Aromatase inhibitors in infertile patients:effects on seminal parameters, serum and seminal plasma testosterone levels, and estradiol levels during short-term follow-up

Aim: To evaluate the effects of an aromatase inhibitor (anastrozole) on seminal parameters, and on serum and seminal plasma testosterone/estradiol ratios in infertile patients, as well as to clarifyits place among empirical infertility treatment modalities.Patients and Methods: The study included 32 patients with spermatozoa numbering 5 million/mL in ejaculate and a serum testosterone/estradiol ratio 0.14. Anastrozole, anaromatase-inhibiting agent, was given (1 mg b.i.d.) and patients were re-evaluated 2 months laterbased on semen analysis, and measurements of serum and seminal plasma testosterone and estradiol levels. Results: Semen analysis parameters before and after treatment, respectively, were as follows:number of spermatozoa: 12.4 ± 4.1 million/mL and 22.3 ± 5.7 million/mL; motility: 33.4 ± 4.2%and 47.6 ± 7.4%; normal morphology: 5.4 ± 1.3% and 8.9 ± 2.7%. Differences between the values before and after treatment were statistically significant (P 0.05). Serum testosterone level was 4.1 ± 1.2 ng/mL, estradiol level was 52.1 ± 9.4 pg/mL, andtestosterone/estradiol ratio was 0.13 ± 0.03 at the beginning of treatment. These values were 3.2 ±0.6 ng/mL, 68.4 ± 7.3 pg/mL, and 0.05 ± 0.001, respectively, in seminal plasma. Following 2 months of anastrozole treatment, testosterone and estradiol levels, and thetestosterone/estradiol ratio showed statistically significant changes in serum and seminal plasma.While testosterone levels significantly increased, estradiol levels decreased (serum pT = 0.001, pE2= 0.001; seminal plasma pT = 0.001, pE2 = 0.001). Conclusion: Aromatase inhibitors are a potential treatment method for infertile male patients with increased plasma estradiol levels and decreased plasma testosterone/estradiol ratios.