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Male infertility: treatment
Last reviewed: 23.04.2024
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[Medical treatment of male infertility
Drug treatment of male infertility is mainly used for STIs, pathozoospermia (oligo, terato, astenozoospermia), endocrine infertility and sexual-ejaculatory disorders.
Varicocele, obstructive azoospermia and congenital malformations (cryptorchidism, epispadia, etc.), erectile dysfunction (impotence) of organic origin inguinal and inguinal and scrotal hernias are indications for surgical intervention in men with suspected infertility.
With unsuccessful conservative and operative treatment, the algorithm provides alternative methods of treating male infertility, which include artificial insemination with the husband's semen, artificial insemination with donor sperm and injection of the sperm into the egg. On average, out of 1,000 families, 3-4 married couples are forced to turn to alternative methods of treating male infertility, and the probability of having a baby is 20-35%. The choice of methods of assisted reproductive technologies is based on existing social and medical indications.
Complex treatment regimens for infectious and inflammatory diseases of the genitourinary system include etiological, pathogenetic, hormonal immunological, restorative treatment and psychotherapy.
Etiotropic treatment of male infertility
Etiotropic treatment of male infertility is aimed at the elimination of infection on the basis of ongoing bacteriological studies under the control of the sensitivity of the pathogen to drugs. For this purpose, antibiotics of a wide spectrum of action are prescribed. The scheme of treatment provides for the alternate use of several antibiotics for 2-4 weeks. The failure of this treatment is most often due to the presence of highly virulent multiresistant strains of microorganisms.
For the prevention of intestinal dysbiosis and candidiasis, drugs of choice for the period of antibiotic therapy are linex, bifidumbacterin, etc., fluconazole and / or nystatin.
Over the past 20 years, great importance is attached to the use of androgens in order to create higher concentrations of testosterone in the blood plasma and in testicular tissues. Usually, testosterone preparations (andriol, testacaps) are used, which improve the function of sexual glands and androgen receptors, without affecting the production of their own gonadotropins and testosterone. The effective therapeutic dose of andriol is 120-160 mg / day. A significant advantage of testosterone prepatates is the absence of hepatotoxic and other side effects, in contrast to androgens used parenterally, which allows them to be used for a long time (up to 9 months).
Drug treatment of male infertility is the use of funds related to gonadotropins - gonadotropin chorionic (pregnil) in a dose of 500 ME. These drugs are prescribed as monotherapy or in combination with other drugs, depending on the nature of the disease. Foliotropins are the most effective medicines in the treatment of spermatogenesis (metronidine HF and Puregon). They are prescribed to patients with the purpose of stimulation to improve quantitative and qualitative indices of spermatogenesis, as well as with normozoospermia to increase the frequency of pregnancy in married couples when using in vitro fertilization. Transfer of embryos and injection of sperm into the egg.
The anti-estrogens include clomiphene (50 mg) and tamoxifen (10 mg), the mechanism of their action is the ability to compete with estrogen receptors in the target organs, thereby preventing the penetration of estrogens into cells and enhancing the secretion of gonadotropins (prolactin, FSH and LH). Clomiphen in a dose of 25 mg / day is an effective drug in the treatment of oligozoospermia. Conducting treatment for 3-6 months can improve sperm rates by 20-35% and the frequency of pregnancy to 26%.
Treatment of hyperprolactinemia in men is aimed at restoring the normal concentration of prolactin in the blood plasma, allows improving their fertility and sexual function, and in the presence of prolactinoma, reduce the mass of the tumor.
Dopaminergic agonists include bromocriptine (2.5 mg). Treatment with bromocriptiom begins, usually with a low dose, increasing it every 3-4 days until the maximum dose of 7.5 mg / day is reached. One of his side effects is orthostatic hypotension. With the withdrawal of the drug, hyperprolactinemia suppression lasts from 3 to 6 months, which is why the drug is highly effective.
Essentiale forte 2 capsules 3 times a day is the drug of choice for idiopathic male infertility. The course of treatment is 6 months. The drug positively affects the mobility and morphology of spermatozoa, increases the volume of ejaculate and increases the number of living cells. The marked positive shifts in the ejaculate persist for 3-6 months after treatment.
Patospermia with varicocele is caused by ischemia, which is proved to be a positive effect when using hyperbaric oxygenation. After 5-10 sessions of psherbaric oxygenation, the sperm motility doubles, the number of normal forms of spermatozoa increases, and this level of fertility persists for 3-6 months.
Treatment of male infertility: assisted reproductive technologies
The use of assisted reproductive technologies makes it possible to achieve pregnancy in 20-25% of cases, and in a combination of several methods of assisted reproductive technologies (artificial insemination with sperm of the husband + extracorporeal fertilization with embryo transfer + intrapitoplasmic sperm injection) in 50-60%.
In oligo-, astheno- and teratozoospermia, various methods of capa- cation are used. To improve the fertility of sperm and prepare it for insemination and / or conservation. The frequency of pregnancy with the use of native sperm with insemination is higher compared with canned.
In obstructive azoospermia and other severe organic lesions of the male reproductive system, it is possible to use the spermatozoa (sperm aspiration from the testicle) and also spermatids of the late stage of differentiation in the program of intracytoplasmic injection of epidermal (aspiration of spermatozoa from the epididymis).
Indications for intracytoplasmic sperm injection:
- obstructive azoospermia;
- pathozoospermia with critical indicators of sperm quality;
- disturbance of spermatozoids;
- sexual and ejaculatory disorders;
- unsuccessful attempts of in vitro fertilization and transfer of embryos without micromanipulation.
It should be noted that using alternative treatment for male infertility, significant results have also been achieved in fundamental studies of human gametes and embryos. With the help of assisted reproductive technologies, virtually all known forms of male and female infertility can be effectively overcome.