marco_da

Ciao leggete qua il caso di uno studio su tre pazienti che hanno avuto infertilita mentre assumevano finasteride 1mg/di da due anni circa. Tratto dal sito: http://www.scielo.br/scielo.php?pid=S0041-...arttext&tlng=en Finasteride-associated male infertility CASE REPORT Patient 1 A male patient, aged 31 years, presented for fertility evaluation. He and his wife had been trying to achieve pregnancy for 10 months. He had a varicocele diagnosed 10 years earlier, and at that time, he had not been surgically treated because he had had a normal seminal analysis. He had been on finasteride 1 mg/day for 2 years because of hair loss. His physical exam showed a normal testis and a moderate left varicocele. His first seminal analysis showed 8.2 million sperm/mL with 70% motility, and 7% normally shaped spermatozoa, according the Kruger criteria.8 The second analysis showed 7 million sperm/mL, with 57% motility and 10% of normal shape. Before a varicocele repair, the patient was asked to interrupt finasteride for 4 months. After that period, a new seminal analysis showed a total concentration of 50 million spermatozoa, with 70% motility and 19% of normal shape.8 Patient 2 A male patient, aged 33 years, was referred for fertility evaluation. He and his wife had been trying to achieve a pregnancy for 6 months. He had been on finasteride 1 mg/day for 1 year because of hair loss. At the physical exam, the testes were normal, but there were small cysts in the head of the epididymis bilaterally and a moderate-sized left varicocele. His seminal analysis showed a total sperm concentration of 15 million spermatozoa/ml with 20% motility and 17% normally shaped spermatozoa/ml.8 Finasteride was interrupted for 3 months, and a new seminal analysis showed a total concentration of 43 million spermatozoa/ml with 42% motility and 15% of normal shape.8 Patient 3 An obese male patient, aged 32 years, was referred for infertility evaluation. The couple had been trying to achieve pregnancy for 6 months. He had been on finasteride 1 mg/day for more than 1 year. There were no abnormalities in his physical exam. His first seminal analysis presented total concentration of 970,000 spermatozoa/ml with 30% motility and 16% normally shaped spermatozoa/ml.8 A second exam showed a total concentration of 360 thousand spermatozoa/ml with 20% motility and 15% of normal shape. Finasteride treatment was interrupted, and after 3 months a seminal analysis showed a total concentration of 10 million spermatozoa/ml with 60% motility and 22% of normal shape.8 Another seminal analysis was done 3 months later and showed total concentration of 7.2 million spermatozoa/ml with 50% motility and 22% of normal shape. DISCUSSION Finasteride has been used for the treatment of benign prostate hyperplasy and male pattern hair loss. Many young men in their fertile age have used this drug for long periods because of hair loss. Finasteride inhibits 5a-reductase, preventing the transformation of testosterone to dihydrotestosterone, which could cause a negative influence on the sperm production. O'Donnell et al. (1999) showed a negative impact of finasteride in rat spermatogenesis.9 However, Overstreet et al. (1999) reported that finasteride 1 mg/day did not affect spermatogenesis, seminal production, sperm motility, or sperm morphology in young healthy men.1 The 3 patients reported on this paper showed abnormal sperm concentration and motility while using finasteride 1 mg/day. Those alterations were completely reversed (patient 1 and 2) or improved (patient 3) 3 or 4 months after the interruption of finasteride treatment. The first patient had a history of having a normal seminal analysis 10 years before when he had been seen by a urologist to evaluate the need for a varicocele repair, which was not done at that time. In case 3 there was a dramatic improvement from less than 1 million sperm/mL to 10 million sperm/mL 3 months after cessation of finasteride treatment. Although the improved sperm concentration was still abnormal, it permitted the couple to be treated with intrauterine insemination instead of with intracytoplasmic sperm injection. It is interesting to stress that 2 patients had a varicocele and the third one was obese. We hypothesize that perhaps finasteride does not dramatically change the spermatogenesis process in healthy men as shown by Overstreet et al. (1999), but in patients with other problems contributing to infertility, the negative influence of finasteride noted by others might be amplified. Future studies should be done to clarify the extent of the effect of finasteride in patients with fertility problems.