Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida.
Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida.
Fertil Steril. 2023 Dec;120(6):1203-1209. doi: 10.1016/j.fertnstert.2023.09.016. Epub 2023 Sep 26.
To study sperm parameters recovery and fertility outcomes in men with azoospermia or severe oligospermia caused by anabolic steroid use who underwent a standardized treatment regimen for spermatogenesis recovery.
A retrospective analysis of a cohort of men with a prior history of anabolic steroid use and infertility complaints (between 2018 and 2022) was conducted.
The standardized treatment approach involved discontinuing testosterone replacement therapy and administering a combination regimen of clomiphene citrate and human chorionic gonadotropin for a minimum of 3 to 6 months.
The main outcome measures included changes in sperm parameters, predominantly sperm concentration, and subsequent pregnancy outcomes.
A total of 45 men (median age 37 years, IQR 32-45) met the inclusion criteria for this analysis. Median duration of prior T use was 4 years (IQR 1.3-10), with the 2 most common modalities consisting of injection therapy (43.5%) and oral therapy (34.8%). The median initial sperm concentration was 0 million/cc (IQR 0-1.15), and 23 (51.1%) men initially presented with azoospermia. The median duration of combination human chorionic gonadotropin/clomid therapy was 5 months (IQR 3-12). In initially azoospermic men (N: 23), 5 were lost to follow-up, 6 (33.3%) progressed to severe oligospermia (<5 million/cc), 6 (33.3%) to oligospermia (<15 million/cc), 1 (5.6%) to normozoospermia (>15 million/cc), and 5 (27.8%) remained azoospermic after medical treatment for 6 months. Among the 24 couples who responded to the follow-up call, a total of 9 (37.5%) achieved a successful subsequent pregnancy. Of these, 33.3% (3 couples) used assisted reproductive technology, whereas 66.7% (6 couples) conceived naturally. On logistic regression analysis, no significant predictors for improved sperm parameters or successful pregnancy were identified.
Despite appropriate treatment regimens, a significant proportion of men with a prior history of anabolic steroid use continue to exhibit severe oligospermia, with more than half showing limited improvement in semen parameters after 6 months of treatment. Only a fraction of men achieves normozoospermia after treatment. Further research is needed to explore predictors for improved sperm parameters and successful pregnancy outcomes in men with a history of anabolic steroid use.
研究因使用合成代谢类固醇而导致无精子症或严重少精子症的男性在接受标准化生精恢复治疗后的精子参数恢复和生育结局。
对 2018 年至 2022 年间有合成代谢类固醇使用和不育投诉史的男性队列进行了回顾性分析。
标准化治疗方法包括停止睾酮替代治疗，并给予枸橼酸氯米芬和人绒毛膜促性腺激素联合治疗至少 3 至 6 个月。
主要观察指标包括精子参数的变化，主要是精子浓度，以及随后的妊娠结局。
共有 45 名男性（中位年龄 37 岁，IQR 32-45）符合本分析的纳入标准。中位既往 T 使用时间为 4 年（IQR 1.3-10），最常见的两种方式为注射治疗（43.5%）和口服治疗（34.8%）。初始精子浓度中位数为 0 百万/cc（IQR 0-1.15），23 名（51.1%）男性最初表现为无精子症。联合人绒毛膜促性腺激素/氯米芬治疗的中位持续时间为 5 个月（IQR 3-12）。在最初无精子症的男性（N：23）中，5 人失访，6 人（33.3%）进展为严重少精子症（<5 百万/cc），6 人（33.3%）进展为少精子症（<15 百万/cc），1 人（5.6%）进展为正常精子症（>15 百万/cc），5 人（27.8%）在接受 6 个月的药物治疗后仍无精子症。在 24 对回应随访电话的夫妇中，共有 9 对（37.5%）成功怀孕。其中，33.3%（3 对）夫妇使用了辅助生殖技术，66.7%（6 对）夫妇自然受孕。Logistic 回归分析未发现精子参数改善或妊娠成功的显著预测因素。
尽管采用了适当的治疗方案，但仍有相当一部分有合成代谢类固醇使用史的男性表现为严重少精子症，超过一半的患者在治疗 6 个月后精液参数改善有限。只有少数男性在治疗后达到正常精子症。需要进一步研究以探讨有合成代谢类固醇使用史的男性精子参数改善和妊娠结局成功的预测因素。
