Conventional treatment for male infertility

GONADOTROPHINS

Hypogonadotrophic hypogonadism responds to gonado-trophin treatment although this has yet to be evaluated in the context of RCTs. Data from uncontrolled observational studies report that administration of FSH and hCG is well tolerated and effective in achieving an acceptable sperm count in 80% of men. Pulsatile GnRH may be as effective as hCG and hMG in improving sperm production in these situations.

SURGICAL TREATMENT

Data on success rates after surgical procedures for post-infective block, including epididymovasotomy, are limited. Observational studies have described a post-surgical patency rate of 52% and a pregnancy rate of 38%. A systematic review based on seven RCTs found no evidence that surgical repair of varicoceles improved pregnancy rates in couples with male or unexplained infertility (RR 1.01 95% CI 0.73-1.40) (Evers, 2002).

EJACULATORY FAILURE

Sildenafil is an effective treatment in men with erectile dysfunction (Burls et al. 2001). Medical treatment of an ejaculation has included the use of alpha-agonists like imipramine and pseudoephedrine or parasympath-omimetic drugs such as neostigmine. The former are less successful than the latter (19 versus 51%) (Kamischke and Nieschlag, 1999). Medical treatment of retrograde ejaculation has relied on measures to increase sympathetic stimulation of the bladder and decrease parasympathetic stimulation, but no clear difference in effectiveness has been found between alpha-agonists and anticholinergic drugs in this context. Sperm recovery from urine has been used successfully in some cases of retrograde ejaculation. Electro ejaculation may be considered in others, especially in men with neurological impairment. In the absence of other options, surgical sperm retrieval followed by IVF/ICSI may be considered.

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