Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial

Ghanem, Hussein; Shaeer, Osama; El-Segini, A.

doi:10.1016/j.fertnstert.2009.01.117

Cited by 117 publications

(93 citation statements)

References 12 publications

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“…Hussein et al reported the usefulness of clomiphene citrate as the observations, the other factors, such as attenuation of oxidative stress and heat damage, improvement of testicular microcirculation, are potentially involved in case of salvage hormonal therapy. Actually the combination of clomiphene citrate and an anti-oxidant could significantly improve sperm count and motility in men with oligozospremia [68], indicating that restoration of spermatogenesis per se enhanced testicular oxidative stress and attenuation of it may be beneficial for spermatogenesis. One important criticism, however, is the quality of first micro-TESE.…”

Section: Establishment Of Gonadotropin Therapy For Noa Menmentioning

confidence: 99%

Gonadotoropin actions on spermatogenesis and hormonal therapies for spermatogenic disorders [Review]

Shiraishi

Matsuyama

2017

Endocr J

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Abstract. Microdissection testicular sperm extraction and intracytoplasmic sperm injection have made it possible for men with non-obstructive azoospermia (NOA) to conceive a child. A majority of men cannot produce sperm because spermatogenesis per se is believed to be "irreversibly" disturbed. For these men, it has been thought that any hormonal therapy will be ineffective. Further understandings of endocrinological regulation of spermatogenesis are needed and LH or FSH receptor knock out (KO) mice have revealed the roles of gonadotropin separately. Spermatogenesis has been shown to shift during evolution from FSH to LH dominance because LH receptor KO causes infertility while FSH receptor KO does not. High concentrations of intratesticular testosterone secreted from Leydig cells, ranging from 100-to 1,000-fold higher than in the systemic circulation, has pivotal roles during spermatogenesis. This is especially important during spermiogenesis, a post-meiotic step for progression from round to elongating spermatids. Sertoli cells are the target of FSH and have numerous androgen receptors, indicating that Sertoli cells are regulated by FSH and the paracrine functions of testosterone. In combination with Leydig cell-derived growth factors, particularly epidermal growth factor-like growth factors, Sertoli cells support spermatogenesis, especially at proximal levels of spermatogenesis (e.g., spermatogonial proliferation). Taken together, the current knowledge from human studies indicating that testosterone optimization by clomiphene, hCG and/or aromatase inhibitors and high dose hCG/FSH treatment can, at least in part, improve spermatogenesis in NOA. Accordingly hormonal therapy may open a therapeutic window for sperm production in selected patients.Key words: Non-obstructive azoospermia, Testicular sperm extraction, Gonadotropin, Hormonal therapy FIFTEEN to twenty percent of couples are categorized as infertile. Generally, a male-related factor is involved in more than half of the cases. Among male-related factors, approximately 10 % of cases are diagnosed as non-obstructive azoospermia (NOA). NOA is the most prevalent and challenging form of azoospermia for both patients and physicians because spermatogenesis per se is believed to be "irreversibly" disturbed and it has been thought that any medical therapy, including hormonal therapy, will be ineffective. Unlike oogenesis, where there is a substantial amount of information regarding endocrine regulation, information regarding spermatogenesis, especially in humans, is very limited.Along with the development and availability of intracytoplasmic sperm injection (ICSI) since the 1990's, the goal of NOA treatment has not necessarily required many sperm in the ejaculate for assisted insemination or in-vitro fertilization. However, a single sperm is theoretically enough for ICSI to perform infertility treatment. As a result, the established surgical approach to retrieve sperm directly from the testis was called microdissection testicular sperm extraction (micro-TESE) [1]....

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Section: Establishment Of Gonadotropin Therapy For Noa Menmentioning

confidence: 99%

Gonadotoropin actions on spermatogenesis and hormonal therapies for spermatogenic disorders [Review]

Shiraishi

Matsuyama

2017

Endocr J

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“…Of the 23 included studies, 7 (n ¼ 1084 patients) evaluated the effect of dietary habits and food intake on semen parameters and quality, 2,25,28,48 4 (n ¼ 232 patients) evaluated the effect of carnitine consumption on sperm parameters and quality, 54-57 3 (n ¼ 148 patients) investigated the effect of selenium on sperm parameters, 58-60 2 (n ¼ 481 patients) evaluated the effect of coenzyme Q10 on sperm quality and parameters, 61,62 and each of the remaining articles investigated the effect of saffron, soybased foods, vitamin C, clomiphene citrate, n-3 polyunsaturated fatty acids, beta carotene, and ubiquinol on sperm parameters. [63][64][65][66][67][68][69] The 23 articles included patients from 9 different countries: Iran (6 articles), 2,[61][62][63]67,69 the United States (7 articles), 28,54,58,64,[70][71][72] Italy (3 articles), [55][56][57] Egypt (2 articles), 66,68 the United Kingdom (1 article), 60 Germany (1 article), 65 Poland (1 article), 59 Spain (1 article), 48 and Brazil (1 article). 25 …”

Section: Overview Of Identified Studiesmentioning

confidence: 99%

“…2,25,28,48,63,64,[70][71][72] The remaining studies, which investigated the role of specific micronutrient(s) on indicators of semen quality, reported conflicting results (Table 3). 17,[54][55][56][57][58][59][60][61][62][65][66][67]69 Dietary habits and food intake. All 7 included studies that investigated the role of diet and food intake on sperm variables reported that diet plays a key role in the improvement of sperm parameters.…”

Section: Outcomes Of Interestmentioning

confidence: 99%

Nutritional modifications in male infertility: a systematic review covering 2 decades

et al. 2015

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Context: Studies suggest that appropriate nutritional modifications can improve the natural conception rate of infertile couples. Objectives: The purpose of this study was to review the human trials that investigated the relation between nutrition and male infertility. Data Sources: A comprehensive systematic review of published human studies was carried out by searching scientific databases. Article selection was carried out in accordance with Preferred Reporting Items for Systematic Reviews and MetaAnalyses. The American Dietetic Association Research Design and Implementation Checklist was also used for quality assessment. Data Extraction: A total of 502 articles were identified, of which 23 studies met the inclusion criteria. Data Synthesis: Results indicated that a healthy diet improves at least one measure of semen quality, while diets high in lipophilic foods, soy isoflavones, and sweets lower semen quality. Conclusion: The role of daily nutrient exposure and dietary quality needs to be highlighted in male infertility. Mechanistic studies addressing the responsible underlying mechanisms of action of dietary modifications are highly warranted.

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“…The efficacy of each agent alone is not established. A randomized controlled trial 16 of daily clomiphene (25 mg) plus vitamin E (400 mg) in men with idiopathic oligoasthenozoospermia demonstrated the efficacy of this regimen over placebo in improving total sperm count, forward progressive motility, and unassisted pregnancy rate (37% versus 13%, P50.04) but only involved 30 couples in each limb with borderline significant odds ratio for pregnancy (odds ratio: 3.76; 95% CI: 1.03-13.64). In a case series from three international centers, comprising 42 patients with non-obstructive azoospermia, 64% of patients responded to clomiphene citrate and produced sperm in the ejaculate, sufficient for intracytoplasmic sperm injection.…”

Section: Anti-estrogensmentioning

confidence: 99%

Medical therapy for spermatogenic failure

Ramasamy¹,

Stahl²,

Schlegel³

2011

Asian J Androl

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Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial

Cited by 117 publications

References 12 publications

Gonadotoropin actions on spermatogenesis and hormonal therapies for spermatogenic disorders [Review]

Gonadotoropin actions on spermatogenesis and hormonal therapies for spermatogenic disorders [Review]

Nutritional modifications in male infertility: a systematic review covering 2 decades

Medical therapy for spermatogenic failure

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