Medical Treatment Of Male Infertility Research Articles

Optimal Diagnosis and Medical Treatment of Male Infertility

Optimal Diagnosis and Medical Treatment of Male Infertility

Optimal Diagnosis and Medical Treatment of Male Infertility

For most, conceiving a child is straightforward and does not involve special planning or intervention. Unfortunately, 15 to 20% of couples will experience undesired delays in conception[1] [2] and seek medical advice for ways to improve fertility. Male infertility is often a frustrating problem, because it is a multifactorial disorder for which an identifiable cause cannot be found in a significant percentage of cases.[3] Unfortunately, for those diagnosed with male-factor infertility, there is a paucity of tried and true treatments and even fewer level-1 evidence-based guidelines. This publication presents a multimodal approach to improve male fertility, by optimizing hormonal balance, minimizing DNA/genetic damage, and utilizing holistic options to minimize stress.

Introduction to J.C. Trussell, MD

Our guest editor for this issue of the Seminars in Reproductive Medicine is Dr. J. C. Trussell. Dr. Trussell is an associate professor in the Division of Urology at the Upstate State University of New York (SUNY) School of Medicine in Syracuse, NY. He was asked to put together an issue focusing on the medical treatment of male infertility including newer diagnostic strategies. He has responded to the call with an outstanding and eclectic group of articles from a well-balanced group of investigators in male fertility.

Sperm cyropreservation and oxidative damage. What does it mean?

Sperm cyropreservation and oxidative damage. What does it mean?

Empirical Medical Therapy for Idiopathic Male Infertility: A Survey of the American Urological Association

We determined empirical medical therapy practice patterns for idiopathic infertility. We performed a survey of 7,745 practicing American Urological Association members from July to November 2010. Respondents were questioned on empirical medical therapy use, patient evaluation and selection, and preferred medications. A total of 387 urologists (5%) participated in the survey, of whom 16% had infertility fellowship training, two-thirds used empirical medical therapy and 78% treated with empirical medical therapy and surgery. Laboratory values important for identifying ideal candidates include sperm concentration, serum follicle-stimulating hormone and serum testosterone. The most common medications used were clomiphene citrate, human chorionic gonadotropin and anastrozole. Of respondents 25% would treat infertile males with testosterone while the patient actively pursued pregnancy. Overall 60.5% of respondents would treat with empirical therapy for 3 to 6 months. Of fellowship trained and general urologist respondents 70% and 47%, respectively, counseled patients that empirical medical therapy has unknown effects on pregnancy and sperm count. Empirical medical therapy is used by two-thirds of survey respondents for idiopathic male infertility. There is no clear, universal pattern to the evaluation or identification of the ideal patient for such therapy among those surveyed. There is no consensus on the optimal medication and considerable ambiguity exists as to perceived effects on fertility. Of concern is that 25% of respondents use exogenous testosterone, a medication known for its contraceptive potential, for male infertility treatment. These findings confirm the need for additional studies to establish recommendations on the empirical use of medical therapy in the setting of male infertility.

Medical therapy for spermatogenic failure

Medical treatment of men with primary spermatogenic failure remains largely ineffective in contrast to those with secondary testicular failure. Treatment has been attempted with a multitude of agents ranging from hormones to nutritional supplements (antioxidants). While some studies have demonstrated benefit to some treatments, no treatments have consistently demonstrated efficacy nor has it been possible to reliably identify patients likely to benefit. Idiopathic spermatogenic failure likely results from multiple discrete defects in sperm production that are as yet unidentified. A better understanding of these defects will yield more effective treatment options and appropriate triage of patients to specific therapeutic regimens. This review focuses on the rationale and current evidence for hormonal and antioxidant therapy in medical treatment of male infertility, spermatogenic failure in particular. Although empiric medical therapy for spermatogenic failure has been largely replaced by assisted reproductive techniques, both treatment modalities could play a role, perhaps as combination therapy.

Medical treatment of male infertility

Although male factors contribute to approximately half of all cases of infertility, no specific cause can be found to explain the majority of abnormalities found in semen parameters. Specific and effective medical treatment is restricted to rare endocrine disorders. As a consequence, various empirical medical treatments are often used to treat idiopathic male infertility, with limited success. This review focuses on the rationale and current evidence on the efficacy of medical treatment of male infertility. Unless new studies provide high quality evidence in favour of medical treatment, assisted reproductive technologies will remain the mainstay of treatment of male infertility.

Oxidative stress and medical antioxidant treatment in male infertility

Oxidative stress (OS) has been recognized as one of the most important cause of male infertility. Despite the antioxidant activity of seminal plasma, epididymis and spermatozoa, OS damages sperm function and DNA integrity. Since antioxidants suppress the action of reactive oxygen species, these compounds have been used in the medical treatment of male infertility or have been added to the culture medium during sperm separation techniques. Nevertheless, the efficacy of such a treatment has been reported to be very limited. This may relate to: (i) patient selection bias; (ii) late diagnosis of male infertility; (iii) lack of double-blind, placebo-controlled clinical trial; and/or (iv) use of end-points that are not good markers of the presence of OS. This review considers the effects of the main antioxidant compounds used in clinical practice. Overall, the data published suggest that no single antioxidant is able to enhance fertilizing capability in infertile men, whereas a combination of them seems to provide a better approach. Taking into account the pros and the cons of antioxidant treatment of male infertility, the potential advantages that it offers cannot be ignored. Therefore, antioxidant therapy should remain in the forefront of preventive medicine, including human reproductive medicine.

I149 Medical treatment of male infertility

I149 Medical treatment of male infertility

Medical Treatment of Male Infertility

Medical Treatment of Male Infertility

Mechanisms of Male Infertility: Role of Antioxidants

Defective sperm function is the most common cause of infertility, and until recently, was difficult to evaluate and treat. Mammalian spermatozoa membranes are rich in poly unsaturated fatty acids and are sensitive to oxygen induced damage mediated by lipid peroxidation. Hence, free radicals and reactive oxygen species [ROS] are associated with oxidative stress and are likely to play a number of significant and diverse roles in reproduction. The excessive generation of reactive oxygen species by abnormal spermatozoa and by contaminating leukocytes [leukocytospermia] has been identified as one of the few defined etiologies for male infertility. Moreover, environmental factors, such as pesticides, exogenous estrogens, and heavy metals may negatively impact spermatogenesis since male sperm counts were declined. In addition, aging is also likely to further induce oxidative stress. Limited endogenous mechanisms exist to reverse these damages. In a normal situation, the seminal plasma contains antioxidant mechanisms which are likely to quench these ROS and protect against any likely damage to spermatozoa. However, during genitourinary infection/inflammation these antioxidant mechanisms may downplay and create a situation called oxidative stress. Assessment of such oxidative stress status [OSS] may help in the medical treatment of male infertility by suitable antioxidants. The cellular damage in the semen is a result of an improper balance between ROS generation and scavenging activities. Therefore, numerous antioxidants such as vitamin C, vitamin E, glutathione, and coenzyme Q10, have proven beneficial effects in treating male infertility. A multi-faceted therapeutic approach to improve male fertility involves identifying harmful environmental and occupational risk factors, while correcting underlying nutritional imbalances to encourage optimal sperm production and function.

Withered Yang: a review of traditional Chinese medical treatment of male infertility and erectile dysfunction.

Infertility is a private, social, and economic problem. Infertility is defined as the inability to conceive a pregnancy within 1 year. Twenty-five percent of couples will seek help for infertility at some point during their relationship (Page, 1989), accounting for over 2 million office visits to health care providers annually (The Endocrine Society, 1998). Male factor infertility is contributory in at least 50% of infertile couples (Collins, 1989). Currently, the therapy for male factor infertility focuses on microsurgery to correct varicoceles or obstruction of the male reproductive ductal system. Additionally, there has been a strong shift away from evaluating and treating the man and proceeding directly to expensive artificial reproductive technologies. Prior attempts at medical therapy for male factor infertility have included hormonal therapy (GnRH agonists and antagonists, gonadotropins, anti-estrogens, testosterone, and aromatase inhibitors), antioxidant therapy, antibiotics, corticosteroids, methylxanthines, vitamins, minerals and amino acids (zinc and arginine), and angiotensin-converting enzyme inhibitors. The observation that no medication is approved by the United States Food and Drug Administration for treatment of male infertility confirms the conclusion that adequate controlled studies of potential therapeutic agents are either lacking or failed to elicit a significant improvement in fertility. Male erectile dysfunction can be defined as the inability of a man to obtain penile rigidity sufficient to permit coitus of adequate duration to satisfy himself and his partner. The personal and private nature of this problem has hindered accurate estimates of the true prevalence in the

Analysis of medical treatment of male infertility.

Since the first injection of a single spermatozoon into the cytoplasm of an oocyte (intracytoplasmic sperm injection, ICSI), this method has become the most successful means of treating male infertility. Even for patients long considered untreatable, a chance of paternity has become reality. Using not only ejaculated but also testicular spermatozoa, pregnancies have been achieved in the partners of patients who had never had a chance previously, including even cases with Klinefelter syndrome. However, despite the tremendous success of ICSI, most couples would prefer to conceive offspring naturally. Therefore we review the effectiveness of current conventional treatments for male infertility and analyse the chances of infertile couples to conceive spontaneously.

Inhibition of angiotensin-converting enzyme — A new concept of medical treatment of male infertility?: Schill W.B.; Parsch E.M.; Miska W. DEU Fertil Steril 1994 61/6 (1123–1128)

International Journal of Gynecology & ObstetricsVolume 48, Issue 2 p. 250-250 Citations from the literature fertility and sterility Inhibition of angiotensin-converting enzyme — A new concept of medical treatment of male infertility? Schill W.B.; Parsch E.M.; Miska W. DEU Fertil Steril 1994 61/6 (1123–1128) First published: February 1995 https://doi.org/10.1016/0020-7292(95)90214-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume48, Issue2February 1995Pages 250-250 RelatedInformation

Inhibition of angiotensin-converting enzyme—a new concept of medical treatment of male infertility?

To evaluate the effectiveness of systemic captopril therapy. Randomized double-blind study. Andrology Unit at the Department of Dermatology, University of Munich, Munich, Germany. Infertile men suffering from oligozoospermia (5-20 x 10(6) spermatozoa/mL) and/or asthenozoospermia. Captopril was given orally; samples of seminal plasma were collected twice before treatment and 4 and 12 weeks after captopril administration. Semen parameters, pregnancy rate, ACE activity, and kinin levels. After 4 weeks of therapy, significant differences between verum group and placebo group were found concerning ACE activity and kinin levels. Sperm density improved significantly after 12 weeks of captopril therapy. All other semen parameters remained unchanged. The pregnancy rate was not improved. The suitability of captopril in the therapy of oligozoospermia and/or asthenozoospermia for improvement of male infertility seems to be limited.

Medical Treatment of Male Infertility

After an appropriate clinical and laboratory assessment of a patient's fertility status, the clinician must often decide whether specific and empiric treatment is indicated. Specific treatment may take the form of replacement therapy (exogenous gonadotropins or GnRH) for pituitary or hypothalamic failure, inhibition of prolactin secretion, antimicrobial therapy, or immunosuppressive therapy for demonstrable immunologic infertility. Finally, ejaculatory dysfunction often requires sympathomimetic agents. Alternatively, in the normogonadotropic oligospermic patient, the major form of empiric therapy relies on the enhancement of physiologic hormone levels that influence spermatogenesis. Such "stimulation" therapy may be achieved by GnRH analogues, antiestrogens, exogenous gonadotropins, or androgens.