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Male Infertility Medication

  • Author: Kassem Faraj; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Jun 07, 2016
 

Medication Summary

The goal of pharmacotherapy is to improve sperm count.

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Estrogen receptor blockers

Class Summary

These agents cause increased hypothalamic secretion of GnRH owing to blockage of estrogen inhibition.

Clomiphene (Clomid, Serophene)

 

Stimulates release of pituitary gonadotropins.

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Dopamine antagonists

Class Summary

These agents are ergot derivatives and dopamine receptor agonists. They act on postsynaptic dopamine receptors while causing no effect on other anterior pituitary functions. Mimic dopamine action of inhibition of prolactin release.

Bromocriptine (Parlodel)

 

Semisynthetic ergot alkaloid derivative with strong dopamine D2-receptor agonist and partial dopamine D1-receptor effects. Therapeutic range is usually 5-7.5 mg/d. Administer with meals to decrease nausea.

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Gonadotropins

Class Summary

These agents stimulate production of gonadal steroid hormones.

Menotropins (Pergonal, Repronex)

 

Stimulate spermatogenesis. Contain 75 IU of FSH and 75 IU of LH per vial.

Human chorionic gonadotropin (Novarel, Profasi, Pregnyl)

 

Polypeptide hormone produced by the human placenta. Composed of an alpha and beta subunit. Alpha is identical to LH and FSH. Effects are similar to that of LH (stimulates Leydig cells to produce testosterone). Has other uses and only use in testicular function is described here.

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Contributor Information and Disclosures
Author

Kassem Faraj Oakland University William Beaumont School of Medicine

Kassem Faraj is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, American Urological Association, Michigan State Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Chirag Dave, MD Resident Physician, Department of Surgery (Urology), William Beaumont Health System

Chirag Dave, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Physicians, American Urological Association

Disclosure: Nothing to disclose.

Richard C Bennett, MD Assistant Professor of Urology, Oakland University William Beaumont School of Medicine; Urologist, Comprehensive Urology

Richard C Bennett, MD is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Michigan State Medical Society, Sexual Medicine Society of North America

Disclosure: Nothing to disclose.

Paras Vakharia, PharmD Medical Student Researcher, Department of Dermatology, Henry Ford Hospital; Medical Student Researcher, Department of Ophthalmology and Department of Radiation Oncology, Oakland University William Beaumont School of Medicine

Paras Vakharia, PharmD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hematology, Michigan State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, SWOG

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Daniel B Rukstalis, MD Professor of Urology, Wake Forest Baptist Health System, Wake Forest University School of Medicine

Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science, American Urological Association

Disclosure: Nothing to disclose.

Jonathan Rubenstein, MD Urologist, Chesapeake Urology Associates

Jonathan Rubenstein, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Robert E Brannigan, MD Associate Professor, Department of Urology, Northwestern University, Feinberg School of Medicine

Robert E Brannigan, MD is a member of the following medical societies: American Society for Reproductive Medicine, American Society of Andrology, Society for the Study of Reproduction, Society for the Study of Male Reproduction, American Urological Association, Endocrine Society

Disclosure: Nothing to disclose.

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Male infertility. Hypothalamic-pituitary-gonadal axis stimulatory and inhibitory signals. Gonadotropin-releasing hormone (GnRH) from the hypothalamus stimulates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary. FSH stimulates the Sertoli cells to facilitate sperm production, while LH stimulates testosterone release from the Leydig cells. Feedback inhibition is from testosterone and inhibin.
Male infertility. Testicular histology magnified 500 times. Leydig cells reside in the interstitium. Spermatogonia and Sertoli cells lie on the basement membrane of the seminiferous tubules. Germ cells interdigitate with the Sertoli cells and undergo ordered maturation, migrating toward the lumen as they mature.
Male infertility. Normal male ductal anatomy.
Male infertility. Varicocele. A - Physical examination revealing the characteristic "bag of worms." B - Anatomy of the dilated pampiniform plexus of veins.
Male infertility. Technique of open vasography: The vas distal to the site of incision is determined to be patent if saline is injected without resistance. Alternatively, radiographic contrast dye is injected through the vas deferens and radiography is performed, or blue dye may be injected and visualized in the urine to confirm patency. A vasovasostomy or vasoepididymostomy may then be performed at this level.
Male infertility. Technique of microscopic varicocelectomy. The individual veins of the pampiniform plexus are isolated (top) and ligated, taking care to preserve the testicular artery (bottom) isolated using the intraoperative Doppler.
Male infertility. Technique of vasovasostomy: Upper left is confirmation of sperm from the proximal vas deferens, proving proximal patency. Upper right is the inner layer anastomosis using interrupted #10-0 Prolene. Lower left is the inner layer anastomosis completed. Lower right is the outer layer anastomosis using #9-0 Prolene completed.
Male infertility. Technique of vasoepididymostomy. Left upper is confirmation of mature sperm in epididymis. Right upper is the inner layer anastomosis of the end of the vas to the side of the epididymal tubule using interrupted #10-0 Prolene. Left lower is the inner layer completed. Right lower is the outer layer anastomosis using interrupted #9-0 Prolene completed.
Male infertility. Technique of intracytoplasmic sperm injection (ICSI). A micropipette is used to inject a single sperm directly into an egg.
Table. Abnormal Findings on Semen Analysis: Possible Follow-up Tests*
Analysis Finding Conclusion
Ejaculate volume Low (< 1.5 mL) Postejaculation urine (retrograde ejaculation)



TRUS (absence of vas deferens)



Hormonal evaluation (hypogonadism)



High (>5 mL) Likely contaminant
Semen quality Does not coagulate TRUS (ejaculatory duct obstruction)
Does not liquefy Hormonal analysis
Sperm density Oligospermia (< 20 million per mL)



Severe oligospermia (< 5 million per mL)



TRUS (partial ejaculatory duct obstruction)



Antisperm antibody evaluation



Hormonal analysis



Physical examination for varicocele



Azoospermia Sperm centrifuged to verify azoospermia



Postejaculation urine (retrograde ejaculation)



Hormonal evaluation



Testicular biopsy (testicular failure)



TRUS (ejaculatory duct obstruction)



Motility Decreased Antisperm antibodies



Physical examination for varicocele



*All semen analyses with abnormal results should be repeated.
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