In a nutshell
These guidelines reviewed current best practices in treating male infertility.
Some background
Male infertility affects half of all couples with infertility. Low sperm count or quality are the most common signs of male infertility. Medical organizations offer guidelines on how to treat male infertility.
Methods & findings
These guidelines used available studies on male infertility. When there was not enough research, they also used expert opinion.
There is not enough evidence that vitamins or antioxidants are beneficial for fertility.
One of the first infertility treatments is often intrauterine insemination (IUI). This procedure injects sperm directly into the uterus. IUI is useful when the sperm count is low but not extremely low (at least 5 million per mL). Assisted reproduction technology (ART) is an option when the sperm count is extremely low. The best-known form of ART is in vitro fertilization (IVF). IVF collects eggs and fertilizes them in the laboratory. Intracytoplasmic sperm injection (ICSI) is a related procedure. ICSI injects a single sperm into each collected egg.
Some men have a hormonal imbalance that reduces fertility. One example is hypogonadotropic hypogonadism (HH). This condition occurs when hormone glands in the brain do not communicate correctly with the testes. An endocrinologist can treat HH using hormones such as gonadotropins (Pregnyl). There are also hormonal treatments for men with low testosterone, including clomiphene citrate (Clomid). However, direct testosterone is not recommended, as it can reduce fertility. For men with normal testosterone, ART is a better option than hormonal treatment.
Varicoceles are enlarged veins of the scrotum, which can reduce fertility. Varicocele repair surgery is recommended for men with infertility and low sperm quality. Surgery may increase expected pregnancy rates from 17% to 35%. However, there is no evidence that repair surgery works for men who do not produce sperm.
There are options for men who produce no sperm (non-obstructive azoospermia). Micro-dissection testicular sperm extraction (micro-TESE) harvests sperm directly from the testes. Micro-TESE can be used with ICSI, which requires few sperm.
For some men, the path of sperm is blocked (obstructive azoospermia). Surgically reconstructing the ducts is one option, and allows conception through intercourse. Alternately, the sperm can be harvested from the testes. Trying to conceive following a vasectomy has similar options.
Fertility is a concern for survivors of cancer. Radiation and chemotherapy treatments can damage the cells which create sperm. However, by one year after treatment, the risk of birth defects is low. Most men resume having sperm 2 to 3 years after treatment. Ideally, couples should wait two years before performing a semen test.
The bottom line
These guidelines found that there are treatment options for most causes of male infertility. Treatments include ART, varicocele repair, and micro-TESE surgery.
What’s next?
These are general guidelines. Your doctor will choose a specific treatment based on your medical history.
Published By :
Fertility and Sterility
Date :
Dec 07, 2020
