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In the structure of infertile marriage male factor of infertility occurs in about 40-50%. About 30% of infertile men who have sought medical care have oligozoospermia or azoospermia of unknown etiology. The question of the chances of spermatogenesis recovery and increased probability of sperm extraction in repeated assisted reproductive technology (ART) programs is important for both the doctor and the patient.Purpose. To evaluate the morphological changes of spermatogenic epithelium in patients with male infertility in terms of prognosis of ART success.Patients and methods. 264 men with infertility were examined. The scope of clinical study of all patients included: history, examination, determination of blood hormones, study of ejaculate, karyotype, ultrasound. We performed a biopsy of the testis according to the patient's symptoms. Testicular tissue was subjected to morphological examination.Results. Primary infertility was observed in 172 men (65.2%), secondary — 92 (34.8%). 112 (42.4%) patients had severe infertility. The results of morphological studies in these men showed a different degree of violation of spermatogenesis. Based on the study, a diagnostic algorithm of patients with male infertility is proposed, which allows to predict the success of ART taking into account morphological changes in the testicle.Conclusion. On the basis of clinical and morphological study of the features of spermatogenesis of a particular patient a plan can be made for further personal diagnostic and therapeutic measures.
In the structure of infertile marriage male factor of infertility occurs in about 40-50%. About 30% of infertile men who have sought medical care have oligozoospermia or azoospermia of unknown etiology. The question of the chances of spermatogenesis recovery and increased probability of sperm extraction in repeated assisted reproductive technology (ART) programs is important for both the doctor and the patient.Purpose. To evaluate the morphological changes of spermatogenic epithelium in patients with male infertility in terms of prognosis of ART success.Patients and methods. 264 men with infertility were examined. The scope of clinical study of all patients included: history, examination, determination of blood hormones, study of ejaculate, karyotype, ultrasound. We performed a biopsy of the testis according to the patient's symptoms. Testicular tissue was subjected to morphological examination.Results. Primary infertility was observed in 172 men (65.2%), secondary — 92 (34.8%). 112 (42.4%) patients had severe infertility. The results of morphological studies in these men showed a different degree of violation of spermatogenesis. Based on the study, a diagnostic algorithm of patients with male infertility is proposed, which allows to predict the success of ART taking into account morphological changes in the testicle.Conclusion. On the basis of clinical and morphological study of the features of spermatogenesis of a particular patient a plan can be made for further personal diagnostic and therapeutic measures.
The proportion of men with impaired sperm fertility is increasing every year, which is one of the factors in the decline in fertility and is becoming both a medical and social problem. Modern diagnostic methods make it possible to recognize many factors of male infertility: genetic, endocrine, infectious, extra-genital, etc. However, despite all modern biomedical advances, 1/3 of patients remain with an unrecognized cause (idiopathic) of male infertility. At the same time, we must not forget that most patients from this category do not want to resort to assisted reproductive technologies to realize paternity, and they strive to achieve pregnancy in a natural way. Therefore, the search for the causes of male infertility remains an urgent issue in modern urology field. This article reviews the literature on the role of mast cells in the formation of fibrosis in tissues, including the testis. Mast cells affect the proliferation, functioning and phenotype of fibroblasts put under hypoxic conditions. Fibroblast activation enhances collagen fibrillogenesis. Studies by Russian and foreign scientists have shown that with sperm pathology, the number of mast cells in the connective tissue of the testicle increases sharply. Against the background of an increase in the number of mast cells in the interstitium of the testis, fibrosis of the wall of the convoluted seminiferous tubules increases. Moreover, in severe spermatogenesis disorders (Sertoli cell-only syndrome, Germ cell aplasia), mast cells were found both in the peritubular space and in the lumen of the convoluted seminiferous tubules. Most infertile men have significant amounts of significant amounts of mast cells in their ejaculate. There are sporadic data on the negative correlation between the presence of mast cells in seminal plasma and the concentration and motility of spermatozoa. Conclusion. The negative effect of mast cells on spermatogenesis remains unknown to the end. Mast cells have a high ability to migrate to connective tissue, which levels increase during inflammation, and the production of many mediators, proteases and histamine, cytokines, which can be both a trigger in the formation of sperm pathology and the cause of the formation of fibrosis in the testicle.
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