Male infertility treatable with Combo therapy

Limited numbers of medical treatments are aimed at improving chances of conception for patients with known causes of infertility. Combination of clomiphene citrate (CC) and anastrozole (AZ)therapy is safe and effective for treatment of male infertility, according to a recent study published in the journal BJU International. The combo therapy can be used for treating patients with elevated estradiol or a low testosterone/estradiol ratio.

Clomiphene citrate is a selective estrogen receptor modulator that increases production of gonadotropin and indirectly stimulates androgen synthesis; it is associated with higher estradiol levels. Anastrozole is an aromatase inhibitor that reduces the conversion of testosterone to estradiol

Male infertility refers to a male's inability to cause pregnancy in a fertile female. In humans, it accounts for 40–50% of infertility. It affects approximately 7% of all men. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.

The researchers gathered data on patients treated with the combination from 2014 to 2017. Patients' total testosterone, bioavailable testosterone, estradiol, and testosterone:estradiol ratio were measured prior to combination therapy (clomiphene citrate alone) and at combination therapy follow-ups. Prostate-specific antigen, hematocrit levels, and treatment side effects were analyzed as part of the safety assessment.

In the study of 51 men, AZ provided an effective means for lowering estradiol levels and increasing the testosterone/estradiol ratio following the initiation of CC therapy. CC is a selective estrogen receptor modulator that increases gonadotropin production and indirectly stimulates androgen synthesis, but it is associated with increased estradiol levels. AZ is an aromatase inhibitor that decreases conversion of testosterone to estradiol.

The data from the study showed significant increases in total testosterone, bioavailable testosterone, and estradiol levels with just clomiphene citrate. Anastrozole was then given to patients with hyperestrogenemia (estradiol >50pg/mL) or testosterone:estradiol ratio <10. Patients treated with the combination therapy maintained therapeutic total testosterone and bioavailable testosterone levels and had normal estradiol levels and testosterone:estradiol ratio .

The researchers concluded that "combination therapy with [clomiphene citrate + anastrozole] is an effective and safe alternative for patients with elevated estradiol level or low testosterone:estradiol ratio."

As of now various available therapies for Male Infertility include gonadotropin-releasing hormone (GnRH) therapy or gonadotropin replacement, immunosuppression using cyclic steroids, Imipramine or alpha-sympathomimetics for promoting antegrade ejaculation, Semen processing, Lifestyle Changes and Vitamins and supplements depending on the cause.

For Further Reference Log on to :

https://physoc.onlinelibrary.wiley.com/doi/10.1111/bju.14390