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Gonadotrophins for idiopathic male factor subfertility

  • Review
  • Intervention

Authors


Abstract

Background

Male factor infertility accounts for 50% of infertility. The treatment of idiopathic male infertility is empirical. Urinary, purified, and recombinant gonadotrophins have been used to improve sperm parameters in idiopathic male infertility with the goal of increasing pregnancy rates. Research addressing pregnancy rates in partners of men treated with gonadotrophins has had conflicting results and needs to be analysed.

Objectives

To determine the effectiveness of gonadotrophin administration to men with idiopathic subfertility on spontaneous pregnancy rate and in assisted reproductive techniques (ARTs).

Search methods

We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (31 May 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 2, 2007), MEDLINE (1966 to May 2007), EMBASE and Biological Abstracts (1980 to Week 21 2007). Searches were not limited by language. The bibliographies of included, excluded trials and abstracts of major meetings were searched for additional trials. Authors and pharmaceutical companies were contacted for missing and unpublished data.

Selection criteria

Truly randomised controlled trials where gonadotrophins were administered for the treatment of idiopathic male subfertility with reporting of pregnancy rates were included in the review.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the trials. We analysed data regarding pregnancy occurring within 3 months after gonadotrophin therapy.

Main results

Four RCTs with 278 participant were included in the analysis. None of the studies had an adequate sample size and they had variable follow-up periods. None of the studies reported live birth or miscarriage rates. Compared to placebo or no treatment, gonadotrophins showed a significantly higher pregnancy rate per couple randomized within 3 months of completing therapy (OR 3.03, 95% CI 1.30 to 7.09). Pregnancy rate was 13.4% (19/142) in the gonadotrophin group and 4.4% (6/136) in the control group.

Authors' conclusions

The number of trials and participants is insufficient to draw final conclusions. A large multicenter study with adequate power is needed.

摘要

背景

以促性腺激素治療男性次不孕症

男性不孕症佔了所有不孕症之50% 。特發性男性不孕症之治療是經驗性的。在特發性男性不孕症中,已針對增加懷孕率之目標而使用尿液、純化、及重組之促性腺激素改善精子參數。針對經促性腺激素治療男性之伴侶的懷孕率所進行之研究具有矛盾的結果並需要進行分析。

目標

測定促性腺激素之投與對於特發性男性生育率低下之男性在改善自然懷孕率及輔助生殖週期方面之有效性。

搜尋策略

我們搜尋 Cochrane Menstrual Disorders以及Subfertility Group trials register (2007年5月31日) 、Cochrane Central Register of Controlled Trials (Cochrane Library, issue 2, 2007) 、MEDLINE (1966年2007年5月) 、EMBASE以及Biological Abstracts (1980年2007年第21周) ,不限定所搜尋語言種類。並搜尋被排除及被納入的試驗、重要研討會摘要的參考書目,以獲得補充試驗。並聯絡作者及藥廠以獲得遺漏或是未發表的數據。

選擇標準

本回顧收錄其中投與促性腺激素以治療特發性男性次不孕症並報導懷孕率之真正隨機對照試驗。

資料收集與分析

由2名回顧作者獨立評估試驗品質並摘錄數據。聯繫實驗作者以取得額外之資訊。由該等試驗取得不良作用之資訊。茲分析在促性腺激素治療後三個月內之懷孕數據。

主要結論

分析中共收錄包括278名參與者之4項RCTs。此等實驗皆無適當之樣本大小,且其具有各異之追蹤期。此等實驗皆未報告活產或流產率。相較於安慰劑或無治療,促性腺激素就完成治療後3個月內之每對隨機分派的夫婦而言具有顯著較高之懷孕率 (OR 4.17, 95% CI 1.30 to 7.09) 。

作者結論

試驗及參與者之數目並不足以做出最終結論。茲需要具有適當檢定力之大型多中心研究。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

以促性腺激素治療特發性男性次不孕症。針對男性不孕症使用促性腺激素可能可增加懷孕率。男性不孕症佔了所有夫婦不孕症之50% 。大約39% 之不孕男性具有特發性不孕症 (未知肇因或起源之男性不孕症) 。促性腺激素 (多種類型之荷爾蒙) 治療已被用於治療特發性男性不孕症。

Plain language summary

Pregnancy rates may increase with the use of gonadotrophins for male infertility

Male infertility contributes to 50% of infertility in couples. Around 39% of infertile men have idiopathic infertility (male infertility with an unknown cause or origin). Treatment with gonadotrophins (types of hormones) have been used for the treatment of idiopathic male infertility. This review did not find enough studies to draw strong conclusions about the use of gonadotrophins for the treatment of idiopathic male infertility. However, analysis of the results of the four included studies showed a significant increase in the pregnancy rates, during and within three months, after gonadotrophin treatment of men with idiopathic subfertility.

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