DOI: https://doi.org/10.30841/2307-5090.1.2018.144143

Антиоксиданты в терапии мужского бесплодия

І. І. Горпинченко, М. Г. Романюк, П. В. Аксьонов, Ю. Ф. Балацька, М. М. Лисенко

Аннотация


Цель исследования: определение эффективности препаратов, содержащих L-карнитин (Новофертил и Новокарнитин) в определенных случаях мужского бесплодия. Исследование является проспективным контролируемым.

Материалы и методы. Были обследованы 100 пациентов (в возрасте 20–40 лет) с анамнезом бесплодия с такими показателями спермограммы: концентрация 10–20×106/мл, общая подвижность 10–30%, прогрессивная подвижность <15%, атипичные формы <70%, скорость 10–30 мкм/с, линейность <4. Завершили исследование 86 пациентов. Больные получали терапию препаратом Новофертил по 1 капсуле 2 раза в день и Новокарнитин 3,00 г по 1 флакону в день или базовую гормонредуцированную терапию (витамины Е и С, цинк, селен); перед терапией был 2-месячный период отбора, затем 2 мес Новофертила совместно с Новокарнитином/базовой терапии, 2 мес контроля, следующие 2 мес перекрестной терапии (базовая терапия/Новофертил и Новокарнитин). Основными исследуемыми показателями были параметры спермограммы, в частности, подвижность.

Результаты. На фоне использования препаратов Новофертил и Новокарнитин отмечалось достоверное улучшение показателей общей и прогрессивной подвижности сперматозоидов, концентрации сперматозоидов (по сравнению с базовой терапией). Улучшение подвижности было более выражено у пациентов с худшими показателями подвижности, в частности <5 млн прогрессивно подвижных сперматозоидов в эякуляте и <2 млн в 1 мл.

Заключение. На основании контролируемого исследования эффективности препаратов Новофертил и Новокарнитин повышается качество спермы, особенно в группах с более низкими начальными показателями.

Ключевые слова


фертильность; мужское бесплодие; олигозооспермия; L-карнитин; подвижность сперматозоидов; митохондрии

Полный текст:

PDF

Литература


Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during the past 50 years. Br Med J 1992;305:609–13. https://doi.org/10.1136/bmj.305.6854.609

Auger J, Kunstmann JM, Czyglik F, Jouannet P. Decline in semen quality among fertile men in Paris during the past 20 years. N Engl J Med 1995;332:281–5. https://doi.org/10.1056/NEJM199502023320501

Gandini L, Lombardo F, Culasso F, Dondero F, Lenzi A. Myth and reality of the decline in semen quality: an example of the relativity of data interpretation. J Endocrinol Invest 2000;23:402–11. https://doi.org/10.1007/BF03343745

Swan SH, Elkin EP, Fenster L. The question of declining sperm density revisited, an analysis of 101 studies published 1934–1996. Environ Health Perspect 2000;108:961–6. https://dx.doi.org/10.1289%2Fehp.00108961

WHO manual for the standardized investigation, diagnosis and management of the infertile male. Rowe P, Comhaire F, Hargreave B, Mahmoud A, eds. Cambridge: Cambridge University Press: 2000:37–60.

Nieschlag E. Care for the infertile male. Clin Endocrinol 1993;38:123– 33. https://doi.org/10.1111/j.1365-2265.1993.tb00983.x

O’Donovan PA, Vandekerckhove P, Lilford RJ, Hughes E. Treatment of male infertility: Is it effective? Review and Meta-analyses of published randomized controlled trials. Hum Reprod 1993;8:1209–22. http://dx.doi.org/10.1093/oxfordjournals.humrep.a138230

Kamischke A, Nieschlag E. Analysis of medical treatment of male infertility. Hum Reprod 1999;14(Suppl 1):1–23. https://doi.org/10.1093/humrep/14.suppl_1.1

Adamopoulos DA. Present and future therapeutic strategies for idiopathic oligozoospermia. Int J Androl 2000;23:320–31. https://doi.org/10.1046/j.1365-2605.2000.00258.x

Oehninger S. Clinical and laboratory management of male infertility: an opinion on its current status. J Androl 2000;21:814–21. https://doi.org/10.1002/j.1939-4640.2000.tb03411.x

Scottish Infertility Group. The effect of clomiphene citrate and vitamin C for male infertility: a randomized trial. Brit J Urol 1982;54:780–4. https://doi.org/10.1111/j.1464-410X.1982.tb13647.x

Scottish Infertility Group. The effect of mesterolone versus vitamin C for male infertility: a randomized trial. Brit J Urol 1984;56:740–4. https://doi.org/10.1111/j.1464-410X.1984.tb06160.x

Knuth UA, Honingl W, Bals-Pratsch M, Schleicher G, Nieschlag E. Treatment of severe oligozoospermia with hCG/hMG, a placebo-controlled, double blind trial. J Clin Endoc Metab 1987;65:1081–7. https://doi.org/10.1210/jcem-65-6-1081

World Health Organization. Mesterolone and idiopathic male infertility, a double blind study. Int J Androl 1989;12:254–64. http://dx.doi.org/10.1111/j.1365-2605.1989.tb01312.x

World Health Organization. A double-blind trial of clomiphene citrate for the treatment of idiopathic male infertility. Int J Androl 1992;15: 299–307. https://doi.org/10.1111/j.1365-2605.1992.tb01129.x

Lenzi A, Culasso F, Gandini L, Lombardo, Dondero F. Placebo-controlled, double-blind, cross-over trial of glutathione therapy in male infertility. Hum Reprod 1993;8:1657–62. http://dx.doi.org/10.1093/oxfordjournals.humrep.a137909

Keck C, Behre HM, Jockenhovel F, Nieschlag E. Ineffectiveness of kallikrein in treatment of idiopathic male infertility: a double-blind, randomized, placebo-controlled trial. Hum Reprod 1994;9:325–9. https://doi.org/10.1093/oxfordjournals.humrep.a138501

Kessopoulou E, Powers HJ, Sharma KK, Pearson MJ, Russell JM, Cooke ID, et al. A double blind randomized placebo controlled trial using the antioxidant vitamin E to treat oxygen species associated male infertility. Fertil Steril 1995;64:825–31. https://doi.org/10.1016/S0015-0282(16)57861-3

Vandekerckhove P, Lilford R, Hughes E. The medical treatment of idiopathic oligo/asthenospermia, androgens (mesterolone or testosterone) versus placebo or no treatment. In: Lilford R, Hughes E, Vandekerckhove P, eds. Subfertility module of the Cochrane database of systematic reviews. Oxford: The Cochrane Library, Update Software,1996.

Vandekerckhove P, Lilford R, Hughes E. The medical treatment of oligo/asthenospermia, anti-oestrogens (clomiphene or tamoxifen) versus placebo or no treatment. In: Lilford R, Hughes E, Vandekerckhove P, eds. Subfertility module of the Cochrane database of systematic reviews. Oxford: The Cochrane Library, Update Software, 1998.

Kamischke A, Behre HM, Bergmann M, Simoni M, Schafer T, Nieschlag E. Recombinant human follicle stimulating hormone for treatment of male idiopathic infertility: a randomized, double-blind, placebo– controlled, clinical trial. Hum Reprod 1998;13:596–603. https://doi.org/10.1093/humrep/13.3.596

Rolf C, Cooper TG, Yeung CH, Nieschlag E. Antioxidant treatment of patients with asthenozoospermia a moderate oligoasthenozoospermia with high-dose vitamin C and vitamin E: a randomized, placebocontrolled, double blind study. Hum Reprod 1999;14:1028–33. https://doi.org/10.1093/humrep/14.4.1028

Lenzi A, Picardo M, Gandini L, Lombardo F, Terminali O, Passi S, et al. Glutathione treatment of dyspermia: effect on the lipoperoxidation process. Hum Reprod 1994;9:2044–50. https://doi.org/10.1093/oxfordjournals.humrep.a138391

Lenzi A, Picardo M, Gandini L, Dondero F. Lipids of sperm plasma membrane: from polyunsaturated fatty acid considered as markers of sperm function to possible scavenger therapy. Hum Reprod Update 1996;2:246–56. https://doi.org/10.1093/humupd/2.3.246

Lenzi A, Gandini L, Picardo M. A rationale for glutatione therapy. In debate on: is antioxidant therapy a promising strategy to improve human reproduction? Hum Reprod 1998;13:1419–22. https://doi.org/10.1093/oxfordjournals.humrep.a019708

Frenkel RA, Mc Garry JD, eds. Carnitine biosyntesis, metabolism and function. [Italian edition] New York: Academic Press, 1984.

Peluso G, Nicolai R, Reda E, Benatti P, Barbarisi A, Calvani M. Cancer and anticancer therapy-induced modifications on metabolism mediated by carnitine system. J Cell Physiol 2000;182:339–50. https://doi.org/10.1002/(SICI)1097-4652(200003)182:3%3C339::AID-JCP4%3E3.0.CO;2-B

Arduini A. Carnitine and its acyl esters as secondary antioxidants? Am Heart J 1992;123:1726–7. https://doi.org/10.1016/0002-8703(92)90850-U

Costa M, Canale D, Filicori M, D’Iddio S, Lenzi A. L-carnitine in idiopathic asthenozoospermia, a multicenter study. Andrologia 1994; 26:155–9. https://doi.org/10.1111/j.1439-0272.1994.tb00780.x

Vicari E, Calogero AE. Effects of treatment with carnitines in infertile patients with prostato-vesiculo-epididymitis. Hum Reprod 2001;16: 2338–42. https://doi.org/10.1093/humrep/16.11.2338

World Health Organization. Laboratory manual for the examination of human semen and semen-cervical mucus interaction, 4th ed. Cambridge: Cambridge University Press, 1999.

Soufir JC, Marson J, Jouannet P. Free L-carnitine in human seminal plasma. Int J Androl 1981;4:388–97. https://doi.org/10.1111/j.1365-2605.1981.tb00723.x

Aitken RJ, Clarkson JS, Fishel S. Generation of reactive oxygen species, lipid peroxidation and human sperm function. Biol Reprod 1989; 41:183–97. https://doi.org/10.1095/biolreprod41.1.183

Gandini L, Menditto A, Chiodo F, Lenzi A. Italian pilot study for an external quality control scheme in semen analysis and antisperm antibiotics detection. Int J Androl 2000;23:1–3. https://doi.org/10.1046/j.1365-2605.2000.00208.x

Lenzi A. Computer-aided semen analysis (CASA) 10 years later, a test-bed for the European scientific andrological community. Int J Androl 1997;20:1–2. https://doi.org/10.1046/j.1365-2605.1997.00107.x

Dondero F, Gandini L, Lombardo F, Salacone P, Caponecchia L, Lenzi A. Antisperm antibody detection: 1. Methods and standard protocol. Am J Reprod Immunol 1997;38:218–23. https://doi.org/10.1111/j.1600-0897.1997.tb00302.x

Bolton S. Pharmaceutical statistics practical and clinical application. New York: Marcell Dekker, 1997:410–5.

Nieschlag E, Leifke E. Empirical therapies for male idiopathic infertility. In: Nieschlag E, Behre G, eds. Andrology: male reproductive health and dysfunction. Berlin: Springer Verlag, 1997:313–24.

Ruiz-Pesini E, Alvarez E, Enriquez JA, Lopez-Perez MJ. Association between seminal plasma carnitine and mitochondrial enzymatic activities. Int J Androl 2001;24:335–40. https://doi.org/10.1111/j.1365-2605.2001.00311.x

Comhaire F. Clinical andrology: from evidence-base to ethics. The “E” quintet in clinical andrology. Hum Reprod 2000;15:2067–71. https://doi.org/10.1093/humrep/15.10.2067

Radford JA. Is prevention of sterility possible in men? Ann Oncol 2000;11(Suppl 3):173–4. https://doi.org/10.1093/annonc/11.suppl_3.173

Sandlow JI. Shattering the myths about male infertility. Treatment of male factors may be more successful and costeffective than you think. Postgrad Med 2000;107:235–9. https://doi.org/10.3810/pgm.2000.02.902

Falcone T. What the internist needs to know about infertility. Cleve Clin J Med 2001;68:65–72.

Giancarlo Balercia, Francesko Regoli, Tatiana Armeni, Aleardo Koverech, Franco Mantero, Marco Boscaro. Placebo-controlled double-blind randomized trial on the use of L-carnitine, L-acetylcarnitine, or combined L-carnitine and L-acetylcarnitine in men with idiopathic asthenozoospermia. Fertility and Sterility 2005;84(3): 662-71. https://doi.org/10.1016/j.fertnstert.2005.03.064

Jehan J. Aram, Kassim J. Al-Shamma, Ansam N. Al-Hassani, Effect of L-carnitine, Multivitamins and their Combination in the Treatment of Idiopathic Male Infertility. Iraqi J Pharm Sci, Vol.21(1) 2012




Copyright (c) 2018 Здоровье мужчины

Creative Commons License
Эта работа лицензирована Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

ISSN 2412-5547 (Online), ISSN 2307-5090 (Print)