FSH treatment for normogonadotropic male infertility: a synergistic role for metformin?

OBJECTIVE: The aim of this paper is to evaluate the effectiveness of follicle-stimulating hormone (FSH) administration in a cohort of insulin resistant (HOMA>2.5) patients with normogonadotropic idiopathic infertility. PATIENTS AND METHODS: We subdivided patients in two clinical groups basing on the adopted therapeutic scheme: group A (n=44) received 150 units of FSH three times a week for three months (group A); group B (n=35) received 150 units of FSH three times a week for three months and 500 mg of slow-release metformin once a day for three months (group B). We evaluated the post-treatment sperm parameters, sperm parameters normalization rate, spontaneous pregnancy rate, and sperm DNA fragmentation normalization rate. RESULTS: 40% of group A patients and 45% of group B patients became normozoospermic after the treatment, while 30% of group A patients and 32% of group B patients achieved a spontaneous pregnancy. B group patients also obtained higher sperm DNA fragmentation normalization rate (45% vs. 33%, p = 0.03). Compared to group A, group B showed a higher sperm concentration, progressive motility and morphology (p < 0.0001). CONCLUSIONS: The results of this study suggest that the addition of the low-dose slow-release metformin in insulin-resistant patients with normogonadotropic infertility improves the efficacy of FSH therapy.

Male accessory gland inflammation, infertility, and sexual dysfunctions: a practical approach to diagnosis and therapy.

The role of urogenital inflammation in causing infertility and sexual dysfunctions has long been a matter of debate in the international scientific literature. The most recent scientific evidences show that male accessory gland infection/inflammation could alter, with various mechanisms, both conventional and biofunctional sperm parameters, and determine worst reproductive outcome. At the same time, the high prevalence of erectile dysfunction and premature ejaculation in patients with male accessory gland infection/inflammation underlines the close link between these diseases and sexual dysfunctions. The aim of this review was to provide the reader the basis for a correct diagnosis of male accessory gland infection/inflammation and a subsequent appropriate therapeutic approach, particularly in patients with infertility and/or sexual dysfunction.

Prevalence of male accessory gland inflammations/infections in patients with Type 2 diabetes mellitus.

BACKGROUND: MAGI is an acronym that identifies the "male accessory gland inflammations/infections", a potential cause of male infertility. Type 2 diabetes mellitus (DM2) prevalence is going to increase among men of reproductive age. Due to the high prevalence of these two conditions, we could suppose that they might appear together in the same patient. AIM: To evaluate MAGI prevalence in patients with DM2 in fertile age. SUBJECTS AND METHODS: A cross-sectional study carried out on patients with DM2 of fertile age. All patients underwent andrological evaluation for the identification of conventional MAGI diagnostic criteria. RESULTS: DM2 patients showed a frequency of MAGI about 43%, significantly lower (p<0.05) than in infertile patients of the same age without diabetes, which showed a MAGI overall frequency of 61%. Among examined diabetic patients the prevalence of MAGI did not significantly differ between patients attending for diabetes care problems (glycemic control) and patients with andrological disorders. Finally, no significant difference in seminal inflammatory signs frequency was detected between patients with DM2 and infertile patients without diabetes. Finally, the correlation analysis showed a significant direct correlation between duration of diabetes and glycemic control with the prevalence of MAGI. CONCLUSION: MAGI prevalence in DM2 is lower than the one detected in age-matched infertile non-diabetic patients, however, as in infertile patients, there is a high frequency of seminal inflammatory signs. Moreover, the observed prevalence among diabetic patients with diabetes care problems and diabetic patients with andrological problems is not statistically different.