focal enhancement of blood flow, which allowed to perform a targeted biopsy of suspected lesion. Fifteen patients had diffusely enhanced blood flow. Sensitivity of power Doppler imaging was 82.4%, specificity was 70.5%, positive and negative predictive values were 66.7% and 72.3% correspondingly. Overall accuracy for prostate cancer detection was 81.1%. Association between observed vascular patterns and Gleason score, tumor dissemination and PSA level was detected. Power Doppler imaging allows efficient detection, staging and prediction of aggressiveness of prostate cancer, when compared to standard transrectal ultrasound imaging.