agxАндрология и генитальная хирургияAndrology and Genital Surgery2070-97812412-8902MedINK Publishing House LLC10.17650/2070-9781-2023-24-4-49-58agx-704Research ArticleОБЗОРНАЯ СТАТЬЯREVIEWВлияние ингибиторов ароматазы на мужскую фертильность: обзор литературыEffect of aromatase inhibitors on male fertility: literature reviewhttps://orcid.org/0000-0002-9041-2687ЕпанчинцеваЕ. А.EpanchintsevaE. A.

Елена Александровна Епанчинцева

630117 Новосибирск, ул. Тимакова, 2

630008 Новосибирск, ул. Кирова, 29

630091 Новосибирск, ул. Красный пр-кт, 52

Elena Aleksandrovna Epanchintseva

2 Timakova St., Novosibirsk 630117

29 Kirova St., Novosibirsk 630008

52 Krasniy Ave., Novosibirsk 630091

EpanE@yandex.ruhttps://orcid.org/0000-0003-4534-7289СелятицкаяВ. Г.SelyatitskayaV. G.

630117 Новосибирск, ул. Тимакова, 2

2 Timakova St., Novosibirsk 630117

https://orcid.org/0000-0001-7347-1901КорнеевИ. А.KorneevI. A.

197022 Санкт-Петербург, ул. Льва Толстого, 6–8

6–8 L’va Tolstogo St., St. Petersburg 197022

https://orcid.org/0000-0002-0559-697XБабенкоА. Ю.BabenkoA. Yu.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

ФГБНУ «Федеральный исследовательский центр фундаментальной и трансляционной медицины»; ООО «Новосибирский центр репродуктивной медицины» ГК «Мать и дитя»; ФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава РоссииРоссияFederal Research Center for Fundamental and Translational Medicine; Novosibirsk Center for Reproductive Medicine, “Mother and Child” Group of Companies; Novosibirsk State Medical UniversityRussian FederationФГБНУ «Федеральный исследовательский центр фундаментальной и трансляционной медицины»РоссияFederal Research Center for Fundamental and Translational MedicineRussian FederationФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова» Минздрава РоссииРоссияI.P. Pavlov First Saint Petersburg State Medical UniversityRussian FederationФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииРоссияV.A. Almazov National Medical Research Center, Ministry of Health of RussiaRussian Federation2023281120232444958Copyright © Епанчинцева Е.А., Селятицкая В.Г., Корнеев И.А., Бабенко А.Ю., 20232023Епанчинцева Е.А., Селятицкая В.Г., Корнеев И.А., Бабенко А.Ю.Epanchintseva E.A., Selyatitskaya V.G., Korneev I.A., Babenko A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://agx.elpub.ru/jour/article/view/704

По данным Российского общества урологов, частота бесплодных браков в разных регионах России колеблется от 8 до 17,2 %, при этом на долю мужского фактора приходится около половины всех случаев бесплодия, что требует взвешенного подхода к диагностике причин снижения фертильности и подбору персонализированной терапии. Согласно клиническим рекомендациям Российского общества урологов в терапии мужского бесплодия могут быть использованы гонадотропины, селективные модуляторы рецепторов к эстрогенам и антиоксиданты. В соответствии с рекомендациями Европейской ассоциации урологов и Американского общества репродуктивной медицины совместно с Американской ассоциацией урологов в этот перечень могут быть включены гонадотропин-рилизинг-гормон и ингибиторы ароматазы (ИА).

Цель работы – представить современные данные литературы о влиянии ИА на мужскую фертильность и уточнить место препаратов класса ИА в лечении мужского бесплодия.

Согласно данным литературы, ИА могут способствовать повышению концентрации, подвижности и доли нормальных форм сперматозоидов, снижению фрагментации ДНК сперматозоидов и нормализации процессов протаминации. Эти эффекты были более заметны у пациентов с избыточной массой тела и ожирением, а также с показателями соотношения уровней тестостерона и эстрадиола <10. В связи с важной ролью эстрогенов в сперматогенезе при использовании ИА целесообразно контролировать гормональный статус и не допускать снижения уровня эстрадиола ниже референсного диапазона с учетом его множественных эффектов. С другой стороны, данных о влиянии ИА на частоту наступления беременности и рождения ребенка накоплено мало. Очевидно, что для принятия решения о возможности применения ИА в клинической практике для лечения мужского бесплодия необходимы дальнейшие исследования, а для использования с этой целью ИА отечественными специалистами потребуется внесение соответствующих изменений в инструкции к лекарственным препаратам и изменение действующих регламентирующих документов.

Aсcording to the Russian Society of Urology the incidence of infertile couples ranges from 8 to 17.2 % in various regions of Russia, while the male factor accounts for about half of all cases, which requires a balanced approach to diagnosing the causes of reduced fertility and selecting personalized therapy. In accordance with the Russian Society of Urology guidelines, gonadotropins, selective estrogen receptor modulators and antioxidants can be used in the treatment of male infertility. According to the European Association of Urologists guidelines and American Urological Association/ American Society for Reproductive Medicine guidelines, this list may also include gonadotropin-releasing hormone and aromatase inhibitors (AI).

Research objective: to review up-to-date literature data on effect of IA on male fertility and clarify the place of AI in the treatment of male infertility.

The data obtained indicate that AI can increase the concentration, mobility and percentage of normal forms of spermatozoa, reduce sperm DNA fragmentation and normalize protamination processes. These effects were more pronounced in patients with overweight and obesity, as well as in patients with testosterone-to-estradiol ratios of <10. Given the important role of estrogens in spermatogenesis, when using AI, it is advisable to control the hormonal status and prevent estradiol from falling below the reference range, taking into account its multiple effects. However, a lack of quality data causes inability to accurately predict the effect of AI treatment on pregnancy rate and childbirth. Further research is required to formulate recommendations based on evidence for the use of AI for treatment of male infertility, in Russia changes in the instructions for medicines and regulatory documents will be required.

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The authors declare that there are no conflicts of interest present.