Concurrently with the rise in male infertility, both internationally and in Ukraine, there is a significant increase in sexually transmitted infections (STIs). Considering Ukraine's persistently low birth rates where the total fertility rate was 1.37 children per woman at the beginning of 2017 and dropped to 1.16 children per woman by the beginning of 2021 prompt screening of the male reproductive system with comprehensive sperm parameter analysis is undoubtedly a necessary step in detecting and treating male factors.
Male infertility is a multifactorial syndrome encompassing various disorders and pathological conditions. Today, dozens of factors are identified that can lead to male infertility. One of the most common factors is infection, closely linked to acute and chronic diseases of the genitourinary system, negative environmental influences, endocrine and immunological disorders, as well as genetic anomalies.
In most cases, microorganisms damage the tissues of the reproductive organs, disrupt the hematotesticular barrier that separates blood from germ cells, participates in regulating spermatogenesis, and ensures the isolation of antigenic cells of the germinal epithelium from the body's immune system. Damage to this barrier is a significant factor in the development of spermatogenic disorders (oligo-, terato-, and azoospermia). Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma genitalium, Neisseria gonorrhoeae, Gardnerella vaginalis, Trichomonas vaginalis, and Mycoplasma hominis are the most common causative agents of bacterial urethritis.
Disruption of the integrity of the mucous membrane of any origin in the affected area initiates an inflammatory reaction, microbial invasion, and the development of pathological processes. As a result of the pathological influence of bacteria on men, there is a decrease in the volume and alteration in the chemical and biochemical composition of semen, an increase in its viscosity and liquefaction time (viscoelasticity), deviations from the normal pH. Sperm motility decreases (akinoozoospermia), their morphology is disturbed (teratozoospermia), antibodies to antisperm cells of IgG and IgA classes are produced. Additionally, the number of peroxidase-positive leukocytes (pus cells) increases, which produce active oxygen forms and a large amount of cytokines. They negatively affect the functional state of spermatozoa, impairing their fertilization capacity, and induce sperm apoptosis.
However, many aspects of the relationship between past urogenital infections and male infertility remain unexplored to date. There is no information about the peculiarities of the influence on the mechanisms of infertility development of individual etiological (microbial) factors, the duration of the inflammatory process, unilateral or bilateral damage to the testicles, and so forth. There is no algorithm for examining this category of patients. This impedes the development of optimal approaches to the therapy of urogenital infections and preventive measures against infertility development.
