Current Concepts: Treatment of Male Infertility

In approximately 30 percent of the cases, an important abnormality is identified in only the man, and in another 20 percent abnormalities are detected in both partners. [...]there is a male factor in infertility in half of the couples. Unfortunately, even after a thorough evaluation, the cause of a man's lack of normal fertility usually remains unknown. Since it is very difficult to develop a rational treatment plan to correct a poorly defined, complicated pathologic process, many of the therapeutic options outlined below are empirical and lack convincing documentation of efficacy, a fact that infertile couples find distressing, especially because their infertility often becomes the central issue in their lives. Skeptics argue that the studies showing a trend toward decreased fertility were not well controlled. [...]the report by Auger et al. in this issue of the Journal 6 warrants serious attention. Gonadotropin therapy is initiated with human chorionic gonadotropin (2000 IU intramuscularly three times a week) for six months, after which menotropins (Pergonal) are added (1 /2 vial [37.5 IU each of human chorionic gonadotropin and follicle-stimulating hormone] intramuscularly three times a week).14 Alternatively, pulsatile gonadotropin-releasing hormone (4 μm every three hours) can be given by means of a portable pump.15 Idiopathic Oligospermia and Asthenospermia For the majority of men with infertility, no specific causal factor can be identified, and the men are classified as having idiopathic oligospermia and asthenospermia.