sildenafil-citrate and Infertility--Male

The objective of this review study is to evaluate the therapeutic role of PDE5 inhibitors (PDE5is) in the amelioration of oligoasthenospermia in infertile males. PDE5is have a beneficial influence on the secretory function of the Leydig and Sertoli cells, the biochemical environment within the seminiferous tubule, the contractility of the testicular tunica albuginea, and the prostatic secretory function. In several studies, the overall effect of sildenafil and vardenafil increased quantitative and qualitative sperm motility. Furthermore, some studies indicate that PDE5is influence positively the sperm capacity to undergo capacitation under biochemical conditions that are known to induce the sperm capacitation process. Additional research efforts are necessary in order to recommend unequivocally the usage of sildenafil, vardenafil, or avanafil for the alleviation of male infertility.

Topics: Andrology; Fertility Clinics; Humans; Infertility, Male; Laboratories; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Reproduction; Semen; Sildenafil Citrate; Sperm Motility; Sulfones; Vardenafil Dihydrochloride

Sildenafil has had a dramatic influence on the field of sexual medicine over the past 20 years. Not only have phosphodiesterase-5 (PDE5) inhibitors improved the treatment of erectile dysfunction (ED), they have indirectly contributed to the treatment of male factor infertility. A review of the literature between 1998 - 2018 was performed using PubMed with regards to sildenafil and male infertility. Numerous studies have demonstrated sildenafil's safety and efficacy for treating ED. Sildenafil does not alter semen parameters, and, in fact, may positively affect semen parameters. Sildenafil is helpful for treating ED caused by the psychological stress of infertility treatments. Sildenafil has improved the treatment of ED and may have a benefit on semen parameters. This has aided in the management of male factor infertility, and has contributed to hundreds of thousands of pregnancies that would have been more difficult, as it was before its advent.

Topics: Erectile Dysfunction; Humans; Infertility, Male; Male; Phosphodiesterase 5 Inhibitors; Sexual Behavior; Sildenafil Citrate; Sperm Motility

Medical and surgical advances in the treatment of spina bifida (SB) have resulted in increasing numbers of patients reaching adulthood. As such, issues related to sexual maturity are being investigated to offer optimal healthcare to men with spina bifida. This report constitutes a review of the current literature relating to adults with spina bifida and issues of sexuality, erectile dysfunction and fertility. In general, adult males with spina bifida have normal sexual desires and an interest in addressing these issues with healthcare providers. Sexual education and access to intimacy are delayed compared to the general population. 75% of men achieve erections, but maintaining erections is a problem and some may be merely reflexive in nature. The many of these men show marked improvement with sildenafil. In SB erectile dysfunction and infertility are related to the level of neurological lesion with the best performance status in those with sacral lesions and intact reflexes. Men with lesions higher than T10 are at risk for azoospermia. There is an increased risk of neural tube defects in the children of men with spina bifida, but the current incidence with modern folic acid therapy is unknown. As the number of males with spina bifida reaching sexual maturity increases, further investigation into sexuality, sex education, intimacy, and treatments for erectile dysfunction and infertility will be needed.

Topics: Adult; Humans; Infertility, Male; Male; Penile Erection; Piperazines; Purines; Sex Education; Sexuality; Sildenafil Citrate; Spinal Dysraphism; Sulfones

Involuntary childlessness is considered to be a chronic stressor for couples suffering from infertility. Stress itself may interfere with spermatogenesis and fertility rate. The long period of diagnostic and treatment procedures may also have a negative impact on the sex life of the infertile couple. In fact, we observed in such patients a higher frequency of male sexual disturbances expressed as erectile dysfunction, ejaculatory disorders, loss of libido and a decrease in the frequency of intercourse. We tried to partially overcome these sexual symptoms by administration of 50 mg of a type-V phosphodiesterase inhibitor (sildenafil) to two selected groups: patients collecting semen for artificial insemination and male partners of couples before post-coital testing. The results of this uncontrolled pilot study suggest that sildenafil is effective in increasing compliance of male patients facing infertile couple management procedures, and also in improving some sperm parameters, above all the number of sperm penetrating the cervical mucus.

Topics: Humans; Infertility, Male; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sexuality; Sildenafil Citrate; Stress, Psychological; Sulfones; Tissue and Organ Harvesting; Tissue Donors

Review of literature.. To review the physical aspects related to penile erection, ejaculatory dysfunction, semen characteristics, and techniques for enhancement of fertility in spinal cord lesioned (SCL) men.. Worldwide: individuals with traumatic as well as non-traumatic SCL.. Recommendations for management of erectile dysfunction in SCL men: If it is possible to obtain a satisfactory erection but of insufficient duration, then try to use a venous constrictor band to find out if this is sufficient to maintain the erection. Otherwise we recommend Sildenafil. If Sildenafil is not satisfactory then use intracavernous injection with prostaglandin E(1) (some SCL men may prefer cutaneous or intraurethral application). We discourage the implantation of penile prosthesis for the sole purpose of erection. Recommendations for management of ejaculatory dysfunction in SCL men: Penile vibratory stimulation (PVS) to induce ejaculation is recommended as first treatment choice. If PVS fails, SCL men should be referred for electroejaculation (EEJ). Semen characteristics: Impaired semen profiles with low motility rates are seen in the majority of SCL men. Recently reported data gives evidence of a decline in spermatogenesis and motility of ejaculated spermatozoa shortly after (few weeks) an acute SCL. It is suggested that some factors in the seminal plasma and/or disordered storage of spermatozoa in the seminal vesicles are mainly responsible for the impaired semen profiles in men with chronic SCL. Fertility: Home insemination with semen obtained by PVS and introduced intravaginally in order to achieve successful pregnancies may be an option for some SCL men and their partners. The majority of SCL men will further enhance their fertility potential when using either PVS or EEJ combined with assisted reproduction techniques such as intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection.

Topics: Alprostadil; Ejaculation; Electric Stimulation Therapy; Erectile Dysfunction; Humans; Infertility, Male; Male; Penile Erection; Phosphodiesterase Inhibitors; Piperazines; Purines; Reproductive Techniques; Semen; Sildenafil Citrate; Sperm Motility; Spinal Cord Injuries; Sulfones; Vasodilator Agents; Vibration

Viagra and in vitro fertilization (IVF) with intraovocyte injection of spermatozoa (ICSI) have revolutionized the treatments of impotence and male sterility. They are able to treat successfully most of the cases whatever is the cause of the problem. The andrologist is tempted to renounce to look for an etiological factor and to treat directly his patient. The risk is to miss a diagnosis such as genital tract obstruction, testicular cancer, gonadotropin deficiency, sperm autoimmunity, coital disorders, or reversible toxin exposures, which could benefit from a specific treatment. Moreover IVF can endanger the woman's health and genetic consequences must not be overlooked if ICSI is performed. Concerning impotence a diagnosis of prolactinoma, diabetes or ischemic cardiopathy must not be missed because Viagra can also have cardio-vascular side-effects. This article reviews some etiological factors responsible for male infertility or impotence. The importance of a global appraisal of the patient is underlined in order not to limit his role to the one of a sperm producer.

Topics: Erectile Dysfunction; Fertilization in Vitro; Humans; Infertility, Male; Male; Piperazines; Purines; Risk Factors; Sildenafil Citrate; Sperm Injections, Intracytoplasmic; Sulfones

To evaluate the acute effect of sildenafil and tadalafil on seminal parameters in young, infertile patients.. Prospective, randomized, double-blind, crossover clinical investigation on semen parameters after the administration of a single dose of sildenafil (50 mg) or tadalafil (20 mg).. An academic hospital as well as a male infertility center and clinical andrology laboratories.. Eighteen young, infertile men.. Oral administration of a single dose of sildenafil (50 mg) or tadalafil (20 mg) in a blind, randomized order. The semen samples were collected 1 or 2 hours after each treatment.. Changes in sperm parameters after sildenafil and tadalafil administration, compared with the basal conditions.. A significant increase in sperm progressive motility (median value, 37.0% vs. 28.5%) was observed after sildenafil administration as compared with baseline; in contrast, a significant decreased value was observed after tadalafil (median value, 21.5% vs. 28.5%).. These preliminary results indicate that sperm motility appears to be acutely affected in young, infertile patients by a single dose of sildenafil and tadalafil, with opposite effects: stimulatory by the former and inhibitory by the latter.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Adult; Carbolines; Cross-Over Studies; Cyclic Nucleotide Phosphodiesterases, Type 5; Depression, Chemical; Double-Blind Method; Humans; Infertility, Male; Male; Phosphodiesterase Inhibitors; Phosphoric Diester Hydrolases; Piperazines; Purines; Sildenafil Citrate; Sperm Motility; Stimulation, Chemical; Sulfones; Tadalafil

Topics: Administration, Oral; Adult; Ejaculation; Erectile Dysfunction; Humans; Infertility, Male; Male; Piperazines; Purines; Sildenafil Citrate; Sulfones

Male infertility prevalence is higher in diabetic patients. Those patients exhibit testicular oxidative damage due to sustained hyperglycemia and inflammation. The study has investigated the efficacy of cilostazol, a phosphodiesterase 3 inhibitor, on testicular damage of diabetic rats.. Streptozotocin-induced diabetes in rats was used as a model. Six control male rats and 24 diabetic male rats were divided into the following: diabetic, cilostazol at low dose, cilostazol at high dose, and sildenafil treated rat groups. Treatment period was 4 weeks. Then, serum testosterone, testicular oxidative parameters, and testicular oxidant defenses were assayed. Real time PCR was done for quantification of Phosphoinositide 3-kinase (PI3K), Akt, and nuclear factor (NF)-κB mRNA. Expression of testicular inducible nitric oxide synthase (iNOS) was assessed.. Diabetes negatively affected the testicular tissue as evident by biochemical analysis and histopathology. Four weeks of cilostazol or sildenafil treatment improved anti-oxidative capacity, ameliorated lipid peroxidation and the pro-inflammatory iNOS expression in testicular tissue. Testosterone level and the spermatogenesis showed marked improvement. Quantitative mRNA expression showed an elevation in PI3K and Akt by cilostazol with decreasing in NF-κB level by both drugs.. Our findings suggest the beneficial role of cilostazol and sildenafil in diabetic testicular damage dependent on anti-inflammatory and anti-oxidant effects.

Topics: Animals; Cilostazol; Diabetes Complications; Diabetes Mellitus, Experimental; Glutathione; Heme Oxygenase (Decyclizing); Hyperglycemia; Infertility, Male; Inflammation; Male; Malondialdehyde; Oxygen; Phosphatidylinositol 3-Kinases; Phosphodiesterase 3 Inhibitors; Proto-Oncogene Proteins c-akt; Rats; Rats, Wistar; Real-Time Polymerase Chain Reaction; Sildenafil Citrate; Streptozocin; Superoxide Dismutase; Testis; Tetrazoles

Diabetes-associated male sexual dysfunction and fertility impairments are both common clinical complications with limited therapeutic options; hence it seriously affects the quality of life of the patients, in particular, the patients of reproductive age. Lycium barbarum polysaccharide (LBP) has long being believed to maintain and to promote reproductive functions in the traditional medical practice in China. The current study was to investigate if LBP may contribute to recovery of male sexual dysfunction and fertility impairments in diabetic individuals. The effects of LBP on sexual behaviors and histological changes of testis were studied in the type-1 diabetes male mice induced by intra-peritoneal (i.p.) injection of streptozotocin (STZ). After oral administration of LBP (10, 20 or 40 mg/kg), sildenafil citrate (SC, 5 mg/kg) or saline for 62 consecutive days, the typical abnormal changes in the sperm parameters, in relative weight of reproductive organs and in morphology of testis were observed in diabetic mice. LBP treatment of the diabetic mice considerably reversed those changes and Johnsen's testicular score, serum testosterone (T), follicular stimulating hormone (FSH) and luteinizing hormone (LH) level were also increased to different degrees. Moreover, our data have also shown that a marked improvement in sexual behavior and fertility level after administration of LBP (40 mg/kg) compared to the diabetic group. These results suggested that LBP can exert functional recovery of male sexual dysfunction and fertility damages induced by diabetes in male mice, which is likely to be mediated through regulating the hypothalamus- pituitary-gonadal axis endocrine activity.

Topics: Animals; Diabetes Mellitus, Experimental; Drugs, Chinese Herbal; Follicle Stimulating Hormone; Hypothalamo-Hypophyseal System; Infertility, Male; Luteinizing Hormone; Male; Mice; Phosphodiesterase 5 Inhibitors; Protective Agents; Sexual Behavior, Animal; Sexual Dysfunction, Physiological; Sildenafil Citrate; Testis; Testosterone

To determine whether sildenafil citrate, a cyclic monophosphate-specific type 5 phosphodiesterase inhibitor, influences sperm motility or the acrosome reaction.. Laboratory analysis of sperm motility after exposure to sildenafil citrate using computer-assisted semen analysis and acrosome reaction by fluorescein isothiocyanate-labeled peanut agglutinin staining.. An assisted reproductive technology (ART) unit.. Fifty-seven male patients.. Sperm were divided into 90% (those with the best fertilizing potential used in assisted conception) and 45% (the poorer population) fractions by density centrifugation and incubated with sildenafil citrate (0.67 muM) at 37 degrees C for up to 180 minutes.. Both the number and velocity of progressively motile sperm were significantly increased by sildenafil citrate between 15 and 135 minutes. Furthermore, samples revealed that these effects were consistent in the 90% and 45% populations of sperm. In both populations, sildenafil also caused a significant increase in the proportion of acrosome-reacted sperm-22.1% compared with 11.8% in the control group of the good quality fraction and 16.6% compared with 9.4% in the control group of the poorer quality fraction.. The use of sildenafil citrate may adversely affect male fertility.

Topics: Acrosome Reaction; Adult; Humans; Infertility, Male; Male; Piperazines; Purines; Sildenafil Citrate; Sperm Motility; Sulfones

To investigate the use the sildenafil citrate, recognized as a first-line therapy for men with erectile dysfunction (ED), and which is safe and effective in men with various causes and severity of ED, including psychogenic ED, in a population of infertile men with sexual dysfunction.. Infertility is a major source of life stress and might be associated with sexual dysfunction through the erosion of self-esteem and self-confidence, and in stimulating discord in a relationship. Men presenting for evaluation of fertility who on questioning by the physician reported the recent onset of sexual dysfunction, had a history taken, a physical examination, hormonal profile, and completed the International Index of Erectile Function (IIEF), a validated inventory for assessing sexual dysfunction. Thirty men with a score of <26 on the erectile function domain of the IIEF, or who complained of new onset rapid or delayed ejaculation, were treated with sildenafil with no randomization or placebo control. The evaluation was repeated and the IIEF completed again > or =3 months after starting treatment.. For men complaining of ED, subjective erectile rigidity, duration of erection, and the percentage of successful penetration attempts significantly improved with sildenafil. The mean (sd) IIEF domain scores for erection and satisfaction, at 18 (4) vs 27 (3), and 12 (2) vs 16 (3) (both P = 0.01), and orgasm, at 4 (1) vs 6 (3) (P = 0.001), respectively, significantly improved after treatment. In patients with ejaculatory dysfunction, the function improved in 64% after sildenafil therapy.. We identified the nature of sexual dysfunction associated with male-factor infertility, and showed the efficacy of sildenafil therapy in men with this condition.

Topics: Adult; Ejaculation; Erectile Dysfunction; Humans; Infertility, Male; Male; Patient Satisfaction; Phosphodiesterase Inhibitors; Pilot Projects; Piperazines; Purines; Self Concept; Sildenafil Citrate; Sulfones; Treatment Outcome

With the assumption that infertility and related diagnostic and therapeutic processes are stressful, an uncontrolled pilot study was designed to evaluate the effect of sildenafil citrate on sexual compliance and reproductive outcome. A group of sexually healthy men were studied after the administration of 50 mg sildenafil before semen collection for intrauterine artificial insemination (n = 25) or planned intercourse for a postcoital test (n = 12). We demonstrated that sexual dysfunction is highly prevalent in patients undergoing diagnostic procedures for infertility, and that sildenafil is effective in reversing stress-induced transitory impotence. Furthermore, sildenafil improved some seminal parameters, such as the percentage of spermatozoa with linear progressive motility, as well as the number of spermatozoa penetrating the cervical mucus. Two pregnancies were obtained after sildenafil administration.

Topics: Adult; Humans; Infertility, Male; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

The aim of this report was to study the effect of sildenafil, a specific type-5 phosphodiesterase inhibitor, on human sperm motility, viability, membrane integrity and sperm penetration assay. Spermatozoa were obtained from normal donors (n = 6) and infertile men (n = 6) were washed using a single Percoll (80%) gradient, suspended in Ham's F-10 medium, and incubated with various doses of sildenafil (125, 250 and 750 ng/ml); pentoxifylline (3 mM) was used as a positive control, and Ham's F-10 was used as a reagent control. Sperm motility, grade, viability, membrane integrity (by hypo-osmotic swelling test), and motion evaluation were carried out at various time intervals. Hamster ova sperm penetration assay (SPA) was used to evaluate overall sperm function. Sildenafil did not affect sperm motility, viability or membrane integrity under these conditions as compared to our Ham's control (P> 0.05). Incubation with pentoxifylline significantly enhanced sperm motility (P < 0.05) and viability without affecting membrane integrity (P < 0.05). Sperm incubated with sildenafil and pentoxifylline from both normal donors and infertile patients demonstrated no significant change in sperm penetration assay from respective controls. In conclusion, sildenafil, at the doses evaluated, did not significantly alter the motility, viability, membrane integrity or sperm penetration characteristics of human spermatozoa from normal donors and infertile patients.

Topics: Animals; Cell Membrane; Cricetinae; Female; Fertilization; Humans; In Vitro Techniques; Infertility, Male; Male; Pentoxifylline; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sperm Motility; Sperm-Ovum Interactions; Spermatozoa; Sulfones