The beneficial effects of toremifene administration on the hypothalamic-pituitary-testicular axis and sperm parameters in men with idiopathic oligozoospermia.
OBJECTIVE
To evaluate whether toremifene, a selective estrogen receptor modulator (SERM), has a beneficiary effect on all three main sperm parameters.


METHODS
Prospective interventional clinical study.


METHODS
University hospital.


METHODS
One-hundred subfertile men with idiopathic oligozospermia.


METHODS
Toremifene (60 mg daily) was administered to all men for 3 months. At baseline and at the end of each month, serum concentrations of follicle-stimulating hormone (FSH), testosterone, inhibin B, and sex hormone-binding globulin (SHBG) were measured. At baseline and at the end, semen analysis was performed and sperm concentration, spermatozoal motility and normal sperm forms were determined.


METHODS
Gonadotropin, testosterone, inhibin-B levels, total sperm count, sperm morphology and motility.


RESULTS
Toremifene administration resulted in a significant increase in FSH, testosterone, SHBG, and inhibin B levels, as well as in sperm concentration, percentage motility and normal sperm forms. Twenty-two men's partners achieved pregnancy within 2 months of the end of treatment. At the end of the third month, serum FSH levels were significantly higher in the men whose partners did not achieve pregnancy, and total sperm count and normal sperm forms were significantly lower compared with the group of men whose partners achieved pregnancy.


CONCLUSIONS
Toremifene administration for a period of 3 months in men with idiopathic oligozoospermia is associated with significant improvements of sperm count, motility, and morphology, mediated by increased gonadotropin secretion and possibly a direct beneficial effect of toremifene on the testes. The above findings are also indicative of a better testicular exocrine (improved sperm parameters) response to treatment in men whose partners achieved pregnancy compared with those who did not. Further randomized, placebo-controlled trials should be conducted to determine whether this particular selective estrogen receptor modulator can be useful as an initial approach in men with oligozoospermia.
Farmakiotis
Dimitrios
D
Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Farmakis
Christos
C
Rousso
David
D
Kourtis
Anargyros
A
Katsikis
Ilias
I
Panidis
Dimitrios
D
D000328:Adult; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000502:physiology; D007265:Inhibins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009845:Oligospermia / Q000188:drug therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*; D012661:Semen / Q000166:cytology; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013081:Sperm Motility / Q000187:drug effects; D013094:Spermatozoa / Q000187:drug effects*; D013737:Testis / Q000187:drug effects* / Q000502:physiology; D013739:Testosterone / Q000097:blood; D017312:Toremifene / Q000627:therapeutic use*
D020845:Selective Estrogen Receptor Modulators; D012738:Sex Hormone-Binding Globulin; C422364:inhibin B; D013739:Testosterone; D007265:Inhibins; D017312:Toremifene; D005640:Follicle Stimulating Hormone