Skip to main content Accessibility help
×
Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-23T07:36:11.606Z Has data issue: false hasContentIssue false

Chapter 13 - Medical Management of Male Infertility

from Section 3 - Clinical Evaluation and Treatment of Male Infertility

Published online by Cambridge University Press:  06 December 2023

Douglas T. Carrell
Affiliation:
Utah Center for Reproductive Medicine
Alexander W. Pastuszak
Affiliation:
University of Utah
James M. Hotaling
Affiliation:
Utah Center for Reproductive Medicine
Get access

Summary

Male factors significantly contribute to the issues faced by couples who are experiencing difficulties with conception. Management of the infertile male is complicated and based on a multitude of factors. Each couple is unique and has diverse issues, necessitating unique interventional approaches. Management can range from the optimization of lifestyle factors to treatment with surgery and medications. Several options exist in the medical optimization of the infertile, or subfertile male including treatment with gonadotropins (HCg, FSH), selective estrogen receptor modulators (i.e., clomiphene citrate), aromatase inhibitors (i.e., arimidex, letrozole), and prolactin altering agents (i.e., dostinex, bromocriptine). The use of the agents, both alone and in combination, is detailed in the current chapter.

Type
Chapter
Information
Men's Reproductive and Sexual Health Throughout the Lifespan
An Integrated Approach to Fertility, Sexual Function, and Vitality
, pp. 106 - 112
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bhasin, S, de Kretser, DM, Baker, HW. Clinical review 64: pathophysiology and natural history of male infertility. J Clin Endocrinol Metab. 1994;79:15251529.Google Scholar
Kovac, JR, Pastuszak, AW, Lamb, DJ. The use of genomics, proteomics, and metabolomics in identifying biomarkers of male infertility. Fertil Steril. 2013;99:9981007.Google Scholar
Madhukar, D, Rajender, S. Hormonal treatment of male infertility: promises and pitfalls. J Androl. 2009;30:95112.Google Scholar
Kovac, JR, Flood, D, Mullen, JB, Fischer, MA. Diagnosis and treatment of azoospermia resulting from testicular sarcoidosis. J Androl. 2012;33:162166.Google Scholar
Kovac, JR, Golev, D, Khan, V, Fischer, MA. Case of the month # 168: seminal vesicle cysts with ipsilateral renal dysgenesis. Can Assoc Radiol J. 2011;62:223225.Google Scholar
Kovac, JR, Smith, RP, Lipshultz, LI. Relationship between advanced paternal age and male fertility highlights an impending paradigm shift in reproductive biology. Fertil Steril. 2013;100:5859.Google Scholar
Kovac, JR, Addai, J, Smith, RP, Coward, RM, Lamb, DJ, Lipshultz, LI. The effects of advanced paternal age on fertility. Asian J Androl. 2013;15:723728.Google Scholar
Hakky, TS, Coward, RM, Smith, RP, Kovac, JR, Lipshultz, LI. Vasovasostomy: a step-by-step surgical technique video. Fertil Steril. 2014;101:e14.CrossRefGoogle ScholarPubMed
Lehmann, KJ, Kovac, JR, Xu, J, Fischer, MA. Isodicentric Yq mosaicism presenting as infertility and maturation arrest without altered SRY and AZF regions. J Assist Reprod Genet. 2012;29:939942.CrossRefGoogle ScholarPubMed
Kovac, JR, Lipshultz, LI. Interaction between oviductal epithelial cells and spermatozoa underlies a systems biology approach to treating infertility. Fertil Steril. 2013;99:12071208.Google Scholar
Patel, DP, Chandrapal, JC, Hotaling, JM. Hormone-based treatments in subfertile males. Curr Urol Rep. 2016;17:56.Google Scholar
Hwang, K, Walters, RC, Lipshultz, LI. Contemporary concepts in the evaluation and management of male infertility. Nat Rev Urol. 2011;8:8694.CrossRefGoogle ScholarPubMed
McLachlan, RI. The endocrine control of spermatogenesis. Baillieres Best Pract Res Clin Endocrinol Metabol. 2000;14:345362.Google Scholar
Plant, TM, Marshall, GR. The functional significance of FSH in spermatogenesis and the control of its secretion in male primates. Endocr Rev. 2001;22:764786.CrossRefGoogle ScholarPubMed
Mehta, A, Nangia, AK, Dupree, JM, Smith, JF. Limitations and barriers in access to care for male factor infertility. Fertil Steril. 2016;105:11281137.CrossRefGoogle ScholarPubMed
Kovac, JR, Khanna, A, Lipshultz, LI. The effects of cigarette smoking on male fertility. Postgrad Med. 2015;127:338341.CrossRefGoogle ScholarPubMed
Ramlau-Hansen, CH, Thulstrup, AM, Aggerholm, AS, Jensen, MS, Toft, G, Bonde, JP. Is smoking a risk factor for decreased semen quality? A cross-sectional analysis. Hum Reprod. 2007;22:188196.CrossRefGoogle ScholarPubMed
Kunzle, R, Mueller, MD, Hanggi, W, Birkhauser, MH, Drescher, H, Bersinger, NA. Semen quality of male smokers and nonsmokers in infertile couples. Fertil Steril. 2003;79:287291.Google Scholar
Oyeyipo, IP, Raji, Y, Emikpe, BO, Bolarinwa, AF. Effects of nicotine on sperm characteristics and fertility profile in adult male rats: a possible role of cessation. J Reprod Infertil. 2011;12:201207.Google ScholarPubMed
Wong, WY, Thomas, CM, Merkus, HM, Zielhuis, GA, Doesburg, WH, Steegers-Theunissen, RP. Cigarette smoking and the risk of male factor subfertility: minor association between cotinine in seminal plasma and semen morphology. Fertil Steril. 2000;74:930935.Google Scholar
Karayiannis, D, Kontogianni, MD, Mendorou, C, Douka, L, Mastrominas, M, Yiannakouris, N. Association between adherence to the Mediterranean diet and semen quality parameters in male partners of couples attempting fertility. Hum Reprod. 2017;32:215222.Google Scholar
Gaskins, AJ, Colaci, DS, Mendiola, J, Swan, SH, Chavarro, JE. Dietary patterns and semen quality in young men. Hum Reprod. 2012;27:28992907.CrossRefGoogle ScholarPubMed
Chiu, YH, Afeiche, MC, Gaskins, AJ, et al. Sugar-sweetened beverage intake in relation to semen quality and reproductive hormone levels in young men. Hum Reprod. 2014;29:15751584.Google Scholar
Jensen, TK, Gottschau, M, Madsen, JO, et al. Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men. BMJ Open. 2014;4:e005462.Google Scholar
Jensen, TK, Swan, S, Jorgensen, N, et al. Alcohol and male reproductive health: a cross-sectional study of 8344 healthy men from Europe and the USA. Hum Reprod. 2014;29:18011809.Google Scholar
Magnusdottir, EV, Thorsteinsson, T, Thorsteinsdottir, S, Heimisdottir, M, Olafsdottir, K. Persistent organochlorines, sedentary occupation, obesity and human male subfertility. Hum Reprod. 2005;20:208215.Google Scholar
Stoy, J, Hjollund, NH, Mortensen, JT, Burr, H, Bonde, JP. Semen quality and sedentary work position. Int J Androl. 2004;27:511.Google Scholar
Gaskins, AJ, Mendiola, J, Afeiche, M, Jorgensen, N, Swan, SH, Chavarro, JE. Physical activity and television watching in relation to semen quality in young men. Br J Sports Med. 2015;49:265270.Google Scholar
Jozkow, P, Rossato, M. The impact of intense exercise on semen quality. Am J Mens Health. 2016;11:654662.Google Scholar
Gaskins, AJ, Afeiche, MC, Hauser, R, et al. Paternal physical and sedentary activities in relation to semen quality and reproductive outcomes among couples from a fertility center. Hum Reprod. 2014;29:25752582.Google Scholar
Wise, LA, Cramer, DW, Hornstein, MD, Ashby, RK, Missmer, SA. Physical activity and semen quality among men attending an infertility clinic. Fertil Steril. 2011;95:10251030.Google Scholar
Sapra, KJ, Eisenberg, ML, Kim, S, Chen, Z, Buck Louis, GM. Choice of underwear and male fecundity in a preconception cohort of couples. Andrology. 2016;4:500508.Google Scholar
Wdowiak, A, Wdowiak, L, Wiktor, H. Evaluation of the effect of using mobile phones on male fertility. Ann Agric Environ Med. 2007;14:169172.Google Scholar
Agarwal, A, Deepinder, F, Sharma, RK, Ranga, G, Li, J. Effect of cell phone usage on semen analysis in men attending infertility clinic: an observational study. Fertil Steril. 2008;89:124128.Google Scholar
Liu, K, Li, Y, Zhang, G, et al. Association between mobile phone use and semen quality: a systemic review and meta-analysis. Andrology. 2014;2:491501.Google Scholar
Adams, JA, Galloway, TS, Mondal, D, Esteves, SC, Mathews, F. Effect of mobile telephones on sperm quality: a systematic review and meta-analysis. Environ Int. 2014;70:106112.Google Scholar
Avendano, C, Mata, A, Sanchez Sarmiento, CA, Doncel, GF. Use of laptop computers connected to internet through wi-fi decreases human sperm motility and increases sperm DNA fragmentation. Fertil Steril. 2012;97:3945 e2.Google Scholar
Liu, PY, Handelsman, DJ. The present and future state of hormonal treatment for male infertility. Hum Reprod Update. 2003;9:923.Google Scholar
Naor, Z, Shacham, S, Harris, D, Seger, R, Reiss, N. Signal transduction of the gonadotropin releasing hormone (GnRH) receptor: cross-talk of calcium, protein kinase C (PKC), and arachidonic acid. Cell Mol Neurobiol. 1995;15:527544.Google Scholar
Kiesel, LA, Rody, A, Greb, RR, Szilagyi, A. Clinical use of GnRH analogues. Clin Endocrinol. 2002;56:677687.Google Scholar
Mortimer, CH, McNeilly, AS, Fisher, RA, Murray, MA, Besser, GM. Gonadotrophin-releasing hormone therapy in hypogonadal males with hypothalamic or pituitary dysfunction. Br Med J. 1974;4:617621.Google Scholar
Klingmuller, D, Schweikert, HU. Maintenance of spermatogenesis by intranasal administration of gonadotropin-releasing hormone in patients with hypothalamic hypogonadism. J Clin Endocrinol Metabol. 1985;61:868872.Google Scholar
Blumenfeld, Z, Makler, A, Frisch, L, Brandes, JM. Induction of spermatogenesis and fertility in hypogonadotropic azoospermic men by intravenous pulsatile gonadotropin-releasing hormone (GnRH). Gynecol Endocrinol. 1988;2:151164.Google Scholar
Ashkenazi, J, Bar-Hava, I, Farhi, J, et al. The role of purified follicle stimulating hormone therapy in the male partner before intracytoplasmic sperm injection. Fertil Steril. 1999;72:670673.Google Scholar
Foresta, C, Bettella, A, Merico, M, Garolla, A, Ferlin, A, Rossato, M. Use of recombinant human follicle-stimulating hormone in the treatment of male factor infertility. Fertil Steril. 2002;77:238244.Google Scholar
Foresta, C, Bettella, A, Garolla, A, Ambrosini, G, Ferlin, A. Treatment of male idiopathic infertility with recombinant human follicle-stimulating hormone: a prospective, controlled, randomized clinical study. Fertil Steril. 2005;84:654661.Google Scholar
Paradisi, R, Natali, F, Fabbri, R, Battaglia, C, Seracchioli, R, Venturoli, S. Evidence for a stimulatory role of high doses of recombinant human follicle-stimulating hormone in the treatment of male-factor infertility. Andrologia. 2014;46:10671072.Google Scholar
Santi, D, Granata, AR, Simoni, M. FSH treatment of male idiopathic infertility improves pregnancy rate: a meta-analysis. Endocr Connect. 2015;4:R46R58.Google Scholar
Tatem, AJ, Beilan, J, Kovac, JR, Lipshultz, LI. Management of anabolic steroid-induced infertility: novel strategies for fertility maintenance and recovery. World J Mens Health. 2020;38:141150.CrossRefGoogle ScholarPubMed
Schlegel, PN, Sigman, M, Collura, B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II. Fertil Steril. 2021;115:6269.Google Scholar
Schlegel, PN, Sigman, M, Collura, B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. Fertil Steril. 2021;115:5461.Google Scholar
Coviello, AD, Matsumoto, AM, Bremner, WJ, et al. Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. J Clin Endocrinol Metab. 2005;90:25952602.Google Scholar
Hsieh, TC, Pastuszak, AW, Hwang, K, Lipshultz, LI. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol. 2013;189:647650.CrossRefGoogle ScholarPubMed
Wenker, EP, Dupree, JM, Langille, GM, et al. The use of HCG-based combination therapy for recovery of spermatogenesis after testosterone use. J Sex Med. 2015;12:13341337.Google Scholar
Rambhatla, A, Mills, JN, Rajfer, J. The role of estrogen modulators in male hypogonadism and infertility. Rev Urol. 2016;18:6672.Google Scholar
Adamopoulos, DA, Nicopoulou, S, Kapolla, N, Karamertzanis, M, Andreou, E. The combination of testosterone undecanoate with tamoxifen citrate enhances the effects of each agent given independently on seminal parameters in men with idiopathic oligozoospermia. Fertil Steril. 1997;67:756762.Google Scholar
Kotoulas, IG, Cardamakis, E, Michopoulos, J, Mitropoulos, D, Dounis, A. Tamoxifen treatment in male infertility. I. Effect on spermatozoa. Fertil Steril. 1994;61:911914.CrossRefGoogle ScholarPubMed
AinMelk, Y, Belisle, S, Carmel, M, Jean-Pierre, T. Tamoxifen citrate therapy in male infertility. Fertil Steril. 1987;48:113117.Google Scholar
Vermeulen, A, Comhaire, F. Hormonal effects of an antiestrogen, tamoxifen, in normal and oligospermic men. Fertil Steril. 1978;29:320327.Google Scholar
Kadioglu, TC, Koksal, IT, Tunc, M, Nane, I, Tellaloglu, S. Treatment of idiopathic and postvaricocelectomy oligozoospermia with oral tamoxifen citrate. BJU Int. 1999;83:646648.Google Scholar
Buvat, J, Ardaens, K, Lemaire, A, Gauthier, A, Gasnault, JP, Buvat-Herbaut, M. Increased sperm count in 25 cases of idiopathic normogonadotropic oligospermia following treatment with tamoxifen. Fertil Steril. 1983;39:700703.Google Scholar
Patel, DP, Brant, WO, Myers, JB, et al. The safety and efficacy of clomiphene citrate in hypoandrogenic and subfertile men. Int J Impot Res. 2015;27:221224.Google Scholar
Wang, C, Chan, CW, Wong, KK, Yeung, KK. Comparison of the effectiveness of placebo, clomiphene citrate, mesterolone, pentoxifylline, and testosterone rebound therapy for the treatment of idiopathic oligospermia. Fertil Steril. 1983;40:358365.Google Scholar
Ghanem, H, Shaeer, O, El-Segini, A. Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial. Fertil Steril. 2010;93:22322235.CrossRefGoogle ScholarPubMed
Roth, LW, Ryan, AR, Meacham, RB. Clomiphene citrate in the management of male infertility. Semin Reprod Med. 2013;31:245250.Google Scholar
World Health Organization. A double-blind trial of clomiphene citrate for the treatment of idiopathic male infertility. World Health Organization. Int J Androl. 1992;15:299307.Google Scholar
Chua, ME, Escusa, KG, Luna, S, Tapia, LC, Dofitas, B, Morales, M. Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis. Andrology. 2013;1:749757.Google Scholar
Burnett-Bowie, SA, McKay, EA, Lee, H, Leder, BZ. Effects of aromatase inhibition on bone mineral density and bone turnover in older men with low testosterone levels. J Clin Endocrinol Metabol. 2009;94:47854792.Google Scholar
Raman, JD, Schlegel, PN. Aromatase inhibitors for male infertility. J Urol. 2002;167:624629.Google Scholar
Pavlovich, CP, King, P, Goldstein, M, Schlegel, PN. Evidence of a treatable endocrinopathy in infertile men. J Urol. 2001;165:837841.Google Scholar
Saylam, B, Efesoy, O, Cayan, S. The effect of aromatase inhibitor letrozole on body mass index, serum hormones, and sperm parameters in infertile men. Fertil Steril. 2011;95:809811.Google Scholar
Gregoriou, O, Bakas, P, Grigoriadis, C, Creatsa, M, Hassiakos, D, Creatsas, G. Changes in hormonal profile and seminal parameters with use of aromatase inhibitors in management of infertile men with low testosterone to estradiol ratios. Fertil Steril. 2012;98:4851.Google Scholar
Singh, P, Singh, M, Cugati, G, Singh, AK. Hyperprolactinemia: an often missed cause of male infertility. J Hum Reprod Sci. 2011;4:102103.Google Scholar
Fitzgerald, P, Dinan, TG. Prolactin and dopamine: what is the connection? A review article. J Psychopharmacol. 2008;22:1219.Google Scholar
Melmed, S, Casanueva, FF, Hoffman, AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metabol. 2011;96:273288.Google Scholar
Bayrak, A, Saadat, P, Mor, E, Chong, L, Paulson, RJ, Sokol, RZ. Pituitary imaging is indicated for the evaluation of hyperprolactinemia. Fertil Steril. 2005;84:181185.Google Scholar
Vilar, L, Vilar, CF, Lyra, R, Freitas, MDC. Pitfalls in the diagnostic evaluation of hyperprolactinemia. Neuroendocrinology. 2019;109:719.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×