Что следует знать урологу о фрагментации ДНК сперматозоидов

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Андрология и генитальная хирургия. 2023; 24: 24-35

Что следует знать урологу о фрагментации ДНК сперматозоидов

Олефир Ю. В., Ефремов Е. А., Родионов М. А., Живулько А. Р., Попов Д. М., Монаков Д. М.

https://doi.org/10.17650/2070-9781-2023-24-1-24-35

Аннотация

Введение. Спермограмма – один из основных методов лабораторной диагностики мужского бесплодия, но нормальные ее показатели не гарантируют, что пациент фертилен, а в 10–30 % случаев данное исследование не позволяет выяснить причину бесплодия. Исследование уровня фрагментации ДНК сперматозоидов (ФДС) – возможное решение данной проблемы.

Цель работы – систематизировать имеющуюся на сегодняшний день информацию о клиническом значении, причинах, методах диагностики и лечения ФДС для ее использования урологом в процессе повседневной практики.

Материалы и методы. Проведен поиск публикаций в базах данных eLIBRARY и PubMed с использованием ключевых слов: мужское бесплодие (male infertility), фрагментация ДНК сперматозоидов (sperm DNA fragmentation), этиология (causes), варикоцеле (varicocele), оксидативный стресс (oxidative stress), диагностика (diagnostics), лечение (treatment). Отобрано 111 исследований, которые включены в настоящий обзор.

Результаты. Алкоголь, курение, наркотические вещества, психоэмоциональный стресс, неблагоприятные факторы окружающей среды и профессиональные вредности, инфекции и воспалительный процесс в органах репродуктивной системы, варикоцеле и старший отцовский возраст могут приводить к повышению уровня ФДС и неблагоприятным репродуктивным исходам, в том числе при использовании вспомогательных репродуктивных технологий. Данные о роли метаболического синдрома в генезе ФДС неоднозначны. Основной механизм развития повреждения ДНК сперматозоидов – оксидативный стресс. Уровень ФДС может быть оценен с помощью прямых (Comet, TUNEL) и непрямых (SDS, SCSA) методов. Лечение при ФДС предполагает устранение факторов, приводящих к ее развитию, борьбу с оксидативным стрессом и назначение рекомбинантного фолликулостимулирующего гормона.

Заключение. Уровень ФДС – важный показатель для оценки мужского репродуктивного потенциала и прогнозирования успеха применения различных методов преодоления бесплодия. В последнее время отмечается расширение показаний для использования методов оценки целостности генетического материала сперматозоидов в клинической практике специалистов в области репродуктивной медицины.

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Andrology and Genital Surgery. 2023; 24: 24-35

What should urologist know about sperm DNA fragmentation

Olefir Yu. V., Efremov E. A., Rodionov M. A., Zhuvilko A. R., Popov D. M., Monakov D. M.

https://doi.org/10.17650/2070-9781-2023-24-1-24-35

Abstract

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.

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