The physiology of male reproduction: Impact of drugs and their abuse on male fertility

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madman

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Abstract

Male factor accounts for about 30–50% of infertility. A common cause of male infertility is drug abuse; either illicit or prolonged use of prescribed drugs. This study provides a review of the physiology of the hypothalamic-pituitary-gonadal axis and recent literature on drugs that have been linked to male infertility and the associated mechanisms. Relevant peer-reviewed papers were assessed online using PubMed/ PubMed Central, Scopus, AJOL, Google Scholar, and DOAJ databases using Medical Subjects Headings (MeSH) indexes and relevant keyword searches. Although drugs are beneficial when used at therapeutic levels, the abuse leads to impairment of hypothalamic-pituitary-gonadal functions, increased sperm DNA fragmentation and apoptosis, and reduced sperm quality. A good knowledge of the physiology of the hypothalamic-pituitary-gonadal axis and the influence of drugs on male fertility will guide healthcare providers in managing cases of infertility.







4 | CONCLUSIONS

Inappropriate drug use, particularly drug abuse, adversely affect male fertility. These drugs impair male fertility in different ways via various mechanisms. Documented studies have revealed that common effects include impairment of hypothalamic-pituitary-gonadal functions, increased sperm DNA fragmentation and apoptosis, and reduced sperm quality. This review provides a useful database for evaluating drug-induced male infertility (Table 1). Further studies on experimental animals should be conducted to assess the effects of some other medications on fertility. Human studies should also be carried out to confirm whether or not these effects are observed in humans.
 

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madman

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FIGURE 1 The hypothalamic–pituitary–testicular axis. Luteinizing hormone releasing hormone (LHRH) from the hypothalamus stimulates the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In males, LH stimulates testosterone production and FSH is important to sperm maturation. +, stimulatory effect; −, inhibitory effect.
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madman

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FIGURE 2 Biosynthesis of testosterone. StAR transport cholesterol to the inner mitochondrial membrane for desmolase action. This is the rate-limiting step in Steroidogenesis. Desmolase is located in the mitochondria, while other enzymes involved in androgen synthesis are located in the smooth endoplasmic reticulum. All enzymes involved in androgen synthesis are P450 enzymes except 3 β-HSD and 17 β-HSD. StAR, steroidogenic acute regulatory protein; HSD, hydroxysteroid dehydrogenase
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