Effects of phosphodiesterase‐5 inhibitors on Leydig cell secretory function in oligoasthenospermic infertile men: a randomized trial

Abstract

Study Type – Therapy (RCT) Level of Evidence 1b OBJECTIVE To evaluate the effects of phosphodiesterase‐5 inhibitors (PDE5‐i) on Leydig cell secretory function (LCSF). PATIENTS AND METHODS In all, 75 men with oligoasthenospermia were treated daily for 12 weeks with either vardenafil (23 men, group A), sildenafil (25 men, group B) or l‐carnitine (26 men, group C); a further group of 22 men with oligoasthenospermia (group D) received no treatment. Serum levels of insulin‐like‐3 peptide (INSL3) were evaluated before and after the end of the treatment in each of groups A, B and C, respectively. Serum INSL3 levels were measured in each participant of group D before and after the 12‐week experimental period. RESULTS Within group A and B, the peripheral serum mean INSL3 concentration, sperm concentration, percentage of motile spermatozoa, and percentage of morphologically normal spermatozoa were significantly greater after PDE5‐i treatment than before. CONCLUSION We suggest that PDE5‐i enhances LCSF, as the mean INSL3 concentration was significantly greater after PDE5‐i administration than before, within groups A and B. This enhancement in LCSF might contribute to the increase in sperm concentration and sperm motility after administration of PDE5‐i.

Current use of phosphodiesterase inhibitors in urology

“…[26,27] In addition to restoring sexual function, PDE5 inhibitors have also been shown to enhance the Leydig cell secretory function, increasing sperm function and aiding sperm motility. [28] The emerging studies point to the efficacy of combination therapy (testosterone supplementation and PDE5 inhibitor use) over monotherapy in the management of ED, especially in men who have a low testosterone level.…”

The Role of PDE5 Inhibitors in the Treatment of Testicular Dysfunction

“…A few studies have suggested that administration of PDE5 inhibitors and in particular sildenafil and vardenafil in infertile men has either positive effects or lack of effects on the standard parameters of semen analysis (Dimitriadis et al, 2010). Leydig cells express PDE5 (Scipioni et al, 2005).…”

“…Leydig cells express PDE5 (Scipioni et al, 2005). Dimitriadis et al, (2010) investigated the effects of PDE5 inhibitors on Leydig cellular secretory function and on the standard parameters of semen analysis. The authors evaluated peripheral serum levels of Insl3 in patients with oligoasthenospermia prior to and after PDE5 administration.…”

“…An enhanced Leydig cell secretory function may result in a more optimal biochemical microenvironment within the seminiferous tubuli of oligoasthenospermic men stimulating spermatogenesis. In addition, an enhanced Leydig cell secretory function increasing probably intraepididymal testosterone concentrations may improve the epididymal sperm maturation process in oligoasthenospermic men increasing sperm motility (Dimitriadis et al, 2010). Additionally, it has been demonstrated that cAMP is the major intracellular messenger for LH action on steroidogenesis and that most, if not all, of the signaling action of cAMP is due to cAMP-dependent protein kinase (PKA)-mediated effects on proteins regulating the steroid biosynthetic pathway (Saez, 1994;Stocco et al, 2005).…”

Neues in der Andrologie

“…2 7 Trifokale TE-SE. (Adaptiert nach [5])Abb 3. 8 Die mikrochirurgische Varikozelektomie verbessert die Schwangerschaftsrate in der unfruchtbaren Partnerschaft [6] Nach resezierenden viszeralchirurgischen Eingriffen hängt das Wohl der Patienten entscheidend von einer intakten Anastomosenheilung ab.…”