Результаты применения комплекса БЕСТФертил у пациентов после микрохирургической подпаховой варикоцелэктомии (операции Мармара)

Abstract

Up to 15% of couples around the world face the problem of infertility, while male factor in infertile marriages occurs in up to 50% of cases. Varicocele occurs in 15% of the male population and in 35% of men with infertility. For now, the only effective method of treating varicocele is operative. After surgical treatment, there is an improvement in spermogram parameters, however, it is not always possible to achieve normal value of each parameter.To assess the efficiency of BESTFertil in patients after varicocelectomy.The single-center, prospective, randomized study at the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov was conducted comparing the postoperative parameters of patients who underwent varicocelectomy, followed by the course of BESTFertil (main group) and without it (control group). A total of 63 patients were included in the study: the main group - 33 patients and the control group - 30 patients. The inclusion criteria for the study were: the presence of varicocele as the cause of pathospermia and / or the absence of pregnancy in marriage for 12 months or more of regular sexual activity without contraception, in the absence of other organic pathology as a possible cause of infertility, age from 18 to 45 years. Patients from both groups underwent surgical treatment of varicocele - microsurgical subinguinal varicocelectomy according to the standard Marmar technique using an operative microscope. Patients from the main group received BESTFertil for 3 months according to the recommended scheme.In the main group an average increase in the volume of ejaculate in 6 months was 0.48 ml (11.2% of the initial), the increase in concentration was 24.4 mln / ml (59.1%), the increase in motility was 25.2% (69.2%), morphologically normal forms - 3.4% (106.3%). A relapse of the disease was revealed in one patient, according to ultrasound and angiography, however, there was also a positive dynamic of spermogram parameters: an increase in ejaculate volume - 0.8 ml; increase in sperm concentration - 22 mln/ml; A + B motility-32%; morphologically normal forms - 1%. Four patients (16.7% of the total number of patients with infertile marriage in the main group) reported pregnancy. In the control group, an average increase in the volume of ejaculate in 6 months was 0.07 ml (1.7% of the initial), the increase in concentration was 11.7 mln / ml (27%), the increase in motility was 10.6% (32.7%), morphologically normal forms - 0.6% (9.8%). Two patients (9.1% of the total number of patients with infertile marriage in the control group) report pregnancy after treatment. One patient had a relapse of the disease, confirmed by angiography, despite his spermogram parameters correspond to normospermia.These results allow us to conclude that the course of BESTFertil in patients after treatment of varicocele allows to achieve a clinically and statistically significant increase in spermogram indicators such as ejaculate volume, its concentration, sperm motility and the number of morphologically normal forms, which can help patients achieve natural pregnancy or resort to assisted reproductive technologies.