Despite many shortcomings, the semen analysis remains the leading method of male fertility assessment. For several decades, the WHO has been working on standardisation of the methodology for examining human ejaculate. In 2021, the sixth edition of WHO laboratory manual for the examination and processing of human semen was released, which proposed several concepts for performing and interpreting the results of a semen analysis. Many of these concepts are not new and have already been covered in previous tutorials. At the same time, the rejection of reference values and the transition to “decision limits” raises several questions that have not yet been answered.

Background. Spermogram remains one of the main laboratory methods of male infertility diagnosis, but normal spermogram do not guarantee the patient’s fertility. More over, it does not allow us to find out the cause of infertility in 10–30 % cases. The sperm DNA fragmentation (SDF) studying is a possible solution to this problem.Aim. To systematize the currently available information about of clinical significance, causes, methods of diagnosis and treatment of SDF to be used by an urologist in rutine practice.Materials and methods. The search of publications in databases was carried out eLIBRARY and PubMed using the keywords: male infertility, sperm DNA fragmentation, etiology, causes, varicocele, oxidative stress, diagnostics, treatment. 111 studies were selected, which are included in this review.Results. Alcohol, tabacco smoking, narcotic substances, psychoemotional stress, adverse environmental factors and occupational intoxications, reproductive system infections and inflammation, varicocele and older paternal age can lead to SDF increasing and unfavorable reproductive outcomes, for natural pregnancy and while use an assisted reproductive technologies. The data on the role of metabolic syndrome in the genesis of SDF are equivocal. The oxidative stress is the main mechanism of sperm DNA damage. The SDF level can be estimated using direct (Comet, TUNEL) and indirect (SDS, SCSA) methods. Treatment of SDF is aimed at eliminating the detrimental factors, combating oxidative stress and recombinant follicle-stimulating hormone use.Conclusion. The level of SDF is an important indicator for assessing male reproductive potential and predicting the success of various methods of overcoming infertility. Recently, there has been an expansion of indications for the use of methods for assessing the integrity of sperm genetic material in the clinical practice of specialists in the field of reproductive medicine.

Surgical treatment of clinically significant varicocele in infertile men with pathospermia is a common practice. However, the question of the role of this disease in the pathogenesis of such conditions as hypogonadism and orchalgia, as well as the role of varicocelectomy in eliminating pain symptoms in the scrotum and increasing testosterone levels, has remained ambiguous for a long time. The expediency of surgical treatment of varicocele in patients with azoospermia also remains a subject of discussion.

Introduction. Male infertility, caused by a high level of sperm DNA fragmentation, remains one of the significant problems of reproductive medicine. One of the methods to overcome it may be the use of recombinant follicle-stimulating hormone (FSH), but the results of studies on this issue are ambiguous. The purpose of this literature review is to systematize publications on this issue. Materials and methods. The search, analysis and systematization of publications in the databases PubMed, eLibrary.ru, Clinicaltrials.gov were carried out using the keywords «male infertility», «sperm DNA fragmentation», «treatment», «follicle stimulating hormone», «FSH». Seventy six publications were selected and included in this review. Results and discussion. The integrity of the genetic material of the sperm is one of the prerequisites for the formation of a normal embryo. Its damage occurs in two main ways: induction of apoptosis and direct damage to DNA by reactive oxygen species. FSH stimulates spermatogenesis and also prevents the induction of spermatozoa apoptosis through the activation of protein kinase B/AKT. Also FSH regulates chromatin packing and increases the ability of spermatozoa to bind to hyaluronic acid. Its use in infertile men led to an improvement in the morphological parameters of spermogram, sperm motility, a decrease in the level of sperm DNA fragmentation, however, the data obtained are difficult to compare due to the heterogeneity of the patient groups included in the study, the lack of standardization of methods for studying the level of sperm DNA fragmentation and using its different threshold values. Conclusions. Therapy with recombinant FSH is one of the promising methods for overcoming infertility in patients with a high level of sperm DNA fragmentation. The heterogeneity of published studies does not allow to draw unambiguous conclusions regarding its effect on the integrity of the genetic material of spermatozoa. Future studies need to use strict inclusion criteria, such as thresholds for the level of sperm DNA fragmentation and the results of a pharmacogenetic study.