WITHDRAWN: Androgens versus placebo or no treatment for idiopathic oligo/asthenospermia.
Oligo-astheno-teratospermia (sperm of low concentration, reduced motility and increased abnormal morphology) of unknown cause is common and the need for treatment is felt by patients and doctors alike. As a result, a variety of empirical, non-specific treatments have been used in an attempt to improve semen characteristics and fertility. Androgens have been suggested as a treatment because its binding proteins maintain a maintain a high intratesticular level testosterone essential for spermatogenesis and because the epididymis and seminal vesicles affect the seminal constitution and sperm motility and are also androgen-dependent. However exogenous testosterone was found to exert negative feedback on the pituitary-gonadal axis and thereby to suppress FSH and LH secretion. Spermatogenesis was thus adversely affected. Nevertheless androgens are used for the treatment of male infertility either for a putative direct "stimulatory" or "rebound" therapy. The stimulatory androgens used are mesterolone and testosterone undecanoate which, it is postulated, in a form and dosage that does not influence pituitary gonadotrophin secretion, either have a direct stimulatory effect on spermatogenesis or influence sperm transport and maturation though an effect on the epididymis, ductus deferens and seminal vesicles. Other androgens have been used to produce a rebound effect. These androgens are administered to suppress gonadotrophin secretion and spermatogenesis. After androgen therapy is discontinued there is a surge of FSH and LH and spermatogenesis is recommenced. Because of their different proposed mechanisms of action, stimulatory and rebound androgen therapy are analysed separately in the comparisons. This review considers the available evidence of the effect of androgens for idiopathic oligo and/or asthenospermia.
The objective of this review was to assess the effect of androgen treatment of men among couples where failure to conceive has been attributed to idiopathic oligo- and/or asthenospermia.
The Cochrane Subfertility Review Group specialised register of controlled trials was searched".
Randomised trials of mesterolone or testosterone undecanoate versus placebo or no treatment (stimulatory therapy), or testosterone enanthate or testosterone undecanoate versus placebo or no treatment (rebound therapy) in couples where subfertility is attributed to male factor.
Eligibility and trial quality were assessed.
Eleven trials involving 930 patients were included. For stimulatory therapy, androgens had little effect on endocrinal outcomes and sperm parameters. The rate of pregnancy after androgens with stimulatory effect compared to no treatment or placebo was also similar (odds ratio 1.10, 95% confidence interval 0.75 to 1.61). In rebound therapy, no difference was found in sperm parameters. The pregnancy rate after androgens with rebound effect also showed no difference compared to no treatment or placebo (odds ratio 1.60, 95% confidence interval 0.42 to 6.16). Adverse effects such as headaches and exanthema were reported.
There is not enough evidence to evaluate the use of androgens for male subfertility.[This abstract has been prepared centrally.].
Available from: PubMed Central
- "Only one randomized double blind study of androgen treatment has reported a marginally significant improvement in sperm morphology and a positive effect on pregnancy rate . However, several meta-analyses have indicated that androgens do not improve pregnancy rates or sperm parameters in men with idiopathic infertility [19,21,22]. In addition, it is necessary to remember that exogenous testosterone suppresses the hypothalamic-pituitary axis, and thereby leads to a decrease in intratesticular testosterone and spermatogenesis [23,24]. "
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ABSTRACT: Male factors account for 20%-50% of cases of infertility and in 25% of cases, the etiology of male infertility is unknown. Effective treatments are well-established for hypogonadotropic hypogonadism, male accessory gland infection, retrograde ejaculation, and positive antisperm antibody. However, the appropriate treatment for idiopathic male infertility is unclear. Empirical medical treatment (EMT) has been used in men with idiopathic infertility and can be divided into two categories based on the mode of action: hormonal treatment and antioxidant supplementation. Hormonal medications consist of gonadotropins, androgens, estrogen receptor blockers, and aromatase inhibitors. Antioxidants such as vitamins, zinc, and carnitines have also been widely used to reduce oxidative stress-induced spermatozoa damage. Although scientifically acceptable evidence of EMT is limited because of the lack of large, randomized, controlled studies, recent systematic reviews with meta-analyses have shown that the administration of gonadotropins, anti-estrogens, and oral antioxidants results in a significant increase in the live birth rate compared with control treatments. Therefore, all physicians who treat infertility should bear in mind that EMT can improve semen parameters and subsequent fertility potential through natural intercourse.
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ABSTRACT: Die medikamentösen Therapiemöglichkeiten des Oligo-Astheno-Teratozoospermie- (OAT-)Syndroms sind vielschichtig. Als klassische Indikationen kommen hierbei hormonelle Störungen sowohl auf hypothalamischer, als auch auf hypophysärer Ebene sowie (sehr viel seltener) die Hyperprolaktinämie in Frage. Weiter gut medikamentös behandelbar sind v. a. akute oder chronische urogenitale Infektionen und Ejakulationsstörungen. Weil häufig keine Ursache für das OAT-Syndrom gefunden werden kann, wird v. a. bei diesen Patienten seit Jahrzehnten mit unterschiedlichen medikamentösen Ansätzen eine Verbesserung der Ejakulatqualität versucht. Die Gabe von Antiöstrogenen, Antioxidantien, Hormonen und Spurenelementen ist in diesem Zusammenhang zu erwähnen. Die Studienlage hierzu ist aber diskrepant und muss kritisch bewertet werden. Dieser Artikel versucht eine Übersicht der aktuellen medikamentösen Therapieoptionen zu geben, erfolglose frühere Anwendungen zu nennen und einen Blick in zukünftige Konzepte zu werfen.
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