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Medikamentöse Therapie primär nichthormonell bedingter männlicher Fertilitätsstörungen

Pharmaceutical treatment of primarily nonhormone-related male fertility disorders

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Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Die Pharmakotherapie stellt neben Maßnahmen der assistierten Reproduktion und operativen Eingriffen eine wichtige Säule in der Behandlung männlicher Fertilitätsstörungen dar. Eine pathophysiologisch begründete Therapie ist nicht nur bei verschiedenen Formen des hypogonadotropen Hypogonadismus oder der Hyperprolaktinämie etabliert, sondern auch bei Infektionen und Entzündungen des männlichen Genitaltrakts möglich. Neben dem erreger- und resistenzgerechten Einsatz von Antibiotika liegen Daten für nichtsteroidale Antiphlogistika, Glukokortikosteroide, Mastzellblocker und Antioxidanzien vor. Ejakulations- und Emissionsstörungen können mit α‑Sympathomimetika, Imipramin oder Brompheniramin behandelt werden; als wirksame Medikation bei Erektionsstörungen sind Phosphodiesterase-5-Inhibitoren verfügbar. Wesentlich problematischer ist dagegen die Frage nach Therapieoptionen bei Patienten mit Einschränkungen der Ejakulatqualität ohne erkennbare Ursache. Für verschiedenste Medikamente liegen Studiendaten mit nicht ausreichendem Evidenzgrad vor. Neuere Metaanalysen sprechen für eine begrenzte Wirksamkeit von Antiöstrogenen wie Tamoxifen oder Clomifen; vielversprechende Ergebnisse fanden sich nach Behandlung mit follikelstimulierendem Hormon. Zunehmende Aufmerksamkeit erlangen Antioxidanzien und Spurenelemente. Für die als Nahrungsergänzungsmittel vertriebenen Kombinationspräparate liegen jedoch keine adäquat kontrollierten klinischen Studien vor.

Abstract

In addition to assisted reproductive techniques and surgical procedures, pharmacotherapy represents an important cornerstone in the management of male infertility. A pathophysiologically founded treatment is not only well-established for various forms of hypogonadotrophic hypogonadism and hyperprolactinemia but is also possible for infections and inflammatory lesions of the male genital tract. Antibiotics are effective when specifically prescribed depending on the pathogen and the resistance; moreover, data for non-steroidal anti-inflammatory drugs, glucocorticosteroids, mast cell blockers, and antioxidants are also available. Based on a pathophysiological rationale, disorders of ejaculation and semen transport can be treated with alpha-sympathomimetics, imipramine and brompheniramine; phosphodiesterase‑5 inhibitors have proven to be highly effective in erectile dysfunction. In contrast, the therapeutic management of patients with impairment of semen quality without any identifiable underlying cause is much more problematic. Clinical studies using a wide range of different drugs produced inconsistent results or did not reach a sufficient level of evidence. Recent meta-analyses indicated that low-dose administration of anti-estrogens, such as tamoxifen or clomiphene may have limited positive effectiveness; promising results were obtained following treatment with follicle-stimulating hormone. Increasing research activities concern the therapeutic efficacy of antioxidants and trace elements. For the plethora of widely used neutriceuticals, however, adequately controlled clinical studies are lacking.

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie und Allergologie, Abt. Andrologie, Universitätsklinikum Bonn – AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland

    G. Haidl & J.-P. Allam

  2. Andrologicum München, München, Deutschland

    F.-M. Köhn

  3. Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Deutschland

    F. Haidl

  4. Sektion Andrologie, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH – Standort Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    H.-C. Schuppe

  5. Hessisches Zentrum für Reproduktionsmedizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    H.-C. Schuppe

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  1. G. Haidl
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Correspondence to G. Haidl.

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G. Haidl, J.-P. Allam, F.-M. Köhn, F. Haidl und H.-C. Schuppe geben an, dass kein Interessenkonflikt besteht.

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Haidl, G., Allam, JP., Köhn, FM. et al. Medikamentöse Therapie primär nichthormonell bedingter männlicher Fertilitätsstörungen. Gynäkologische Endokrinologie 17, 236–244 (2019). https://doi.org/10.1007/s10304-019-00273-2

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