Critical Commentary

Pentoxifylline is an oral supplement commonly used to improve blood flow in patients with circulation problems by decreasing the viscosity of blood. As a xan-thine derivative, pentoxifylline acts as a competitive nonselective phosphodiesterase inhibitor, thereby raising intracellular cAMP. It has also shown an anti-inflammatory effect in neutralizing ROS by controlling the release of superoxide anions [101, 102], This presumably reduces the amount of OS by downregulating the body's ability to initiate an inflammatory response.

Pentoxifylline's antioxidant nature has been studied for its role in improving sperm quality [101, 102] . It has been demonstrated to be effective in preserving sperm motility in vitro [103] and in improving semen parameters in vivo [105],

Table 22.7 Quality assessment of oral pentoxifylline supplementation


Study design





Main outcome

Prospective Case-control

Pentoxifylline (3.6 mM)A; Pentoxifylline

(300 mg/day); Pentoxifylline (1.200 mg/day)

1-h incubation + 24-h incubation 4-m intervention + 4-m intervention (follow-up every 4w)

t VCL A(p<0.05) t ALHA(p<0.05) t Motility A*®><0.05) f Mean curvilinear velocity A*-®V<0.05)

m month; w week; VCL curve linear velocity; ALU amplitude of lateral sperm head displacement A*Sperm preparations generated detected ROS levels at steady state

®* 18/3 5 with asthenospermia whose sperm preparations failed to generate detectable ROS levels at steady state

In a study by Okada et al., asthenozoospermic patients with detectable steady state levels of ROS were seen to have lowered ROS production levels and preserved sperm motion parameters following pentoxifylline treatment [104]. A low dosage (300 mg/day) treatment was found to be relatively ineffective in comparison to a higher dosage (1,200 mg/day), which increased sperm motility and motion parameters. However, no improvement in pregnancy rate was seen to result from either treatment regimen. Another report found that pentoxifylline increased the curvilinear velocity, path velocity, and straight-line velocity in both normozoospermic and asthenozoospermic specimens, but did not modify the percentage of motile spermatozoa [106].

These studies may suggest that pentoxifylline may serve to enhance sperm motil-ity, making it a potential therapeutic approach for treatment of idiopathic male infertility. Nevertheless, data remain inconclusive. Studies focusing on the pharmacokinetics of pentoxifylline are essential in understanding its mechanism of action. In addition, prospective, double-blind clinical trials with fecundity as the main outcome measure are necessary to validate the full effects of pentoxifylline.

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