Infertility:Treatment of male infertility: is it effective? Review and meta-analyses of published randomized controlled trials

Abstract

There are few widely accepted treatments for male subfertility. Controlled trials are necessary to evaluate different subfertility treatments because pregnancies and spontaneous improvements in semen parameters occur without treatment. Properly randomized trials can find out whether pregnancy rates are higher or lower than expected after treatment. Quantitative meta-analysis improves precision where individual trials are not powerful enough to demonstrate moderate treatment effects. Only 174 published randomized treatment trials for male subfertility were found after extensive literature review, both by computerized search and hand searches of 41 journals. In 72 of the studies, pregnancy was an outcome measure and these are analysed and discussed. The quality of most trials is poor. Meta-analysis was possible on seven themes, but the results of this exercise appear to be unduly influenced by trials of poor quality. Few conventional treatments (i.e. those not involving assisted conception techniques) result in improved fertility rates.

Overview of male infertility

“…Dans les oligoasth6nospermies, divers traitements m6di-camenteux ont 4t6 utilis4s, certains sur des bases physiopathologiques incertaines (arginine, zinc, vitamines), d'autres bas4s sur les m6canismes de contr61e hormonal de la spermatog6n6se. Les antioestrog6nes (Clomif'ene -Tamoxif'ene) paraissent avoir une certaine efficacit6, n6anmoins, les r6sultats sont modestes et il faut recourir ~ la m4thode de la m4ta-analyse [35] pour objectiver leur efficacit4. L'irr4gularit6 des effets des anticestrog~nes renforce l'hypoth6se de m4canismes physiopathologiques diff6rents selon les patients.…”

Homeopathic Treatment of Infertility: A Medical and Bioethical Perspective

“…Generally, the homeopathy physician does not publish his or her results, nor does he replicate the same technique of treatment for patients with the same disorder. O'Donovan et al [21] conducted a metaanalysis of homeopathic trials for infertility, and concluded that the quality of the majority of trials was poor. Furthermore, it is difficult to evaluate the results of homeopathic treatments in the same manner as conventional treatment as a result of the differing medical principles and differing healing processes underlying each method [22].…”

Keynote Address - Reproductive health: global infertility trend

“…Some authors believe that varicocele causes oligospermia by elevating the temperature around the testicles and, therefore, recommend varicocoelectomy in every case of male infertility in which a varicococele is detected (Nieschlag, 1992) A few others disagree and argue that varicocoelectomy has no place in the management of male infertility (O'Donovan et al, 1993). Hence, further studies are required to identify the relationship between male infertility and varicocoeles.…”