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

Attia AM, Al-Inany HG

Published Online:

January 21, 2009

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.

Abstract (click to read)

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 strategy:

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 Authors and pharmaceutical companies were contacted for missing and unpublished data.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.

This record should be cited as:

Attia AM, Al-Inany HG. Gonadotrophins for idiopathic male factor subfertility. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005071. DOI: 10.1002/14651858.CD005071.pub3

Assessed as up to date:

June 22, 2007

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Primary Review Group:

Menstrual Disorders and Subfertility Group

Health topics:

Gynaecology > Subfertility > Female: other

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

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

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