Method for predicting male sterility

FIELD: medicine, andrology.

SUBSTANCE: one should study patient's ejaculate for the content of metals and at detecting either mercury or lead being above 3.15 mcg/l on should conclude upon intoxication type of sterility. The present innovation enables to conduct differentiated diagnostics between idiopathic and intoxication types of male sterility.

EFFECT: higher accuracy of investigation.

3 ex, 1 tbl

 

The present invention relates to medicine, namely to andrology, and can be used for differential diagnosis of secretory and intoxication of male infertility and the appointment of adequate treatment.

It is known that the decrease in sperm quality causes of male infertility. In the last fifty years in most developed countries decreased semen quality in men of reproductive age. Infertility in men leads to growth of infertile marriages, a small number of children families, divorce, and, ultimately, to the worsening of the demographic indicators. The proportion of infertile marriages in the world reaches 15%. This male infertility in the structure of infertile couples is from 30% to 50%.

The main method of diagnosis of male infertility is a macro - and microscopic examination of semen. This method allows the calculation of spermatozoa in 1 ml in the entire ejaculate, to determine the number of motile sperm, percentage of morphologically modified forms of spermatozoa and the concentration of leukocytes (Laboratory diagnosis of male infertility: a Method recommendations. - M., 1979. - 20 C.). This method allows to conclude visible pathology of sperm - the presence of high content of leukocytes and erythrocytes, indicating inflammatory and infectious diseases Polo who's ways; the presence of a small amount of sperm or their complete absence; the presence of abnormal (pathological degenerative forms of sperm cells; reduction in the percentage of motile sperm.

When using this method causes pathological changes in the sperm is not identified, therefore, to assign adequate treatment of male infertility is extremely difficult.

Also known biochemical methods of sperm, which includes the determination of the content of citric and ascorbic acids, acid phosphatase (Laboratory diagnosis of male infertility. Method recommendations. M, - 1979, p.22-30).

The disadvantages of this method include the fact that on the basis of biochemical studies of sperm diagnosed only secretory male infertility, as this method allows to estimate only the functional state of the accessory sex glands - seminal vesicles and the prostate gland and testicles.

It is also known that the toxic effects of certain chemicals on the sex glands, including heavy metals, leads to similar clinical picture. Environmental pollution by a large number of industrial poisons increased the likelihood of these substances in the human body. In particular, mercury compounds found is more in paints, seeds, food products, medicines and cosmetics. Lead compounds are used in the printing industry, in the manufacture of various coatings, paints, alloys, toys, rubber products, added to gasoline. Go on the human body of heavy metal compounds orally, by inhalation and by absorption from the surface of the skin and mucous membranes.

Closest to the present invention is a method for the diagnosis of male infertility, including the determination of the content of chemical elements, including metals in the ejaculate (Chen Wei, Han Xiaodong et ai. //Nanjing daxue xuebao. Ziran kexue, No. 4, 1996, p.346-349). Study 13 chemical elements in the seminal fluid is conducted in men of reproductive age suffering from infertility (azo - and oligospermia).

Authors known way marked some regularity in the change of concentration of 13 trace elements, among which the most significant is the change in the content of zinc and phosphorus. It is noted that the content of zinc and phosphorus was different in the groups of healthy and infertile men of reproductive age.

The disadvantages of this method include the fact that the content of zinc in seminal fluid is not a diagnostic criterion of infertility, because the toxicity of zinc is low, and the introduction of it in excess it does not accumulate and is derived from the organization of the mA (Avtsin A.P., Larks A.A., riche M.A. the Microelementoses person. - M.: Medicine, 1991). Moreover, zinc deficiency in the body leads to disruption of sexual development, the disruption of normal body hair growth, atrophy of the testicles and prostate gland, the disease Prasada” (see ibid.). The normal concentration of zinc in seminal fluid 1900 µg/g

Not a diagnostic criterion of male infertility and content in the ejaculate of phosphorus, because phosphorus does not apply to cumulative elements. In addition, phosphorus is found in all body tissues and is an essential component of its internal environment. In the adult human body contains 650 g of phosphorus, phosphate anions are present in the cytoplasm of cells mainly in the form of phosphates (Moskalev SCI Mineral metabolism. - M.: Medicine, 1985).

Consequently, changes in the concentration of these chemical elements in the ejaculate is not an accurate indicator of male infertility.

The objective of the proposed solutions is to develop a method for the diagnosis of male infertility.

The technical result of the proposed method is to improve the accuracy of differential diagnosis of idiopathic and toxic forms of male infertility.

The technical result is achieved by a method for the diagnosis of male infertility includes the study of ejaculate on the content of the metals.

The difference lies in the fact that conduct the determination of metals in the ejaculate and when the mercury detection or the detection of lead >3,15 µg/l set may be a form of infertility.

The analysis of special and patent literature showed that the proposed method does not provide the same solutions for the diagnosis of intoxication forms of infertility. Consequently, the proposed solution meets the criteria of the invention of "novelty."

The authors of the proposed method for the first time the survey ejaculate on the presence and quantitative content of metals such as mercury and lead.

Despite the known toxic effects of lead and mercury on a living organism, previously has not been proposed to use these metals as markers in the diagnosis of male infertility.

Since the change in vital trace elements varies depending on the state of the body (vitamin deficiency, hypervitaminosis, intake of vitamins and trace elements, etc. and not always an indicator of male infertility, the authors claimed method is proposed to estimate the disruption of spermatogenesis in the presence of seminal fluid mercury and lead-free >3,15 µg/L.

In addition, the study only two components can reduce the number of performed tests with the icenii accuracy of diagnosis.

This method is intended for use in health care and can be used in andrology, urology, endocrinology departments. The implementation of its capabilities is confirmed as described in the application techniques and equipment.

Therefore, the Method of diagnosis of male infertility” meets the criteria of "inventive step" and "industrial applicability".

The proposed method lies in the fact that men surveyed about infertile couples, in samples of ejaculate determine the content of mercury and/or lead method flameless atomic absorption analysis (atomic absorption spectrophotometry).

The proposed method is as follows. Mineralization ejaculate taken 1 hour after ejaculation, is carried out in a sealed reactor. Then 2 cm3studied ejaculate pipette contribute in a Teflon vessel, add 1 cm3concentrated nitric acid, 1 cm330% hydrogen peroxide, seal the reactor and placed in a drying Cabinet at a temperature of 150°within hours. The final volume of the mineralization is brought to 5 cm3with distilled water. For analysis of solutions obtained after decomposition of the samples by flame method, atomization, use an air-propane flame and trendlewood g is Relco or acetylene flame and single-slot burner. The concentration of metals in the sample solution is determined by the calibration curve in comparison with the standard solutions. Basic standard solutions of 1 mg/cm3made from standard samples on the State registry of measures and measuring instruments (Techniques of measurements. GOST 8.563-96. - M.: Russian State Standard. - 1997. - 20 C.).

The essence of the proposed method for the diagnosis of male infertility is illustrated by examples of specific performance.

Example 1.

Extract from the patient card. Patient A. 30 years appealed to the Regional diagnostic and treatment center with a complaint about the absence of children in marriage. Married for five years. Sexual life regular, two or three times a week. Contraceptives wife not in use. Wife examined by gynecologist - endocrinologist. Pathology it is not revealed. From the anamnesis of a patient's life: first child was born, grew and developed normally. Suffered diseases - measles (in 2 years), pneumonia (10 years). Occupational hazards has not. In semen analysis (only made in four different time) determined the reduction in the number and mobility of sperm. Semen analysis: a Volume of 2.0 ml, grey color, texture is viscous. The number of sperm in 1 ml of 10 million; the total number of sperm in the ejaculate 20 million Motility of sperm: rapidly progressive movement - no, not progressive movement (5%), molopo wijnia - 15%, motionless - 80%. The morphology of sperms: normal form - 38%, pathology of the head is 30%, and cervical pathology - 25%, pathology tail - 5%, young forms - 2%. Viability (% live) - 57%. Leukocytes are isolated, 7,8.

Conducted additional tests: General blood and urine tests, ultrasound of the kidneys, bladder, organs scrotum, prostate gland. Defined levels luteina-stimulating hormone (LH), testosterone, follicle-stimulating hormone (FSH) in the blood plasma. Results within normal limits.

Consultation of the urologist revealed no pathology. Consultation of the endocrinologist endocrine system without pathology.

For diagnosis in sperm samples by atomic absorption analysis determined the presence of heavy metals - mercury and lead. The study showed that the presence of mercury were not detected lead concentration in semen was 3,15 µg/L.

On the basis of the presence in the semen lead diagnosed with Toxic form of infertility. Oligoasthenozoospermia.

Treatment: unithiol (chelating agents) under the scheme, vitamins, biostimulants, adaptogens. Semen analysis after treatment: the Volume of 4.0 ml, grey, liquid. The number of sperm in 1 ml 40 ml, the total number of sperm in the ejaculate 160 ml Motility of sperm: rapidly progressive movement - 15%, slowly progressive is the movement - 4%, non-progressive movement - 25%, sedentary 36 percent fixed - 20%. The morphology of sperms: Normal form - 62%, pathology of head - 12%, and cervical pathology - 7%, pathology tail - 2%, young forms - 2%. The viability of 83%. pH of 7.6. Leukocytes are isolated.

As can be seen from the results of semen, fertility sperm after treatment has increased. As a result of repeated studies established: the presence of mercury were not detected lead concentration in semen was 1,07 g/l After 4 months after treatment, the patient's wife became pregnant. Normal pregnancy.

Example 2.

Extract from the patient card. Patient S. 28 years appealed to the Regional diagnostic and treatment center with a complaint about the absence of children in marriage. Married 3 years. Sexual life regular. Contraceptives wife not in use. Wife examined by gynecologist - endocrinologist about infertile marriage, revealed no pathology. From the anamnesis of a patient's life: he was born the third child, grew and developed normally. The disease - ARD. Professional activity is connected with harmful conditions, characterized by a high content of mercury vapor in the air electrolysis shop aluminum plant. Work experience 5 years. Five analyses of sperm made in the dynamics, we found a decrease in the number and mobility of sperm. Semen analysis: Yam 2.0 ml, color grey, the texture is viscous. The number of sperm in 1 ml - 5 million; the total number of sperm in the ejaculate is 10 million Motility of sperm: rapidly progressive movement - no, not progressive movement - 5%, sedentary - 20%, motionless - 75%. The morphology of sperms: normal form - 15%, head pathology - 40%, and cervical pathology - 35%, pathology tail - 5%, young forms - 5%. Viability (% live) - 43%. Leukocytes are isolated, 7,8.

Conducted additional tests: General blood and urine tests, ultrasound of the kidneys, bladder, organs scrotum, prostate gland. Defined levels luteina-stimulating hormone (LH), testosterone, prolactin, follicle-stimulating hormone (FSH) in the blood plasma. Results within normal limits.

Consultation of the urologist revealed no pathology. Consultation of the endocrinologist endocrine system without pathology.

To clarify the diagnosis was carried out by atomic absorption analysis of semen samples of the content and the amount of mercury and lead. The study showed that the mercury concentration in semen was 0.45 ág/l, the content of lead was not detected.

On the basis of the presence in the semen of mercury diagnosed with Toxic form of infertility. Oligoasthenozoospermia.

Treatment: unithiol (chelating agents) under the scheme, vitamins, beastialy the ora, adaptogens. Semen analysis after treatment: a Volume of 3.0 ml, grey, liquid. The number of sperm in 1 ml of 11 million, the total number of sperm in the ejaculate 33 million Motility of sperm: rapidly progressive movement - 1%, non-progressive movement - 19%, sedentary - 56%, motionless - 24%. The morphology of sperms: Normal form - 55%, pathology of the head is 22%, and cervical pathology - 17%, pathology tail - 3%, young form - 3%. Viability - 73%. pH of 7.6. Leukocytes are isolated.

As can be seen from the results of semen, fertility sperm after treatment has increased. The re-survey conducted three months, established: the presence of lead were not detected mercury concentration in semen was estimated to be 0.05 ág/l After 8 months after treatment, the patient's wife became pregnant. He was born a healthy child.

Example 3.

To assess the diagnostic accuracy intoxication forms of male infertility were formed 2 groups of patients, 6 men in each group. Patients of the 1st group was conducted comprehensive therapy of secretory infertility in the usual way: hormones, biogenic agents, Immunostimulants, vitamins. Increase fertility sperm after treatment registered 1 men.

Patients of group 2 was assigned to combination therapy, comprising an antidote to heavy metal - unithiol. This drug is you who leads the poison from the body, forming heavy metals, persistent cyclic compounds. Treatment of this group of men carried out in two stages. The first stage involved pathogenetic therapy aimed at removing mercury and lead from the body - intravenous administration of a 5% solution of unithiol. In the second phase of treatment was administered hormones in stimulating doses, vitamins, biogenic agents, Immunostimulants.

After treatment increase fertility sperm registered in 4 patients, normalization of sperm in 1 men, semen unchanged in 1 patient.

The proposed method was examined 28 semen samples of men, consisting in a barren marriage. The control group consisted of 28 men ejaculate within which the presence of lead and mercury were not detected.

Changes of parameters of ejaculate on overall group data before and after treatment are given in the table.

The investigated parameters of the ejaculateThe control groupBefore the treatmentAfter the treatment
Lead0,7±0,24,5±1,11,9±0,8
Mercury00,45±0,10
To the of sperm in 1 ml 45±3 million15±1 million40±4 million
Total number of sperm126±7 million30±3 million120±5 million
Rapidly progressive movement20%0%18%
Non-progressive movement22%5%22%
Sedentary40%55%45%
Fixed12%40%15%
Viability (% live)85%47%85%
LeukocytesEd. in the p/SP12 in the p/SPEd. in the p/SP
Morphology (normal forms)75%43%72%
volume4 ml2 ml3 ml

All these patients at earlier stages of the survey was diagnosed with Idiopathic infertility. After study offers the established method was diagnosed with toxic form of infertility.

Thus, the proposed method for the diagnosis of male infertility allows to determine the content of mercury and lead in the sperm and differential diagnosis idiopathic and toxic forms of male infertility.

A method for the diagnosis of male infertility, including examination of the ejaculate on the metal content, wherein when the detection of the presence of mercury or the detection of lead >3,15 µg/l set may be a form of infertility.



 

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