gastroesophageal re!ux disease and sporadically with 2 mg
of bromazepam for mild generalized anxiety disorder. He had
used minoxidil topical solution for hair loss for approximately
4 years, until 1999. He then continued with 1 mg of oral finasteride
daily for an additional 10 years, which he had discontinued
3 months before our evaluation.
The patient had no history of sexual dysfunction, and physical
examination was unremarkable. The first semen analysis
showed severe oligospermia: volume 4.2 mL; sperm count
3.5 x 106/mL, and 30% progressive motility. Color Doppler
ultrasound showed no varicocele and revealed only a mild
decrease in left testicular volume. Serum hormonal levels
were: follicle-stimulating hormone 6.6 mIU/mL, luteinizing
hormone 4.2 mIU/mL, estradiol 16 pg/mL, prolactin 8 ng/
mL, testosterone 6 ng/mL, free testosterone 15.5 pg/mL, and
dehydroepiandrosterone sulfate 133 ng/mL. The patient was
advised not to resume finasteride therapy.
A second semen analysis was performed 1 month later, and
an increase in sperm concentration was found: volume 4.2 mL,
sperm count 12 x 106/mL, and 29% progressive motility. The couple
was counseled to undergo assisted reproduction treatment,
but they conceived spontaneously 1 month later. The pregnancy
was uneventful, and fetal growth was regular. A spontaneous labor
with normal vaginal delivery occurred at full term.
At birth, the male child weighed 3,455 g and was in good health.
Postnatal growth was normal. At 1-year follow-up, the development
of the child was regular, and the semen analysis of
the patient confirmed moderate oligospermia: volume 2.3 mL,
sperm count 9 x 106/mL, and 32% progressive motility.
DISCUSSION
To the best of our knowledge, this is the first reported case of a
successful full-term pregnancy and live birth in a couple whose
male partner had a history of long-term treatment with finasteride.
Finasteride (1 mg daily) is widely used for the treatment of
men with AGA, many of whom are of reproductive age.
Scant data are available on the effects of finasteride on
semen parameters. We have reviewed the literature on finasteride's
effects on male fertility and have identified very
few randomized studies and some case reports. A doubleblind,
placebo-controlled study of 181 healthy men showed
that daily treatment with 1 mg of finasteride for 48 weeks did
not significantly affect semen parameters.5 Although an early
study showed no influence on spermatogenesis in 47 men
taking a higher dose of finasteride (5 mg daily),7 a more recent
randomized, double-blind, placebo-controlled study of
99 healthy men found that finasteride 5 mg or dutasteride
0.5 mg once daily for 1 year had only mild effects on semen
parameters.6 The authors observed a decrease in semen volume, sperm concentration, and sperm motility at the end of
treatment, but no change in sperm morphology. At 24-week
follow-up, there was nearly complete recovery for total sperm
count and semen volume, but not for sperm motility, which
was significantly reduced.6 It should be noticed that these
randomized studies enrolled only healthy men with no history
of infertility or difficulty conceiving5 or those with normal
semen parameters.6 Therefore, counseling for men taking finasteride
and planning pregnancy is particularly difficult.
Recently, some authors have suggested that in subfertile patients,
the negative effects of finasteride therapy might be
amplified.8-10 Glina et al8 first reported 3 cases of young patients
with very poor semen quality during daily treatment
with 1 mg of finasteride. Semen parameters improved considerably
after cessation of the drug. Liu et al9 described 2
cases of azoospermia and severe oligospermia in men using
1 mg of finasteride. There was significant improvement
in semen parameters and reverse of azoospermia 6 months
after the cessation of the finasteride. Another case of azoospermia
during treatment with 1 mg of finasteride was
described by Chiba et al.10 The patient had been diagnosed
with oligospermia 5 years earlier. A significant improvement
of semen quality was observed after the discontinuation of
finasteride, which allowed the patient to try obtaining pregnancy
by intrauterine insemination.
In order to investigate the potential submicroscopic sperm
alterations induced by finasteride, Collodel et al11 evaluated
sperm morphology by transmission electron microscope,
sperm chromosomal abnormalities by fluorescence in situ
hybridization and the presence of Y-chromosome microdeletions
by polymerase chain reaction in a single patient with
azoospermia and in 2 patients with severe asthenozoospermia.
Alterations of morphology consistent with necrosis and
elevated diploidy and sex chromosome disomy frequencies
were found. A significant improvement of semen parameters
was observed 1 year after discontinuation of finasteride
therapy, whereas the frequency of chromosomal abnormalities
was unchanged.
Tu and Zini12 found an elevated sperm DNA fragmentation
index (DFI) in a patient receiving 1 mg of finasteride daily
who presented for secondary infertility of 4 years' duration.
The couple had had 4 consecutive spontaneous abortions. A
significant progressive reduction of sperm DFI was observed
3 and 6 months after finasteride discontinuation. The authors
