[Time factor in initiating antioxidant therapy in the varicocele model]

Varicocele (VC) is one of the main causes of male infertility; however, it is not always associated with infertility. In addition to surgical correction of pathospermia in VC, adjuvant antioxidant therapy has been proposed. It is known from experience that not all patients are immediately treated with surgery, and, similar to cancer, neoadjuvant therapy may be beneficial. The optimal method for assessing the effectiveness of this hypothesis is to conduct a study using a varicocele model in a chronic experimental setting.

to study the effect of the timing of initiation of antioxidant therapy on spermogram parameters and testicular structure in a varicocele model.

The chronic experiment involved 20 mature male rabbits randomized into 4 groups: Group I (N) - intact animals to provide normal anatomy of the testis and spermogram indicators (n=5). Group II - control group (GC) - VC model without drug exposure, withdrawal 2 months after VC formation (n=5). Group III - main group 1 (MG1) - VC model and drug exposure during the first month from the formation of VC and seven-day daily administration of progesterone (n=5). Group IV - main group 2 (OG2) - VC model and delayed drug exposure during the second month from the moment of VC formation and seven-day daily administration of progesterone (n=5). The drug was administered intragastrically at a dose of L-carnitine 26.15 mg/day, taking into account the species characteristics of the rabbit. Seminal fluid was examined using light microscopy to assess the quantity and quality of sperm. The removed testes were subjected to morphological examination using Mallory staining and hematoxylin and eosin. A semi-quantitative count of fibroblasts in a microslide was carried out.

After 14 days from the creation of the model, dilated spermatic veins were visualized in all animals of experimental groups II-IV (on average up to 1.8 mm, without differences between groups) and hemodynamic reflux was recorded in them. The average diameter of the spermatic veins (up to 2.1 mm) was 2.1 mm on the 30th day; 2.0 mm on the 60th day. A progressive decrease in the volume of the left testicle was noted over 60 days by an average of 1.1 cm3 (p>0.05 between all groups). In group I (N), the initial characteristics of the general spermogram parameters were significantly higher than in experimental groups II-IV (p<0.05-0.01). The total number of spermatozoa was 310.2 million (in group N) versus 199.3 million (in GC), 247.6 million (in OG1) and 221.3 million (in OG2). In group N: 94.3% of live sperm, total sperm motility (PR+NP) - 91.4%, progressive sperm motility (PR) - 87.2%, sperm velocity - 13 /sec. Between groups OG1 and OG2, there was a difference in spermogram results with a predominance for the better in group OG1: the total sperm count was 247.6 million (in OG1) / 221.3 million (in OG2); live sperm - 80.6% / 74.4%, respectively; PR+NP - 73.4% / 67.1%, respectively; PR - 65.4% / 56.7%, respectively, and sperm velocity of 8 / 6 /sec, respectively) (p<0.05 vs N). The spermogram parameters in the GC group were significantly worse than in OG 1 and OG2: total sperm count - 199.3 million (in GC) / 247.6 million (in OG1) and 221.3 million (in OG2); live forms - 68.3% (in GC) / 80.6% (in OG1) / 74.4% (in OG2); PR+NP - 61.5% / 73.4% / 67.1%, respectively, PR - 48.7% / 65.4% / 56.7%, respectively, sperm velocity - 4 / 8 / 6 g/sec. respectively (p<0.01). Evaluation of the morphology of the spermatogenic epithelium according to Johnsen S.G. (1970) as modified (2014): Group I (N) - 10 points; GK - heterogeneous histological picture with significant reduction of spermatogenesis, 6-7 points; OG1 - heterogeneous picture with slight reduction of spermatogenesis, 8-9 points; OG2 - heterogeneous picture with noticeable reduction of spermatogenesis, 7-8 points.

The varicocele formed in the experiment had a negative effect on testicular function and structure, confirming the effectiveness of the modeling method. L-Carnitine had a protective effect on gonadal tissue and ejaculate quality. This effect was greater with earlier administration of the drug after the model was formed. This effect may be useful in clinical practice and requires further study.