Treatments for male infertility
- Bradley D Anawalt, MD
Bradley D Anawalt, MD
- Chief of Medicine, University of Washington Medical Center
- Professor and Vice Chair of Medicine
- University of Washington
- Stephanie T Page, MD, PhD
Stephanie T Page, MD, PhD
- Professor of Medicine
- University of Washington School of Medicine
- Section Editors
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Alvin M Matsumoto, MD
Alvin M Matsumoto, MD
- Section Editor — Male Reproductive Endocrinology
- Professor of Medicine
- University of Washington School of Medicine
In the United States, infertility in a couple is defined as the inability to achieve conception despite one year of frequent, unprotected intercourse (figure 1) . This topic provides an overview of the treatments of male infertility. The causes and approach to evaluation of male infertility are reviewed separately. (See "Approach to the male with infertility" and "Causes of male infertility".)
In studies of untreated couples pursuing pregnancy, 50 percent conceived within three months, 70 percent within six months, and 85 percent within 12 months (figure 1) . Up to 50 percent of young, healthy couples who fail to conceive in the first 12 months will conceive in the next 12 months . Therefore, it might be appropriate to delay invasive reproductive techniques in couples where the female partner has normal menstrual cycles, the male partner has normal semen analyses, and neither partner has an identifiable cause of infertility.
Categories of male infertility — The causes of male infertility can be divided into four main areas (table 1):
●Endocrine and systemic disorders (usually related to secondary [hypogonadotropic] hypogonadism) – 2 to 5 percent.
●Primary testicular defects in spermatogenesis – 65 to 80 percent, of which the majority have idiopathic dysspermatogenesis, an isolated defect in spermatogenesis without an identifiable cause.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Categories of male infertility
- General principles
- - Concurrent male and female infertility
- - Documentation of treatment efficacy
- - Is the patient hypogonadal?
- - Eugonadal, infertile men
- - Use of assisted reproductive technologies
- APPROACH BASED UPON DIAGNOSIS
- Endocrine and systemic disorders
- - Secondary (hypogonadotropic) hypogonadism: Induction of spermatogenesis
- - Hyperprolactinemia
- Primary testicular defects in sperm production
- - Low serum T, elevated FSH and LH
- - Normal serum T and LH, high FSH
- - Normal serum T, normal LH and FSH
- - Treatment options based upon presence of sperm
- Sperm in the ejaculate
- Spermatids or mature spermatozoa seen only in testicular biopsies
- No sperm seen in testicular biopsies
- - Unproven therapies
- Surgical repair of varicocele
- Treatment of leukospermia
- Medical therapies to increase circulating gonadotropin concentrations
- Lifestyle changes
- Sperm transport disorders
- - Sexual disorders
- - Retrograde ejaculation
- - Obstructive azoospermia
- Obstruction of epididymis or ejaculatory duct
- Congenital bilateral absence of the vasa deferentia
- ASSISTED REPRODUCTIVE TECHNOLOGIES
- Intrauterine insemination
- IVF with ICSI
- - Retrieval of sperm
- - Pregnancy outcome with ICSI
- - Genetic counseling and testing
- - ART with donor semen
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS