DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20211099

Acarbose versus orlistat in weight management of infertile women with polycystic ovarian syndrome: a prospective randomized controlled trial

Afrin S., Ishrat S., Banu J., Jahan I., Ansary S. A., Nasreen K.

Abstract


Background: Some men with severely defective sperm production commonly have excess aromatase activity, reflected by low serum testosterone and relatively elevated estradiol levels. Elevated levels of estrogen lead to feedback inhibition of the hypothalamic -pituitary-gonadal axis, and the end result is a decrease in LH necessary for the production of testosterone, and FSH to optimize sperm production. The aim of this study was to evaluate the effect of aromatase inhibitor, letrozole on the semen parameters of infertile male having oligozoospermia, low serum testosterone level and testosterone to estradiol ratio <10.

Methods: This Prospective study was conducted in the Department of Reproductive Endocrinology and Infertility at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from May 2019 to April 2020. The sample size was 30 subfertile men with oligozoospermia (≤ 10 million/ml), low serum testosterone level (<300 ng/dl) and low testosterone to estradiol ratio (<10). All patients were treated with letrozole 2.5 mg daily for 4 months. At the end of the 4 months the semen analysis was performed. Statistical analysis was carried out by using IBM Statistical Package for Social Sciences version 25 for windows (SPSS version 25.0).

Results: The sperm concentration, sperm motility and total motile sperm count significantly increased after letrozole treatment. The side effects were mild and well tolerated.

Conclusions: This study suggests that some men with oligozoospermia, low serum testosterone levels and normal gonadotropin concentration may have a treatable endocrinopathy. Letrozole may be used to improve sperm parameters in infertile men with low serum testosterone to estradiol ratio.


Keywords


Aromatase inhibitor, Estradiol, Letrozole, Male infertility, Oligozoospermia, Testosterone

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References


Weyer C, Funahashi T, Tanaka S, Hotta K, Matsuzawa Y, Pratley RE, et al. Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia. J Clinic Endocrinol Metabol. 2001;86(5):1930-5.

Dunaif A, Graf M, Mendeli J, Laumas V, Dobrjansky A. Characterization of groups of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance, and/or hyperinsulinemia. J Clinical Endocrinol Metabol. 1987;65:499-507.

Dunaif AKR, Segal W. Futterweit, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome, Diabetes. 1989;38:1165-74.

Fauser B, Tarlatzis, Fauser. Revised 2003 consensus on diagnostic criteria and long term health risks related to polycystic ovary syndrome, Human Reproduction. 2004;19:41-7.

Ehrmann DA, Rosenfield RL, Barnes RB, Brigell DF, Sheirh Z. Detection of functional ovarian hyperandrogenism in women with androgen excess. New English J Medic. 1992;327:157-62.

Rachmani R, Bar‐Dayan Y, Ronen Z, Levi Z, Slavachevsky I, Ravid M. The effect of acarbose on insulin resistance in obese hypertensive subjects with normal glucose tolerance: a randomized controlled study. Diabetes, Obesity and Metabolism. 2004;6(1):63-8.

Coniff RF, Seaton TB, Shapiro JA, Robbins D, Kleinfield R, MacGill JB, et al. Reduction of glycosylated hemoglobin and postprandial hyperglycemia by acarbose in patients with NIDDM. Diabetes Care. 1996;18:817-20.

Laube H. Acarbose. Clinical Drug Investigation. 2002;22:141-56.

Metwally M, Amer S, Li TC, Ledger WL. An RCT of metformin versus orlistat for the management of obese anovulatory women. Human Reproduction. 2009;24:966-75.

Ghandi S, Aflatoonian A, Tabibnejad N, Moghaddam MH. The effects of metformin or orlistat on obese women with polycystic ovary syndrome: a prospective randomized open-label study. Journal of assisted reproduction and genetics. 2011;28(7):591.

Ciotta L, Calogero AE, Farina M, De Leo V, La Marca A. Cianci A. Clinical, endocrine and metabolic effects of acarbose,an a-glucosidase inhibitor, in PCOS patients with increased insulinresponse and normal glucose tolerance. Human Reproduction. 2001;16:2066-72.

Geisthövel F, Frorath B, Brabant G. Endocrinology: Acarbose reduces elevated testosterone serum concentrations in hyperinsulinaemic premenopausal women: a pilot study. Human reproduction. 1996;11(11):2377-81.

Penna IARB, Canella RM, Reis MF. Silva de Sáand R. Ferriani A. Acarbose in obese patients with polycystic ovarian syndrome: a double-blind, randomized, placebo-controlled study. Human Reproductionvol. 2005;20:.2396-01.

Trikudanathan S, Raji A, Chamarthi B, Seely EW, Simonson DC. Comparison of insulin sensitivity measures in South Asians. Metabolism. 2013;62(10):1448-54.

WHO Expert Consultation. Appropriate body mass index for Asian population and its implication for policy and intervention strategies. Lancet 2004; 363:157-63.

NICE. Obesity, identification, assessment and management. Clinical guidelines [CG189] 2014.

Hanefeld M, Fischer S, Schulze J, Spengler M, Wargenau M, Schollberg K, et al. Therapeutic potentials of acarbose as first-line drug in NIDDM insufficiently treated with diet alone. Diabetes care. 1991;14(8):732-7.

Calle-Pascual A, Garcia-Honduvilla J, Martin-Alvarez PJ, Calle JR, Maranes JP. Influence of 16-week monotherapy with acarbose on cardiovascular risk factors in obese subjects with non-insulin-dependent diabetes mellitus: a controlled, double-blind comparison study with placebo. Diabetes & metabolism. 1996;22(3):201-2.

Mendes D, Alves C, Batel-Marquis F. Number needed to treat (NNT) in clinical literature: an appraisal. BMC Medicine. 2017;15:112.

Metwally M, Amer S, Li TC, Ledger WL. An RCT of metformin versus orlistat for the management of obese anovulatory women. Human Reproduction. 2009;24:966-75.