Nonsurgical Treatment of Male Infertility: Non-Specific Therapy

Year 2022, , 26 - 29, 30.10.2022

Emre Tokuç , Metin Öztürk

https://doi.org/10.18678/dtfd.1182340

Abstract

In male infertility, all possible known causes should be carefully evaluated and if detected, targeted treatment options for the cause should be implemented. The known causes of male infertility such as hypogonadotropic hypogonadism, hyperprolactinemia, genital tract infections, disorders of ejaculation, thyroid hormone disorders and varicocele can be treated efficiently by targeted therapies or surgical corrections. Unfortunately, these known causes cover about 20% of male infertility and the rest remains idiopathic. On the other hand, management of idiopathic, unexplained male infertility, in which no etiological factors can be found, is a challenge for both the clinician and couples seeking solutions. In the era of assisted reproductive technology, few medical options in this regard are still available with limited benefits and low scientific foundation based on theoretical concepts but empirical medical therapy continues as a mostly off-label option for obtaining a natural pregnancy. Comprehending the hypothalamic-pituitary-gonadal axis and the regulation of hormones is crucial in this regard. Empirical therapies have the potential to overcome overtreatment with assisted reproductive technology yet clinicians and couples must be aware of the limitations of empirical therapies and should be counseled in this direction. In this review, non-specific medical treatment options for idiopathic male infertility were covered.

Keywords

Male infertility, medical treatment, empiric therapy

Erkek İnfertilitesinin Cerrahi Dışı Tedavisi: Spesifik Olmayan Tedavi

Abstract

Erkek infertilitesinde bilinen tüm olası nedenler dikkatlice değerlendirilmeli ve tespit edilirse o neden için hedefe yönelik tedavi seçenekleri uygulanmalıdır. Erkek infertilitesinin hipogonadotropik hipogonadizm, hiperprolaktinemi, genital sistem enfeksiyonları, boşalma bozuklukları, tiroid hormon bozuklukları ve varikosel gibi bilinen nedenleri, hedefe yönelik tedaviler veya cerrahi düzeltmeler ile etkili bir şekilde tedavi edilebilir. Ne yazık ki, bu bilinen nedenler erkek infertilitesinin yaklaşık %20'sini kapsamaktadır ve geri kalanı idiyopatik olarak kalmaktadır. Öte yandan, etiyolojik faktörlerin bulunamadığı, idiyopatik, açıklanamayan erkek infertilitesinin yönetimi hem klinisyen hem de çözüm arayan çiftler için zorlu bir süreçtir. Yardımcı üreme teknolojisi çağında, teorik kavramlara dayanan sınırlı yararları ve düşük bilimsel temeli olan bu konuda hala birkaç tıbbi seçenek mevcuttur, ancak spesifik olmayan tıbbi tedavi, doğal bir hamilelik elde etmek için çoğunlukla endikasyon dışı bir seçenek olarak devam etmektedir. Hipotalamus-hipofiz-gonad aksını kavramak ve hormonların düzenlenmesi bu konuda çok önemlidir. Ampirik tedaviler, yardımcı üreme teknikleriyle yapılacak olan aşırı tedavisinin üstesinden gelme potansiyeline sahiptir, ancak klinisyenler ve çiftler, ampirik terapilerin sınırlamalarının farkında olmalı ve bu yönde danışmanlık almalıdır. Bu derlemede, idiyopatik erkek infertilitesi için spesifik olmayan tıbbi tedavi seçenekleri ele alınmıştır.

Keywords

Erkek infertilitesi, medikal tedavi, ampirik tedavi

References

• Irvine DS. Epidemiology and aetiology of male infertility. Hum Reprod. 1998;13(Suppl 1):33-44.
• Tournaye H, Krausz C, Oates RD. Novel concepts in the aetiology of male reproductive impairment. Lancet Diabetes Endocrinol. 2017;5(7):544-53.
• Rastrelli G, Lotti F, Reisman Y, Sforza A, Maggi M, Corona G. Metabolically healthy and unhealthy obesity in erectile dysfunction and male infertility. Expert Rev Endocrinol Metab. 2019;14(5):321-34.
• Håkonsen LB, Thulstrup AM, Aggerholm AS, Olsen J, Bonde JP, Andersen CY, et al. Does weight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men. Reprod Health. 2011;8:24.
• Lee Y, Dang JT, Switzer N, Yu J, Tian C, Birch DW, et al. Impact of bariatric surgery on male sex hormones and sperm quality: a systematic review and meta-analysis. Obes Surg. 2019;29(1):334-46.
• Ibañez-Perez J, Santos-Zorrozua B, Lopez-Lopez E, Matorras R, Garcia-Orad A. An update on the implication of physical activity on semen quality: a systematic review and meta-analysis. Arch Gynecol Obstet. 2019;299(4):901-21.
• Sharma R, Harlev A, Agarwal A, Esteves SC. Cigarette smoking and semen quality: a new meta-analysis examining the effect of the 2010 world health organization laboratory methods for the examination of human semen. Eur Urol. 2016;70(4):635-45.
• Ricci E, Al Beitawi S, Cipriani S, Candiani M, Chiaffarino F, Viganò P, et al. Semen quality and alcohol intake: a systematic review and meta-analysis. Reprod Biomed Online. 2017;34(1):38-47.
• Dabaja AA, Schlegel PN. Medical treatment of male infertility. Transl Androl Urol. 2014;3(1):9-16.
• Badenoch DF, Waxman J, Boorman L, Sidhu B, Moore HD, Holt WV, et al. Administration of a gonadotropin releasing hormone analogue in oligozoospermic infertile males. Acta Endocrinol (Copenh). 1988;117(2):265-7.
• Crottaz B, Senn A, Reymond MJ, Rey F, Germond M, Gomez F. Follicle-stimulating hormone bioactivity in idiopathic normogonadotropic oligoasthenozoospermia: double-blind trial with gonadotropin-releasing hormone. Fertil Steril. 1992;57(5):1034-43.
• Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, et al. European association of urology guidelines on male sexual and reproductive health: 2021 update on male infertility. Eur Urol. 2021;80(5):603-20.
• Knuth UA, Honigl W, Bals-Pratsch M, Schleicher G, Nieschlag E. Treatment of severe oligospermia with human chorionic gonadotropin/human menopausal gonadotropin: a placebo-controlled, double blind trial. J Clin Endocrinol Metab. 1987;65(6):1081-7.
• Siddiq FM, Sigman M. A new look at the medical management of infertility. Urol Clin North Am. 2002;29(4):949-63.
• Matorras R, Pérez C, Corcóstegui B, Pijoan JI, Ramón O, Delgado P, et al. Treatment of the male with follicle-stimulating hormone in intrauterine insemination with husband's spermatozoa: a randomized study. Hum Reprod. 1997;12(1):24-8.
• Kumar R, Gautam G, Gupta NP. Drug therapy for idiopathic male infertility: rationale versus evidence. J Urol. 2006;176(4 Pt 1):1307-12.
• Attia AM, Abou-Setta AM, Al-Inany HG. Gonadotrophins for idiopathic male factor subfertility. Cochrane Database Syst Rev. 2013;8:CD005071.
• Jung JH, Seo JT. Empirical medical therapy in idiopathic male infertility: Promise or panacea? Clin Exp Reprod Med. 2014;41(3):108-14.
• Gordetsky J, van Wijngaarden E, O'Brien J. Redefining abnormal follicle-stimulating hormone in the male infertility population. BJU Int. 2012;110(4):568-72.
• Clark RV, Sherins RJ. Treatment of men with idiopathic oligozoospermic infertility using the aromatase inhibitor, testolactone. Results of a double-blinded, randomized, placebo-controlled trial with crossover. J Androl. 1989;10(3):240-7.
• 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(2):809-11.
• Raman JD, Schlegel PN. Aromatase inhibitors for male infertility. J Urol. 2002;167(2 Pt 1):624-9.
• Del Giudice F, Busetto GM, De Berardinis E, Sperduti I, Ferro M, Maggi M, et al. A systematic review and meta-analysis of clinical trials implementing aromatase inhibitors to treat male infertility. Asian J Androl. 2020;22(4):360-7.
• Cannarella R, Condorelli RA, Mongioi LM, Barbagallo F, Calogero AE, La Vignera S. Effects of the selective estrogen receptor modulators for the treatment of male infertility: a systematic review and meta-analysis. Expert Opin Pharmacother. 2019;20(12):1517-25.
• World Health Organization. A double-blind trial of clomiphene citrate for the treatment of idiopathic male infertility. Int J Androl. 1992;15(4):299-307.
• Cocuzza M, Agarwal A. Nonsurgical treatment of male infertility: specific and empiric therapy. Biologics. 2007;1(3):259-69.
• Kamischke A, Nieschlag E. Analysis of medical treatment of male infertility. Hum Reprod. 1999;14(Suppl 1):1-23.
• 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(5):749-57.
• Ross C, Morriss A, Khairy M, Khalaf Y, Braude P, Coomarasamy A, et al. A systematic review of the effect of oral antioxidants on male infertility. Reprod Biomed Online. 2010;20(6):711-23.
• Steiner AZ, Hansen KR, Barnhart KT, Cedars MI, Legro RS, Diamond MP, et al. The effect of antioxidants on male factor infertility: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial. Fertil Steril. 2020;113(3):552-60.e3.
• Smits RM, Mackenzie-Proctor R, Yazdani A, Stankiewicz MT, Jordan V, Showell MG. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2019;3(3):CD007411.