Center for Male Fertility, Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2012 Mar;187(3):973-8. doi: 10.1016/j.juro.2011.10.137. Epub 2012 Jan 20.
We determined empirical medical therapy practice patterns for idiopathic infertility.
We performed a survey of 7,745 practicing American Urological Association members from July to November 2010. Respondents were questioned on empirical medical therapy use, patient evaluation and selection, and preferred medications.
A total of 387 urologists (5%) participated in the survey, of whom 16% had infertility fellowship training, two-thirds used empirical medical therapy and 78% treated with empirical medical therapy and surgery. Laboratory values important for identifying ideal candidates include sperm concentration, serum follicle-stimulating hormone and serum testosterone. The most common medications used were clomiphene citrate, human chorionic gonadotropin and anastrozole. Of respondents 25% would treat infertile males with testosterone while the patient actively pursued pregnancy. Overall 60.5% of respondents would treat with empirical therapy for 3 to 6 months. Of fellowship trained and general urologist respondents 70% and 47%, respectively, counseled patients that empirical medical therapy has unknown effects on pregnancy and sperm count.
Empirical medical therapy is used by two-thirds of survey respondents for idiopathic male infertility. There is no clear, universal pattern to the evaluation or identification of the ideal patient for such therapy among those surveyed. There is no consensus on the optimal medication and considerable ambiguity exists as to perceived effects on fertility. Of concern is that 25% of respondents use exogenous testosterone, a medication known for its contraceptive potential, for male infertility treatment. These findings confirm the need for additional studies to establish recommendations on the empirical use of medical therapy in the setting of male infertility.
我们确定了特发性不育的经验性医学治疗模式。
我们于 2010 年 7 月至 11 月对 7745 名美国泌尿科协会会员进行了调查。调查对象被问到经验性医学治疗的使用、患者评估和选择以及首选药物。
共有 387 名泌尿科医生（5%）参与了调查，其中 16%接受过不育症奖学金培训，三分之二的人使用经验性医学治疗，78%的人使用经验性医学治疗和手术。对识别理想候选者很重要的实验室值包括精子浓度、血清卵泡刺激素和血清睾丸酮。最常用的药物是氯米芬、人绒毛膜促性腺激素和阿那曲唑。25%的受访者会在患者积极备孕时用睾酮治疗不育男性。总的来说，60.5%的受访者会用经验性治疗法治疗 3 到 6 个月。接受过奖学金培训和普通泌尿科医生的受访者中，分别有 70%和 47%的人告知患者经验性医学治疗对妊娠和精子计数的效果未知。
三分之二的调查对象对特发性男性不育症采用经验性医学治疗。在接受调查的人群中，对于这种治疗方法，没有一个明确的、普遍的模式来评估或确定理想的患者。对于最佳药物也没有共识，而且对于潜在的生育效果存在很大的模糊性。令人担忧的是，25%的受访者使用外源性睾酮治疗男性不育症，而这种药物已知具有避孕潜力。这些发现证实需要进行更多的研究，以确定男性不育症的经验性医学治疗建议。
