Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
Andrology. 2013 Sep;1(5):749-57. doi: 10.1111/j.2047-2927.2013.00107.x.
The aim of this study was to synthesize and present the latest available evidence regarding the use of oestrogen antagonists as empiric medical therapy for idiopathic male infertility with oligo and/or asthenoteratozoospermia through meta-analysis of randomized controlled trials (RCTs). Systematic literature acquisition was done for English and other foreign language biomedical databases up to March, 2013. RCTs relevant to the topic were identified and critically appraised independently by two physician reviewers. Dichotomous data of pregnancy rate and adverse events were extracted for calculation of odds ratio (OR) and 95% confidence interval (CI). Effect estimates were pooled using Peto method with fixed effect model. The continuous data of semen and endocrine parameters were calculated for the mean difference between pre- and post-treatment effects, the weighted mean difference (WMD) and SD between the control and intervention group were determined and pooled using the random effects model. Inter-study heterogeneity and publication bias were assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline for meta-analysis reporting was followed. Eleven RCTs of good methodological quality were included for meta-analysis. The pooled effect estimates showed that oestrogen antagonists use was associated with a statistically significant increased pregnancy rate compared with controls (pooled OR 2.42; 95% CI 1.47-3.94; p = 0.0004). Significant increase in sperm concentration (WMD 5.24; 95% CI 2.12, 88.37; p = 0.001) and per cent sperm motility (WMD 4.55; 95% CI 0.73, 8.37; p = 0.03) were also noted. While significant elevation of serum follicle stimulating hormone (WMD 4.19 95% CI 2.05, 6.34; p = 0.0001) and testosterone (WMD 54.59; 95% CI 15.92, 93.27; p = 0.006) was associated with its use. No significant difference in adverse event was noted between oestrogen antagonists-treated group and controls. The evidence suggests that oestrogen antagonists as empiric medical therapy for idiopathic male infertility with low non-serious adverse event associated, may increase spontaneous pregnancy rate, improve sperm concentration and per cent sperm motility.
本研究旨在通过对随机对照试验（RCT）的荟萃分析，合成并呈现最新的关于使用雌激素拮抗剂作为特发性少精子症和/或弱精子症伴特发性男性不育症的经验性医学治疗的证据。系统地检索了截至 2013 年 3 月的英文和其他外国语言生物医学数据库中的文献。由两位医生独立地识别和批判性评价与主题相关的 RCT。提取妊娠率和不良事件的二项数据，以计算比值比（OR）和 95%置信区间（CI）。使用固定效应模型的 Peto 法汇总效应估计值。通过治疗前后效应的均值差、对照组和干预组的加权均数差（WMD）和标准差，计算并汇总精液和内分泌参数的连续数据，使用随机效应模型进行汇总。评估了研究间异质性和发表偏倚。遵循系统评价和荟萃分析报告的首选报告项目指南进行荟萃分析报告。有 11 项高质量的 RCT 被纳入荟萃分析。汇总的效应估计表明，与对照组相比，雌激素拮抗剂的使用与妊娠率的统计学显著增加相关（汇总 OR 2.42；95%CI 1.47-3.94；p=0.0004）。还观察到精子浓度（WMD 5.24；95%CI 2.12，88.37；p=0.001）和精子活力百分比（WMD 4.55；95%CI 0.73，8.37；p=0.03）的显著增加。同时，血清卵泡刺激素（WMD 4.19 95%CI 2.05，6.34；p=0.0001）和睾酮（WMD 54.59；95%CI 15.92，93.27；p=0.006）的显著升高也与雌激素拮抗剂的使用有关。雌激素拮抗剂治疗组与对照组之间的不良事件发生率无显著差异。证据表明，雌激素拮抗剂作为特发性男性不育症的经验性医学治疗，具有低非严重不良事件相关，可能会提高自然妊娠率，改善精子浓度和精子活力百分比。
