Shahid Muhammad Nabeel, Khan Tahir Mehmood, Neoh Chin Fen, Lean Qi Ying, Bukhsh Allah, Karuppannan Mahmathi
Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia.
Department of Pharmacy Practice, Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan.
Front Pharmacol. 2021 Aug 16;12:638628. doi: 10.3389/fphar.2021.638628. eCollection 2021.
Infertility is an emerging health issue for men. Comparative efficacy of different pharmacological interventions on male infertility is not clear. The aim of this review is to investigate the efficacy of various pharmacological interventions among men with idiopathic male infertility. All randomized control trials evaluating the effectuality of interventions on male infertility were included for network meta-analysis (NMA) from inception to 31 April 2020, systematically performed using STATA through the random effect model. The protocol was registered at PROSPERO (CRD42020152891). The outcomes of interest were semen and hormonal parameters. Treatment effects ( < 0.05) were estimated through WMD at the confidence interval of 95%. Upon applying exclusion criteria, n=28 RCTs were found eligible for NMA. Results from NMA indicated that consumption of supplements increases sperm concentration levels [6.26, 95% CI 3.32, 9.21] in comparison to SERMs [4.97, 95% CI 1.61, 8.32], hormones [4.14, 95% CI 1.83, 6.46], and vitamins [0.15, 95% CI -20.86, 21.15)] with placebo, whereas the use of SERMs increased percentage sperm motility [6.69, 95% CI 2.38, 10.99] in comparison to supplements [6.46, 95% CI 2.57, 10.06], hormones [3.47, 95% CI 0.40, 6.54], and vitamins [-1.24, 95% CI -11.84, 9.43] with placebo. Consumption of hormones increased the sperm morphology [3.71, 95% CI, 1.34, 6.07] in contrast to supplements [2.22, 95% CI 0.12, 4.55], SERMs [2.21, 95% CI -0.78, 5.20], and vitamins [0.51, 95% CI -3.60, 4.62] with placebo. Supplements boosted the total testosterone levels [2.70, 95% CI 1.34, 4.07] in comparison to SERMs [1.83, 95% CI 1.16, 2.50], hormones [0.40, 95% CI -0.49, 1.29], and vitamins [-0.70, 95% CI -6.71, 5.31] with placebo. SERMs increase the serum FSH levels [3.63, 95% CI 1.48, 5.79] better than hormones [1.29, 95% CI -0.79, 3.36], vitamins [0.03, 95% CI -2.69, 2.76], and supplements [-4.45, 95% CI -7.15, -1.76] in comparison with placebo. This review establishes that all interventions had a significantly positive effect on male infertility. Statistically significant increased sperm parameters were noted in combinations of zinc sulfate (220 mg BID), clomiphene citrate (50 mg BID), and testosterone undecanoate and CoQ10; tamoxifen citrate and FSH were shown to improve the hormonal profile in infertile males.
不育是男性中一个新出现的健康问题。不同药物干预对男性不育的相对疗效尚不清楚。本综述的目的是研究各种药物干预对特发性男性不育症男性的疗效。纳入了所有评估干预措施对男性不育有效性的随机对照试验，进行从开始到2020年4月31日的网络荟萃分析（NMA），使用STATA通过随机效应模型系统地进行分析。该方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42020152891）登记。感兴趣的结局指标是精液和激素参数。通过加权均数差（WMD）在95%置信区间估计治疗效果（P<0.05）。应用排除标准后，发现28项随机对照试验符合网络荟萃分析的纳入标准。网络荟萃分析结果表明，与使用选择性雌激素受体调节剂（SERM）[4.97，95%置信区间1.61，8.32]、激素[4.14，95%置信区间1.83，6.46]和维生素[0.15，95%置信区间-20.86，21.15]加安慰剂相比，服用补充剂可提高精子浓度水平[6.26，95%置信区间3.32，9.21]；与使用补充剂[6.46，95%置信区间2.57，10.06]、激素[3.47，95%置信区间0.40，6.54]和维生素[-1.24，95%置信区间-11.84，9.43]加安慰剂相比，使用SERM可提高精子活力百分比[6.69，95%置信区间2.38，10.99]；与使用补充剂[2.22，95%置信区间0.12，4.55]、SERM[2.21，95%置信区间-0.78，5.20]和维生素[0.51，95%置信区间-3.60，4.62]加安慰剂相比，服用激素可改善精子形态[3.71，95%置信区间1.34，6.07]；与使用SERM[1.83，95%置信区间1.16，2.50]、激素[0.40，95%置信区间-0.49，1.29]和维生素[-0.70，95%置信区间-6.71，5.31]加安慰剂相比，补充剂可提高总睾酮水平[2.70，95%置信区间1.34，4.07]；与使用激素[1.29，95%置信区间-0.79，3.36]、维生素[0.03，95%置信区间-2.69，2.76]和补充剂[-4.45，95%置信区间-7.15，-1.76]加安慰剂相比，SERM升高血清促卵泡生成素（FSH）水平[3.63，95%置信区间1.48，5.79]的效果更好。本综述表明，所有干预措施对男性不育均有显著的积极影响。在硫酸锌（每日2次，每次220mg）、枸橼酸氯米芬（每日2次，每次50mg）、十一酸睾酮和辅酶Q10联合使用时，精子参数有统计学意义的增加；枸橼酸他莫昔芬和FSH可改善不育男性的激素水平。
