Андрология и генитальная хирургия. 2015; 16: 88-93
Параметры эякулята у пациентов с абдоминальным ожирением
https://doi.org/10.17650/2070-9781-2015-1-88-93Аннотация
Цель исследования – определение ассоциации уровней половых стероидных гормонов и параметров эякулята с разными типами распределения жира у бесплодных мужчин с избыточной массой тела и ожирением.
Материалы и методы. Обследованы 119 соматически здоровых русских мужчин, обратившихся в 2012–2014 гг. в Новосибирский центр репродуктивной медицины с проблемой бесплодия. На основании результатов антропометрического обследования все мужчины были разделены на 3 группы. В 1-ю группу вошли мужчины с избыточной массой тела, ожирением и верхним типом распределения жира (отношение окружности талии (ОТ) к окружности бедер (ОБ) ≥ 0,95); во 2-ю группу – мужчины с избыточной массой тела, ожирением и нижним типом распределения жира (ОТ/ОБ < 0,95); в 3-ю группу – мужчины с нормальной массой тела. Проведено анкетирование, определение в сыворотке крови концентраций общего тестостерона, эстрадиола, глобулина, связывающего половые гормоны (ГСПГ), рассчитан уровень свободного тестостерона. Специальное исследование эякулята включало спермограмму, оценку морфологии сперматозоидов по строгим критериям Крюгера, МАР-тест, НВА-тест, анализ фрагментации ДНК сперматозоидов.
Результаты. Во всех 3 группах были проанализированы частоты встречаемости медико-социальных факторов риска бесплодия: инфекций, передаваемых половым путем (ИППП), хронического простатита, систематического употребления алкоголя и курения. Оказалось, что эти факторы встречались с высокой, но достоверно не различающейся частотой у мужчин 3 групп: частота ИППП в 1-й, 2-й и 3-й группах составила 65,8; 61,0 и 63,2 %; систематического употребления алкоголя – 85,4; 78,1 и 63,2 %; систематического курения – 36,6; 53,7 и 34,21 %; хронического простатита – 68,3; 56,1 и 50,0 % соответственно. Средние концентрации половых стероидных гормонов и ГСПГ в сыворотке крови мужчин всех групп не выходили за пределы референсных диапазонов. У пациентов 1-й и 2-й групп концентрация общего тестостерона в сыворотке была достоверно ниже по сравнению с 3-й группой, причем указанное снижение было выражено в большей степени у мужчин 1-й группы. Содержание ГСПГ в сыворотке крови также было достоверно ниже в 1-й и 2-й группах относительно 3-й. Сравнение показателей эякулята выявило достоверные различия в 1-й и 2-й группах мужчин, различающихся по типу распределения жира, в показателях объема эякулята, доли прогрессивно подвижных сперматозоидов и степени фрагментации ДНК. По ряду показателей эякулята определены различия между 1-й и 3-й группами, но различий между 2-й и 3-й группами ни по одному показателю не обнаружено.
Заключение. Выявленные различия указывают на негативное влияние на показатели эякулята именно верхнего типа распределения жира, характерного для мужчин 1-й группы. Полученные результаты обосновывают предположение, что абдоминальное ожирение с верхним типом распределения жира является независимым фактором риска снижения мужской фертильности.
Список литературы
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Andrology and Genital Surgery. 2015; 16: 88-93
Ejaculate parameters in patients with abdominal obesity
https://doi.org/10.17650/2070-9781-2015-1-88-93Abstract
Objective: the definition of association of levels of sex steroid hormones and ejaculate parameters with different types of fat distribution in infertile men with overweight and obesity.
Materials and methods. A total of 119 somatically healthy Russian men who contacted Novosibirsk Center of Reproductive Medicine in 2012–2014 with the problem of infertility have been examined. Based on the results of anthropometric surveys all the men were divided into 3 groups. The 1st group included men with overweight, obesity, and upper type of fat distribution (the ratio of waist circumference (WC) to the hip circumference (HC) ≥ 0.95); the 2nd group – men with overweight, obesity and lower type of fat distribution (WC/HC < 0.95); the 3rd group – men with normal body weight. Questionnaires have been completed; determination in serum of concentrations of total testosterone, estradiol, sex hormones binding globulin (SHBG); free testosterone calculated. Special study of ejaculate included semen analysis, sperm morphology assessment by strict criteria of Kruger MAP test, NCA-test, analysis of DNA fragmentation of sperm.
Results. In all 3 groups frequency of medical and social risk factors occurrence for infertility were analyzed: sexually transmitted infections, 88 chronic prostatitis, the systematic consumption of alcohol and smoking. It was revealed that these factors occurred with a high, but not significantly different frequency in men of 3 groups: the frequency of sexually transmitted infections in the 1st, 2nd and 3rd groups was 65.8; 61.0 and 63.2 %; systematic consumption of alcohol – 85.4; 78.1 and 63.2 %; systematic smoking – 36.6; 53.7 and 34.21 %; chronic prostatitis – 68.3; 56.1 and 50.0 % respectively. The average concentrations of sex steroid hormones and SHBG in the serum of men of all groups did not go beyond the reference range. Patients of the 1st and 2nd groups had significantly lower concentration of total testosterone in serum compared with the third group, moreover the indicated decline was more pronounced in men of the 1st group. The content of SHBG in serum was also significantly lower in the 1st and 2nd groups in relation to the 3rd group. Comparison of ejaculate indicators revealed significant differences in the 1st and 2nd groups of men, differing in the type of fat distribution, in terms of volume of ejaculate, share of progressively motile sperm and DNA fragmentation level. Differences are identified for some indicators of ejaculate between the 1st and 3rd groups, but the differences between the 2nd and 3rd groups on any indicator are not detected.
Conclusion. The revealed differences indicate a negative effect on the ejaculate indicators, particularly of upper type of fat distribution, peculiar to the men of the 1st group. The obtained results justify the assumption that abdominal obesity with upper type fat distribution is an independent risk factor of male fertility reduction.
References
1. Mascarenhas M.N., Flaxman S.R., Boerma T. et al. National, regional and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PloS Med 2012;9(12):e1001356.
2. Jungwirth A., Diemer T., Dohle G.R. et al. Guidelines on male infertility. 2014. http://www.uroweb.org/gls/pdf/17%20 Male%20Infertility_LR.pdf.
3. The practice committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril 2012;98(2):294–301.
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5. Anderson K., Nisenblat V., Norman R. Lifestyle factors in people seeking infertility treatment – a review. Aust NZ J Obstet Gynaecol 2010;50(1):8–20.
6. Li Y., Lin H., Liet Y. et al. Association between socio-psycho-behavioral factors and male semen quality: systematic review and meta-analyses. Fertil Steril 2011;95(1):116–23.
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11. Pinkhasov B.B., Selyatitskaya V.G., Karapetyan A.R., Astrakhatseva E.L. Metabolic syndrome in men and women with upper or lower types of body fat distribution. Health 2012;4(12A):1381–9.
12. Emerging Risk Factors Collaboration; Wormser D., Kaptoge S., Di Angelantonio E. et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet 2011;377(9771):1085–95.
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19. Chavarro J.E., Toth T.L., Wright D.L. et al. Body mass index in relation to semen quality, sperm DNA integrity, and serum reproductive hormone levels among men attending an infertility clinic. Fertil Steril 2010;93(7):2222–31.
20. de Lamirande E., San Gabriel M.S., Zini A. Numan sperm chromatin undergoes physiological remodeling during in vitro capacitation and acrosome reaction. J Androl 2012;33(5):1025–33.
21. Seli E., Sakkas D. Spermatozoal nuclear determinants of reproductive outcome: implications for ART. Hum Reprod 2005;11(4): 337–49.
22. Simon L., Castillo J., Oliva R., Lewis S.E. Relationships between human sperm protamines, DNA damage and assisted reproduction outcomes. Reprod Biomed 2011;23(6):724–34.
23. Benchaib M., Braun V., Lornage J. et al. Sperm DNA fragmentation decreases the pregnancy rate in an assisted reproductive technique. Hum Reprod 2003;18(5):1023–8.
24. McLaughlin T. Metabolic heterogeneity of obesity: role of adipose tissue. Int J Obes Suppl 2012;2(Suppl 1): S8–10.
25. Hsieh C.J., Wang P.W., Chen T.Y. The relationship between regional abdominal fat distribution and both insulin resistance and subclinical chronic inflammation in nondiabetic adults. Diabetol Metab Syndr 2014;6(1):49–55.
