MAIN ASPECTS OF DEPENDENCE OF METABOLIC SYNDROME AND MALE INFERTILITY (LITERATURE REVIEW)

Abstract

Oxidative stress of sperm (OSS) due to hyperproduction in seminal plasma of reactive oxygen species (ROS) (ozone, free radicals, hydrogen peroxide) is currently being considered among the most actively discussed causes of male infertility. Normally, ROS are present in the seminal plasma and act as physiological regulators of sperm function (activation of the acrosomal reaction, regulation of biochemical redox reactions of energy synthesis, elimination of biologically foreign proteins (exo- and endotoxins of microbes). Metabolic syndrome (MS) is now approximately equally common in men and women, and its incidence, for example, in the United States reaches 39%. In general, the problem of CU has acquired global significance today, as an increase in its frequency is observed in almost all developed countries. MS is a combination of abdominal obesity, insulin resistance (IR) or type 2 diabetes mellitus (DM-2), atherogenic dyslipidemia, hypertension, hemostasis disorders, endothelial dysfunction and chronic subclinical inflammation. According to most definitions, obesity and IR/ CD-2 are key components of MS. Decreased testosterone (androgen deficiency) is a new pathogenetically important component of MS in men, as the frequency and severity of androgen deficiency are directly proportional to obesity and impaired carbohydrate metabolism. Obesity is a key component of MS that has clear diagnostic criteria: with a European man’s waist circumference ≥ 94 cm, any specialist should diagnose «obesity», which has its code in ICD-10 (E.66). However, the negative contribution of obesity to the pathogenesis of male infertility is still clearly not appreciated in everyday clinical practice. The negative effect of obesity on testicular function is manifested in a decrease in total testosterone and sex-binding globulin, with adipose tissue hormones leptin, resistin and ghrelin play the most important role. Occurring in obesity androgen deficiency can lead to IP, which is a major metabolic factor that triggers systemic oxidative stress. P.M. Mah and G.A. Wittert cites similar evidence that obesity in men is significantly associated with low levels of total and free blood testosterone, which in turn increases the risk of developing both IR and diabetes-2. Today it is absolutely obvious that comprehensive diagnosis and pathogenetic therapy of male infertility is possible only with a team of specialists and these are the strict requirements of the XXI century – the century of pathogenetic and preventive medicine and interdisciplinary interactions. Therefore, a modern urologist from a surgeon must become a clinician and actively interact with related specialists (especially endocrinologists). Otherwise, the loss of reproductive potential by the male population may soon reach its «point of no return»...

Keywords

• metabolism
• insulin resistance
• infertility
• obesity