Introduction. According to Rosstat, the population of the Russian Federation as of January 2025 was 146.15 million, which is incredibly low for a country with a territory of 17.1 million square kilometers. According to official statistics for 2024, the country's population decreased by 599.000, and the negative trend of population decline continues, even at an accelerating rate. Therefore, the issue of reproductive security is becoming one of the most pressing issues in the country today. The medical community is tasked with providing comprehensive medical care to the population to ensure reproductive function. Male pathospermia is an extremely complex problem from a pathophysiological perspective, requiring a comprehensive approach to its treatment.
Оbjective. Evaluation of the efficacy and safety of different types of stimulating therapy in patients with pathospermia and infertility associated with hypogonadism, hyperestrogenism, and obesity.
Materials and methods. The study involved 17 men aged 35 to 47 with a verified diagnosis of marital infertility (male infertility) who complained of their spouse's (sexual partner's) inability to conceive for a year or more despite regular sexual intercourse. A multidisciplinary approach to patient care was employed, with the mandatory participation of a urologist-andrologist, an endocrinologist, a nutritionist, and a certified fitness instructor at all stages of the treatment and diagnostic process. These specialists collaborated to develop an individualized nutrition and exercise program, as well as medication therapy. The Spermafert complex was used as a source of antioxidants and micronutrients.
Results. A comprehensive multidisciplinary treatment approach, along with increased testosterone levels and normalization of estradiol, resulted in a statistically significant increase in sperm count per ml of ejaculate, as well as improved sperm morphology and motility.
The treatment efficacy after three months was 70% for oligoasthenoteratozoospermia and 23% for conception. Extending therapy to six months resulted in pregnancy in an additional 17% of cases. Thus, the overall conception efficacy was 40% with six months of treatment.
Conclusion. The comprehensive multidisciplinary approach presented in this study to treating comorbid patients with obesity, insulin resistance, hypogonadism, and, consequently, pathospermia demonstrated significant effectiveness, reflected in statistically significant improvements in the quantitative and qualitative parameters of the spermogram. The obtained results allow us to recommend this treatment approach for patients with pathospermia associated with obesity and hypogonadism. The Spermafert complex, as an additional source of microelements and minerals, has proven to be safe and effective and can be recommended for regular use to maintain normal sexual, reproductive, hormonal, and copulatory functions.
