Download PDF
Geburtshilfe Frauenheilkd 2006; 66(1): 26-33
DOI: 10.1055/s-2005-872897
Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Therapeutische Ansätze bei idiopathischer Infertilität des Mannes

Is the Treatment of Idiopathic Male Infertility at all Effective?K. Hancke1 , D. Denschlag1 , G. Gitsch1 , C. Keck2
  • 1Universitätsfrauenklinik Freiburg
  • 2Serono International S. A. Geneva, Schweiz
Further Information

Publication History

Eingang Manuskript: 8.8.2005

Akzeptiert: 2.9.2005

Publication Date:
31 January 2006 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Bei Paaren mit unerfülltem Kinderwunsch lassen sich in ca. 40 % der Fälle Einschränkungen der männlichen Fertilität nachweisen [[1]]. Als Ursachen für männliche Sub-/Infertilität kommen genetische Veränderungen, Infektionen der ableitenden Samenwege, hormonelle Störungen u. a. infrage. In ca. 30 % der Fälle lässt sich keine eindeutige Ursache ermitteln, man spricht dann auch von „idiopathischer“ Infertilität. Naturgemäß lässt sich für die idiopathische Infertilität keine kausale Therapie anbieten. Die folgende Übersicht stellt eine Zusammenfassung der heute vorliegenden Erkenntnisse über konservative Behandlungsversuche bei idiopathischer andrologischer Infertilität dar.

Abstract

Male infertility factors are identified in approx. 40 % of infertile couples. This is partially due to genetic aberrations, infections or endocrine disorders. However in approx. 30 % of the cases there is no clear evidence of an underlying disease. These cases are classified as “unexplained” or “idiopathic” infertility. As the reason for infertility in these cases is unknown, there is no causal treatment available. This review provides an update on empirical treatment options for idiopathic male infertility.

Schlüsselwörter

Andrologische Infertilität - unerfüllter Kinderwunsch

Key words

Idiopathic male infertility

Literatur

  • 1 Keck C, Neulen J, Behre H M. Praxis der Frauenheilkunde. (3 Bde.) Endokrinologie, Reproduktionsmedizin, Andrologie. 2. Aufl. Stuttgart; Thieme 2002
    Search in Google Scholar
  • 2 Agarwal A, Nallella K P, Allamaneni S S, Said T M. Role of antioxidants in treatment of male infertility: an overview of the literature.  Reprod Biomed Online. 2004;  8 616-627
    CrossrefPubMedSearch in Google Scholar
  • 3 Hull M G, Glazener C M, Kelly N J, Conway D I, Foster P A, Hinton R A. et al . Population study of causes, treatment, and outcome of infertility.  Br Med J (Clin Res Ed). 1985;  291 1693-1697
    CrossrefPubMedSearch in Google Scholar
  • 4 Sharlip I D, Jarow J P, Belker A M, Lipshultz L I, Sigman M, Thomas A J. et al . Best practice policies for male infertility.  Fertil Steril. 2002;  77 873-882
    CrossrefPubMedSearch in Google Scholar
  • 5 Ben Rafael Z, Farhi J, Feldberg D, Bartoov B, Kovo M, Eltes F. et al . Follicle-stimulating hormone treatment for men with idiopathic oligoteratoasthenozoospermia before in vitro fertilization: the impact on sperm microstructure and fertilization potential.  Fertil Steril. 2000;  73 24-30
    CrossrefPubMedSearch in Google Scholar
  • 6 Kamischke A, Behre H M, Bergmann M, Simoni M, Schafer T, Nieschlag E. Recombinant human follicle stimulating hormone for treatment of male idiopathic infertility: a randomized, double-blind, placebo-controlled, clinical trial.  Hum Reprod. 1998;  13 596-603
    CrossrefPubMedSearch in Google Scholar
  • 7 Iwasaki A, Gagnon C. Formation of reactive oxygen species in spermatozoa of infertile patients.  Fertil Steril. 1992;  57 409-416
    PubMedSearch in Google Scholar
  • 8 Kovalski N N, de Lamirande E, Gagnon C. Reactive oxygen species generated by human neutrophils inhibit sperm motility: protective effect of seminal plasma and scavengers.  Fertil Steril. 1992;  58 809-816
    PubMedSearch in Google Scholar
  • 9 Rolf C, Cooper T G, Yeung C H, Nieschlag E. Antioxidant treatment of patients with asthenozoospermia or moderate oligoasthenozoospermia with high-dose vitamin C and vitamin E: a randomized, placebo-controlled, double-blind study.  Hum Reprod. 1999;  14 1028-1033
    CrossrefPubMedSearch in Google Scholar
  • 10 Suleiman S A, Ali M E, Zaki Z M, el Malik E M, Nasr M A. Lipid peroxidation and human sperm motility: protective role of vitamin E.  J Androl. 1996;  17 530-537
    PubMedSearch in Google Scholar
  • 11 Yeung C H, De Geyter C, De Geyter M, Nieschlag E. Production of reactive oxygen species by and hydrogen peroxide scavenging activity of spermatozoa in an IVF program.  J Assist Reprod Genet. 1996;  13 495-500
    PubMedSearch in Google Scholar
  • 12 Bleau G, Lemarbre J, Faucher G, Roberts K D, Chapdelaine A. Semen selenium and human fertility.  Fertil Steril. 1984;  42 890-894
    PubMedSearch in Google Scholar
  • 13 Scott R, MacPherson A, Yates R W, Hussain B, Dixon J. The effect of oral selenium supplementation on human sperm motility.  Br J Urol. 1998;  82 76-80
    CrossrefPubMedSearch in Google Scholar
  • 14 Keskes-Ammar L, Feki-Chakroun N, Rebai T, Sahnoun Z, Ghozzi H, Hammami S. et al . Sperm oxidative stress and the effect of an oral vitamin E and selenium supplement on semen quality in infertile men.  Arch Androl. 2003;  49 83-94
    PubMedSearch in Google Scholar
  • 15 Kessopoulou E, Powers H J, Sharma K K, Pearson M J, Russell J M, Cooke I D. et al . A double-blind randomized placebo cross-over controlled trial using the antioxidant vitamin E to treat reactive oxygen species associated male infertility.  Fertil Steril. 1995;  64 825-831
    PubMedSearch in Google Scholar
  • 16 Lenzi A, Lombardo F, Sgro P, Salacone P, Caponecchia L, Dondero F. et al . Use of carnitine therapy in selected cases of male factor infertility: a double-blind crossover trial.  Fertil Steril. 2003;  79 292-300
    CrossrefPubMedSearch in Google Scholar
  • 17 Wong W Y, Merkus H M, Thomas C M, Menkveld R, Zielhuis G A, Steegers-Theunissen R P. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial.  Fertil Steril. 2002;  77 491-498
    CrossrefPubMedSearch in Google Scholar
  • 18 Kvist U, Kjellberg S, Bjorndahl L, Soufir J C, Arver S. Seminal fluid from men with agenesis of the Wolffian ducts: zinc-binding properties and effects on sperm chromatin stability.  Int J Androl. 1990;  13 245-252
    PubMedSearch in Google Scholar
  • 19 Riffo M, Leiva S, Astudillo J. Effect of zinc on human sperm motility and the acrosome reaction.  Int J Androl. 1992;  15 229-237
    PubMedSearch in Google Scholar
  • 20 Hamdi S A, Nassif O I, Ardawi M S. Effect of marginal or severe dietary zinc deficiency on testicular development and functions of the rat.  Arch Androl. 1997;  38 243-253
    PubMedSearch in Google Scholar
  • 21 Ebisch I M, van Heerde W L, Thomas C M, van der P N, Wong W Y, Steegers-Theunissen R P. C677T methylenetetrahydrofolate reductase polymorphism interferes with the effects of folic acid and zinc sulfate on sperm concentration.  Fertil Steril. 2003;  80 1190-1194
    CrossrefPubMedSearch in Google Scholar
  • 22 Omu A E, Dashti H, Al Othman S. Treatment of asthenozoospermia with zinc sulphate: andrological, immunological and obstetric outcome.  Eur J Obstet Gynecol Reprod Biol. 1998;  79 179-184
    CrossrefPubMedSearch in Google Scholar
  • 23 Courtens J L, Courot M. Acrosomal and nuclear morphogenesis in ram spermatids: an experimental study of hypophysectomized and testosterone-supplemented animals.  Anat Rec. 1980;  197 143-152
    PubMedSearch in Google Scholar
  • 24 Steinberger E. Hormonal control of mammalian spermatogenesis.  Physiol Rev. 1971;  51 1-22
    PubMedSearch in Google Scholar
  • 25 Moudgal N R, Murthy G S, Prasanna Kumar K M, Martin F, Suresh R, Medhamurthy R. et al . Responsiveness of human male volunteers to immunization with ovine follicle stimulating hormone vaccine: results of a pilot study.  Hum Reprod. 1997;  12 457-463
    CrossrefPubMedSearch in Google Scholar
  • 26 Tapanainen J S, Aittomaki K, Min J, Vaskivuo T, Huhtaniemi I T. Men homozygous for an inactivating mutation of the follicle-stimulating hormone (FSH) receptor gene present variable suppression of spermatogenesis and fertility.  Nat Genet. 1997;  15 205-206
    CrossrefPubMedSearch in Google Scholar
  • 27 Bouloux P, Warne D W, Loumaye E. Efficacy and safety of recombinant human follicle-stimulating hormone in men with isolated hypogonadotropic hypogonadism.  Fertil Steril. 2002;  77 270-273
    CrossrefPubMedSearch in Google Scholar
  • 28 Foresta C, Bettella A, Ferlin A, Garolla A, Rossato M. Evidence for a stimulatory role of follicle-stimulating hormone on the spermatogonial population in adult males.  Fertil Steril. 1998;  69 636-642
    CrossrefPubMedSearch in Google Scholar
  • 29 Foresta C, Bettella A, Rossato M, La Sala G, De Paoli M, Plebani M. Inhibin B plasma concentrations in oligozoospermic subjects before and after therapy with follicle stimulating hormone.  Hum Reprod. 1999;  14 906-912
    CrossrefPubMedSearch in Google Scholar
  • 30 Foresta C, Bettella A, Merico M, Garolla A, Ferlin A, Rossato M. Use of recombinant human follicle-stimulating hormone in the treatment of male factor infertility.  Fertil Steril. 2002;  77 238-244
    CrossrefPubMedSearch in Google Scholar
  • 31 Matorras R, Perez C, Corcostegui B, Pijoan J I, Ramon O, Delgado P. et al . Treatment of the male with follicle-stimulating hormone in intrauterine insemination with husband's spermatozoa: a randomized study.  Hum Reprod. 1997;  12 24-28
    CrossrefPubMedSearch in Google Scholar
  • 32 Yamamoto M, Hibi H, Miyake K. Comparison of the effectiveness of placebo and alpha-blocker therapy for the treatment of idiopathic oligozoospermia.  Fertil Steril. 1995;  63 396-400
    PubMedSearch in Google Scholar
  • 33 Gregoriou O, Vitoratos N, Papadias C, Gargaropoulos A, Konidaris S, Giannopoulos V. et al . Treatment of idiopathic oligozoospermia with an alpha-blocker: a placebo-controlled double-blind trial.  Int J Fertil Womens Med. 1997;  42 301-305
    PubMedSearch in Google Scholar
  • 34 Vandekerckhove P, Lilford R, Vail A, Hughes E. Kinin-enhancing drugs for unexplained subfertility in men.  Cochrane Database Syst Rev. 2000;  2 CD000153
    PubMedSearch in Google Scholar
  • 35 Glezerman M, Lunenfeld E, Potashnik G, Huleihel M, Soffer Y, Segal S. Efficacy of kallikrein in the treatment of oligozoospermia and asthenozoospermia: a double-blind trial.  Fertil Steril. 1993;  60 1052-1056
    PubMedSearch in Google Scholar
  • 36 Izzo P L, Canale D, Bianchi B, Meschini P, Esposito G, Menchini Fabris G F. et al . The treatment of male subfertility with kallikrein.  Andrologia. 1984;  16 156-161
    PubMedSearch in Google Scholar
  • 37 Keck C, Behre H M, Jockenhovel F, Nieschlag E. Ineffectiveness of kallikrein in treatment of idiopathic male infertility: a double-blind, randomized, placebo-controlled trial.  Hum Reprod. 1994;  9 325-329
    PubMedSearch in Google Scholar
  • 38 Maier U, Hienert G. Tamoxifen and kallikrein in therapy of oligoasthenozoospermia: results of a randomized study.  Eur Urol. 1990;  17 223-225
    PubMedSearch in Google Scholar
  • 39 Schill W B. Treatment of idiopathic oligozoospermia by kallikrein: results of a double-blind study.  Arch Androl. 1979;  2 163-170
    PubMedSearch in Google Scholar
  • 40 Micic S, Bila S, Ilic V, Sulovic V. Treatment of men with oligoasthenozoospermia and asthenozoospermia with kallikrein.  Acta Eur Fertil. 1985;  16 51-54
    PubMedSearch in Google Scholar
  • 41 Schill W B, Parsch E M, Miska W. Inhibition of angiotensin-converting enzyme-a new concept of medical treatment of male infertility?.  Fertil Steril. 1994;  61 1123-1128
    PubMedSearch in Google Scholar
  • 42 Vermeulen A, Comhaire F. Hormonal effects of an antiestrogen, tamoxifen, in normal and oligospermic men.  Fertil Steril. 1978;  29 320-327
    PubMedSearch in Google Scholar
  • 43 Willis K J, London D R, Bevis M A, Butt W R, Lynch S S, Holder G. Hormonal effects of tamoxifen in oligospermic men.  J Endocrinol. 1977;  73 171-178
    PubMedSearch in Google Scholar
  • 44 Zalata A, Hafez T, Verdonck L, Vermeulen L, Comhaire F. Androgens in seminal plasma: markers of the surface epithelium of the male reproductive tract.  Int J Androl. 1995;  18 271-277
    PubMedSearch in Google Scholar
  • 45 AinMelk Y, Belisle S, Carmel M, Jean-Pierre T. Tamoxifen citrate therapy in male infertility.  Fertil Steril. 1987;  48 113-117
    PubMedSearch in Google Scholar
  • 46 Kotoulas I G, Cardamakis E, Michopoulos J, Mitropoulos D, Dounis A. Tamoxifen treatment in male infertility. I. Effect on spermatozoa.  Fertil Steril. 1994;  61 911-914
    PubMedSearch in Google Scholar
  • 47 Krause W, Holland-Moritz H, Schramm P. Treatment of idiopathic oligozoospermia with tamoxifen - a randomized controlled study.  Int J Androl. 1992;  15 14-18
    CrossrefPubMedSearch in Google Scholar
  • 48 Adamopoulos D A, Pappa A, Billa E, Nicopoulou S, Koukkou E, Michopoulos J. Effectiveness of combined tamoxifen citrate and testosterone undecanoate treatment in men with idiopathic oligozoospermia.  Fertil Steril. 2003;  80 914-920
    CrossrefPubMedSearch in Google Scholar
  • 49 Matsumiya K, Kitamura M, Kishikawa H, Kondoh N, Fujiwara Y, Namiki M. et al . A prospective comparative trial of a gonadotropin-releasing hormone analogue with clomiphene citrate for the treatment of oligoasthenozoospermia.  Int J Urol. 1998;  5 361-363
    CrossrefPubMedSearch in Google Scholar
  • 50 Crottaz B, Senn A, Reymond M J, Rey F, Germond M, Gomez F. Follicle-stimulating hormone bioactivity in idiopathic normogonadotropic oligoasthenozoospermia: double-blind trial with gonadotropin-releasing hormone.  Fertil Steril. 1992;  57 1034-1043
    PubMedSearch in Google Scholar
  • 51 Merino G, Martinez Chequer J C, Barahona E, Bermudez J A, Moran C, Carranza-Lira S. Effects of pentoxifylline on sperm motility in normogonadotropic asthenozoospermic men.  Arch Androl. 1997;  39 65-69
    PubMedSearch in Google Scholar
  • 52 Rizk B, Fountain S, Avery S, Palmer C, Blayney M, Macnamee M. et al . Successful use of pentoxifylline in male-factor infertility and previous failure of in vitro fertilization: a prospective randomized study.  J Assist Reprod Genet. 1995;  12 710-714
    PubMedSearch in Google Scholar
  • 53 Tournaye H, Janssens R, Camus M, Staessen C, Devroey P, Van Steirteghem A. Pentoxifylline is not useful in enhancing sperm function in cases with previous in vitro fertilization failure.  Fertil Steril. 1993;  59 210-215
    PubMedSearch in Google Scholar
  • 54 Wang C, Chan C W, Wong K K, Yeung K K. Comparison of the effectiveness of placebo, clomiphene citrate, mesterolone, pentoxifylline, and testosterone rebound therapy for the treatment of idiopathic oligospermia.  Fertil Steril. 1983;  40 358-365
    PubMedSearch in Google Scholar
  • 55 Micic S, Hadzi-Djokic J, Dotlic R, Tulic C. Pentoxifyllin treatment of oligoasthenospermic men.  Acta Eur Fertil. 1988;  19 135-137
    PubMedSearch in Google Scholar
  • 56 Agarwal A, Said T M. Carnitines and male infertility.  Reprod Biomed Online. 2004;  8 376-384
    CrossrefPubMedSearch in Google Scholar
  • 57 Peluso G, Nicolai R, Reda E, Benatti P, Barbarisi A, Calvani M. Cancer and anticancer therapy-induced modifications on metabolism mediated by carnitine system.  J Cell Physiol. 2000;  182 339-350
    CrossrefPubMedSearch in Google Scholar
  • 58 Arduini A. Carnitine and its acyl esters as secondary antioxidants?.  Am Heart J. 1992;  123 1726-1727
    PubMedSearch in Google Scholar
  • 59 Lenzi A, Sgro P, Salacone P, Paoli D, Gilio B, Lombardo F. et al . A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia.  Fertil Steril. 2004;  81 1578-1584
    CrossrefPubMedSearch in Google Scholar
  • 60 Lilford R, Jones A M, Bishop D T, Thornton J, Mueller R. Case-control study of whether subfertility in men is familial.  BMJ. 1994;  309 570-573
    PubMedSearch in Google Scholar
  • 61 Cooper T G, Neuwinger J, Bahrs S, Nieschlag E. Internal quality control of semen analysis.  Fertil Steril. 1992;  58 172-178
    PubMedSearch in Google Scholar

Dr. Katharina Hancke

Universitätsfrauenklinik

Hugstetter Straße 55

79106 Freiburg

Email: hancke@frk.ukl.uni-freiburg.de