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Abstract

Volume 8, Issue 2 (March 2006) 8, 143–157; 10.1111/j.1745-7262.2006.00123.x

Male idiopathic oligoasthenoteratozoospermia

Giorgio Cavallini

Operative Unit of Andrology, Società Italiana di Medicina della Riproduzione (SISMER), Via Mazzini 12, 40138 Bologna, Italy

Correspondence: Dr Giorgio Cavallini, Via Mascheraio 46, 44100 Ferrara, Italy. Fax: +39-532-246-496. E-mail: giorgiocavallini@libero.it

Received 29 February 2005; Accepted 29 November 2005

Abstract

Idiopathic oligoasthenoteratozoospermia (iOAT) affects approximately 30% of all infertile men. This mini-review discussed recent data in this field. Age, non-inflammatory functional alterations in post-testicular organs, infective agents (Chlamydia trachomatis, herpes virus and adeno-associated viruses), alterations in gamete genome, mitochondrial alterations, environmental pollutants and "subtle" hormonal alterations are all considered possible causes of iOAT. Increase of reactive oxygen species in tubules and in seminal plasma and of apoptosis are reputed to affect sperm concentration, motility and morphology. iOAT is commonly diagnosed by exclusion, nevertheless spectral traces of the main testicular artery may be used as a diagnostic tool for iOAT. The following can be considered therapies for iOAT: 1) tamoxifen citrate (20 mg/d) + testosterone undecanoate (120 mg/d) (pregnancy rate per couple/month [prcm]: 3.8%); 2) folic acid (66 mg/d) + zinc sulfate (5 mg/d); 3) L-carnitine (2 g/d) alone or in combination with acetyl-L-carnitine (1 g/d) (prcm: 2.3%); and 4) both carnitines + one 30 mg cinnoxicam suppository every 4 days (prcm: 8.5%). Alpha-blocking drugs improved sperm concentration but not morphology, motility or pregnancy rate. Tranilast (300 mg/d) increased sperm parameters and pregnancy rates in an initial uncontrolled study. Its efficacy on sperm concentration (but not on sperm motility, morphology or prcm) was confirmed in subsequent published reports. The efficacy of tamoxifen + testosterone undecanoate, tamoxifen alone, and recombinant follicle-stimulating hormone is still a matter for discussion.

Keywords: idiopathic oligoasthenoteratozoospermia, male infertility, diagnosis, pathogenesis

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