05 Oct Hormonal therapy for Male Infertility
Male infertility can be due to many causes. One of them is Hypogonadotropic Hypogonadism. It occurs as a result of disorders with the pituitary gland or hypothalamus, which cause lack of hormones that stimulate the testes. Replacement of these hormones, which include Luteinizing hormone (LH) (or human chorionic gonadotropin) and follicle-stimulating hormone (FSH) is very effective in the treatment of this particular type of male infertility.
Androgens are absolutely essential for spermatogenesis, but exogenous testosterone therapy has been found to be ineffective in benefiting men with low sperm count. This is because very high local levels of testosterone in the testes are required to mediate spermatogenesis, while exogenous testosterone therapy is given intravenously. In fact, exogenous androgen therapy can actually suppress gonadotropin secretion from the pituitary gland, resulting in male infertility.
Estrogen, at a lower concentration, is also essential for male fertility/spermatogenesis. And similarly to androgens, excessively high estrogen levels can impair male fertility by suppressing gonadotropin secretion which then decrease intratesticular androgen levels. In fact, clomiphene citrate (an antiestrogen) and aromatase inhibitors such as testolactone or anastrozole may be attempted to improve spermatogenesis. In some men with oligospermia, low-dose estrogen & testosterone combination therapy may improve sperm count and motility.
Clomiphene citrate acts centrally in the brain by stimulating the pituitary gland to produce natural FSH, which stimulates spermatogenesis. First, baseline semen analysis, FSH, LH, and male hormone measurements should be performed immediately prior to initiating therapy, and then to serially repeated throughout the treatment duration, with the final assessment approximately 100 days after initiating therapy. Some minor, reversible side effects include dryness of the mouth, headaches, slight changes in mood and, rarely, hot flashes. Gonadotropin Therapy
FSH, LH and HCG
If clomiphene treatment is unsuccessful, FSH alone (Follistim, Gonal F, Bravelle) or as combined FSH+LH (e.g. Menopur, Repronex) can be attempted with a goal to stimulate testicles directly. This therapy may be combined with hormone human chorionic gonadotropin (HCG), which mimics the effects of LH. Administration of these drugs is typically carried out 3 times per week, for a period of about 100 days. It is relatively harmless and with minimal side effects.
There is very little evidence that vitamins or amino acid preparations help with male fertility. In some cases, there may be systemic deficiencies affecting other areas of the body which indirectly limit pituitary gland’s function, an example of which is hypothyroidism. In cases where pituitary gland overproduces called prolactin (prolactinoma), the production and activity of FSH and LH are inhibited. In such cases, it may be necessary to administer bromocriptine or cabergoline to suppress prolactin production.
Testosterone should never be prescribed in an attempt to improve sperm function. More than 2-3 months of testosterone will almost always compromise sperm count, motility and even morphology.