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Meta-Analysis
. 2013 Aug 23;2013(8):CD005071.
doi: 10.1002/14651858.CD005071.pub4.

Gonadotrophins for idiopathic male factor subfertility

Abdelhamid M Attia  1 , Ahmed M Abou-Setta, Hesham G Al-Inany
Affiliations
Meta-Analysis

Gonadotrophins for idiopathic male factor subfertility

Abdelhamid M Attia et al. Cochrane Database Syst Rev. .

Abstract

Background: Male factors leading to subfertility account for at least half of all cases of subfertility worldwide. Although some causes of male subfertility are treatable, treatment of idiopathic male factor subfertility remains empirical. Researchers have used gonadotrophins to improve sperm parameters in idiopathic male factor subfertility with the ultimate goal of increasing birth and pregnancy rates, but results have been conflicting.

Objectives: To determine the effect of systemic follicle-stimulating hormone (FSH) on live birth and pregnancy rates when administered to men with idiopathic male factor subfertility .

Search methods: We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register (14 January 2013), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 12 of 12, 2012), Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE (1946 to 14 January 2013), Ovid EMBASE (1980 to week 2 of 2013), Ovid PsycINFO (1806 to week 2 of 2013), trial registers for ongoing and registered trials at ClinicalTrials.gov (19 January 2013), the World Health Organisation International Trials Registry Platform (19 January 2013), The Cochrane Library Database of Abstracts of Reviews of Effects (19 January 2013) and OpenGrey for grey literature from Europe (19 January 2013). Searches were not limited by language. Bibliographies of included and excluded trials and abstracts of major meetings were searched for additional trials.

Selection criteria: Randomised controlled trials (RCTs) in which gonadotrophins were compared with placebo or no treatment for participants with idiopathic male factor subfertility.

Data collection and analysis: Two review authors independently selected the trials, assessed risk of bias and extracted data on live birth, pregnancy and adverse effects. We included data on pregnancies that occurred during or after gonadotrophin therapy. Study authors and pharmaceutical companies were asked to provide missing and unpublished data and/or additional information.

Main results: Six RCTs with 456 participants and variable treatment and follow-up periods were included. From the limited data, the live birth rate per couple randomly assigned (27% vs 0%; Peto odds ratio (OR) 9.31, 95% confidence interval (CI) 1.17 to 73.75, one study, 30 participants, very low-quality evidence) and the spontaneous pregnancy rate per couple randomly assigned (16% vs 7%; Peto OR 4.94, 95% CI 2.13 to 11.44, five studies, 412 participants, I(2) = 0%, moderate-quality evidence) were significantly higher in men receiving gonadotrophin treatment than in men receiving placebo or no treatment. No significant difference between groups was noted when intracytoplasmic sperm injection (ICSI) or intrauterine insemination (IUI) was performed. None of the included studies reported miscarriage rates, and adverse events data were sparse.

Authors' conclusions: Encouraging preliminary data suggest a beneficial effect on live birth and pregnancy of gonadotrophin treatment for men with idiopathic male factor subfertility, but because the numbers of trials and participants are small, evidence is insufficient to allow final conclusions. Large multi-centre trials with adequate numbers of participants are needed.

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Conflict of interest statement

None known.

Figures

1
1
Forest plot of comparison: 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, outcome: 1.2 Pregnancy rate per couple randomly assigned.
2
2
Forest plot of comparison: 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, outcome: 1.3 Subgroup analysis: pregnancy rate per couple randomly assigned with no female factor.
3
3
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
4
4
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
5
5
Forest plot of comparison: 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, outcome: 1.1 live‐birth rate per couple randomly assigned.
1.1
1.1. Analysis
Comparison 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, Outcome 1 Live birth rate per couple.
1.2
1.2. Analysis
Comparison 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, Outcome 2 Pregnancy rate per couple.
1.3
1.3. Analysis
Comparison 1 Gonadotrophins versus placebo/no treatment for the treatment of idiopathic male subfertility, Outcome 3 Subgroup analysis: Pregnancy rate per couple with no female factor.
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Update of

References

References to studies included in this review

Baccetti 2004 {published data only}
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References to studies excluded from this review

Ashkenazi 1999 {published data only}
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Bouloux 2003 {published data only}
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