Men's Health - Male Infertility
MEDICAL TREATMENT
| MEDICAL TREATMENT A- SPECIFIC THERAPY 1- Hypogonadotrophic Hypogonadism: · FSH + LH are required to initiate spermatogenesis. · LH can maintain spermatogenesis and secondary sex characters through testosterone production from the Leydig cells. · Testosterone replacement can maintain male secondary sex characters but will not maintain spermatogenesis. 2- Antisperm Antibodies: · Prednisone · Sperm washing & ejaculation in sperm antigen containing media to attach antibodies before they adhere to sperm surface. · GIFT (see later). · Condoms in cases of female immunologic infertility. 3- Genital Tract Infection: (appropriate antibiotics). 4- Retrograde ejaculation: · Sympathomimetics or Imipramine (inhibits reuptake of noradrenaline). · Ejaculation with a full bladder. · Sperm retrieval from the bladder through catheterisation followed by centrifugation, washing & intrauterine insemination. The urine should be alkalinized and diluted (by large fluid & alkali intake) prior to this procedure. · V-Y plasty of bladder neck. 5- Anejaculation: · Emission could be induced by vibratory stimulation, para-sympathomimetics, or electroejaculation using a rectal probe. · Microaspiration of sperm from the genital ducts + IVF B- EMPIRICAL THERAPY Used if no cause was identified and aims at hyperstimulation of existing spermatogenesis. 1-Antiestrogens · Clomiphene citrate: competitive inhibition of estrogen receptors at the hypothalamus leading to increased GnRH, FSH, LH & (T) due to decreased negative feed back inhibition by estrogens. · Tamoxifen: Similar to clomiphene with no intrinsic estrogenic activity. · Testolactone: Inhibits the aromatase enzyme thus decreasing the peripheral conversion of (T) to E2.) 2- Androgens Most androgens suppress gonadotrophins &- sperm production, however some newer products are claimed to assist spermatogenesis without inhibiting gonadotrophins e.g. mestrolone, methyl testosterone & luoxymestrolone. 3- Gonadotrophins · LH: To stimulate Leydig cells. · FSH: Very expensive, no confirmed benefit to justify empirical use. · GnRH: Is tried as a nasal spray or subcutaneous pump. 4- Others e.g. Kallikrein (enzyme releasing kinins from kininogen), arginine, bromocryptine, corticosteroids, vitamin C, thyroxin. |
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Copyrights Dr. Hussein Ghanem 1999 All Rights
Reserved
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جميع حقوق الطبع والنشر محفوظة للدكتور حسين
غانم لعام 1999
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Page written & discussion moderated by:
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Professor of Andrology, Cairo University
Formerly: Fellow in Male Reproductive Medicine and Surgery, Baylor College of Medicine, Houston, Texas, USA Formerly: Fellow in Male Sexual Function, Reproduction, and Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA |
| Telephone: +(202) 761 3334 |
| E-mail: ghanem@family-clinics.com |
| Address: 139 (A) Al-Tahrir Street, Dokki, Cairo, Egypt |