The study objective is to perform clinical laboratory evaluation of the effectiveness of Prostatilen® AC and Arginine-zinc in treatment of patients with sperm pathology and concomitant varicocele and chronic nonbacterial prostatitis.Materials and methods. The study included 60 patients between 23 and 46 years of age. The first group included 30 patients (15 patients with varicocele and 15 patients with chronic nonbacterial prostatitis) who received Prostatilen® AC. The second group included 30 patients (15 patients with varicocele and 15 patients with chronic nonbacterial prostatitis) who received Arginine-zinc. Therapy duration was 20 days. Standard clinical and laboratory examination, spermiologic examination as well as measurement of antisperm antibodies, DNA fragmentation, oxidative stress level, cryotest, electron microscopy examination of the ejaculate were performed.Results. Five (5) days after the end of therapy, percentage of progressive motile sperm increased by 62 % in the Prostatilen® AC patient group with chronic nonbacterial prostatitis (р <0.001) compared to the baseline, and by only 10 % in the Arginine-zinc patient group. Administration of Prostatilen® AC lead to a more significant decrease of reactive oxygen intermediates in the ejaculate (р <0.001) and percentage of sperm with fragmented DNA (р <0.001) compared to administration of Arginine-zinc. The applied treatment schemes had no significant effect on the number of sperm with acrosomal hypoplasia. An anti-inflammatory effect of Prostatilen® AC was also identified (decreased number of leukocytes in sperm). During the study, 3 cases of adverse effects were registered: 1 after administration of Prostatilen® AC and 2 after administration of Arginine-zinc.Conclusion. Prostatilen® AC can be considered more effective and safer compared to Arginine-zinc for 20-day administration. In patients with sperm pathology, it more effectively improves sperm characteristics: increases sperm motility, sperm morphology, decreases DNA fragmentation and oxidative stress levels.

The study objectiveis to evaluate the results of treatment of patients with chronic nonbacterial prostatitis, increased level of sperm DNA fragmentation, and concomitant reproductive function disorders with the Prostatilen® AC drug 1, 2, and 3 months after the end of therapy.Materials and methods. Thirty five men aged 21–46 years (mean age 31.3 ± 4.3 years) with a verified diagnosis of “chronic nonbacterial prostatitis, associated reproductive function disorders, history of early-stage missed miscarriage in a wife/sex partner” were examined. All patients received Prostatilen® AC as rectal suppositories daily for 10 days with a repeat course 20 days later. Before and after the treatment, as well as after 1, 2, and 3 months after its end, the fraction of spermatozoa with fragmented DNA was measured in all patients using sperm chromatin structure assay with flow cytofluorometry. The risk of decreased fertility was considered low if the number of spermatozoa with fragmented DNA was 15 % or lower (this value is considered the norm). If DNA fragmentation was 16 % or higher, it was considered increased.Results. The fraction of spermatozoa with fragmented DNA significantly decreased during the treatment, and 1 month after the end of the therapy it was 7.5 ± 4.2 % (prior to treatment it was 17.8 ± 6.7 %) (p <0.005). Prior to Prostatilen® AC treatment, enhanced DNA fragmentation was observed in 18 (51 %) patients, 1 month after treatment – only in 6 (17 %); the difference is statistically significant (p <0.001). Two months after the end of treatment, increased level of DNA fragmentation was detected in 7 (20 %) patients, 3 months after – in 15 (42 %) patients. Aside from that, if the fraction of spermatozoa with fragmented DNA was more than 30 % before treatment, then a decrease in this value during treatment wasn’t statistically significant.Conclusion. Prostatilen® AC promotes a reduction in the level of sperm DNA fragmentation in patients with chronic nonbacterial prostatitis. A steady positive effect persists for 2 months with a tendency to weaken at the end of month 3 which indicates advisability of repeated courses of Prostatilen® AC treatment 2 months after the end of therapy.

The study objective is to microscopically evaluate the morphology of sperm in patients with varicocele after surgical treatment and therapy with Prostatilen® AC.Materials and methods. The treatment group included 20 males between 26 and 45 years of age (mean age 31.6 ± 6.1 years) with various stages of varicocele and fertility problems; among them, 10 patients with subclinical stages of varicocele received conservative treatment with Prostatilen® AC (group 1) and were examined before and after the treatment; 10 males with infertility caused in part by varicocele of the spermatic cord veins were examined 6 months to 3 years after surgical treatment (group 2). Standard clinical and lab tests, sperm analysis, electron microscopy of the ejaculate were performed. The control group included 65 fertile males whose sperm samples were obtained from a bank of reproductive cells and tissues and used for comparison in microscopic examination.Results. In patients who received conservative treatment the number of sperm with immature chromatin decreased (p = 0.045) compared to the control group. This characteristic differed in patients after varicocelectomy and patients after conservative treatment (p = 0.037). Compared to control, the number of sperm with excess residual cytoplasm in the head and neck was higher in patients after varicocelectomy (p = 0.011). After conservative treatment, the number of sperm with excess residual cytoplasm was close to the control number and lower than in patients after varicocelectomy (р = 0.028).Conclusion. In patients with subclinical varicocele, conservative treatment with Prostatilen® AC leads to significant improvement in sperm ultrastructure compared to patients who underwent surgery to treat this pathology.