Мужская фертильность после варико-целэктомии: возможные алгоритмы ведения, прогнозирование и мультидисциплинарный подход
Варикоцелэктомия остается одной из наиболее эффективных хирургических опций при лечении мужского бесплодия, связанного с варикоцеле. Однако вероятность наступления спонтанной беременности после операции значительно варьируется даже при объективном улучшении параметров спермы. Современные данные подчеркивают важность персонализированного подхода к послеоперационному ведению, основанного на динамике общего числа прогрессивно подвижных сперматозоидов в эякуляте (ЧППСЭ). Предложены клинические алгоритмы для стратификации пациентов на группы: активное наблюдение, внутриматочная инсеминация (ВМИ) и экстракорпоральное оплодотворение (ЭКО/ИКСИ), в зависимости от уровня ЧППСЭ. Также разработаны предиктивные инструменты, такие как номограммы и критерии «клинически значимого улучшения» (КЗУ), для оптимизации принятия решений. Дополнительно в отдельных случаях может рассматриваться использование антиоксидантной терапии для улучшения качества эякулята у пациентов с умеренным улучшением параметров спермы. Мультидисциплинарный подход с участием специалистов по репродуктивной медицине, диетологов/нутрициологов, а также врачей других специальностей также крайне важен для достижения наилучших репродуктивных результатов у пар после варикоцелэктомии.Шомаруфов А.Б., Акилов Ф.А., Аюбов Б.А., Гуломов Ш.Х., Мирниёзов М.М.
Ключевые слова
варикоцеле
варикоцелэктомия
мужское бесплодие
число прогрессивно подвижных сперматозоидов (ЧППСЭ)
спонтанная беременность
вспомогательные репродуктивные технологии (ВРТ)
внутриматочная инсеминация (ВМИ)
экстракорпоральное оплодотворение (ЭКО)
номограммы и предиктивные модели
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Об авторах / Для корреспонденции
А в т о р д л я с в я з и: Ш.Х. Гуломов – магистр 3-го курса кафедры урологии Ташкентского государственного медицинского университета, Ташкент, Узбекистан; e-mail: shokhrukhgulomov3@gmail.comТакже по теме
