UROLOGY - CASE REPORT Secondary infertility due to use of low-dose finasteride Ahmet S ¸ alvarci • Okan Istanbulluog ˘lu Received: 16 May 2012 / Accepted: 4 October 2012 / Published online: 16 October 2012 Ó Springer Science+Business Media Dordrecht 2012 Abstract Herein, we present an unusual case of secondary infertility after prolonged use of low-dose finasteride for androgenetic alopecia in a 40-year-old man. We detected sperm DNA damage in the patient. Despite such a long-term use, we observed that impairment in semen parameters and sperm DNA fragmentation index regressed after the drug was discontinued. Consequently, pregnancy occurred and resulted in live birth. Keywords Long-term low-dose finasteride use Á Infertility Á TUNEL assay Introduction Finasteride is a type II 5a-reductase inhibitor. In clinical practice, dermatologists frequently use 1 mg finasteride daily for the treatment of androgenic alopecia [1]. It has been reported that low-dose finasteride may cause spermatogenic failure [2, 3]. In this report, we describe an unusual case of reversible secondary infertility after prolonged use of low-dose finasteride. Although controlled studies have demon- strated that chronic treatment with finasteride for 48 weeks does not impair semen quality in young men, we found that semen quality was impaired with 101-month finasteride use [4]. Neither such a long- term use nor pregnancy after discontinuation of the drug has been reported. Case report A 40-year-old male patient with secondary infertility for six years was admitted to our clinic. He had a 30-year-old wife with regular menstrual cycle and without gynecologic pathology on examination. He underwent surgery for grade II left varicocele five years ago. Intracytoplasmic sperm injection (ICSI) was performed two years ago upon the request of the family, but it did not result in pregnancy. Sperm parameters before varicocele surgery were as follows: semen volume, 1.1 cc; sperm count, 3.9 9 10 6 /mL; motility, 7 %; and normal sperm morphology, 5 %. Semen analysis performed after varicocele surgery revealed a semen volume of 0.9 cc, sperm count of 4.5 9 10 6 /mL, motility of 10 %, and normal sperm morphology of 5 %. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone levels were in turn 5.7 IU/L, 4.9 IU/L, 11 ng/mL, and 492 ng/mL; all were within the normal limits. Total and free prostate-specific antigen (PSA) levels were also within the normal limits. Karyotype A. S ¸ alvarci (&) Á O. Istanbulluog ˘lu Department of Urology, Faculty of Medicine, Rumi University, Aksinne Mah, Esmetas ¸ Sok, No: 16, 42040 Meram, Konya, Turkey e-mail: drsalvarci@hotmail.com 123 Int Urol Nephrol (2013) 45:83–85 DOI 10.1007/s11255-012-0315-9