Men's Health - Male Infertility
MEDICAL TREATMENT
New Research – Combination Antiestrogen Antioxidant treatment
in the treatment o f Male infertility
| Professor Hussein Ghanem and Egyptian researchers have identified a combination drug treatment that appears to significantly improve sperm count and motility in infertile men and result in increased pregnancy rates in their partners. Sixty male factor infertility patients at Cairo University’s Department of Andrology were randomly assigned to one of two groups. One group received a daily dose of clomiphene citrate and vitamin E for six months; the control group received a placebo. At the end of the study, the treated group had achieved a significantly higher pregnancy rate than the control group, 36.7% versus 13.3%. The men in the treatment group also showed a significantly higher increase in sperm concentration and an improvement in sperm progression as compared to the placebo group. R. Dale McClure, MD, President of American Society of Reproductive Medicine remarked, “The results of this study will be encouraging to male factor patients and their doctors. However, more research is needed to determine how the components of the combination therapy affect the different semen parameters observed, and the advantages of using these drugs singly or in combination with other drugs not used in this study.” Ghanem et al, Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial, Fertility and Sterility, Advanced online publication 2009 |
| MEDICAL TREATMENT A- SPECIFIC THERAPY 1- Hypogonadotrophic Hypogonadism: · FSH + LH are required to initiate spermatogenesis. · LH can maintain spermatogenesis and secondary sex characters through testosterone production from the Leydig cells. · Testosterone replacement can maintain male secondary sex characters but will not maintain spermatogenesis. 2- Antisperm Antibodies: · Prednisone · Sperm washing & ejaculation in sperm antigen containing media to attach antibodies before they adhere to sperm surface. · GIFT (see later). · Condoms in cases of female immunologic infertility. 3- Genital Tract Infection: (appropriate antibiotics). 4- Retrograde ejaculation: · Sympathomimetics or Imipramine (inhibits reuptake of noradrenaline). · Ejaculation with a full bladder. · Sperm retrieval from the bladder through catheterisation followed by centrifugation, washing & intrauterine insemination. The urine should be alkalinized and diluted (by large fluid & alkali intake) prior to this procedure. · V-Y plasty of bladder neck. 5- Anejaculation: · Emission could be induced by vibratory stimulation, para-sympathomimetics, or electroejaculation using a rectal probe. · Microaspiration of sperm from the genital ducts + IVF B- EMPIRICAL THERAPY Used if no cause was identified and aims at hyperstimulation of existing spermatogenesis. 1-Antiestrogens · Clomiphene citrate: competitive inhibition of estrogen receptors at the hypothalamus leading to increased GnRH, FSH, LH & (T) due to decreased negative feed back inhibition by estrogens. · Tamoxifen: Similar to clomiphene with no intrinsic estrogenic activity. · Testolactone: Inhibits the aromatase enzyme thus decreasing the peripheral conversion of (T) to E2.) 2- Androgens Most androgens suppress gonadotrophins &- sperm production, however some newer products are claimed to assist spermatogenesis without inhibiting gonadotrophins e.g. mestrolone, methyl testosterone & luoxymestrolone. 3- Gonadotrophins · LH: To stimulate Leydig cells. · FSH: Very expensive, no confirmed benefit to justify empirical use. · GnRH: Is tried as a nasal spray or subcutaneous pump. 4- Others e.g. Kallikrein (enzyme releasing kinins from kininogen), arginine, bromocryptine, corticosteroids, vitamin C, thyroxin. |
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Copyrights Dr. Hussein Ghanem 1999 All Rights
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جميع حقوق الطبع والنشر محفوظة للدكتور حسين
غانم لعام 1999
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Page written & discussion moderated by:
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Professor of Andrology, Cairo University
Formerly: Fellow in Male Reproductive Medicine and Surgery, Baylor College of Medicine, Houston, Texas, USA Formerly: Fellow in Male Sexual Function, Reproduction, and Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA |
| Telephone: +(202) 761 3334 |
| E-mail: ghanem@family-clinics.com |
| Address: 139 (A) Al-Tahrir Street, Dokki, Cairo, Egypt |