Male Infertility - Treatment Options

Treatment of male infertility

In recent years there has been a great increase in scientific and medical interest in male infertility and the range of treatment options currently available includes drug therapy, surgery and ART. The main approaches to the treatment of male infertility are summarized in the table below and are also described in detail.

Table 2: Main approaches to the treatment of male infertility

Diagnosis Treatments
Anatomic Immune Endocrine Other (Idiopathic)
  • Surgery
  • ICSI
  • Steriods
  • ICSI
  • Drug Theraphy with
  • Ganadotropin preparations:
    (FSH + LH) + hyCS
  • ICSI
  •  

    Drug therapy

    Drug therapy

    Fewer than 5% of infertile men have a hormonal disorder that can be treated with hormone therapy. Hormonal imbalances caused by a dysfunction in the mechanism of interaction between the hypothalamus, the pituitary gland and the testes directly affect the development of sperm. In this type of fertility disorder, FSH therapy is highly successful.

    Gonadotropins & clomiphene citrate are sometimes chosen to treat unexplained male infertility, as seen in the cases of oligozoospermia (when sperm count is abnormally low) or asthenospermia (when less than 40% of the sperm are motile). But today RCOG in 2005 recommends GT treatment only for male hypogonadotrophic hypogonadism . However it has been seen that drug treatments are ineffective in treatment of idiopathic male Infertility . Other types of drug treatment include antibiotics to treat infertility resulting from infections and treatment with bromocriptine when impaired sperm production is due to hyperprolactinaemia (increased levels of prolactin hormone in the blood). Most of the medical treatments offered for male infertility are empirical & therefore improvement is not guaranteed. Specific therapy is only for hypothalamic or pituitary failure where gonadotropins work, bromocryptine for hyperprolactinaemia, antibiotics for infection

    Surgical therapy

    Surgical therapy in male infertility aims at overcoming anatomical barriers impeding sperm production and maturation (in the testes and the epididymis) or ejaculation. Several techniques have been developed, whereby spermatozoa are retrieved either from the epididymis (percutaneous epididymal sperm aspiration, PESA, or microsurgical epididymal sperm aspiration, MESA) or from the testes (testicular sperm aspiration, TESA or testicular sperm extraction, TESE). These techniques are mainly used in conjunction with ICSI. Varicocele surgery in grade III varicocele has a success rate of only 25 – 30 %. It is of no use in patients with mild to moderate varicocele.

    Laparoscopic varicicele ligation


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