In recent years, the accelerated development of technologies in the field of molecular genetics and cytogenetics has led to significant opportunities of the research and diagnosis of mutations and variations of the genome. This article provides a brief review of new molecular technology, also as the results of their use in reproductive medicine and their perspectives in the genetic diagnosis of male infertility. 

The article presents the medical-rehabilitation program, designed to meet a determining role in the formation of mental pathology of disorders of sexual desire. The basic principles of therapeutic measures are graded and comprehensive, appointed according to the nature of mental disorders, libido disorders, clinical manifestations and characteristics of the partnership situation. The dynamics of the therapeutic are described in detail. 

Malignant tumors of the testicle comprise about 1–2 % of all neoplasms in males and 5 % of tumors of the urinary system and male genitals. At early stages, malignant tumors of the testicle have no clinical manifestations. Gradually increasing in size, they change the shape and density of the testicle. Men seeking medical consultation on infertility are recommended to undergo ultrasound examination of the scrotum. As a result, in patients with normal tumor marker levels and lack of symptoms small (less than1 cmin diameter) testicular tumors (incidentalomas of the testicle) and testicular microlithiasis are diagnosed. Lately, a number of studies has shown a possible need to expand indications for organ-preserving treatment, in particular, for incidentalomas of the testicle. Here we present a literature review on this subject and our clinical observations. 

May–Thurner syndrome is a complex disease diagnosed. Most often it occurs in young men with unrealized fatherhood. From September 2015 to December 2016 164 men are examined with suspected varicocele. The diagnosis of May–Thurner syndrome is confirmed in 6 patients (2.7 %). The average age of patients with May–Thurner syndrome was 26.4 ± 4.4g (17–38 years old). If you suspect a May–Thurner syndrome, diagnostic algorithm appropriate to start with a search of the asymmetry of blood flow in the iliac veins according to Doppler ultrasound. The optimum therapeutic tactics in these patients will be left intravascular stenting iliac veins in identifying positive pressure gradient in it more than10 mmHg compared with the inferior vena cava. 

Introduction. In the last decade, an understanding of the two-fold nature of genetic apparatus damage in spermatozoa has emerged: abnormal chromatin condensation (“immature” chromatin, ICH) related to defective protaminization and leading to altered epigenetic regulation of the early embryogenesis, and disruption of DNA integrity, i. e. DNA fragmentation (DFS).

Objective. Study of the correlation between abnormal chromatin condensation in spermatozoa and DFS.

Materials and methods. The study included spermatozoa of 54 fertile males (1^st group, control), 46 patients with primary infertility (2^nd group), and 111 patients whose wives had a history of pregnancy abnormalities or failures of the assisted reproductive technology (ART), i. e. arrested embryonic development (3^rd group). Presence of ICH was identified by quantitative electron microscopy, presence of DFS by TUNEL. Study of ICH and DFS in the same spermatozoon was conducted using correlation microscopy (TUNEL with subsequent ultrastructural analysis of the labeled cells).

Results. The number of ICH spermatozoa significantly differed in the 3^rd group from the control group (29.26 ± 13.49 vs. 22.43 ± 9.54; p = 0.006). The number of ICH spermatozoa in the 2nd group was higher than in the control group, but the difference wasn’t statistically significant (p = 0.061). A significant difference in the number of spermatozoa with residual cytoplasm on the head was observed between the fertile group and 2^nd and 3^rd groups (p = 0.0001 and p = 0.0006, respectively) and on the neck (p = 0.0002 and p = 0.0003, respectively). Number of DFS spermatozoa in the second group significantly differed from the control (21.40 ± 11.88 vs. 13.70 ± 7.00, p = 0.03), but this difference wasn’t observed for the 3^rd group. A very weak correlation between the number of DFS and ICH spermatozoa was observed in all three groups (r = 0.18, r = 0.33, and r = 0.01, respectively). Forty-six (46) spermatozoa were studied using correlation microscopy, among them 23 were DFS and 23 were ICH. In 11 of 23 HDS spermatozoa DFS was observed. In spermatozoa with condensed chromatin, DFS was identified in 6 spermatozoa.

Conclusion. DFS and abnormal chromatin condensation are highly independent parameters, which should be considered during identification of the cause of infertility. ICH is more frequent in spermatozoa of patients whose wives have a history of embryogenesis abnormalities. DNS is more frequent in primary infertility.

Male factor contributes significantly to the problem of infertile marriages. Alterations of morphological and/or functional characteristics of germ cells can result in infertility. We analyzed 122 semen samples – 55 samples with normal (≥ 15 million/ml) sperm concentration (group I) and 67 samples with cryptozoospermia or severe oligozoospermia (concentration < 1 million/ml, group II). Standard semen analysis and quantitative karyological analysis of immature germ cells from ejaculate (QKA IGC) (patent L.F. Kurilo № 2328736, 2007) were performed for all samples. The results of QKA IGC are significantly different in the two groups analyzed. The proportion of IGC at stages of preleptotene-zygotene and pachytene is verified to be higher (p < 0.01) in the sperm samples with normal concentration (group 1), indicating spermatogenesis arrest at prophase I of meiosis. In the semen samples of group 2 (patients with cryptozoospermia or with severe oligozoospermia, sperm concentration < 1 million/ml) proportion of spermatocytes II and spermatids is significantly higher than in the group with normal sperm concentration, that indicates the spermatogenesis arrest at the stage of sperm formation (spermiogenesis). IGC index in 58 % of the samples from the group I is higher than normal IGC index. For the majority of the samples from the group II the IGC index was not estimated because of lack of spermatozoa. In all sperm samples with suspected azoospermia examined through QKA IGC spermatozoa were identified (44 samples from group II). Thus, if azoospermia is suspected, QKA IGC can be recommended to patients as an alternative to diagnostic testicular or epididimal biopsy. QKA IGC is unique in the assessment of the of spermatogenesis dynamics, as it is precise, safe, non-invasive and time-saving method that allows multiple repeated evaluation of IGC at different stages of spermatogenesis. 

In this study, an analysis data on the etiology, pathogenesis, diagnosis and treatment of male sterility with hypogonadotropic hypogonadism. Examination of the patients requires attention of urologist, andrologist, endocrinologist, neurosurgeon, medical geneticist. Clinical case, described by us, shows the necessity of development of a unified algorithm for working with these patients and search for effective and safe treatment of patients with hypergonadotropic hypogonadism. 

The article gives the results of the use of embolization of prostatic arteries in benign prostatic hyperplasia in 3 patients, two of whom have been with suprapubic drainage of the bladder. The patient was 120 ml without suprapubic drainage of the bladder residual urine. The age of patients was 68 to 70 years. According TRUS, the average prostate volume was 86.0 ± 12.6 cm3 . 4 patients» superselective prostatic artery chemoembolization was performed in prostate cancer. Chemicals for carrying out this procedure served adriamycin at a dose of 50 mg. Two of the four patients with prostate cancer was hormone-resistant form. Three patients had PCa T3b N0M0 stage T2bN0M0 histologically verified number Gleason 7, 7, 8, 9. All four had difficulty urinating, the amount of residual urine was 54 to 98 ml. As a source of transportation used chemotherapy microspheres (gepasfery) size of 300–500 microns. Treatment outcomes assessed at one month. The efficiency of the methods for the treatment of benign prostatic hyperplasia and prostate cancer in the form of return of spontaneous urination, decrease in residual urine, reducing the prostate-specific antigen. 

Prostate cancer (PC) treatment is a pressing problem both inRussiaand worldwide. According to data for Saint-Petersburg, from 1990 to 2002 morbidity increase rate for PC was 141.3 %. Even after nerve-sparing radical prostatectomy (RP) erectile dysfunction of some level is observed in 65–75 % of patients. During follow-up examination, data on sexual history were gathered including information on past and current sexual contacts. A questionnaire based on the International Index of Erectile Function was used which allows to evaluate different parameters of sexual function (sexual drive, erection, orgasm, ejaculation, sexual act, and satisfaction with sexual relationships), as well as determine treatment effectiveness. We performed combined two-stage treatment of erectile dysfunction in patients with PC after RP. At the first stage, phosphodiesterase type 5 inhibitors (sildenafil 100 mg) were used. If the drug was ineffective, the second stage was initiated (intracavernosal alprostadil injections). Drug effectiveness, complications, patient compliancy were evaluated.

Study of the efficacy and safety of natural complex multi-component biologically active additives (BAA) to food Spermstrong and Testogenona in the diagnosis and treating 63 men with reproductive disorders after illness, sexually transmitted diseases (STDs). During the 12 weeks 41 patients the primary group assigned Spermstrongom combination therapy in combination with Testogenonom, 22 patient control group received only Spermstrong. Immediate treatment results evaluated through 4 weeks and distant through 12 weeks after stopping treatment. It has been established that the appointment of a combination therapy of complex components Spermstrong and Testogenon was statistically significantly increases the effectiveness of treatment. In the main group was marked by a more pronounced positive clinical effect through 12 weeks after treatment in 84.5 % of patients receiving combination therapy (increase the concentration and mobility of spermatozoa to normozoospermii, increase testosterone levels to normal values, improving the quality of erections, improve blood flow in the prostate gland, testes), in the control group who received Spermstrong, the effect is achieved in two times fewer patients, i. e. normozoospermija in 40.9 % have patients. The results confirm that the components of the Spermstrong complexes and Testogenon in combination therapy is effective, safe, have no side effects and can be used in complex treatment of reproductive disorders in men who have STDs, as well as for prophylaxis of incremental sexual glands: prostate, testicules and improve sexual function. 

Background. The problem of male infertility has a large proportion of patient treatment to andrologyst. The quality of seminal plasma affects the result of successful conception. We investigated in a detail a positive effect of Androdoz complex on a change of semen’s parameters. Objective is to study in a detail the changes in indications of seminal plasma after applications of Androdoz complex.

Materials and methods. 62 patients were included in a study (middle age 28,4 ± 2,3). The patients were divided into 2 groups. Men group 1 (n = 33) received AndroDoz complex (2 capsules 2 times a day for 30 days). Men group 2 (n = 29) received L-сarnitine (150 mg 2 times a day for 30 days). All patients were examined according to the recommendations of the Russian Society of Urologists, and biochemical analysis of ejaculate was performed before the drugs» appointment.

Results. In Group 1 obtained statistically significant differences in terms of: the volume of ejaculate, the level of fructose, citrate and zinc. In group 2 the changes were not statistically significant.

Conclusion. Thus, the use of AndroDoz complex significant positive effect on the quality of the seminal plasma. 

In the article, the results of diagnostics and treatment of 30 men aged 30–45 (mean age 36.2 ± 5.3 years) with chronic nonbacterial prostatitis (CNP) and male factor infertility in marriage are presented. Among the patients, 15 patients had CNP and secretory infertility (1st group; mean age 35.2 ± 4.3 years), 15 men with infertility caused by CNP and varicocele in the postoperative period (2nd group; mean age 33.6 ± 3.3 years). Duration of the male factor infertility varied from 1 to 4.5 years, and on average it was 2.8 ± 1.6 years. After detailed questioning and examination, including a spermiogram, determination of antisperm antibodies, DNA fragmentation test, and electron microscopy of the ejaculate, patients in the 1st group received Prostatilen AC as rectal suppositories for 10 days. Patients in the second group received Prostatilen AC in the form of rectal suppositories for 20 days. We showed an improvement of quality of life and spermatogenesis characteristics with decreased MAR test (more pronounced in the 2nd group), a decrease in the DNA fragmentation index, and an improvement in ultrastructural morphofunctional characteristics of spermatozoa. We justify the use of Prostatilen AC to increase effectiveness of assisted reproductive technologies in men in programs of preconception preparation to fatherhood.