Male Infertility: Conventional Treatments

Male Infertility can be treated in several ways, and you should be aware that there may be side effects to some of them. Treatments vary from ineffective Vitamin supplements to the highly successful advanced ICSI (Intracytoplasmic Sperm Injection) treatment

Conventional treatment of male infertility in the past used a wide array of medicines to try to improve a low sperm count in the infertile man. These included :

These hormonal injections of gonadotropins are only useful in stimulating sperm production in azoospermic men ( zero sperm count) who have hypogonadotropic hypogonadism (men with low FSH and LH levels, because of hypothalamic or pituitary malfunction), but this is a very rare condition. In these men, treatment often takes many months to restore the sperm quality to fertile levels. Combination treatment is required, with HCG to stimulate testosterone production; and HMG to stimulate sperm production. Initially, the man takes HCG injections thrice a week for about 6 months. This normally causes the size of the testes to increase and the testosterone to reach normal levels. HMG injections are then added. These can be mixed with the HCG and are also given thrice a week. Once sperm production has been achieved, the HMG can be stopped; and HCG treatment continued alone. While sperm counts achieved are usually low (less than 10 million per ml), a successful pregnancy can be achieved in 50 % of correctly diagnosed patients.
Unfortunately, these expensive injections are often misused as “empiric” therapy in men with low sperm counts – with extremely disappointing results. Since the vast majority of infertile males have normal levels of these hormones, unfortunately, giving them additional injections does not help to boost their sperm production. The reason this is confusing for many men is that the very same injections are given to their wives to make them grow more eggs – so why can’t the injections be used to make them produce more sperm ? While this is a logical argument, which is why doctors will try out these injections, unfortunately they simply do not work, so using them is just a waste of time, money and energy.

Bromocryptine
As in the female, this is used to lower unusually elevated levels of prolactin. However , this is a very rare problem in infertile men; and most men with high levels of prolactin are also impotent.

Testosterone
This is given to suppress sperm production in the hope that when medication is stopped (usually after 5-6 months), then the sperm production will “rebound ” to higher levels than originally (testosterone rebound). This form of treatment is now seldom used as it may further impair fertility and is hazardous. Testosterone is also be used for the treatment of impotence or diminished libido when blood testosterone levels are low. Testosterone is available as an oily injection and is given intramuscularly, usually once a week. Oral preparations are also available now, but these are more expensive and may not be as effective.

Clomiphene
This is the most commonly prescribed medicine for infertile men – and the one which is most widely misused. Its use is largely empirical and very controversial as the results are not predictable. This is usually prescribed as a 25 mg tablet, to be taken once a day, for 25 days per month, for a course of 3 to 6 months. It acts by increasing the levels of FSH and LH, which stimulate the testes to produce testosterone and sperm. The group of men who seem to benefit the most from clomiphene have low sperm counts, with low or low-normal gonadotropin levels. However, while clomiphene may increase sperm counts in selected men, it hasn’t been proven effective in increasing pregnancy rates.
Antibiotics Just as in the female, antibiotics can resolve a chronic infection in the reproductive tract in the male. However, there is no evidence that treating pus cells in the semen helps to improve male fertility.
Many men will observe that their sperm count increases after taking these medicines, and they get very excited when this happens. However, do remember that sperm counts fluctuate all the time – and often the increase is inspite of the medicines, not because of it . In any case, a sperm count is not like a bank account that you should get excited when it increases ! The end-point is not an increase in the sperm count or motility – it’s a baby ! While some of these medicines may improve sperm counts in some men on some occasions, double blind clinical trials have shown they do not help to improve pregnancy rates. This criticism is also true for the currently fashionable Proxeed, which is being marketed very aggressively and cleverly in the USA.

It is worth emphasising how small the list for male infertility treatment is – especially as compared to female treatment. This simply reflects our ignorance about male infertility – we know very little about what causes it, and our knowledge about how to treat it is even more limited!

Abstracted from fertility magazine