Indomethacin in male infertility: effectiveness and predictors of response

ABSTRACT

Prostaglandins [PG] inhibit testosterone synthesis and spermatogenesis. Indomethacin [a PG synthase inhibitor] has been used in male infertility but improves the sperm count in only a proportion of patients. The present study was done to determine parameters which will predict a favourable response to Indomethacin [In]. 21 infertile males were given 25 mg. In three times a day for 12 weeks. Pre and post treatment semenanalysis levels were compared. Pre treatment FSH, LH and Prolactin [PRL] levels and level of Endogenous Inhibitors of Platelet Aggregation [EIPA] and endogenous inhibitors of lipooxygenase [EILO] were also determined. In 11 [52.4%] patients sperm counts improved. 19.1% patients showed improvement at six weeks with a decline of sperm count at 12 weeks. 6 [29%] patients showed improved motility. Oligospermics responded better than azoospermics. Of the three patients with varicocele who were not treated by operation, two responded. The mean FSH and LH were lower [and in the normal range] in the responders to In therapy. The mean T was lower [and the lower end of T range] in patients who responded. Only one azoospermic responded to therapy. There was no statistical difference in the mean EIPA and EILO levels of responders and non-responders. Indomethacin raised sperm counts in patients with normal FSH and LH and low T levels. EILO and EIPA do not have predictor value. Indomethacin will be ineffective in most patients with azoospermia, and raised FSH levels. The role of In in varicocele therapy needs to be explored