Letrozole Therapy for Obstructive Azoospermic Men before in vitro Fertilization (IVF) treatment with Percutaneous Epididymal Sperm Aspiration

Abstract

Letrozole can be considered a reliable treatment to improve sperm recovery for men with OA undergoing PESA-ICSI cycles by increasing serum gonadotropins and testosterone (T) levels, and-most importantly-the motile sperm count.

Effect of Letrozole on sperm parameters, chromatin status and ROS level in idiopathic Oligo/Astheno/Teratozoospermia

“…This study is a longitudinal, prospective, interventional and open-labelled clinical trial (Trial Registration: IRCT20191030045283N1, Registered 16 November 2019) and has received the approval of the Ethical Board of Shiraz University of Medical Sciences (IR.SUMS.-REC.1397.273). During 2018 and 2019, the patients with iOAT and a serum T:E2 ratio of ≤10 [15][16][17][18][19], referred to male infertility clinics affiliated with Shiraz University of Medical Sciences, were considered as candidates for inclusion in our study. Individuals with leukocytospermia (more than 1 million/ml), tobacco or alcohol abuse, ongoing medical treatment (gonadotropins, anabolic steroids, non-steroids anti-inflammatory drugs and cancer chemotherapy), previous cancer radiotherapy or chemotherapy, varicocele and Klinefelter syndrome were excluded in this study [18].…”

“…All the participants were orally treated with 2.5 mg letrozole (Soha Pharma Company, Iran) per day for 3 months [15][16][17][18]. Semen parameters, sperm chromatin integrity, intracellular ROS level and BMI was evaluated before and after letrozole administration, and also serum testosterone and estradiol levels were measured at the end of treatment.…”

“…According to this research, a cut-off point 10 was proposed as the lower limit of the T: E2 ratio for normal men [14]. Therefore, based on such observations, aromatase inhibitors (especially letrozole) have gained much attention for the treatment of iOAT with T:E 2 ratio ≤ 10 [15][16][17][18][19].…”

“…Letrozole as an aromatase inhibitor has been widely used in the treatment of female infertility [20][21][22]. There are limited studies that have evaluated the therapeutic potential of letrozole in male infertility [15][16][17][18][19]. Letrozole is a selective and highly potent aromatase inhibitor that inhibits the enzyme activity of intracellular aromatase.…”

“…There is a positive relationship between letrozole and improvement of sperm concentration, percentage of sperm motility and morphology [15][16][17][18][19]. But regarding to our information, there is no research about the effect of letrozole on sperm functional characteristics, while the sperm DNA constitute approximately 50% of the future progeny DNA, and chromatin anomalies have a negative impact on fertilization rate, embryo development, live birth and abortion rate [25][26][27][28][29][30][31][32][33].…”