The role of infectious and inflammatory processes in the formation of male infertility

Background. Male infertility has a multifactorial genesis, due to both congenital genetic disorders and acquired pathologies, such as urogenital infections, immune and endocrine diseases, hyperproduction of reactive oxygen species, etc. More than 30% of cases of male infertility are attributed to idiopathic disorders with an unexplained etiology. At the same time, men have an age-related decline in reproductive function, change of the architectonics of the testicles and the levels of reproductive hormones. Women got pregnant from older men have high risk of miscarriage and children of such couples have the likelihood of developing some disorders, including schizophrenia, autism, bipolar disorder, suicide attempts, and substance use. All of the above indicates the relevance of studies of risk factors for male infertility in the age aspect, which is necessary for the development of algorithms for timely prevention, as well as for the treatment of infertility. Objective. Analysis of the role of infectious and inflammatory processes associated with risk factors for infertility in men from infertile couples in terms of age. Methods. An observational retrospective, cross-sectional study was carried out. Outpatient medical records of 1380 male patients with the problem of the absence of pregnancy after marriage were analyzed. All patients were followed-up in Novosibirsk Center for Reproductive Medicine, GC “Mother and Child". Men from the formed sample (n=1380) were divided into 5 groups: group 1 (n=322) included patients aged 20.0-24.9 years (n=20) and patients aged 25.0-29.9 years (n=302); group 2 (n=488) - 30.0-34.9 years; group 3 (n=315) - 35.0-39.9 years; group 4 (n=163) - 40.0-44.9 years; group 5 (n=92) included patients aged 45.0-49.9 years (n=62), 50.0-54.9 years (n=22), and 55.0-59.9 years (n=8). Combining in groups 1 and 5 was carried out due to the small number of participants in individual age groups and the need to analyze the entire sample of patients. Results. In the general sample of men (n=1380), a high prevalence of persons (52.7%) with sexually transmitted infections (STIs), prostatitis (31.7%), and hepatitis B/C (5.9%) was detected. Analysis of infectious and inflammatory risk factors depending on age in the surveyed men has revealed a significant increase in the incidence of STIs in men under 45, an increase in the prevalence of prostatitis with age and a significant increase in the incidence of hepatitis B/C in men aged 35-45 years. Conclusion. Analysis of the risk factors for the development of infertility associated with infectious etiology has revealed STIs with the maximum frequency in men from infertile couples; prostatitis took the leading place among inflammatory diseases of the urogenital system, and hepatitis B/C - among socially significant infections. Given the significant increase in the incidence of STIs with age, it is necessary to carry out health education aimed at increasing the frequency of the use of barrier methods of contraception and regular assessment of the presence of STIs in men at any age. Taking into account the increase in the incidence of prostatitis with age and the complex underlying pathophysiological mechanisms, an integrated approach to this problem is required. Due to the high prevalence of hepatitis B and C in the 35-45 year-old age group and its pronounced negative impact on both fertility and the somatic status of patients, it is necessary to conduct screening tests for infection in this age group, and if it is detected, conduct antiviral therapy, aimed at both reducing viral load and complete cure.

sexually transmitted infections, prostatitis, epididymitis, orchitis, tuberculosis, hepatitis B, hepatitis C, HIV, male infertility, risk factors for the development of male infertility