Nonsurgical Treatment of Male Infertility: Non-Specific Therapy

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

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