Kalkanli Arif, Akdere Hakan, Cevik Gökhan, Salabas Emre, Cilesiz Nusret Can, Kadioglu Ateş
Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey.
Department of Urology, Trakya University, Medical Faculty, Edirne, Turkey.
Curr Pharm Des. 2021;27(24):2790-2795. doi: 10.2174/1381612826666201102110456.
Medical treatments are used either alone or in combination with assisted reproductive techniques for the treatment of infertile patients with hypergonadotropic hypogonadism. A wide range of treatment options such as gonadotropins, aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs) and their combination are available as options.
The aim of this review was to evaluate treatment options for infertile men with hypergonadotropic hypogonadism.
A literature search of MEDLINE (1980-2019) was conducted using the terms 'hypogonadism', 'male infertility', 'gonadotropins', 'SERMs' and 'AIs'. Pathologies leading to hypergonadotropic hypogonadism and treatment modalities such as gonadotropins, SERMs, AIs and surgical treatment were discussed.
FSH increases spontaneous pregnancy rates but the level of evidence was proven to be low for live birth rates. AIs are valid treatment options for patients with low T/E2 ratio as they significantly increase sperm concentrations. SERMs are recommended for infertile males with a sperm concentration between 10-20 million. Varicocele was reported to increase testosterone levels of hypogonadic infertile males.
Medical treatment modalities such as gonadotropins, SERMs, AIs and a combination of these therapies has been showed to have some effect in improvement of fertility but is not mainstream of the treatment.
医疗手段可单独使用，也可与辅助生殖技术联合使用，用于治疗高促性腺激素性性腺功能减退的不孕患者。有多种治疗选择，如促性腺激素、芳香化酶抑制剂（AIs）、选择性雌激素受体调节剂（SERMs）及其联合使用。
本综述旨在评估高促性腺激素性性腺功能减退的不孕男性的治疗选择。
使用“性腺功能减退”“男性不育”“促性腺激素”“SERMs”和“AIs”等术语对MEDLINE（1980 - 2019）进行文献检索。讨论了导致高促性腺激素性性腺功能减退的病理情况以及促性腺激素、SERMs、AIs和手术治疗等治疗方式。
促卵泡生成素（FSH）可提高自然受孕率，但证据水平显示其对活产率的作用较低。芳香化酶抑制剂（AIs）是T/E2比值低的患者的有效治疗选择，因为它们可显著提高精子浓度。对于精子浓度在1000万至2000万之间的不育男性，推荐使用选择性雌激素受体调节剂（SERMs）。据报道，精索静脉曲张可提高性腺功能减退的不育男性的睾酮水平。
促性腺激素、SERMs、AIs等医疗治疗方式以及这些疗法的联合使用已显示出对改善生育能力有一定作用，但并非治疗的主流方法。
