小剂量氯米芬与左卡尼汀联合治疗特发性少弱精症

目的:探讨小剂量氯米芬联合左卡尼汀治疗特发性少弱精子症的疗效和安全性。方法:根据WTO标准选择特发性少弱精子症患者60例,给予小剂量氯米芬(25mg),每日1次;左卡尼汀口服液1.0g,每日2次。两种药物连服3个月为1疗程,根据情况,维持治疗1～2个疗程。分别于治疗前、治疗后3个月及6个月行计算机辅助精液分析。治疗开始后2周、4周及3个月,用放射免疫法测定血清睾酮(T)卵泡刺激素(FSH)。治疗中分别有8例患者和5例患者的血清睾酮水平和FSH水平超出正常值高限,随即减低氯米芬剂量至25mg,隔日1次。治疗中了解配偶妊娠情况及不良反应发生情况。结果:随访3～6个月,有10例患者因各种原因(2例女方妊娠)提前退出。服药后,患者的睾酮及卵泡刺激素迅速升高,接近正常上限水平。治疗后患者的精子密度及前向运动精子百分率较治疗前增加显著(P<0.05),治疗后女方妊娠者为11例。治疗期间,所有患者均未报告明显的不良反应。结论:小剂量氯米芬联合左卡尼汀治疗特发性少弱精子症能有效提高患者精子密度及前向运动精子百分率,增加妊娠率,无明显不良反应。

Small doses of clomiphene citrate combined with levocarnitine in the treatment of idiopathic oligoasthenospermia

Objectives: To study the efficacy and safety of small doses of clomiphene citrate combined with levocarnitine in the treatment on idiopathic oligoasthenospermia.Methods: According to WTO standard,sixty patients with idiopathic oligoasthenospermia were selected and treated with small dose of clomiphene citrate(25 mg,once a day),combined with oral L carnitine(1.0 g,twice a day).A course of treatment took three months and each patient covered one or two courses.The computer-assisted semen analysis was done before the treatment,3 months and 6 months after the treatment.Their serum testosterone(T) and follicle stimulating hormone(FSH) were measured by radioimmunoassay 2 weeks,4 weeks and 3 months after the treatment.In the process,8 patients had abnormal serum testosterone levels and 5 patients with abnormal FSH levels,for whom the clomiphene dose was reduced to 25mg every other day.The pregnancy and adverse reactions of their spouses were observed.Results: The patients were followed up for 3 to 6 months.Ten patients quitted for various reasons(2 cases because of pregnancy).The patient’s testosterone and follicle stimulating hormone increased rapidly after the treatment,approaching the upper limit of the normal levels.The sperm density and motility sperm percentage after treatment increased significantly(P<0.05),and 11 cases got pregnant.None of the patients had severe adverse reactions.Conclusion: Small doses of clomiphene citrate combined with levocarnitine can effectively improve the sperm density and increase the ratio of forward mobile sperm.The combined treatment can increase pregnancy rate without causing obvious adverse reactions.