Vandekerckhove P, Lilford R, Vail A, Hughes E
Institute of Epidemiology, University of Leeds, 34 Hyde Terrace, Leeds, Yorkshire, UK, LS2 9LN.
Cochrane Database Syst Rev. 2000;1996(2):CD000151. doi: 10.1002/14651858.CD000151.
Oligo-astheno-teratospermia (sperm of low concentration, reduced motility and increased abnormal morphology) of unknown cause is common and the need for treatment is felt by patients and doctors alike. As a result, a variety of empirical, non-specific treatments have been used in an attempt to improve semen characteristics and fertility. The administration of anti-oestrogens is a common treatment because anti oestrogens interfere with the normal negative feedback of sex steroids at hypothalamic and pituitary levels in order to increase endogenous gonadotropin-releasing hormone secretion from the hypothalamus and FSH and LH secretion directly from the pituitary. In turn, FSH and LH stimulate Leydig cells in the testes, and this has been claimed to lead to increased local testosterone production, thereby boosting spermatogenesis with a possible improvement in fertility. There may also be a direct effect of anti-oestrogens on testicular spermatogenesis or steroidogenesis. This review considers the available evidence of the effect of both Clomiphene citrate and tamoxifen, both of which have a predominant anti-oestrogenic effect, for idiopathic oligo and/or asthenospermia.
The objective was to assess the effects of treating subfertile men with anti-oestrogens (clomiphene or tamoxifen) on pregnancy rates among couples where subfertility has been attributed to idiopathic oligo- and/or asthenospermia.
The Cochrane Subfertility Review Group specialised register of controlled trials was searched".
Randomised trials of anti-oestrogen therapy for 3 months or more compared to placebo or no placebo for subfertile males among couples where subfertility is attributed to male factor.
Data were extracted independently by two reviewers. Any differences were resolved with a third reviewer.
Ten studies involving 738 men were included. Five of the trials did not specify method of randomisation. Anti-oestrogens had a positive effect on endocrinal outcomes, such as serum testosterone levels. In trials with secure randomisation there was no difference in the pregnancy rate between the anti-oestrogen groups and the control groups (odds ratio 1.26, 95% confidence interval 0.99 to 1.56). The overall pregnancy rate for these five trials was 15.4% compared to the spontaneous rate of 12.5% in the control groups. These odds increased to 1.56 (95% confidence interval 0.99 to 2.19) when all 10 trials were included, but this result is likely to be artificially inflated.
REVIEWER'S CONCLUSIONS: Anti-oestrogens appear to have a beneficial effect on endocrinal outcomes, but there is not enough evidence to evaluate the use of anti-oestrogens for increasing the fertility of males with idiopathic oligo-asthenospermia.
病因不明的少弱畸精子症（精子浓度低、活力下降及形态异常增加）很常见，患者和医生都认为有治疗的必要。因此，人们尝试了各种经验性、非特异性治疗方法来改善精液特征和生育能力。抗雌激素药物的使用是一种常见的治疗方法，因为抗雌激素会干扰下丘脑和垂体水平的性类固醇正常负反馈，以增加下丘脑促性腺激素释放激素的内源性分泌以及垂体直接分泌的促卵泡生成素（FSH）和促黄体生成素（LH）。反过来，FSH和LH会刺激睾丸中的间质细胞，据称这会导致局部睾酮生成增加，从而促进精子发生，有可能提高生育能力。抗雌激素对睾丸精子发生或类固醇生成也可能有直接作用。本综述考虑了枸橼酸氯米芬和他莫昔芬这两种主要具有抗雌激素作用的药物对特发性少精子症和/或弱精子症的现有疗效证据。
评估用抗雌激素药物（氯米芬或他莫昔芬）治疗不育男性对不育归因于特发性少精子症和/或弱精子症的夫妇妊娠率的影响。
检索了Cochrane不育症综述小组专门的对照试验注册库。
在不育归因于男性因素的夫妇中，对不育男性进行3个月或更长时间抗雌激素治疗与安慰剂或无安慰剂对照的随机试验。
由两名 reviewers 独立提取数据。如有任何差异，由第三名 reviewer 解决。
纳入了10项涉及738名男性的研究。其中5项试验未明确随机化方法。抗雌激素对内分泌指标有积极影响，如血清睾酮水平。在随机化可靠的试验中，抗雌激素组和对照组的妊娠率没有差异（优势比1.26，95%置信区间0.99至1.56）。这5项试验的总体妊娠率为15.4%，而对照组的自然妊娠率为12.5%。当纳入所有10项试验时，这些优势比增加到1.56（95%置信区间0.99至2.19），但这个结果可能是人为夸大的。
抗雌激素似乎对内分泌指标有有益影响，但没有足够证据评估使用抗雌激素来提高特发性少弱畸精子症男性的生育能力。
