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Aim. To assess the safety and efficacy of assisted reproductive technology (ART) programs in patients with systemic lupus erythematosus (SLE) with/without comorbid antiphospholipid syndrome (APLS). Materials and methods. The observational study included 26 patients with diagnosed SLE, of whom 7 women had comorbid APLS and disorders of reproductive function. The analysis of the causes of impaired fertility was based on history and comprehensive examination data, which, along with risk factors for possible complications, determined the choice of ART programs. Results. In 23 of 26 patients, infertility (primary: 14, secondary: 9) was diagnosed, and 3 patients were diagnosed with repeated miscarriage. The main etiological factors of infertility were tubal (n=6), male (n=8) and their combination (n=3); in 9 cases the etiology of infertility remained unclear. 10 patients with a history of lupus nephritis had a reduced ovarian reserve. In total, 23 infertile patients underwent 33 in vitro fertilization programs. 11 (33%) clinical pregnancies were registered, of which 7 ended in live birth. There were no cases of severe exacerbation of SLE and thrombotic complications. Conclusion. ART can be used in patients with SLE with / without APLS, if the underlying disease is compensated for and prevention for complications is used. The effectiveness of ART programs is comparable to that in the general population. Further research is needed to make a final judgment on the safety of various ART programs in SLE with/without APLS.
The study objective is to analyze spermogram values in HIV-positive men receiving antiretroviral therapy (ART). Materials and methods. The prospective case-controlled study included 115 men: the main group consisted of 51 patients with HIV, control group consisted of 64 patients with negative serological test for HIV and normal spermogram values. In total, 97 and 111 sperm samples were analyzed. HIV status was evaluated based on disease stage and phase, viral load, CD3+, CD4+, CD8+ lymphocyte counts and ART duration. Results. History of HIV varied between 2 and 9 years (median 5 years). All patients were receiving ART. Median duration of drug administration was 1.5 years. In 48.4 % of HIV-positive patients, normozoospermia was observed. In the structure of pathological zoospermia, teratozoospermia was the most prevalent (40 %), and the percentage of pathological forms of spermatozoa in HIV-positive men was significantly
The goal of the study was to evaluate the impact of antiretroviral therapy (ART) on the semen characteristics in HIV-infected men.Materials and methods. A prospective case-control study enrolled 66 HIV-infected male patients who presented for fertility assessment. Group 1 included 51 male patients treated with ART; Group 2 included 15 males who were not receiving ART. 97 and 25 semen samples were analyzed, respectively. HIV status was assessed based on the data regarding the stage and phase of the disease, viral load, CD3+, CD4+, CD8+ counts and the ART duration.Study results. At enrollment in the study, the duration of HIV infection in Group 1 was longer than that in Group 2 (the difference being statistically significant): 5 years (2–9 years) versus 2,5 years (0,4–4,5), respectively (р=0,0004). Median duration of treatment in Group 1 was 1,5 years. The most common type of abnormal semen morphology in ART-treated patients was teratozoospermia (40%), and the percentage of abnormally shaped spermatozoa in this group was higher compared to Group 2 (the difference being statistically significant): 97 (96–98) versus 96 (94,5–96,5); р=0,006). Group 1 demonstrated a negative relationship between the count of abnormally shaped spermatozoa and CD4+ cell count (r=–0,362; р=0,026), disease duration (r=0,173; р=0,173) and sperm count (r=–0,242; р=0,020), progressively motile (category B) sperm count (r=–0,241; р=0,024). The ART duration showed an inverse correlation with the progressively motile sperm count (category B) (r=–0,224; р=0,036). Group 2 demonstrated a statistically significant positive relationship between the CD4+ cell count, the semen volume (r=0,778; p=0,014), and the count of progressively motile (category B) spermatozoa (r=0,667; р=0,05). We also revealed a statistically significant inverse relationship between the viral load and the semen volume (r=–0,669; р=0,035). Sperm DNA fragmentation was found to be higher in HIV-infected patients treated with ART compared to HIV-infected men not receiving ART (15,8% (12,4–23,0) and 14% (10,9–20,5); р=0,533), respectively. Thus, HIV-infected patients treated with ART demonstrated abnormal sperm morphology (increased abnormal sperm count), decreased sperm motility and increased sperm DNA fragmentation level. The percentage of abnormally shaped sperm was higher in patients with lower CD4+ cell counts. In patients with a long history of HIV infection, the sperm count decreases and the count of immotile spermatozoa increases. HIV-infected individuals who are not receiving ART and have high viral loads show decreased semen volume. This value increases upon an increase in the CD4+ cell count.
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