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Eisa EFM, Ezzeldein SAM, Mohammed HA, Abdallah AA, Ghonimi WAM, Abd El Raouf M. Comparison of the therapeutic effect of platelet-rich plasma and injectable platelet-rich fibrin on testicular torsion/detorsion injury in rats. Sci Rep 2024; 14:18045. [PMID: 39103420 PMCID: PMC11300838 DOI: 10.1038/s41598-024-67704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024] Open
Abstract
Testicular torsion is a common disorder in males and results in blockage of testicular circulation with subsequent damage of testicular germ cells. The current work aimed to compare the therapeutic effect of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) on torsion/detorsion (T/D) injury in rats. Forty mature male Wister rats were arranged into 4 groups; (1) Control, (2) T/D, (3) T/D + PRP, and (4) T/D+ i-PRF. The right testis was twisting 1080° clockwise for 3 h in groups 2, 3 and 4, then 10 μl of PRP or i-PRF was injected intra-testicular 3 h after detorsion in groups 3 and 4, respectively. After 30 days postoperatively, the semen quality and hormonal assay were improved in PRP and i-PRF-treated groups with superiority of i-PRF (P < 0.001). High significance of Catalase, Glutathione Peroxidase (GPx), Superoxide Dismutase, Interleukin-1β (IL-1β), Caspase-3 and Tumor necrosis factor-α (TNF-α) was reported in treated rats with PRP and i-PRF (P < 0.001) with superiority to i-PRF-treated rats (P < 0.001). Testicular histoarchitectures were improved in PRP and i-PRF-treated rats with superiority of i-PRF-treated rats. It was concluded that PRP and i-PRF have regenerative efficacy on testicular damage after induced T/D injury with a superior efficacy of i-PRF.
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Affiliation(s)
- Eslam F M Eisa
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Shimaa A M Ezzeldein
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Haiam A Mohammed
- Department of Physiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Asmaa A Abdallah
- Department of Theriogenology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Wael A M Ghonimi
- Department of Histology and Cytology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Mustafa Abd El Raouf
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt.
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Rastegar Panah M, Jarvi K, Lo K, El-Sohemy A. Vitamin B 12 Is Associated with Higher Serum Testosterone Concentrations and Improved Androgenic Profiles Among Men with Infertility. J Nutr 2024:S0022-3166(24)00352-3. [PMID: 38936552 DOI: 10.1016/j.tjnut.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/04/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Infertility impacts 16% of North American couples, with male factor infertility contributing to ∼30% of cases. Reproductive hormones, especially testosterone, are essential for spermatogenesis. An age-independent population-level decline in testosterone concentrations over the past few decades has been proposed to be a consequence of diet and lifestyle changes. Vitamin B12 is present in the testes and has been suggested as an adjuvant nutritional therapy for male infertility due to its potential to improve sperm parameters. However, evidence examining the relationship between vitamin B12 and reproductive hormones is limited. OBJECTIVES The objective was to cross-sectionally examine the relationship between serum vitamin B12 and male reproductive hormones (luteinizing hormone, follicular stimulating hormone, total testosterone, estradiol, and prolactin). METHODS Men with infertility (n = 303) were recruited from Mount Sinai Hospital in Toronto, Canada. Serum was analyzed for vitamin B12 and reproductive hormones. Statistical analyses included nonparametric Spearman's rank correlation coefficient, linear regression, logistic regression, and effect modification by age and BMI linear regressions. RESULTS An independent monotonic relationship between serum vitamin B12 and total testosterone (ρ = 0.19, P = 0.001) was observed. Serum vitamin B12 was linearly associated with total testosterone (unadjusted β = 0.0007, P = 0.008 and adjusted β = 0.0005, P = 0.03). Compared to individuals in the lowest tertile of serum vitamin B12, those in the middle tertile (adjusted odds ratio [OR] = 0.48; 95% confidence interval [CI]: 0.25, 0.93, P = 0.03) and the highest tertile (unadjusted OR = 0.41; 95% CI: 0.22, 0.77, P = 0.005 and adjusted OR = 0.44; 95% CI: 0.22, 0.87, P = 0.02) had reduced odds of testosterone deficiency. CONCLUSIONS These findings suggest that among men with infertility, low serum vitamin B12 is associated with a higher risk of testosterone deficiency and impaired androgenic hormonal profiles that impact spermatogenesis and consequently, fertility.
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Affiliation(s)
| | - Keith Jarvi
- Department of Urology, Murray Koffler Urologic Wellness Center, Mount Sinai Hospital, Toronto, Canada
| | - Kirk Lo
- Department of Urology, Murray Koffler Urologic Wellness Center, Mount Sinai Hospital, Toronto, Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada.
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Rastegar Panah M, Jarvi K, Lo K, El-Sohemy A. Biomarkers of Iron Are Associated with Anterior-Pituitary-Produced Reproductive Hormones in Men with Infertility. Nutrients 2024; 16:290. [PMID: 38257183 PMCID: PMC10819645 DOI: 10.3390/nu16020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Approximately 16% of North American couples are affected by infertility, with 30% of cases being attributable to male factor infertility. The regulation of reproductive hormones via the hypothalamic-pituitary-gonadal axis is important for spermatogenesis and subsequently male fertility. Maintaining iron homeostasis is critical to normal reproductive physiological function. This cross-sectional study's objective was to determine the association between serum biomarkers of iron and reproductive hormones. Men experiencing infertility (n = 303) were recruited from Mount Sinai Hospital, Toronto. Serum was analyzed for iron and ferritin as biomarkers of iron status and reproductive hormones (follicle-stimulating hormone, luteinizing hormone, testosterone, estradiol, and prolactin), which were the primary outcome. Associations were determined using non-parametric Spearman's rank correlation coefficient, linear regressions, and logistic regressions. A significant independent monotonic inverse relationship between serum iron and prolactin (p = 0.0002) was found. In linear regression analyses, iron was inversely associated with luteinizing hormone (unadjusted p = 0.03, adjusted p = 0.03) and prolactin (unadjusted p = 0.001 and adjusted p = 0.003). Serum ferritin was inversely associated with both gonadotropins, follicle-stimulating hormone (adjusted p = 0.03), and luteinizing hormone (adjusted p = 0.02). These findings suggest that biomarkers of iron are associated with pituitary-produced reproductive hormones, which play a role in the hypothalamic-pituitary-gonadal signaling pathway involved in spermatogenesis, testicular testosterone production, and male fertility.
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Affiliation(s)
- Matineh Rastegar Panah
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 5th Floor, Room 5326A, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada;
| | - Keith Jarvi
- Murray Koffler Urologic Wellness Centre, Department of Urology, Mount Sinai Hospital, 60 Murray Street, 6th Floor, Toronto, ON M5T 3L, Canada
| | - Kirk Lo
- Murray Koffler Urologic Wellness Centre, Department of Urology, Mount Sinai Hospital, 60 Murray Street, 6th Floor, Toronto, ON M5T 3L, Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 5th Floor, Room 5326A, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada;
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Rastegar Panah M, Tahir I, Garcia-Bailo B, Lo K, Jarvi K, El-Sohemy A. Ascorbic acid is associated with favourable hormonal profiles among infertile males. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1143579. [PMID: 37361344 PMCID: PMC10285163 DOI: 10.3389/frph.2023.1143579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Infertility affects about 16% of North American couples, with the male factor contributing to ∼30% of cases. Reproductive hormones play an integral role in regulating the reproductive system and consequently, fertility. Oxidative stress reduces testosterone synthesis, and reduction in oxidative stress can improve hormone profiles. Ascorbic acid is a potent antioxidant that accounts for up to 65% of seminal antioxidant activity; however, its effects on reproductive hormones in humans are unknown. Methods The objective was to determine the association between serum ascorbic acid concentrations and male reproductive hormones. We conducted a cross-sectional study involving infertile males (n = 302) recruited from Mount Sinai Hospital, Toronto. Serum was analyzed for ascorbic acid, luteinizing hormone (LH), follicular stimulating hormone (FSH), total testosterone (TT), prolactin and estradiol. Statistical analyses included Spearman's rank correlations, linear regressions, logistic regressions, simple slope and Johnson-Neyman procedures. Results After adjusting for covariates, ascorbic acid was inversely associated with LH (P = 0.01). Ascorbic acid was positively associated with TT only among males over the age of 41.6 years (P = 0.01). Discussion Our findings show that ascorbic acid is associated with higher testosterone levels and improved androgenic status in infertile males, and some of the effects appear to be age dependent.
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Affiliation(s)
- Matineh Rastegar Panah
- El-Sohemy Lab, Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Irtaza Tahir
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bibiana Garcia-Bailo
- El-Sohemy Lab, Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kirk Lo
- Murray Koffler Urologic Wellness Centre, Division of Urology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Keith Jarvi
- Murray Koffler Urologic Wellness Centre, Division of Urology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ahmed El-Sohemy
- El-Sohemy Lab, Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Zhao W, Jing J, Shao Y, Zeng R, Wang C, Yao B, Hang D. Circulating sex hormone levels in relation to male sperm quality. BMC Urol 2020; 20:101. [PMID: 32680497 PMCID: PMC7367383 DOI: 10.1186/s12894-020-00674-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although sex hormones play critical roles in spermatogenesis and sperm maturation, it remains inconclusive whether circulating sex hormones can serve as non-invasive biomarkers to improve the assessment of sperm quality. METHODS We systematically evaluated the association of various sex hormones in serum with sperm quality among 338 men in subfertile couples. Concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), total estradiol (E2), and sex hormone-binding globulin (SHBG) were detected by chemiluminescent immunoassay. Free testosterone and estradiol were calculated using a validated algorithm. A generalized liner regression model controlling for lifestyle factors was used to evaluate the associations with sperm count, concentration, motility, and morphology. RESULTS After adjusting for age, body mass index, current smoking and alcohol drinking, LH, FSH, and TT levels were all inversely associated with sperm motility (all P for trend < 0.05); however, in mutual adjustment analysis, only LH remained an inverse association with sperm motility after adjusting for FSH and TT levels (P for trend = 0.04). Higher concentrations of LH were also associated with lower sperm progressive motility (P for trend = 0.04). Moreover, LH and FSH levels were both inversely associated with normal sperm morphology (P for trend = 0.04 and 0.02, respectively). CONCLUSIONS Increased levels of LH are associated with poor sperm motility and morphology, suggesting that LH may play a central role in sperm maturation. Future studies are warranted to assess potential clinical utility of LH for risk stratification and tailed prevention of male infertility.
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Affiliation(s)
- Wei Zhao
- Reproductive Medical Center, Jinling Hospital Affiliated Medical School of Nanjing University, Nanjing, China
| | - Jun Jing
- Reproductive Medical Center, Jinling Hospital Affiliated Medical School of Nanjing University, Nanjing, China
| | - Yong Shao
- Reproductive Medical Center, Jinling Hospital Affiliated Medical School of Nanjing University, Nanjing, China
| | - Rong Zeng
- Reproductive Medical Center, Jinling Hospital Affiliated Medical School of Nanjing University, Nanjing, China
| | - Cencen Wang
- Reproductive Medical Center, Jinling Hospital Affiliated Medical School of Nanjing University, Nanjing, China
| | - Bing Yao
- Reproductive Medical Center, Jinling Hospital Affiliated Medical School of Nanjing University, Nanjing, China.
- Reproductive Medical Centre, Nanjing Jinling Hospital, Nanjing University School of Medicine, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China.
| | - Dong Hang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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Systematic review of hormone replacement therapy in the infertile man. Arab J Urol 2017; 16:140-147. [PMID: 29713545 PMCID: PMC5922183 DOI: 10.1016/j.aju.2017.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/10/2017] [Accepted: 11/18/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives To highlight alternative treatment options other than exogenous testosterone administration for hypogonadal men with concomitant infertility or who wish to preserve their fertility potential, as testosterone replacement therapy (TRT) inhibits spermatogenesis, representing a problem for hypogonadal men of reproductive age. Materials and methods We performed a comprehensive literature review for the years 1978–2017 via PubMed. Also abstracts from major urological/surgical conferences were reviewed. Review was consistent with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) criteria. We used Medical Subject Heading terms for the search including ‘testosterone replacement therapy’ or ‘TRT’ and ‘male infertility’. Results In all, 91 manuscripts were screened and the final number used for the review was 56. All studies included were performed in adults, were written in English and had an abstract available. Conclusions Exogenous testosterone inhibits spermatogenesis. Hypogonadal men wanting to preserve their fertility and at the same time benefiting from TRT effects can be prescribed selective oestrogen receptor modulators or testosterone plus low-dose human chorionic gonadotrophin (hCG). Patients treated for infertility with hypogonadotrophic hypogonadism can be prescribed hCG alone at first followed by or in combination from the start with follicle-stimulating hormone preparations.
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Arafa MM, Majzoub A, AlSaid SS, El Ansari W, Al Ansari A, Elbardisi Y, Elbardisi HT. Chromosomal abnormalities in infertile men with azoospermia and severe oligozoospermia in Qatar and their association with sperm retrieval intracytoplasmic sperm injection outcomes. Arab J Urol 2017; 16:132-139. [PMID: 29713544 PMCID: PMC5922002 DOI: 10.1016/j.aju.2017.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/04/2017] [Accepted: 11/19/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To study the types and incidence of chromosomal abnormalities in infertile men with azoospermia and severe oligozoospermia in Qatar, and to compare the hormonal changes, testicular sperm retrieval rate, and intracytoplasmic sperm injection (ICSI) outcome between patients with chromosomal abnormalities and patients with idiopathic infertility. Patients and methods This study involved the retrospective chart review of 625 infertile male patients attending an academic tertiary medical centre in Qatar. Retrieved information included data on medical history, family history, clinical examination, semen analysis, initial hormonal profiles, and genetic studies, ICSI, and sperm retrieval results. Results The incidence of chromosomal abnormalities was 9.59% (10.6% amongst Qatari patients, 9.04% amongst non-Qataris). About 63.6% of the sample had azoospermia, of whom 10.8% had chromosomal abnormalities. Roughly 36.4% of the sample had oligozoospermia, of whom 7.5% had chromosomal abnormalities. There were no differences between patients with chromosomal abnormalities and those with idiopathic infertility for demographic and infertility features; but for the hormonal profiles, patients with idiopathic infertility had significantly lower luteinising hormone and follicle-stimulating hormone values. For ICSI outcomes, patients with chromosomal abnormalities had a significantly lower total sperm retrieval rate (47.4% vs 65.8%), surgical sperm retrieval rate (41.2% vs 58.1%), and lower clinical pregnancy rate (16.7% vs 26.6%) when compared to the idiopathic infertility group. Conclusion The incidence of chromosomal abnormalities in Qatar as a cause of severe male infertility is within a similar range as their prevalence internationally.
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Affiliation(s)
- Mohamed M. Arafa
- Urology Department, Hamad Medical Corporation, Doha, Qatar
- Andrology Department, Cairo University Medical School, Cairo, Egypt
- Corresponding author at: Department of Urology, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Ahmad Majzoub
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Sami S. AlSaid
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Abdulla Al Ansari
- Urology Department, Hamad Medical Corporation, Doha, Qatar
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Rago R, Salacone P, Caponecchia L, Sebastianelli A, Marcucci I, Calogero AE, Condorelli R, Vicari E, Morgia G, Favilla V, Cimino S, Arcoria AF, La Vignera S. The semen quality of the mobile phone users. J Endocrinol Invest 2013; 36:970-4. [PMID: 23722985 DOI: 10.3275/8996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The increased use of mobile phones, the media's attention for general health, and the increase of idiopathic male infertility suggest to investigate the possible consequences of an excessive use of mobile phones on semen quality. AIM To evaluate the conventional and some of the main biofunctional sperm parameters in healthy men according to the different use of the mobile phone. SUBJECTS AND METHODS All the enrolled subjects in this study were divided into four groups according to their active cell phone use: group A= no use (no.=10 subjects); group B= <2 h/day (no.=16); group C= 2-4 h/day (no.=17); and group D= >4 h/day (no.=20). Among the subjects of the group D (>4 h/day), a further evaluation was made between the "trousers users"(no.=12) and "shirt users"(no.=8), and they underwent semen collection to evaluate conventional and biofunctional sperm parameters (density, total count, morphology, progressive motility, apoptosis, mithocondrial membrane potential, chromatin compaction, DNA fragmentation). RESULTS None of the conventional sperm parameters examined were significantly altered. However, the group D and the trousers users showed a higher percentage of sperm DNA fragmentation compared to other groups. CONCLUSION These results suggest that the sperm DNA fragmentation could represent the only parameter significantly altered in the subjects who use the mobile phone for more than 4 h/day and in particular for those who use the device in the pocket of the trousers.
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Affiliation(s)
- R Rago
- Unit of Andrology and Pathophysiology of Reproduction, S.M. Goretti Hospital, Latina, Italy
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Abstract
This article summarizes the current office-based evaluation of male infertility and offers speculation, based on current research, on the future evolution of this encounter. A comprehensive history, physical examination, and semen analysis remain paramount to directing the evaluation; however, new advances continue to refine diagnostic and treatment algorithms. Interpretation of the routine semen analysis as well as adjunctive assessments, including reactive oxygen species, DNA fragmentation, and fluorescent in situ hybridization (FISH) are discussed. The analysis of genetic and endocrine abnormalities is reviewed.
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Affiliation(s)
- Ryan P Smith
- Department of Urology, University of Virginia, PO Box 800422, Charlottesville, VA 22908, USA
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Abstract
Endocrine therapy for male infertility is broadly categorized as specific or nonspecific therapy. Although uncommon, primary endocrine diagnoses in infertile men are amenable to targeted therapy. The efficacy of empiric endocrine therapy for idiopathic male infertility, however, has not been demonstrated conclusively by clinical trials. With better understanding of the underlying pathophysiology of idiopathic male infertility, careful evaluation of endocrine therapy in well-selected treatment groups and well-designed randomized, controlled trials is warranted. Although empiric endocrine therapy for idiopathic male infertility has been largely replaced by assisted reproductive techniques, both treatment modalities could play a role, perhaps as combination therapy.
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Affiliation(s)
- Howard H Kim
- Department of Urology, Weill Medical College of Cornell University and Cornell Institute for Reproductive Medicine, 525 East 68th Street, New York, NY 10065, USA
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Abstract
Idiopathic oligoasthenoteratozoospermia (iOAT) affects approximately 30% of all infertile men. This mini-review discussed recent data in this field. Age, non-inflammatory functional alterations in post-testicular organs, infective agents (Chlamydia trachomatis, herpes virus and adeno-associated viruses), alterations in gamete genome, mitochondrial alterations, environmental pollutants and "subtle" hormonal alterations are all considered possible causes of iOAT. Increase of reactive oxygen species in tubules and in seminal plasma and of apoptosis are reputed to affect sperm concentration, motility and morphology. iOAT is commonly diagnosed by exclusion, nevertheless spectral traces of the main testicular artery may be used as a diagnostic tool for iOAT. The following can be considered therapies for iOAT: 1) tamoxifen citrate (20 mg/d) + testosterone undecanoate (120 mg/d) (pregnancy rate per couple/month [prcm]: 3.8%); 2) folic acid (66 mg/d) + zinc sulfate (5 mg/d); 3) L-carnitine (2 g/d) alone or in combination with acetyl-L-carnitine (1 g/d) (prcm: 2.3%); and 4) both carnitines = one 30 mg cinnoxicam suppository every 4 days (prcm: 8.5%). Alpha-blocking drugs improved sperm concentration but not morphology, motility or pregnancy rate. Tranilast (300 mg/d) increased sperm parameters and pregnancy rates in an initial uncontrolled study. Its efficacy on sperm concentration (but not on sperm motility, morphology or prcm) was confirmed in subsequent published reports. The efficacy of tamoxifen + testosterone undecanoate, tamoxifen alone, and recombinant follicle-stimulating hormone is still a matter for discussion.
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Affiliation(s)
- Giorgio Cavallini
- Operative Unit of Andrology, Società Italiana di Medicina della Riproduzione, Via Mazzini 12, 40138 Bologna, Italy.
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