[Evaluation of hormonal treatments for idiopathic oligospermia]

Many hormonal treatments have been tried in idiopathic oligospermia because of the physiologic roles of the hormones FSH and testosterone in regulation of spermatogenesis, the possibility of increasing spermatogenesis in normal monkeys by increasing their serum FSH up to supraphysiologic levels, and of several hormone abnormalities reported in this condition (abnormal pulsatile release of LH and thus probably of LHRH, abnormal bioactivity of FSH, compensated hyperestrogenism). None of these treatments proved to be effective until now, though a modest beneficial effect cannot be totally excluded for some of them, because of the poor discriminating power of most of the trials. Many methodological difficulties do indeed hamper the objective assessment of male infertility treatments. Pulsatile administration of LHRH, human menopausal gonadotropins, androgens, bromocriptine, and angiotensin-converting enzyme inhibitors are definitely uneffective or without practical interest. A beneficial effect of the anti-estrogens clomifene and tamoxifene cannot be excluded. It would be modest, increasing the annual pregnancy rate from 18 to 30%, only in case of normogonadotropic oligospermia. The possibility of increasing the vitro fertilization success rate by treating the oligospermic males with purified FSH needs confirmation. Whatever the benefit, it would not reach the success rate of intracytoplasmic injection of spermatozoa.