Dynamics of the functional state of the testes and thyroid gland in men with infertility and with chlamydial infection under the influence of pathogenetic therapy
Background. Chlamydial infection (СI) in infertile men is associated from the one hand, with a violation of the androgenestrogen balance, and on the other hand, with the development of dysthyroidism and the growth of antibodies to thyroid peroxidase (Ab TPO). These changes may cause the development of autoimmune thyroiditis (AT) and subclinical or manifested hypothyroidism associated with AT. The purpose of the study was to determine the features of impaired functionality of the testes and thyroid gland in infertile men against the background of СI and the effect of antibacterial and antioxidant therapy. Materials and methods. The study involved 30 men aged 23–44 years who had been in an infertile marriage for more than a year, including 15 with chronic prostatitis (CP) on the background of СI (first group) and 15 with latent CI without inflammation of the urogenital tract (second group). The presence of CI was verified by the polymerase chain reaction (PCR) method and the level of antibodies to chlamydia. The parameters of spermogram were analyzed according to WHO criteria. Treatment included the appointment of azithromycin and immunomodulator lavamax for 15 and 18 days. Patients with CP used rectal antiinflammatory suppositories vitaprost for 20 days. After a course of antibiotic therapy, a complex of antioxidants was prescribed for 45 days: cefasel 100 µg and vitamin E 200 mg per day. Before treatment, after 1 and 2 months after treatment, in the patients the parameters of spermogram, blood levels of testosterone (T), estradiol (E2), thyroid stimulating hormone, free thyroxine, Ab TPO were investigated. The control group consisted of 10 practically healthy men of the corresponding age with normozoospermia (NZS) and without СI. Results. After providing the antibiotic therapy in patients with CP, against the background of the elimination of inflammation of the prostatevesicular complex (group 1), the percentage of mobile spermatozoids significantly increased. NZS did not follow the treatment one month later in the patients with latent CI (group 2). After therapy with antioxidants NZS was established in 73.3 % of cases in group 1 and 53.3 % in group 2. After 2 months of treatment in group 1, the rate of T level normalization in blood and the ratio of T/E2 increased. At the same time, the normalization of the content of T and T/E2 in the group 2 was not significant. In the posttreatment period, changes in thyroid functionality were not detected, but there was a significant decrease in the level of Ab TPO. Conclusions. Reduction of the inflammatory process in the prostate and СI as the factor causing it promotes the activation of sperm motility in infertile men. The following appointment of antioxidant therapy significantly increases the endocrine function of the testis and improves the androgenestrogen balance. The use of specific antibiotic therapy and shortterm appointment for 15 days of cefasil and vitamin E in latent СI does not have positive effect on spermatogenesis. In the future, the use of antioxidants within one month significantly stimulates the sperm motility, but does not change the level of T and E2. Twostage therapy of infertility at СI does not impact the thyroid functional state, but contributes to lowering blood levels of Ab TPO.
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