Skip to main content
SpringerLink
Log in

Management Strategies for Male Factor Infertility

  • Therapy in Practice
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Although modern assisted reproduction techniques contribute a lot to overcoming severe male factor infertility, application of these methods in every infertile couple would represent an over-treatment. Therefore, conventional treatment modalities are still the first approach to male fertility disorders. Apart from assisted reproduction techniques, these include surgical procedures and the administration of drugs. Causal treatment regimens of proven effectiveness are only available for patients with infertility resulting from hypogonadotrophic hypogonadism. Drug treatment of retrograde ejaculation is also effective. Inconsistent results have been obtained with empirical treatment including antiestrogens, androgens, aromatase-inhibitors, mast cell blockers, zinc and pentoxifylline. Anti-inflammatory and immunosuppressive therapy as well as treatment with antioxidants in the presence of reactive oxygen species has not yet been demonstrated to be effective by controlled studies but represent at least a rational approach which should be investigated more thoroughly. High dosage administration of follicle stimulating hormone aimed particularly at improving disturbed sperm structures, and the combination of tamoxifen with androgens, may be promising developments. A careful diagnostic work-up is necessary before any andrological treatment is commenced so that adequate treatment options can be selected for individual patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Fig. 1

Similar content being viewed by others

References

  1. Guzick DS, Overstreet JW, Factor-Litvak P, et al. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med 2001 Nov; 345(19): 1388–93

    Article  PubMed  CAS  Google Scholar 

  2. Centola GM, Eberly S. Seasonal variations and age-related changes in human sperm count, motility, motion parameters, morphology, and white blood cell concentration. Fertil Steril 1999 Nov; 72(5): 803–8

    Article  PubMed  CAS  Google Scholar 

  3. Knuth UA, Honigl W, Bals-Pratsch M, et al. Treatment of severe oligospermia with human chorionic gonadotropin/human menopausal gonadotropin: a placebo-controlled, double blind trial. J Clin Endocrinol Metab 1987 Dec; 65(6): 1081–7

    Article  PubMed  CAS  Google Scholar 

  4. Jarow JP, Sharlip ID, Belker AM, et al. Best practice policies for male infertility. J Urol 2002 May; 167: 2138–44

    Article  PubMed  Google Scholar 

  5. Nieschlag E, Hertle L, Fischedick A, et al. Update on treatment of varicocele: counselling as effective as occlusion of the vena spermatica. Hum Reprod 1998 Aug; 13(8): 2147–50

    Article  PubMed  CAS  Google Scholar 

  6. Hargreave TB. Varicocele: overview and commentary on the results of the World Health Organisation varicocele trial. In: Waites G, Frick J, editors. Current advances in andrology. Bologna (Italy): Mundi Editore, 1997: 31–44

    Google Scholar 

  7. Gilbert BR, Witkin SS, Goldstein M. Correlation of sperm-bound immunoglobulins with impaired semen analysis in infertile men with varicoceles. Fertil Steril 1989; 52: 469–73

    PubMed  CAS  Google Scholar 

  8. Rowe PJ, Comhaire FH, Hargreave TB, et al. WHO manual for the standardized investigation, diagnosis and management of the infertile male. Cambridge (UK): Cambridge University Press, 2000

    Google Scholar 

  9. Shlansky-Goldberg RD, Van Arsdalen KN, Rutter CM, et al. Percutaneous varicocele embolization vs surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes. J Vasc Interv Radiol 1997 Sep–Oct; 8(5): 759–67

    Article  PubMed  CAS  Google Scholar 

  10. Schopohl J, Mehltretter G, von Zumbusch R, et al. Comparison of gonadotropin-releasing hormone and gonadotropin therapy in male patients with idiopathic hypothalamic hypogonadism. Fertil Steril 1991; 56: 1143–50

    PubMed  CAS  Google Scholar 

  11. Kliesch S, Behre HM, Nieschlag E. Recombinant human follicle-stimulating hormone for induction of spermatogenesis in a hypogonadotropic male. Fertil Steril 1995; 63: 1326–8

    PubMed  CAS  Google Scholar 

  12. Haidl G, Schill W-B. Guidelines for drug treatment of male infertility. Drugs 1991; 41(1): 60–8

    Article  PubMed  CAS  Google Scholar 

  13. Atkinson LE, Chang YL, Snyder PJ. Long-term experience with testosterone replacement through scrotal skin. In: Nieschlag E, Behre HM, editors. Testosterone: Action-deficiency-substitution. Barlin(Germany): Springer Verlag, 2000: 365–88

    Google Scholar 

  14. Gerris J, Comhaire F, Hellemans P, et al. Placebo-controlled trial of high-dose Mesterolone treatment of idiopathic male infertility. Fertil Steril 1991; 55: 603–7

    PubMed  CAS  Google Scholar 

  15. Weidner W, Krause W, Ludwig M. Relevance of male accessory gland infection for subsequent fertility with special focus on prostatitis. Hum Reprod Update 1999; 5: 421–32

    Article  PubMed  CAS  Google Scholar 

  16. Weidner W. Which efforts towards conservative treatment of male infertility will be successful?: antibiotic therapy [abstract]. Andrologia 1999 Sept; 31: 297

    Article  PubMed  CAS  Google Scholar 

  17. Reinhardt A, Haidl G, Schill W-B. Granulocyte elastase indicates silent male genital tract inflammation and appropriate anti-inflammatory treatment. Andrologia 1997 Mar–Apr; 29: 187–92

    Article  PubMed  CAS  Google Scholar 

  18. Haidl G. Macrophages in semen are indicative of chronic epididymal infection. Arch Androl 1990; 25: 5–11

    Article  PubMed  CAS  Google Scholar 

  19. Martin-Du Pan R, Bischof P, de Boccard G, et al. Is diclofenac helpful in the diagnosis of partial epididymal obstruction? Hum Reprod 1997; 12: 396–7

    Article  PubMed  CAS  Google Scholar 

  20. Montag M, van der Ven H, Haidl G. Recovery of ejaculated spermatozoa for intracytoplasmic sperm injection after anti-inflammatory treatment of an azoospermic patient with genital tract infection: a case report. Andrologia 1999 May; 31: 179–81

    Article  PubMed  CAS  Google Scholar 

  21. Lombardo F, Gandini L, Dondero F, et al. Antisperm immunity in natural and assisted reproduction. Hum Reprod Update 2001 Sep–Oct; 7(5): 450–6

    Article  PubMed  CAS  Google Scholar 

  22. Check ML, Check JH, Katsoff D, et al. ICSI as an effective therapy for male factor with antisperm antibodies. Arch Androl 2000 Nov–Dec; 45(3): 125–30

    Article  PubMed  CAS  Google Scholar 

  23. Bals-Pratsch M, Doeren M, Karbowski B, et al. Cyclic corticosteroid immunosuppression is unsuccessful in the treatment of sperm antibody-related male infertility: a controlled study. Hum Reprod 1992; 7: 99–104

    PubMed  CAS  Google Scholar 

  24. Shin D, Palermo GD, Goldstein M, et al. Indications for corticosteroids prior to epididymal sperm retrieval. Int J Fertil Womens Med 1998 May–Jun; 43(3): 165–70

    PubMed  CAS  Google Scholar 

  25. Ulcova-Gallova Z, Bouse V, Rokyta Z, et al. Effect of corticosteroids on sperm antibody concentration in different biological fluids and on pregnancy outcome in immunologic infertility. Zentralbl Gynakol 2000; 122(9): 495–9

    Article  PubMed  CAS  Google Scholar 

  26. Hofmann N, Kuwert E. Die chronische, nicht Erreger-bedingte Orchitis. Zeitschrift für Hautkrankheiten 1979; 54: 173–80

    PubMed  CAS  Google Scholar 

  27. Comhaire FH, Christophe AB, Zalata AA, et al. The effects of combined conventional treatment, oral antioxidants and essential fatty acids on sperm biology in subfertile men. Prostaglandins Leukot Essent Fatty Acids 2000 Sep; 63(3): 159–65

    Article  PubMed  CAS  Google Scholar 

  28. Lenzi A, Culasso F, Gandini L, et al. Placebo controlled, double-blind, cross-over trial of glutathione therapy in male infertility. Hum Reprod 1993; 8: 1657–62

    PubMed  CAS  Google Scholar 

  29. Bhat VB, Madyastha KM. Antioxidant and radical scavenging properties of 8-oxo derivatives of xanthine drugs pentoxifylline and lysofylline. Biochem Biophys Res Commun 2001 Nov; 288(5): 1212–7

    Article  PubMed  CAS  Google Scholar 

  30. Suleiman SA, Elamin Ali M, Zaki ZMS, et al. Lipid peroxidation and human sperm motility: protective role of vitamin E. J Androl 1996; 17: 530–7

    PubMed  CAS  Google Scholar 

  31. Geva E, Bartoov B, Zabludovsky N, et al. The effect of antioxidant treatment on human spermatozoa and fertilization rate in an in vitro fertilization program. Fertil Steril 1996; 66: 430–4

    PubMed  CAS  Google Scholar 

  32. Kessopoulou E, Powers HJ, Sharma KK, et al. A double-blind randomized placebo cross-over controlled trial using antioxidant vitamin E to treat reactive oxygen species associated with male infertility. Fertil Steril 1995; 64: 825–31

    PubMed  CAS  Google Scholar 

  33. Rolf C, Cooper TG, Yeung CH, et al. Antioxidant treatment of patients with asthenozoospermia or moderate oligoastheno-zoospermia with high-dose vitamin C and vitamin E: a randomized, placebo-controlled, double blind study. Hum Reprod 1999; 14: 1028–33

    Article  PubMed  CAS  Google Scholar 

  34. Köhn FM, Schill W-B. The alpha-sympathomimetic midodrin as a tool for diagnosis and treatment of sperm transport disturbances. Andrologia 1994; 26: 283–7

    Article  PubMed  Google Scholar 

  35. Ochsenkuhn R, Kamischke A, Nieschlag E. Imipramine for successful treatment of retrograde ejaculation caused by retroperitoneal surgery. Int J Androl 1999 Jun; 22(3): 173–7

    Article  PubMed  CAS  Google Scholar 

  36. Schill W-B. Pregnancy after brompheniramine treatment of a diabetic with incomplete emission failure. Arch Androl 1990; 25: 101–4

    Article  PubMed  CAS  Google Scholar 

  37. Schill W-B. Established and new approaches in medical treatment of male sterility. Fertilität 1996; 2: 7–17

    Google Scholar 

  38. Kamischke A, Nieschlag E. Analysis of medical treatment of male infertility. Hum Reprod 1999; 14: 1–23

    Article  PubMed  Google Scholar 

  39. Adamopoulos DA, Nicopoulou S, Kapolla N, et al. 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: 756–62

    Article  PubMed  CAS  Google Scholar 

  40. Adamopoulos DA. Present and future therapeutic strategies for idiopathic oligozoospermia. Int J Androl 2000 Dec; 23(6): 320–31

    Article  PubMed  CAS  Google Scholar 

  41. Klingmüller D, Haidl G. Inhibin B in men with normal and disturbed spermatogenesis. Hum Reprod 1997; 12: 2376–8

    Article  PubMed  Google Scholar 

  42. Pavlovich CP, King P, Goldstein M, et al. Evidence of a treatable endocrinopathy in infertile men. J Urol 2001 Mar; 165(3): 837–41

    Article  PubMed  CAS  Google Scholar 

  43. Raman JD, Schlegel PN. Aromatase inhibitors for male infertility. J Urol 2002 Feb; 167(2): 624–9

    Article  PubMed  CAS  Google Scholar 

  44. Ashkenazi J, Bar-Hava I, Farhi J, et al. The role of purified follocle stimulating hormone therapy in the male partner before intracytoplasmic sperm injection. Fertil Steril 1999; 72: 670–3

    Article  PubMed  CAS  Google Scholar 

  45. Ben-Rafael Z, Farhi J, Feldberg D, et al. Follicle-stimulating hormone treatment for men with idiopathic oligoterato-asthenozoospermia before in vitro fertilization: the impact on sperm microstructure and fertilization potential. Fertil Steril 2000 Jan; 73(1): 24–30

    Article  PubMed  CAS  Google Scholar 

  46. Foresta C, Bettella A, Mercio M, et al. Use of recombinant follicle-stimulating hormone in the treatment of male factor infertility. Fertil Steril 2002 Feb; 77(2): 238–44

    Article  PubMed  Google Scholar 

  47. Maseki Y, Miyake K, Mitsuya H, et al. Mastocytosis occurring in the testes from patients with idiopathic male infertility. Fertil Steril 1981; 36: 814–7

    PubMed  CAS  Google Scholar 

  48. Schill W-B, Schneider J, Ring J. The use of ketotifen, a mast cell blocker, for treatment of oligo- and asthenozoospermia. Andrologia 1986; 18: 570–3

    Article  PubMed  CAS  Google Scholar 

  49. Yamamoto M, Hibi H, Miyake K. New treatment of idiopathic severe oligozoospermia with mast cell blocker: results of a single-blind study. Fertil Steril 1995; 64: 1221–3

    PubMed  CAS  Google Scholar 

  50. Matsuki S, Sasagawa I, Suzuki Y, et al. The use of ebastine, a mast cell blocker, for treatment of oligozoospermia. Arch Androl 2000 Mar–Apr; 44(2): 129–32

    Article  PubMed  CAS  Google Scholar 

  51. Tournaye H, van Steirteghem AC, Devroey P. Pentoxifylline in idiopathic male-factor infertility: a review of ist therapeutic efficacy after oral administration. Hum Reprod 1994 Jun; 9(6): 996–1000

    PubMed  CAS  Google Scholar 

  52. Wong WY, Merkus HM, Thomas CM, et al. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Fertil Steril 2002 Mar; 77(3): 491–8

    Article  PubMed  Google Scholar 

  53. Kynaston HG, Lewis-Jones DI, Lynch RV, et al. Changes in seminal quality following oral zinc therapy. Andrologia 1988; 20: 21–2

    Article  PubMed  CAS  Google Scholar 

  54. Chvapil N. New aspects in the biological role of zinc: a stabilizer of macromolecules and biological membranes. Life Sci 1973; 13: 1041–9

    Article  PubMed  CAS  Google Scholar 

  55. Saitoh S, Kumamoto Y, Ohno K, et al. Studies of kallikrein-kinin system in human male sexual organs. Jpn J Fertil Steril 1985; 30: 276–92

    CAS  Google Scholar 

  56. Keck C, Behre HM, Jockenhövel F, et al. Ineffectiveness of kallikrein in treatment of idiopathic male infertility: a double-blind, randomized placebo-controlled study. Hum Reprod 1994; 9: 325–9

    PubMed  CAS  Google Scholar 

  57. Schill W-B, Blöcher S, Monsees TK. Are there new aspects in the pharmacotherapy with kallikrein?. Andrologia. In press

  58. Yamamoto M, Hibi H, Mijake K. Comparison of the effectiveness of placebo and alpha-blocker therapy for treatment of idiopathic oligozoospermia. Fertil Steril 1995; 63: 396–400

    PubMed  CAS  Google Scholar 

  59. Menken J, Trusseel J, Larsen U. Age and infertility. Science 1986; 233: 1389–94

    Article  PubMed  CAS  Google Scholar 

  60. Prietl G, Haidl G, Krebs D. Homologous intrauterine insemination for the treatment of infertility: a literature survey of prospective, randomized studies for male-factor subfertility (German). Reproduktionsmedizin 2000 Dec; 16(6): 376–83

    Article  Google Scholar 

  61. Dickey RP, Pyrzak R, Lu PY, et al. Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organization threshold values for normal sperm. Fertil Steril 1999 April; 71(4): 684–9

    Article  PubMed  CAS  Google Scholar 

  62. Rhemrev JPT, Lens JW, McDonnell J, et al. The postwash total progressively motile sperm cell count is a reliable predictor of total fertilization failure during in vitro fertilization treatment. Fertil Steril 2001 Nov; 76(5): 884–91

    Article  PubMed  CAS  Google Scholar 

  63. American Society for Reproductive Medicine. Patient’s fact sheet. Intracytoplasmic sperm injection (ICSI). Birmingham (AL), 2001 Aug

    Google Scholar 

  64. Ron-El R, Raziel A, Strassburger M, et al. Outcome of assisted reproductive technology in women over the age of 41. Fertil Steril 2000 Sep; 74(3): 471–5

    Article  PubMed  CAS  Google Scholar 

  65. Comhaire F. Clinical andrology: from evidence-base to ethics. The “E” quintet in clinical andrology. Hum Reprod 2000 Oct; 15(10): 2067–71

    CAS  Google Scholar 

  66. World Health Organization. Towards more objectivity in diagnosis and treatment of male infertility. Int J Androl 1987; 10 Suppl. 7: 4–5

    Google Scholar 

Download references

Acknowledgements

This article is dedicated to Prof. Dr Carl Schirren on the occasion of his 80th birthday.

Author information

Authors and Affiliations

  1. Department of Dermatology/Andrology Unit, University of Bonn, Sig.-Freud-Str. 25, Bonn, 53105, Germany

    Gerhard Haidl

Authors
  1. Gerhard Haidl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerhard Haidl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haidl, G. Management Strategies for Male Factor Infertility. Drugs 62, 1741–1753 (2002). https://doi.org/10.2165/00003495-200262120-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-200262120-00004

Keywords

Search

Navigation