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
  therapy
• 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
    count
  • 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

ICSI

Supplements

• 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
    sperm
• Cysteine
  • Anti-oxidant-protects against DNA
    damage

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