On-label and off-label drugs used in the treatment of male infertility

Chehab, Mahmoud; Madala, Alosh; Trussell, J. C.

doi:10.1016/j.fertnstert.2014.12.122

Cited by 69 publications

(63 citation statements)

References 67 publications

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“…110,136–138 The three most commonly used medications all attempt to increase endogenous testosterone production, with the premise that higher intratesticular concentration will stimulate spermatogenesis. 137 The first, human chorionic gonadotropin, stimulates leydig cells by binding to the LH receptor, thereby increasing testosterone production if the leydig cell is at least partially functional. 137,139 This is currently the only FDA approved medication for male infertility, however no studies specifically in KS-related infertility have been done.…”

Section: Fertility and Reproductionmentioning

confidence: 99%

“…137 The first, human chorionic gonadotropin, stimulates leydig cells by binding to the LH receptor, thereby increasing testosterone production if the leydig cell is at least partially functional. 137,139 This is currently the only FDA approved medication for male infertility, however no studies specifically in KS-related infertility have been done. Clomiphene citrate is a selective estrogen receptor modulator that blocks the negative feedback at the level of the hypothalamus and pituitary thus increasing both LH and FSH secretion.…”

Section: Fertility and Reproductionmentioning

confidence: 99%

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Testis Development and Fertility Potential in Boys with Klinefelter Syndrome

Davis

Rogol

Ross

2015

Endocrinology and Metabolism Clinics of North America

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Synopsis Klinefelter syndrome (KS) is the leading genetic cause of primary hypogonadism and infertility in men.1,2 The clinical phenotype has expanded beyond the original description of infertility, small testes and gynecomastia.3 Animal models, epidemiological studies, and clinical research of males with KS throughout the lifespan have allowed us to better characterize the variable phenotype of this condition. This review will provide an overview on what is known of the epidemiology, clinical features, and pathophysiology of KS, followed by a more focused discussion of testicular development and the clinical management of hypogonadism and fertility in men with KS.

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Section: Fertility and Reproductionmentioning

confidence: 99%

Section: Fertility and Reproductionmentioning

confidence: 99%

Testis Development and Fertility Potential in Boys with Klinefelter Syndrome

Davis

Rogol

Ross

2015

Endocrinology and Metabolism Clinics of North America

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“…7 Through blockade of the estrogen receptor at both the level of the hypothalamus and pituitary, estrogenic negative feedback inhibition of FSH and LH secretion Clomiphene citrate rescue of spermatogenesis in men with infertility while remaining on finasteride: A case report…”

Section: Discussionmentioning

confidence: 99%

“…The increased concentrations of FSH and LH lead to increased testosterone production (higher circulating and intratesticular testosterone levels). 3,7 The efficacy of CC therapy on fertility is controversial, with studies showing improvement in semen parameters, but no statistically significant improvement in pregnancy rates. 8,9 For our patient, CC therapy resulted in increases in sperm count.…”

Section: Residents' Roommentioning

confidence: 99%

Clomiphene citrate rescue of spermatogenesis in men with infertility while remaining on finasteride: A case report

Forbes

Jarvi³

2017

CUAJ

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Finasteride is a selective inhibitor of type-2 5-alpha reductase enzyme, preventing the conversion of testosterone to dihydrotestosterone (DHT). Finasteride is used as an oral drug for the treatment of benign prostatic hyperplasia at the 5 mg/day dose and is also used for the treatment of androgenic alopecia, or male pattern hair loss, at a dosage of 1 mg orally. There are now a number of studies documenting that finasteride, even at the low dose of 1 mg, may have an adverse effect on fertility for some men.In the largest study, Samplaski et al reported that sperm counts improved over 11-fold once the men had stopped the finasteride, but most of the men did not recover to normal sperm parameters. Presently, if men using finasteride are subfertile, the recommendation is to stop the finasteride and wait for a recovery of spermatogenesis. There has been no report of the use of any hormone therapy, such as clomiphene citrate, gonadotropin, or aromatase inhibitors, to treat subfertile men on finasteride. This is the first case report of the use of clomiphene citrate to improve fertilty for a man on finasteride.

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“…This blockade of negative feedback indirectly enhances LH and FSH excretion from the anterior pituitary, increasing both testosterone and spermatogenesis. Because of this, clomiphene is not as effective in patients with a pretreatment elevated FSH or in patients lacking a posttreatment FSH “surge.”[19]…”

Section: Selective Estrogen Receptor Modulatorsmentioning

confidence: 99%

Empiric medical therapy with hormonal agents for idiopathic male infertility

Tadros

Sabanegh

2017

Indian J Urol

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Introduction:Infertility affects approximately 15% of all couples, and male factor contribute to up to 50% of cases. Unfortunately, the cause of male infertility is unknown in about 30% of these cases. Infertility of unknown origin is classified as idiopathic male infertility when abnormal semen parameters are present. Despite not having a definable cause, these men may respond to treatment. This review focuses on the use of empiric hormonal therapies for idiopathic male infertility.Methods:A detailed PubMed/MEDLINE search was conducted to identify all publications pertaining to empiric use of hormonal therapies in the treatment of idiopathic male infertility using the keywords “idiopathic,” “male infertility,” “empiric treatment,” “clomiphene,” “SERM,” “gonadotropin,” “aromatase inhibitor,” and “androgen.” These manuscripts were reviewed to identify treatment modalities and results.Results:Gonadotropins, androgens, aromatase inhibitors, and selective estrogen receptor modulators (SERMs) have all been used with varying results. The studies on these treatments are of variable quality. The most well-studied agents are the SERMs which show a modest increase in semen parameters and pregnancy rates. Aromatase inhibitors are most effective in non-idiopathic patients. Gonadotropin treatment is limited by their inconvenience and relative ineffectiveness in this population. Testosterone suppresses spermatogenesis and should not be used to treat infertility.Conclusion:Gonadotropins, SERMs, and aromatase inhibitors may improve semen parameters and hormone levels in men with idiopathic infertility with the best results from SERMs. Testosterone should never be used to treat infertility. Large multicenter randomized controlled studies are needed to better determine the success of empiric use of hormonal therapy on pregnancy rates.

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On-label and off-label drugs used in the treatment of male infertility

Cited by 69 publications

References 67 publications

Testis Development and Fertility Potential in Boys with Klinefelter Syndrome

Testis Development and Fertility Potential in Boys with Klinefelter Syndrome

Clomiphene citrate rescue of spermatogenesis in men with infertility while remaining on finasteride: A case report

Empiric medical therapy with hormonal agents for idiopathic male infertility

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