The state of the reproductive system in men with infertility, patients with subclinical hypothyroidism

It was found that infertile men with subclinical hypothyroidism, the mean values of testosterone levels in the blood decrease. It is shown that the formation of testicular dysfunction occurs as a normogonadotropic hypogonadism. The impairment of the fertility of sperm in subclinical hypothyroidism is due to a decrease in the number of mobile and viable spermatozoa.

It is now known that a deficiency of thyroid hormones in hypothyroidism can lead to a violation of the spermatogenic and endocrine functions of the testes in adult men. At the same time, a so-called "subclinical hypothyroidism" is often encountered in the practice of a doctor, in which the clinical manifestations of thyroid hypothyroidism (TG) are diagnosed against the background of normal thyroid hormone levels, in particular free thyroxine (T4cv) levels and elevated blood levels of thyrotropic a hormone (TTG). There is evidence that the incidence of subclinical hypothyroidism is five to six times higher than the prevalence of overt hypothyroidism. Subclinical hypothyroidism is the easiest form of thyroid function deficiency with minimal clinical symptoms, which are eliminated by the appointment of thyroid hormones. There is an opinion that subclinical hypothyroidism, as well as obvious, is associated with hyperandrogenemia in men. However, as the parameters of spermograms change, as well as the levels of gonadotropic hormones in men with infertility, patients with subclinical hypothyroidism, at present, almost not studied.

The aim of this work is to study the levels of the hormones of the pituitary - gonadal system in the blood and the parameters of spermograms in men who are in infertile marriage, with subclinical hypothyroidism.

Of the infertile couples for more than a year, 21 men aged 22-39 years were examined. The diagnosis of subclinical hypothyroidism was established on the basis of clinical examination, ultrasound examination of the thyroid gland, blood levels of thyroid-stimulating hormone and free thyroxin by an enzyme immunoassay. All patients underwent spermogram parameters analysis in accordance with the WHO standard criteria, and also measured testosterone (T), luteinizing (LH), follicle stimulating (FSH) hormones and prolactin (PRL) in the blood serum using sets for enzyme immunoassay.

Similarly, 12 practically healthy men of the same age were examined with the corresponding WHO norm spermogram parameters, which formed a control group.

Statistical processing of the obtained data was carried out by the method of variational statistics using a standard statistical calculation package. The reliability of the discrepancies in the mean values was determined by the Student's test. The data are presented as X ± Sx.

In the patients examined, there was a significant increase in the average values of the thyroid-stimulating hormone relative to the control values. At the same time, the T4CB levels, although they were within the reference norm values, were significantly reduced in comparison with the average values of the hormone in practically healthy men. Primary latent thyroid dysfunction in patients with infertility led to a significant decrease in testosterone levels against the background of increased levels of follicle-stimulating and luteinizing hormones (p <0.001). The decrease in their T / LH relative to control indicates that in patients with subclinical hypothyroidism there is a hyporealization of the action of the luteinizing hormone on the testes, characteristic of patients with primary and normogonadotropic hypogonadism. It should be noted that unlike the obvious hypothyroidism in patients with subclinical hypothyroidism, the mean values of prolactin did not differ from the control (p> 0.05).

At the same time, analyzing the frequency of compliance with the norm of hormone levels of the pituitary-gonad system, it was found that in a significant majority of patients the values of follicle-stimulating and luteinizing hormones, as well as prolactin, were within reference values of the norm. Nevertheless, in 47.6% of patients the testosterone level was below 12.0 nmol / L, indicating that they have hypoandrogenemia. This pattern of changes in the hormones of the pituitary-gonad system in infertile men with subclinical hypothyroidism testifies to the formation of dysfunction of the sexual glands in the given contingent in the type of normogonadotropic hypogonadism.

Attention is drawn to the fact that unlike the classical variants of prepubertal hypogonadism in men with reduced testicle size, testicular volumes in patients with subclinical hypothyroidism did not differ from normal values. At the same time, the concentration of spermatozoa in a milliliter of ejaculate in most of them was within the norm of WHO. Nevertheless, the average value of this parameter of the spermogram was significantly less than in the case of practically healthy men.

In turn, the average percentages of mobile and viable sperm forms in patients with subclinical hypothyroidism were significantly less than not only the control values, but also the lower limit of WHO standards. Such changes in spermogram parameters indicate the formation of asthenozoospermia in the examined patients.

The data obtained in the work show that not only with obvious, but subclinical hypothyroidism in men of reproductive age can be androgen deficiency. At the same time, a normogonadotropic variant of testicular dysfunction is mainly formed.

Infertility in men with subclinical hypothyroidism is mainly due to impaired mobility and viability of spermatozoa, which indicates a violation of their functional maturity. To ensure the full maturation of spermatozoa in the appendages of the testes, a sufficient level of testosterone in the blood is needed. At the same time, the frequency of ascertaining asthenozoospermia in patients was established in 81% of cases, and the decrease in testosterone level - only in 47.6% of patients. Consequently, in the mechanism of the formation of this pathospermia, not only the hypoandrogenic status is important, but, possibly, the violation of pro and antioxidant balance in the testes, as well as with obvious hypothyroidism, which is the reason for the insufficient maturity of spermatozoa and impairment of their mobility. This should be taken into account in the therapy of pathospermia in men with subclinical hypothyroidism.

Zh. S. Spivak. The state of the reproductive system in men with infertility, patients with subclinical hypothyrosis // International Medical Journal - №4 - 2012