枸橼酸克罗米芬和他莫昔芬对特发性男性不育患者妊娠率的影响：一项系统回顾和荟萃分析

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology Pub Date : 2025-01-01 DOI:10.1016/j.ajur.2024.09.001

Shadi Khashaba , Shehab Khashaba , Anil Krishan , Angus Bruce , Abdullatif Almaghlouth , Jason Huang , Mahmoud Mima , Craig Niederberger

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引用次数: 0

摘要

目的选择性雌激素受体调节剂（SERMs）治疗男性性腺功能减退和男性因素性不育症的疗效显著。柠檬酸克罗米芬和他莫昔芬这两种serm药物，现在被规定用于治疗这两种情况的男性。然而，现有文献将混合方案与主动管理进行了比较。我们旨在进行一项荟萃分析，以评估克罗米芬和他莫昔芬与安慰剂对自然妊娠率的影响。方法对MEDLINE、PubMed/PMC、EMBASE、CINAHL、Cochrane Central Register of Controlled Trials （Central）、Scopus、谷歌Scholar、Web of Science等电子数据库进行全面系统评价。对满足所有选择标准的文章进行分析。主要结局是接受治疗后的妊娠发生率。次要结局包括血清促卵泡激素、促黄体生成素、睾酮水平、精子数量和活力。我们计算了合并优势比、风险比和风险差异，以确定合并效应大小方向上可能发生的变化。结果最终纳入10项随机对照试验，并进行数据提取。克罗米芬组和安慰剂组的妊娠率相似(分别为10.4%和7.1%；优势比1.30[95%可信区间0.27-6.17]；p = 0.74)。没有荟萃分析可以计算出他莫昔芬组与安慰剂组的妊娠率。两种serm研究的异质性从低到高不等。结论虽然枸橼酸克罗米芬和他莫昔芬经常被用于治疗性腺功能减退的继发性男性不育症，但SERMs治疗特发性男性因素不育症的研究有限且异质性，这使得本荟萃分析无法调查SERMs对男性不育症的疗效。枸橼酸克罗米芬或他莫昔芬对妊娠率的影响尚不确定。

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Efficacy of clomiphene citrate and tamoxifen on pregnancy rates in idiopathic male subfertility: A systematic review and meta-analysis

Objective

Selective estrogen receptor modulators (SERMs) have demonstrated efficacy in the treatment of hypogonadism in males and male factor infertility. Two SERMs, clomiphene citrate and tamoxifen, are now prescribed for off-label use to treat both conditions in males. However, existing literature compares mixed protocols with active management. We aimed to conduct a meta-analysis to evaluate the effect of clomiphene and tamoxifen versus placebo on natural pregnancy rates.

Methods

We conducted a comprehensive systematic review of electronic databases: MEDLINE, PubMed/PMC, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Google Scholar, and Web of Science. Articles satisfying all selection criteria were analyzed. The primary outcome was the incidence of pregnancy after receiving the treatment. Secondary outcomes included serum follicle-stimulating hormone, luteinizing hormone, and testosterone levels, and sperm count and motility. We calculated the pooled odds ratio, risk ratio, and risk difference to ascertain possible alterations in the direction of the pooled effect size.

Results

Ten randomized controlled trials were ultimately included and underwent data extraction. Clomiphene citrate and placebo groups had similar pregnancy rates (10.4% and 7.1%, respectively; odds ratio 1.30 [95% confidence interval 0.27–6.17]; p=0.74). No meta-analysis could be calculated for pregnancy rates in tamoxifen versus placebo groups. Heterogeneity among the studies of both SERMs ranged from low to high.

Conclusion

Although clomiphene citrate and tamoxifen are often used off-label for the treatment of male infertility secondary to hypogonadism, studies of SERMs in the treatment of idiopathic male factor infertility are limited and heterogenous, preventing this meta-analysis from investigating the efficacy of SERMs on male infertility. The effect of clomiphene citrate or tamoxifen on the pregnancy rate remains uncertain.

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来源期刊

Asian Journal of Urology UROLOGY & NEPHROLOGY-

CiteScore

4.00

自引率

3.80%

发文量

100

审稿时长

4 weeks

期刊介绍： Asian Journal of Urology (AJUR), launched in October 2014, is an international peer-reviewed Open Access journal jointly founded by Shanghai Association for Science and Technology (SAST) and Second Military Medical University (SMMU). AJUR aims to build a communication platform for international researchers to effectively share scholarly achievements. It focuses on all specialties of urology both scientifically and clinically, with article types widely covering editorials, opinions, perspectives, reviews and mini-reviews, original articles, cases reports, rapid communications, and letters, etc. Fields of particular interest to the journal including, but not limited to: • Surgical oncology • Endourology • Calculi • Female urology • Erectile dysfunction • Infertility • Pediatric urology • Renal transplantation • Reconstructive surgery • Radiology • Pathology • Neurourology.