Мета: порівняти репродуктивну функцію у чоловіків з ідіопатичним безпліддям на основі показників спермо грами з радіаційно забруднених та умовно чистих регіонів України. Матеріали і методи. У відділі сексопатології та андрології ДУ «Інститут урології НАМН України» було проведе но дослідження репродуктивної функції у 143 осіб (І група) з ідіопатичним безпліддям у вигляді астенозоос пермії ІІ ступеня, які мешкають на територіях Київської області (Поліського, Чорнобильського, Іванківського, Бородянського, Вишгородського районів) та зазнали впливу іонізуючої радіації внаслідок аварії на ЧАЕС у 1986 році. Усі особи І групи були народжені від батьків, які знаходилися під час аварії на ЧАЕС в зоні радіаційного забруднення та постійно проживали на території з підвищеним радіоактивним фоном. Групу контролю склали особи, які народилися та мешкали на території Івано Франківської області, з аналогічним станом здоров'я (ІІ група, n = 157). Середній вік обстежених осіб І групи становив (28,3 ± 2,4) років, ІІ групи-(30,1 ± 2,8) років. Діагностика ідіопатичного безпліддя проводилася на амбулаторному етапі згідно зі стандартами ВООЗ та МОЗ України. Дослідження полягало у вивченні і порівнянні показників спермограми у пацієнтів обох груп. Результати. Репродуктивні проблеми у чоловіків з ідіопатичним безпліддям, які мешкають у радіаційно забруд нених районах Київської області України полягають в достовірному порушенні якісних показників еякуляту (рухливість сперматозоїдів за даними пулу А + В є меншою у 1,6 раза; р < 0,05), що корелюють з модифікаціями фізико хімічних (середній показник часу розрідження більший у 1,4 раза; р < 0,05) і біохімічних (зниження рівнів фруктози у 2,2 раза, цитрату-в 1,6 раза; р < 0,001-0,05) даних. Висновки. Встановлено, що рівень загальних показників спермограми є достовірно гіршим у регіонах України, які зазнали радіоактивного забруднення під час аварії на ЧАЕС, на відміну від показників осіб з умовно чистих регіонів. Ключові слова: ідіопатичне безпліддя, радіаційне забруднення, астенозооспермія, фруктоза.
The objective: the rationalization of a personalized approach to the selection of the program art on the basis of the allocation of risk. Patients and methods. Were analyzed 180 couples with male factor infertility, which in 2012-2015, in the Institute of reproductive medicine (IRM) (Kiev) was held the program of intracytoplasmic sperm injection (ICSI) with the aim of restoring fertility. Examination and ICSI procedure is carried out in accordance with clinical protocols. Results. According to the results of analytical and synthetic analysis of primary documents (enhanced, adapted to the purpose of the work of the medical record) were identified risk factors (and their signs) for the development of male infertility and grouped by direction of impact. As a result, 25 of the 51 factors and their basis formed three groups: social (behavioral), biological/clinical and special medical. With the help of mathematical analysis it was determined the boundary values of the minimum and maximum of reliability of the negative result of the application of ART. Conclusion. It was proposed the predictive map for the determination of the probability of pregnancy in couples with male infertility problems with the application of ART. Was justified the separation of three risk groups to restore fertility in couples with male factor infertility using ART. Was based the principle of personalized approach to choosing the best program of art-based stratification of men at risk groups. Key words: male infertility, assisted reproductive technologies, risk factors, prognostic chart.
The objective: analysis of the results in the resumption of fertility of infertile couples with male factor with a program of insemination with husband's sperm. Patients and methods. There are analyzed the results of achievement of genital function in 140 married couples with man’s infertility who in 2013–2015 underwent the program of insemination by man’s sperm at the Institute of Reproductive Medicine (Kyiv). Results. It has been stated that the pregnancy number and births after 3 attempts (420 cycles) with 3–5 month interval was reached in 17.0±1.8% and 15.0±1.8% of cases, respectively. There was confirmed the linear dependence between the fact of renewal of fertility and such factor as an age of a woman, duration of absence of native pregnancy, response of ovular function on stimulation. There was objectivized the influence on the result of readings of a spectrogram: the kind of pathospermia, the concentration of spermatozoons which is in the inverse dependence on the presence of predictors and determinants aggravating the total state of a man, and also the percent of actively movable fractions of sperms. Conclusions. Confirmed a causal relationship the result with such factors as age of women, duration of occurrence of natural pregnancy, ovulatory response to the stimulation. However, it is crucial to objectively brought the semen: patospermia, concentration of sperm and percentage of actively motile fractions thereof, as well as overall health of men. Key words: male infertility factor, insemination by man’s sperm, result.
Objective. The article attempts to analyze the nature of sexual dysfunctions in patients living in areas exposed to ionizing radiation as a result of the Chornobyl accident. Materials and methods. A study of sexual function was carried out in 186 people (group I) living in the territories of Kyiv (Polisske, Chornobyl, Ivankiv, Borodianka, Vyshhorod, Makariv districts) and Zhytomyr (Malyn and Korosten districts) regions. The control group consisted of persons who were born and lived on the territory of IvanoFrankivsk and Chernivtsi regions (group II, n = 123). Diagnostics was carried out on an outpatient basis in accordance with the standards of the WHO and the Ministry of Health of Ukraine. Results. Analyzing the obtained research results, a significantly larger number of patients with sexual dysfunction was identified in group I (82.3 %) than in group II (44.7 %) (р < 0.01). Psychopathological disorders disturbed, respectively, 60.2 % and 41.4 % (p < 0.01). Complaints of decreased libido were presented by 25.8 % of the surveyed men exposed to ionizing radiation, and 6.5 % of them were concerned about a sharp depression of libido. In group II patients, this indicator was 14.6 % and 3.3 %, respectively. The integral index of «libido» of the ICEF questionnaire revealed a statistically significant difference between the groups (9.23 ± 0.89 and 12.22 ± 1.26, respectively; р < 0.05). In patients exposed to ionizing radiation as a result of the Chornobyl accident, the concentration of testosterone decreases, and the content of FSH, LH, as well as globulin, which makes sex hormones, increases. Erectile dysfunction in patients of group I was detected in 58.1 % of men, and in patients of group II – 35.0 % (р < 0.01). The difference in the integral indicators of the ICEF questionnaire between the groups was 1.3 times behind the «libido» domain. For other domains – by 1.5–1.6 times. In men living in the territories of Kyiv and Zhytomyr regions, erectile dysfunction occurs earlier and is characterized by a more severe course than in people born and lived in the territory of Ivano-Frankivsk and Chernivtsi regions. Both in terms of low rates of normal erection (in patients of groups I and II, respectively 3.8 % and 13.3 %), and for high percentages of existing moderate/severe ED (respectively 71.0 % and 45.5 %), persons from group I are characterized by significantly worse data than persons from group II (р < 0.01). Orgasm pathology was found in 40.3 % of patients in group I and in 25.2 % of patients in group II (р < 0.01). The quality of life index according to the QoL index in the context of existing sexual disorders in group I of patients was 4.7 ± 0.4, in patients of group II – 3.9 ± 0.2 (р < 0.05). Conclusions. The data obtained indicate a tendency for a more significant violation of sexual functions in men who were born and lived in territories exposed to radioactive contamination as a result of the Chornobyl accident. Key words: Chornobyl accident, radioactively contaminated areas, men, sexual dysfunctions.
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