Do men with normal testosterone-oestradiol ratios benefit from letrozole for the treatment of male infertility?

RESEARCH QUESTION: Previous studies of aromatase inhibitors on male infertility have focused on men with low testosterone-oestradiol ratio of less than 10. Can aromatase inhibitors improve spermatogenesis in men with idiopathic male infertility with normal testosterone-oestradiol ratio? DESIGN: Prospective study of men with idiopathic severe oligozoospermia (sperm concentration <5 million/ml) carried out between February 2015 and March 2017. The objective was to assess if semen-analysis parameters improved after treatment with letrozole. Secondary objectives were to monitor the safety of letrozole in men, and to measure the alterations in serum FSH, LH, oestradiol and testosterone levels. RESULTS: Fifteen men with normal testosterone-oestradiol ratio (>10) were treated with letrozole 2.5 mg daily for 4 months. This produced a 5.5-fold increase in sperm concentration (P = 0.0068). All men had increased total serum testosterone and suppressed oestradiol levels after treatment, thus raising the overall testosterone-oestradiol ratio (P < 0.0001). Adverse effects from letrozole were relatively minor and included loss of libido (54%), headaches (25%), fatigue (21%), weakness (13%), loss of hair (8%) and dry mouth (8%). CONCLUSIONS: Letrozole improves sperm concentration and increases testosterone-oestradiol ratio for men with oligozoospermia who have normal testosterone-oestradiol ratio; its role in the treatment of male infertility may be extended to this group of patients. In addition, it is a relatively well-tolerated drug with no serious adverse effects.

[Experience in the treatment of autoimmune male infertility in patients with category 4 chronic prostatitis].

Administration of longidaza at a dose of 3000 IU intramuscularly twice a week after 1 month of treatment leads to the statistically significant reduction of antisperm antibodies (ASAB) at the surface of sperm cells to 23% (7-48%) for MARIgG and to 14.5% (3-34%) for MARIgA. Maximum reduction of ASAB, however, was observed after third month of treatment, mean MARIgG was 2% (1-26,5%) and MARIgA - 1% (0-11.5%). ASAB level has not reduced less than 50% only in one patient (1.67%). At follow-up three months after the cancellation of Longidaza, only 17 (28.33%) men showed an increase of ASAB IgG and (or) IgA more than 50%. Inthe study group, during the observation, spontaneous pregnancy occurred in 6 (10%) pairs, and IVF was successfully performed in 3 (5%) pairs. Thus, we consider it necessary to appoint Longidaza in patients with category 4 chronic prostatitis and elevated levels of antisperm antibodies on sperm cells, who preparing for assisted reproductive technologies, or preparing for natural pregnancy, as a high-effective pathogenetical agent for the treatment of autoimmune infertility.

Effects of the reduced form of coenzyme Q10 (ubiquinol) on semen parameters in men with idiopathic infertility: a double-blind, placebo controlled, randomized study.

PURPOSE: We investigated the effects of the administration of ubiquinol (a reduced form of coenzyme Q(10)) on semen parameters and seminal plasma antioxidant capacity in infertile men with idiopathic oligoasthenoteratozoospermia. MATERIALS AND METHODS: A total of 228 men with unexplained infertility were randomly assigned 1:1 into 2 groups. Group 1 (114) received 200 mg ubiquinol daily by mouth for 26 weeks and group 2 (114) received a similar regimen of placebo. After completion of the 26-week treatment phase, all participants were followed for another 12-week off-drug period. Primary outcomes were improvement in sperm density, sperm motility and sperm strict morphology. RESULTS: At the end of the 26-week treatment period mean ± SD sperm density in the ubiquinol and placebo groups was 28.7 ± 4.6 × 10(6)/ml and 16.8 ± 4.4 × 10(6)/ml (p = 0.005), sperm motility was 35.8% ± 2.7% and 25.4% ± 2.1% (p = 0.008), and sperm strict morphology was 17.6% ± 4.4% and 14.8% ± 4.1% (p = 0.01) of normal sperm, respectively. During the treatment period serum follicle-stimulating hormone levels decreased significantly (p = 0.02) and serum inhibin B concentrations increased significantly (p = 0.01). During the off-drug period semen parameters gradually returned to baseline values but the differences were still significant for sperm density (p = 0.03) and sperm motility (p = 0.03). The correlation coefficients analysis revealed a positive association between the duration of treatment with ubiquinol and sperm density (r = 0.74, p = 0.017), sperm motility (r = 0.66, p = 0.024) and sperm morphology (r = 0.57, p = 0.027). CONCLUSIONS: Ubiquinol was significantly effective in men with unexplained oligoasthenoteratozoospermia for improving sperm density, sperm motility and sperm morphology.

[Kallmann syndrome]. / Kallmann-Syndrom.

The Kallmann syndrome is a very rare congenital association of gonadotropin-releasing hormone deficiency and hyposmia or anosmia. Clinically it is characterized by low serum concentrations of testosterone and inadequate low levels of luteinizing hormone and follicle-stimulating hormone as well as incomplete sexual maturation, lack of secondary sexual features (facial and body hair growth, deepening of the voice), micropenis and sometimes even cryptorchidism. The reduced or absent sense of smell is typical for the Kallmann syndrome and distinguishes this syndrome from other causes of hypogonadotropic hypogonadism. Additional findings may include synkinesia, hearing loss, unilateral renal aplasia, brachy- or syndactyly, agenesis of corpus callosum, cleft palate and dental agenesis. A 19-year-old man presented to our male infertility clinic with delayed sexual maturation, eunuchoid habitus, micropenis, cryptorchidism, erectile dysfunction and absence of ejaculation, anemia and osteoporosis as well as low serum concentrations of luteinizing hormone, follicle-stimulating hormone and testosterone in combination with hyposmia.

Clinical toxicity study of Semecarpus anacardium Linn. f.

PIP: Semecarpus anacardium was administered to 266 cases in 3 formulations: Amrit Bhallatak (186 cases), RB 3 (48 cases), and Garsin (32 cases). The Amrit Bhallatak is a compound formulation containing extract of both the cotyledons and the pericarp of the fruit of Semecarpus anacardium. RB3 is composed of the whole cotyledon (300 mg); the daily dose of cotyledons was 3.6 g. Garsin contained 200 g of cotyledons. The extract is derived by separating the oil by a physical process. The daily dosage of Amrit Bhallatak was 10 g/day, that of Garsin, 2.4 g/day. No toxicity or side effects were observed. The therapeutic value of Semecarpus anacardium in arthropathies, atopic dermatitis, leucoderma, leprosy, hypothyroidism, oligospermia, and azoospermia and its value as an oral contraceptive have been studied. The most significant effect was on the ovaries and testes. The drug probably acts via the hypophysics. Out of 266 patients, 189 were men, 77 women between 30-45 years of age. The treatment was restricted to internal medication by mouth. No external contact or application of the drug was applied. Of the 77 women treated with the drug, 41 were followed up after treatment. 12 had become pregnant and none showed any teratogenecity.^ieng

Individualized homeopathic therapy for male infertility.

This prospective observational pilot study investigated the effect of individualized homeopathy on male infertility based on sperm count, hormone values and general health. Forty-five subfertile men were treated with single homeopathic remedies for an average of 10.3 months. The drugs were prescribed on the basis of the overall symptomatic situation. The variables 'sperm density', 'percentage of sperm with good progressive motility' and 'density of sperm with good propulsive motility' improved significantly, especially in cases of oligoasthenozoospermia. The general health of patients improved significantly. The following factors emerged as positive predictors of therapy success: alcohol consumption below 30 g/day, non-smoking, the presence of less than five dental amalgam fillings, no exposure to noxious substances at the workplace and no previous inflammatory genital diseases. The factors stress, age above 36, high coffee consumption and long duration of unwanted childlessness did not have a negative impact on therapy outcome in this study. The rate of improvement in sperm count through homeopathic therapy is comparable to the improvement achieved by conventional therapy, so that individualized-homeopathic treatment may be considered a useful alternative to conventional treatment of subfertile men. For further investigation, a randomised, therapy-controlled clinical study with parallel group design would be useful (homeopathic therapy vs conventional andrological therapy).