Андрология и генитальная хирургия. 2022; 23: 61-71
Агглютинация сперматозоидов и время разжижения эякулята как негативный прогностический фактор при ICSI
https://doi.org/10.17650/2070-9781-2022-23-3-61-71Аннотация
Введение. В настоящее время не для всех патологических механизмов нарушения фертильности у мужчин разработаны корректные диагностические тесты, это значительно снижает прогностическую ценность спермограммы и делает вопрос оценки нарушений параметров спермограммы и их влияния на эффективность вспомогательных репродуктивных технологий (ВРТ) чрезвычайно актуальным. В данном исследовании мы ретроспективно оценивали параметры эякулята и их влияние на исходы ВРТ.
Цель исследования – оценить влияние агглютинации сперматозоидов и времени разжижения эякулята на результаты экстракорпорального оплодотворения (ЭКО) с интрацитоплазматической инъекцией сперматозоида (ICSI) в ооцит.
Материалы и методы. Набор супружеских пар осуществлялся на базе ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России. В исследование были включены 6416 супружеских пар, обратившихся для проведения цикла ЭКО-ICSI в период с декабря 2012 г. по декабрь 2016 г. Возраст мужчин варьировал от 23 до 74 лет, возраст женщин – от 17 до 53 лет. Данные обследования пациентов были взяты из программы BABE. Параметры спермограммы оценивались в рамках подготовки к программе ЭКО-ICSI и в день трансвагинальной пункции яичников. С помощью методов унивариантного и регрессионного анализа выполнен поиск прогностических факторов наступления клинической беременности и рождения ребенка после ЭКО-ICSI.
Результаты. Степень агглютинации сперматозоидов отрицательно влияет на частоту клинической беременности (отношение вероятностей (ОВ) 0,701; 95 % доверительный интервал (ДИ) 0,589–0,834; p <0,001) и рождения ребенка (ОВ 1,719; 95 % ДИ 1,220–2,422; p = 0,002) в программе ВРТ методом ЭКО-ICSI. Время разжижения эякулята отрицательно влияет на частоту клинической беременности методом ЭКО-ICSI (ОВ 0,967; 95 % ДИ 0,949–0,986; p = 0,001).
Выводы. Андрологи должны стремиться улучшить вышеуказанные параметры эякулята различными методами лечения для повышения результативности программ ВРТ.
Список литературы
1. Jo J., Lee S.H., Lee J.M., Jerng U.M. Semen quality improvement in a man with idiopathic infertility treated with traditional Korean medicine: a case report. Explore (NY) 2015;11(4):320–3. DOI: 10.1016/j.explore.2015.04.007
2. Hamada A., Esteves S.C., Nizza M., Agarwal A. Unexplained male infertility: diagnosis and management. Int Braz J Urol 2012;38(5):576–94. DOI: 10.1590/s1677-55382012000500002
3. Kumar R. Male infertility – current concepts. Indian J Urol 2011;21(1):39–40. DOI: 10.4103/0970-1591.78419
4. Nicolau P., Miralpeix E., Solà I. et al. Alcohol consumption and in vitro fertilization: a review of the literature. Gynecol Endocrinol 2014;30(11):759–63. DOI: 10.3109/09513590.2014.938623
5. Sanchez M., Aran B., Blanco J. et al. Preliminary clinical and FISH results on hyaluronic acid sperm selection to improve ICSI. Hum Reprod 2005;20:i200. Available at: https://www.researchgate.net/publication/285075274_Preliminary_clinical_and_FISH_results_on_hyaluronic_acid_sperm_selection_to_improve_ICSI (access date: 22.05.2022).
6. Artini P.G., Obino M.E., Carletti E. et al. Conventional IVF as a laboratory strategy to rescue fertility potential in severe poor responder patients: the impact of reproductive aging. Gynecol Endocrinol 2013;29(11):997–1001. DOI: 10.3109/09513590.2013.822063
7. Gupta S., Sharma R., Agarwal A. Antisperm antibody testing: a comprehensive review of its role in the management of immunological male infertility and results of a global survey of clinical practices. World J Mens Health 2022;40(3):380–98. DOI: 0.5534/wjmh.210164
8. Vazquez-Levin M.H., Marín-Briggiler C.I., Veaute C. Antisperm antibodies: invaluable tools toward the identification of sperm proteins involved in fertilization. Am J Reprod Immunol 2014;72(2):206–18. DOI: 10.1111/aji.12272
9. Mazumdar S., Levine A.S. Antisperm antibodies: etiology, pathogenesis, diagnosis, and treatment. Fertil Steril 1998;70(5):799–810. DOI: 10.1016/s0015-0282(98)00302-1
10. Restrepo B., Cardona-Maya W. [Antisperm antibodies and fertility association (In Spanish)]. Actas Urol Esp 2013;37(9):571–8. DOI: 10.1016/j.acuro.2012.11.003
11. Kaur G., Thompson L.A., Dufour J.M. Sertoli cells – immunological sentinels of spermatogenesis. Semin Cell Dev Biol 2014;30:36–44. DOI: 10.1016/j.semcdb.2014.02.011
12. Francavilla F., Santucci R., Barbonetti A., Francavilla S. Naturally-occurring antisperm antibodies in men: interference with fertility and clinical implications. An update. Front Biosci 2007;12(8):2890–911. DOI: 10.2741/2280
13. Lombardo F., Gandini L., Dondero F., Lenzi A. Immunology and immunopathology of the male genital tract: antisperm immunity in natural and assisted reproduction. Hum Reprod Update 2001;7(5):450–6. DOI: 10.1093/humupd/7.5.450
14. Dimitrov D.G., Urbánek V., Zvĕrina J. et al. Correlation of asthenozoospermia with increased antisperm cell-mediated immunity in men from infertile couples. J Reprod Immunol 1994;27(1):3–12. DOI: 10.1016/0165-0378(94)90011-6
15. Verón G.L., Molina R.I., Tissera A.D. Incidence of sperm surface autoantibodies and relationship with routine semen parameters and sperm kinematics. Am J Reprod Immunol 2016;76(1):59–69. DOI: 10.1111/aji.12519
16. Gopalkrishnan K., Padwal V., Balaiah D. Does seminal fluid viscosity influence sperm chromatin integrity? Arch Androl 2000;45(2):99–103. DOI: 10.1080/014850100418783
Andrology and Genital Surgery. 2022; 23: 61-71
Sperm agglutination and ejaculate liquefaction time as negative prognostic factor in ICSI
https://doi.org/10.17650/2070-9781-2022-23-3-61-71Abstract
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 <0.001) and childbirth (PR 1.719; 95 % CI 1.220–2.422; p = 0.002) in IVF-ICSI assisted reproductive technologies. Ejaculate liquefaction has a negative effect on the incidence of clinical IVF-ICSI pregnancy (PR 0.967; 95 % CI 0.949–0.986; p = 0.001).
Conclusion. Andrologists should seek to improve the above ejaculate parameters with various treatments to improve the effectiveness of ART programs.
References
1. Jo J., Lee S.H., Lee J.M., Jerng U.M. Semen quality improvement in a man with idiopathic infertility treated with traditional Korean medicine: a case report. Explore (NY) 2015;11(4):320–3. DOI: 10.1016/j.explore.2015.04.007
2. Hamada A., Esteves S.C., Nizza M., Agarwal A. Unexplained male infertility: diagnosis and management. Int Braz J Urol 2012;38(5):576–94. DOI: 10.1590/s1677-55382012000500002
3. Kumar R. Male infertility – current concepts. Indian J Urol 2011;21(1):39–40. DOI: 10.4103/0970-1591.78419
4. Nicolau P., Miralpeix E., Solà I. et al. Alcohol consumption and in vitro fertilization: a review of the literature. Gynecol Endocrinol 2014;30(11):759–63. DOI: 10.3109/09513590.2014.938623
5. Sanchez M., Aran B., Blanco J. et al. Preliminary clinical and FISH results on hyaluronic acid sperm selection to improve ICSI. Hum Reprod 2005;20:i200. Available at: https://www.researchgate.net/publication/285075274_Preliminary_clinical_and_FISH_results_on_hyaluronic_acid_sperm_selection_to_improve_ICSI (access date: 22.05.2022).
6. Artini P.G., Obino M.E., Carletti E. et al. Conventional IVF as a laboratory strategy to rescue fertility potential in severe poor responder patients: the impact of reproductive aging. Gynecol Endocrinol 2013;29(11):997–1001. DOI: 10.3109/09513590.2013.822063
7. Gupta S., Sharma R., Agarwal A. Antisperm antibody testing: a comprehensive review of its role in the management of immunological male infertility and results of a global survey of clinical practices. World J Mens Health 2022;40(3):380–98. DOI: 0.5534/wjmh.210164
8. Vazquez-Levin M.H., Marín-Briggiler C.I., Veaute C. Antisperm antibodies: invaluable tools toward the identification of sperm proteins involved in fertilization. Am J Reprod Immunol 2014;72(2):206–18. DOI: 10.1111/aji.12272
9. Mazumdar S., Levine A.S. Antisperm antibodies: etiology, pathogenesis, diagnosis, and treatment. Fertil Steril 1998;70(5):799–810. DOI: 10.1016/s0015-0282(98)00302-1
10. Restrepo B., Cardona-Maya W. [Antisperm antibodies and fertility association (In Spanish)]. Actas Urol Esp 2013;37(9):571–8. DOI: 10.1016/j.acuro.2012.11.003
11. Kaur G., Thompson L.A., Dufour J.M. Sertoli cells – immunological sentinels of spermatogenesis. Semin Cell Dev Biol 2014;30:36–44. DOI: 10.1016/j.semcdb.2014.02.011
12. Francavilla F., Santucci R., Barbonetti A., Francavilla S. Naturally-occurring antisperm antibodies in men: interference with fertility and clinical implications. An update. Front Biosci 2007;12(8):2890–911. DOI: 10.2741/2280
13. Lombardo F., Gandini L., Dondero F., Lenzi A. Immunology and immunopathology of the male genital tract: antisperm immunity in natural and assisted reproduction. Hum Reprod Update 2001;7(5):450–6. DOI: 10.1093/humupd/7.5.450
14. Dimitrov D.G., Urbánek V., Zvĕrina J. et al. Correlation of asthenozoospermia with increased antisperm cell-mediated immunity in men from infertile couples. J Reprod Immunol 1994;27(1):3–12. DOI: 10.1016/0165-0378(94)90011-6
15. Verón G.L., Molina R.I., Tissera A.D. Incidence of sperm surface autoantibodies and relationship with routine semen parameters and sperm kinematics. Am J Reprod Immunol 2016;76(1):59–69. DOI: 10.1111/aji.12519
16. Gopalkrishnan K., Padwal V., Balaiah D. Does seminal fluid viscosity influence sperm chromatin integrity? Arch Androl 2000;45(2):99–103. DOI: 10.1080/014850100418783
