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
- 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
- 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
- 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
- 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
- 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
- 7
Iwasaki A, Gagnon C.
Formation of reactive oxygen species in spermatozoa of infertile patients.
Fertil Steril.
1992;
57
409-416
- 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
- 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
- 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
- 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
- 12
Bleau G, Lemarbre J, Faucher G, Roberts K D, Chapdelaine A.
Semen selenium and human fertility.
Fertil Steril.
1984;
42
890-894
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 24
Steinberger E.
Hormonal control of mammalian spermatogenesis.
Physiol Rev.
1971;
51
1-22
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 34
Vandekerckhove P, Lilford R, Vail A, Hughes E.
Kinin-enhancing drugs for unexplained subfertility in men.
Cochrane Database Syst Rev.
2000;
2
CD000153
- 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
- 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
- 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
- 38
Maier U, Hienert G.
Tamoxifen and kallikrein in therapy of oligoasthenozoospermia: results of a randomized
study.
Eur Urol.
1990;
17
223-225
- 39
Schill W B.
Treatment of idiopathic oligozoospermia by kallikrein: results of a double-blind study.
Arch Androl.
1979;
2
163-170
- 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
- 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
- 42
Vermeulen A, Comhaire F.
Hormonal effects of an antiestrogen, tamoxifen, in normal and oligospermic men.
Fertil Steril.
1978;
29
320-327
- 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
- 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
- 45
AinMelk Y, Belisle S, Carmel M, Jean-Pierre T.
Tamoxifen citrate therapy in male infertility.
Fertil Steril.
1987;
48
113-117
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 55
Micic S, Hadzi-Djokic J, Dotlic R, Tulic C.
Pentoxifyllin treatment of oligoasthenospermic men.
Acta Eur Fertil.
1988;
19
135-137
- 56
Agarwal A, Said T M.
Carnitines and male infertility.
Reprod Biomed Online.
2004;
8
376-384
- 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
- 58
Arduini A.
Carnitine and its acyl esters as secondary antioxidants?.
Am Heart J.
1992;
123
1726-1727
- 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
- 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
- 61
Cooper T G, Neuwinger J, Bahrs S, Nieschlag E.
Internal quality control of semen analysis.
Fertil Steril.
1992;
58
172-178
Dr. Katharina Hancke
Universitätsfrauenklinik
Hugstetter Straße 55
79106 Freiburg
Email: hancke@frk.ukl.uni-freiburg.de