The use of recombinant FSH in the treatment of infertility associated with a high level of sperm DNA damage

Introduction. Male infertility, caused by a high level of sperm DNA fragmentation, remains one of the significant problems of reproductive medicine. One of the methods to overcome it may be the use of recombinant follicle-stimulating hormone (FSH), but the results of studies on this issue are ambiguous. The purpose of this literature review is to systematize publications on this issue. Materials and methods. The search, analysis and systematization of publications in the databases PubMed, eLibrary.ru, Clinicaltrials.gov were carried out using the keywords «male infertility», «sperm DNA fragmentation», «treatment», «follicle stimulating hormone», «FSH». Seventy six publications were selected and included in this review. Results and discussion. The integrity of the genetic material of the sperm is one of the prerequisites for the formation of a normal embryo. Its damage occurs in two main ways: induction of apoptosis and direct damage to DNA by reactive oxygen species. FSH stimulates spermatogenesis and also prevents the induction of spermatozoa apoptosis through the activation of protein kinase B/AKT. Also FSH regulates chromatin packing and increases the ability of spermatozoa to bind to hyaluronic acid. Its use in infertile men led to an improvement in the morphological parameters of spermogram, sperm motility, a decrease in the level of sperm DNA fragmentation, however, the data obtained are difficult to compare due to the heterogeneity of the patient groups included in the study, the lack of standardization of methods for studying the level of sperm DNA fragmentation and using its different threshold values. Conclusions. Therapy with recombinant FSH is one of the promising methods for overcoming infertility in patients with a high level of sperm DNA fragmentation. The heterogeneity of published studies does not allow to draw unambiguous conclusions regarding its effect on the integrity of the genetic material of spermatozoa. Future studies need to use strict inclusion criteria, such as thresholds for the level of sperm DNA fragmentation and the results of a pharmacogenetic study.