A method of treating autoimmune infertility in men

 

(57) Abstract:

The invention relates to medicine, in particular to urology and andrology, and can be used in the treatment of autoimmune infertility in men. To do this, enter prednisolone at a daily dose of 1.2 mg per kg of body weight of the patient within 5 days. Then undergo plasmapheresis prior to normalize the number of antisperm antibodies (AA) in the patient's blood. Using the proposed method can improve the quantity and quality of spermatogenesis due to the excretion of AA from semen, and prevent complications of glucocorticoid therapy.

The invention relates to medicine, in particular to urology, and can be used in the treatment of autoimmune infertility in men.

The prototype of the invention is a method of treating autoimmune infertility in men, based on the use of prednisolone (C. A. Bogdonov and other Andrology and genital surgery. 2000. No. 1. - S. 50). The authors used prednisolone at a dose of 40 mg/day rates of up to 3-5 days. The purpose of prednisone short course in the dose suppresses the production of antisperm antibodies.

The disadvantage of this method is that the circulation of antisperm the t quality of sperm.

The objective of the invention is to improve quantitative (volume and number of sperm) and quality (motility, morphology, resistance, fertilizing capacity) indicators of spermatogenesis, increased efficiency in the treatment of autoimmune infertility in men.

The problem is solved in that in the method of treatment of autoimmune infertility in men, including the introduction of prednisolone, according to the invention prednisolone is administered in a daily dose of 1.2 mg per kg of body weight of the patient within 5 days, and then undergo plasmapheresis prior to normalize the number of antisperm antibodies in the patient's blood.

The normal function of the spermatogenic cells is possible due to the presence of hepatolenticular barrier, which is formed by its own membrane of the seminiferous tubules and the cytoplasm of Sertoli cells with selective permeability between the blood and the contents of the seminiferous tubules, it plays a significant role in the pathogenesis of autoimmune infertility in men. Ripe Spermatid and especially sperm cells have antigenic properties. Therefore, the violation of hepatolenticular barrier (trauma, ischemia, infection, and so on) leads to the formation in kravia.

The suggested dose of prednisolone suppresses the production of antibodies, immune complexes, and the subsequent course of plasmapheresis leads to their removal from the patient's blood to normalize the number of antisperm antibodies. The proposed method leads to improved spermatogenesis and fertilizing capacity of spermatozoa, expands the indications for conservative treatment of male autoimmune infertility. Improving semen confirmed the pregnancy in the observations. The proposed method enables the treatment of autoimmune male infertility in both residential and outpatient settings. Methodically the claimed method meets the objectives of the comprehensive etiopathogenetic therapy that can significantly improve therapeutic effect of treatment of autoimmune infertility men.

The method is carried out, for example, as follows.

Prednisolone is administered for 5 days, every day, at a daily dose of 1.2 mg per kg of body weight of the patient (30 mg per os 3 times a day that is 90 mg with an average weight of 75 kg patient). Prednisolone inhibits the production of antibodies, which leads to a decrease in their number in the blood. Due to the fact that the use of the structure of electrolyte balance, the proposed therapy should not exceed 6 days. After treatment prednisolone patient through the day undergo plasmapheresis, for example, on the plazmafiltr TFM-800 using a roller pump with capacity 50-70 ml / min in plasma volume to 15 ml per kilogram of body weight of the patient for removal of antisperm antibodies and immune complexes from the blood of the patient to normalize indicators.

The method is illustrated by the following clinical examples.

1. Patient K., 39 years old, medical history, No. 22444, asked for infertility in marriage. History of trauma to the scrotum without the localization of damage. In the semen: sperm count 60 million in 1 ml motile sperm 40%, degenerative forms 30%. Antisperm antibodies in the serum - 1650 IU/l (N - up to 70 IU/l). The diagnosis of Autoimmune infertility. Asthenozoospermia. After treatment, the proposed method according to the described method, the number of antisperm antibodies in the serum decreased to 73 IU/l Control tests of semen in 2 weeks and 1 month: the number of sperm - 80 million in 1 ml of mobile forms 65%, degenerative forms 20%.

2. Patient O. 24 year history No. 21399, asked about Otsu the research Institute in the semen sperm count 30 million in 1 ml, mobile forms 40%, degenerative forms - 25%. In serum, the number of antisperm antibodies was 380 IU/L. Diagnosis: autoimmune male infertility, oligozoospermia. After the course, we offer therapy number of antisperm antibodies in the serum decreased to 30 IU/l At follow-up semen after 2 weeks and 1 month: sperm count to 60 million in 1 ml of mobile forms up to 70%, degenerative forms up to 20%.

According to the claimed method were treated 56 patients with autoimmune infertility. In 89% of patients improved key indicators. The effectiveness of the treatment was confirmed by pregnancy in the majority of observations.

Using the proposed method can improve the quantity and quality of sperm production, increase the efficiency of treatment of autoimmune infertility in men.

A method of treating autoimmune infertility in men, including the introduction of prednisolone, characterized in that prednisolone is administered in a daily dose of 1.2 mg per kg of body weight of the patient within 5 days, and then undergo plasmapheresis prior to normalize the number of antisperm antibodies in the patient's blood.

 

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