Acta Medica Leopoliensia (Feb 2019)
Infertility prognostic factors of the pro-/antioxidant system in patients with varicocele
Abstract
Aim. To identify infertility prognostic factors of thepro-/ antioxidant system in men with left-side varicocele grade II-III. Materials and methods. The trial includes 67 patients with left-side varicocele grade II-III and concomitant changes in spermogram and / or infertility. During the follow up, three months after varicocelectomy, 62 patients were reexamined. The control group consisted of 25 virtually healthy men aged 19 to 33 years. Enzymes activity of pro-/antioxidant system in the blood plasma from periferal and from testicular veins, as well as in the spermatozoa were measured, before and 3 months after varicocelectomy. In particular, the activity of glutathione peroxidase, glutathione reductase and glutathione transferase, the concentration of reduced glutathione and malonic dialdehyde were determined. In addition, the activity of arginase, constitutive and inducible isoforms of nitric oxide synthase, the activity of ion-transport systems of sodium, potassium and calcium, magnesium adenosine triphosphatase in the spermatozoa were studied. Results and Discussion. The activity of glutathione antioxidant enzymes and the concentration of malonic dialdehyde as well as reduced glutathione in the serum of the internal spermatic veins in men with left side varicocele grade II-III were significantly different in comparison groups. Thus, a statistically significant reduction in the concentration of the glutathione-peroxidase system enzymes and of reduced glutathione in the serum of the internal spermaticvein were observed against the background of a reliable increase in the level of malonic dialdehyde compared with the concentrations of these parameters in serum of peripheral venous blood, and even more so with norm. Therefore, the ROC analysis of the above enzymes’ activity of the pro-/antioxidant system in serum from the internal spermatic vein of patients with left side varicocele grade II-III revealed certain patterns. Concentrations of glutathione-peroxidase system enzymes and reduced glutathione in spermatozoa of patients with left side varicocele grade II-III by analogy with the differences observed in the serum of the internal spermatic vein of these same patients, were characterized by a significant lag behind the rates in practically healthy men. In contrast, the level of malonic dialdehyde statistically significantly exceeded the norm. The obtained results confirm the thesis about the exhaustion of the compensatory mechanisms of the glutathione antioxidant system and increase the intensity of lipoperoxidic processes in spermatozoa in men with left-side varicocele grade II-III. The reduction in serum of the internal testicular vein of glutathione peroxidase activity to £148,55 nmol GSH/min·g Hb, of glutathione reductase to £32.7 mcmol NADPH/min·g Hb, and glutathione transferase to £137 nmol GSH/min·g Hb, as well as reduced glutathione to£0.85 mmol/l with malondialdehyde growth greater than 7,9 mcmol/l should be attributed to the prognostic predictors of the probability of infertility development in patients with left-side varicocele grade II-III. Results showed, that the most significant predictors of the probability of infertility development in spermatozoa were decreased activities of arginase £46 pmol citrulline/min ·1 mg protein and inducible nitric oxide synthase >1,2 pmol citrulline/min·1 mg protein. Conclusions. The negative influence of the reactive oxygen species on the quality of the ejaculate remains a relevant issue. Therefore, the practical application of the data about antioxidant imbalance in patients with varicocele requires further, more detailed study. Changes in fertility status in patients with varicocele leads to decreased levels of antioxidant and increased levels of prooxidant enzymes in the blood and spermatozoa wich can be used as a predictors of maleinfertility. Indicators of the pro-/antioxidant system have proven themselves as predictors of infertility in patients with varicocele.
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