Abstract
Background: Pentoxifylline (PTX) is a member of methylxanthine chemicals and a type of non-selective phosphodiesterase-5 inhibitors, which has been used in male infertility treatment to improve sperm quality and erectile dysfunction (ED) treatment. Mutually tight associations existed between ED and male infertility. Using PTX might kill two birds with one stone by improving sperm quality and erectile function in infertile men with ED. Methods: PubMed, Cochrane Library, EMBASE, and Web of Science were searched by October 2021. Based on available evidence from observational studies and randomized-controlled trials (RCTs), we conducted a systematic review to summarize the efficacy and safety of PTX in treating ED and male infertility. The protocol of the article was registered and updated in PROSPERO (CRD42021291396). Results: From 202 records, eight studies (7 RCTs) evaluating the role of PTX in ED and three studies (2 RCTs) assessing the efficacy of PTX in male infertility were included in the systematic review. Three studies (100.00%) and two studies (100.00%) reported the beneficial role of PTX in improving sperm progressive motility and normal sperm morphology rate, respectively. In contrast, only one study (33.33%) indicated the favorable role of PTX in enhancing sperm concentration. As for ED, three (60.00%) studies supported the treatment role of PTX alone in ED, and two studies (66.67%) favored the combination use of PTX and selective PDE5Is compared with selective PDE5Is alone. Safety analysis showed that PTX was a well-tolerated drug in ED and male infertility treatment. Conclusion: Given the association between ED and male infertility and satisfying findings from available evidence, PTX administration for the simultaneous treatment of poor sperm quality and mild ED in infertile men will highly enhance the treatment compliance. However, the finding should be treated carefully until validated by further studies.
Highlights
Male infertility, a prevalent condition affecting millions of couples, is a medical issue and a huge social problem
Under the established search strategy, we found 202 non-repeated records
Conflicting results were found in three studies (Micic et al, 1988; Safarinejad, 2011; Nasimi Doost Azgomi et al, 2018), only one (33.33%) randomized controlled trials (RCTs) reported the advantageous role of PTX in sperm concentration (Safarinejad, 2011)
Summary
A prevalent condition affecting millions of couples, is a medical issue and a huge social problem. Research on this issue is becoming much more crucial in the context of population aging (Fisher and Hammarberg, 2012; Inhorn and Patrizio, 2015). Drugs, surgical interventions, and artificial reproductive technology are frequently used treatment in male infertility, while empirical drug intervention with a long history is still the most commonly used method for the treatment of oligoasthenoteratozoospermia (OAT) (de Kretser, 1997; Bisht et al, 2017). Pentoxifylline (PTX) is a member of methylxanthine chemicals and a type of non-selective phosphodiesterase-5 inhibitors, which has been used in male infertility treatment to improve sperm quality and erectile dysfunction (ED) treatment.
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