Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore; OBGYN Academic Clinical Program, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore.
Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore; Knox Private Hospital, 262 Mountain Highway, Wantirna Victoria 3152, Australia.
Reprod Biomed Online. 2019 Jan;38(1):39-45. doi: 10.1016/j.rbmo.2018.09.016. Epub 2018 Oct 30.
Previous studies of aromatase inhibitors on male infertility have focused on men with low testosterone-oestradiol ratio of less than 10. Can aromatase inhibitors improve spermatogenesis in men with idiopathic male infertility with normal testosterone-oestradiol ratio?
Prospective study of men with idiopathic severe oligozoospermia (sperm concentration <5 million/ml) carried out between February 2015 and March 2017. The objective was to assess if semen-analysis parameters improved after treatment with letrozole. Secondary objectives were to monitor the safety of letrozole in men, and to measure the alterations in serum FSH, LH, oestradiol and testosterone levels.
Fifteen men with normal testosterone-oestradiol ratio (>10) were treated with letrozole 2.5 mg daily for 4 months. This produced a 5.5-fold increase in sperm concentration (P = 0.0068). All men had increased total serum testosterone and suppressed oestradiol levels after treatment, thus raising the overall testosterone-oestradiol ratio (P < 0.0001). Adverse effects from letrozole were relatively minor and included loss of libido (54%), headaches (25%), fatigue (21%), weakness (13%), loss of hair (8%) and dry mouth (8%).
Letrozole improves sperm concentration and increases testosterone-oestradiol ratio for men with oligozoospermia who have normal testosterone-oestradiol ratio; its role in the treatment of male infertility may be extended to this group of patients. In addition, it is a relatively well-tolerated drug with no serious adverse effects.
以前关于芳香化酶抑制剂对男性不育的研究集中在睾丸酮-雌二醇比值低于 10 的低睾酮男性。芳香化酶抑制剂能否改善睾丸酮-雌二醇比值正常的特发性男性不育症患者的精子发生？
这是一项 2015 年 2 月至 2017 年 3 月间进行的特发性严重少精子症（精子浓度 <500 万/ml）男性的前瞻性研究。目的是评估来曲唑治疗后精液分析参数是否改善。次要目标是监测来曲唑在男性中的安全性，并测量血清 FSH、LH、雌二醇和睾酮水平的变化。
15 名睾丸酮-雌二醇比值（>10）正常的男性接受来曲唑 2.5 mg/d 治疗 4 个月。这导致精子浓度增加了 5.5 倍（P=0.0068）。所有男性在治疗后总血清睾酮升高，雌二醇水平降低，从而提高了总体睾丸酮-雌二醇比值（P<0.0001）。来曲唑的不良反应相对较小，包括性欲下降（54%）、头痛（25%）、疲劳（21%）、乏力（13%）、脱发（8%）和口干（8%）。
来曲唑可提高特发性少精子症患者的精子浓度和增加睾丸酮-雌二醇比值，这些患者的睾丸酮-雌二醇比值正常；其在男性不育治疗中的作用可能扩展到这组患者。此外，它是一种相对耐受良好的药物，没有严重的不良反应。
