Treatments for Male Factor Infertility

Listed below are common causes for inadequate sperm delivery which can contribute to male factor infertility, before treatment is sought out:

  • Erectile dysfunction
  • Hypospadias
  • Premature ejaculation
  • Use of spermicidal lubricants
  • Retrograde ejaculation
    – Beta Blockers
    – Diabetes

Medical Treatments

  • Ejaculatory disorders
    – Sympathomimetic drugs
    – Electroejaculation (EEJ)
  • Erectile dysfunction
    – PDE-5 inhibitors (Viagra, Cialis, Levitra)
  • Retrograde ejaculation
    – Sperm rescue from urine (after urine is alkalized)
  • Antisperm antibodies
    – Immunosuppressive drugs: variable success

HP Testicular Axis

Clomiphene Citrate Therapy

  • Increasing gonadotropin levels might increase sperm production (if FSH and LH already increased, this won’t work)
  • Anti-estrogens decrease negative feedback to pit/hypo axis, increasing GnRH release and subsequent FSH/LH release
  • Clomiphene citrate 12.5 mg daily or 25 mg QOD
    • Also can use tamoxifen or aromatase inhibitors
  • Might increase T and E2 levels, but not necessarily improve pregnancy rates
  • Used in men with low/normal levels of T

Male Hypogonadotropic Hypogonadism

  • Congenital: Kallman syndrome; Prader-Willi
  • Acquired: pituitary tumor, steroid abuse, T replacement
  • Symptoms:
    • Azoospermia
    • Deficient virilization
    • Atrophic/hypotrophic testes
    • Low levels of FSH, LH and T

Therapy for Male HH

  • Injectable hCG
    • Can increase total T level,
      testicular volume and sperm
    • 1000 U SQ daily X 5 days
      (test dose)
    • 500-1000 U SQ 3x/week
  • hMG
    • 75 IU SQ 3x/week
  • Monitor T levels and sperm
    parameters. Continue until
    sperm appears

Please reference image above for clarification.

Other Treatments

  • Decrease % of sperm fragmentation
    • Treat infection
    • Antioxidants (Vit C, Vit E, Selenium)
      • Selenium- present in sperm in high amounts and might affect motility
    • Zinc supplementation-necessary for T production and might boost sperm quality
    • Stop smoking, healthy BMI, limit alcohol
    • Avoid hot tubs, jacuzzis
  • IVF with ICSI



  • L-carnitine and Acetyl-L-carnitine
    • Provides energy for sperm motility
    • Present in high levels in epididymis
    • Might increase sperm concentration and
      total sperm count but no significant
      benefit on pregnancy rates*
  • L-Arginine
    • A.A. which is building block in head of
  • Cysteine
    • Anti-oxidant-protects against DNA

(Costa, 1994; Campaniello, 1988; Loumbakis, 1995, Moncada, 1992)