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纽约（路透社健康版）1月四日报道：据发表在12月出版的《生育与不育》杂志的一项报告指出克罗米酚对部分低促性腺素性功能减退的男性患者有利。

来自伯明翰阿拉巴马大学的该报告的第一作者Scott J. Whitten博士在接受路透通讯社采访时说：“原发性或获得性HH患者在接受侵害性更大和更为昂贵的治疗（例如注射促性腺激素类）前进行4个月的克罗米酚试验性治疗是有利的。”Whitten博士和同事研究了克罗米酚对10名HH男性患者（HH是导致男性不育的少见因素）是否有效。

报告称克罗米酚治疗1年后，4名卡尔曼(氏)综合征患者中只有一名患者的精子浓度增加而全垂体功能减退症患者的精子缺乏症状均没有得到改善。相反，该报告指出3名成年发病的原发性HH男性患者经过3个月克罗米酚的治疗精子浓度有了明显增加。目前为止该组患者已有两名恢复了生育能力。

Whitten博士说：“除非对克罗米酚治疗没有反应，我们不会因为副作用停止对患者使用该药物。”

最后作者总结说：“因为条件有限，对HH患者促性腺激素类药物和克罗米酚的随机研究难以进行，然而利用多系列的严格选择标准对患者进行分级可能帮助进一步验证克罗米酚恢复男性低生育能力的有效性。

Male Hypogonadotropic Hypogonadism May Respond to Clomiphene Citrate

By Will Boggs, MD

NEW YORK (Reuters Health) Jan 04 - Some men with hypogonadotropic hypogonadism (HH) benefit from treatment with clomiphene citrate, according to a report in the December issue of Fertility and Sterility.

Patients with idiopathic or acquired HH "may benefit from a 4-month trial (of clomiphene citrate) before proceeding with more invasive and expensive therapies, such as injectable gonadotropins," lead author Dr. Scott J. Whitten, from University of Alabama at Birmingham, told Reuters Health.

Dr. Whitten and colleagues investigated whether 10 men with HH, a rare cause of male infertility, might respond to treatment with clomiphene citrate.

Only one of four patients with Kallmann's syndrome experienced an improvement in sperm concentration after 1 year of therapy with clomiphene citrate, the authors report, and no patient with panhypopituitarism experienced a reversal of azoospermia with clomiphene citrate treatment.

In contrast, all three men with adult-onset idiopathic HH experienced significant increases in sperm concentrations and testosterone levels after 3 months of therapy with clomiphene citrate, the report indicates. Two pregnancies have been achieved in this subgroup so far.

"We did not have any of our patients discontinue the clomiphene because of side effects, only if there was lack of response," Dr. Whitten said.

"Because this is such a rare condition, additional randomized studies comparing gonadotropins with clomiphene in this subtype of HH patients would be difficult to perform," the authors conclude. "However, larger series using strict inclusion criteria for stratifying patients may be helpful to further examine the success of clomiphene treatment in restoration of this form of male subfertility."

Fertil Steril 2006;86:1664-1668.

http://www.medscape.com/viewarticle/550304

编辑：蓝色幻想