Management strategies for male factor infertility
Management strategies for male factor infertility
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DOI：
10.2165/00003495-200262120-00004
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发表时间：
2002-01-01
期刊：
影响因子：
11.5
通讯作者：
Haidl, G
中科院分区：
文献类型：
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作者：
Haidl, G
虽然现代辅助生殖技术在克服严重男性因素不育方面做出了很大贡献，但将这些方法应用于每对不育夫妇都是一种过度治疗。因此，传统治疗方式仍然是男性生育障碍的首选方法。除了辅助生殖技术外，这些技术还包括外科手术和药物管理。经证实有效的因果治疗方案仅适用于低促性腺激素性性腺功能减退症导致的不孕症患者。药物治疗逆行射精也是有效的。经验性治疗（包括抗雌激素、雄激素、芳香化酶抑制剂、肥大细胞阻滞剂、锌和戊茶碱）获得了不一致的结果。抗炎和免疫抑制治疗以及在存在活性氧的情况下使用抗氧化剂治疗尚未被对照研究证明是有效的，但至少代表了一种合理的方法，应进行更彻底的研究。高剂量的促卵泡激素的管理，特别是旨在改善精子结构紊乱，并结合他莫昔芬与雄激素，可能是有前途的发展。在开始任何男科治疗之前，必须进行仔细的诊断检查，以便为个别患者选择适当的治疗方案。
Although modem assisted reproduction techniques contribute a lot to overcoming severe male factor infertility, application of these methods in every infertile couple would represent an over-treatment. Therefore, conventional treatment modalities are still the first approach to male fertility disorders. Apart from assisted reproduction techniques, these include surgical procedures and the administration of drugs. Causal treatment regimens of proven effectiveness are only available for patients with infertility resulting from hypogonadotrophic hypogonadism. Drug treatment of retrograde ejaculation is also effective. Inconsistent results have been obtained with empirical treatment including antiestrogens, androgens, aromatase-inhibitors, mast cell blockers, zinc and pentoxifylline. Anti-inflammatory and immunosuppressive therapy as well as treatment with antioxidants in the presence of reactive oxygen species has not yet been demonstrated to be effective by controlled studies but represent at least a rational approach which should be investigated more thoroughly. High dosage administration of follicle stimulating hormone aimed particularly at improving disturbed sperm structures, and the combination of tamoxifen with androgens, may be promising developments. A careful diagnostic work-up is necessary before any andrological treatment is commenced so that adequate treatment options can be selected for individual patients.