An empiric treatment for idiopathic oligozoospermia revisited: a 20-year investigative saga

Abstract

A series of studies aiming at introducing an effective treatment for idiopathic oligozoospermia was conducted in a step-wise fashion spanning over a 20-year period. The concept was that co-administration of an accessory gland-stimulating androgen, testosterone undecanoate (40 mg t.i.d.) and the FSH raising anti-oestrogen tamoxifen citrate (10 mg b.i.d.) may improve sperm parameters. A prerequisite for such an effect was the demonstration that testosterone undecanoate had no suppressing action on pituitary-testicular axis. In this context, initial studies demonstrated no change in basal or stimulated gonadotrophin and testosterone secretion in short- or long-term protocols. Two subsequent trials with this combination showed a marked improvement of sperm parameters and pregnancy incidence, with a seasonal variation noted in response to treatment, this being higher during the cold seasons of autumn and winter. Regarding the mechanism of testosterone undecanoate's action, a recent study from our unit showed that its administration resulted in a marked rise of serum DHT levels. Because this steroid is an epididymal function promoter, it appears that its contribution in the combination is mediated mainly through its DHT raising effect. By and large, this empiric approach for the treatment of idiopathic oligozoospermia was satisfactorily documented after a 20-year investigative saga.

Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis

“…However, treatment of idiopathic male infertility, defined as a condition of abnormal semen parameters noted without an identifiable cause remains a challenge even now (Koukkou et al, 2012). Despite the success of assisted reproductive technology (ART) in dealing with male infertility in recent reviews, several major risks such as birth defect, genetic disorder and preterm birth have been associated with ART (Hvidtjørn et al, 2009;Wen et al, 2012).…”

Testicular ultrasound score: A new proposal for a scoring system to predict testicular function

“…This comparison led to similar results in both groups in terms of predictors and their coefficients; therefore, the analyses were reconducted on the cohort as a whole and these results are reported herein. We employed a composite index based on the Functioning Sperm Fraction (FSF) in the existing literature, 36‐38 defined as the total number of motile spermatozoa in the ejaculate with a normal morphology using a cutoff of 0.625 × 10 6 /ejaculate, derived from the 5th centiles of the WHO 2010 reference parameters (39 × 10 6 spermatozoa × 40% motility × 4% normal forms) 35 …”

More attention should be paid to the treatment of male infertility with drugs-testosterone: to use it or not?

“…In research on empirical drug therapy for idiopathic male infertility that was conducted by the American Urological Medical Association, approximately 25% of urologists who were questioned prescribed androgen for patients who wanted reproductive benefits 29. Treatment of male infertility by the coadministration of testosterone and other drugs has been employed as a first line of treatment by centers and specialists in various parts of the world, especially in those where ART are not available on technical, social, religious or economic grounds 30. In general, approximately 60.5% of doctors would propose a 3- to 6-month empirical drug regimen for male infertility, and when professionally trained doctors were questioned, this percentage reached 70%.…”