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Male Infertility - Treatment
Last reviewed: 06.07.2025
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[ Drug treatment of male infertility
Drug treatment of male infertility is mainly used for STIs, pathozoospermia (oligo-, terato-, asthenozoospermia), endocrine infertility and sexual-ejaculatory disorders.
Varicocele, obstructive azoospermia and congenital malformations (cryptorchidism, epispadias, etc.), erectile dysfunction (impotence) of organic origin, inguinal and inguinoscrotal hernias are indications for surgical intervention in men with suspected infertility.
In case of unsuccessful conservative and surgical treatment, the algorithm provides for alternative methods of treating male infertility, which include artificial insemination with the husband's sperm, artificial insemination with donor sperm and injection of sperm into the egg. On average, out of 1000 families, 3-4 married couples are forced to seek help from alternative methods of treating male infertility, and the probability of having a child 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, general strengthening treatment and psychotherapy.
Etiotropic treatment of male infertility
Etiotropic treatment of male infertility is aimed at eliminating the infection based on bacteriological studies under the control of the pathogen's sensitivity to drugs. For this purpose, broad-spectrum antibiotics are prescribed. The treatment regimen involves 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 dysbacteriosis and candidiasis, the drugs of choice during antibiotic therapy are Linex, Bifidumbacterin, etc., Fluconazole and/or Nystatin.
Over the past 20 years, great importance has been attached to the use of androgens to create higher concentrations of testosterone in the blood plasma and in the testicular tissue. Testosterone preparations (andriol, testocaps) are usually used, which improve the function of the sex glands and androgen receptors, without affecting the production of their own gonadotropins and testosterone. An effective therapeutic dose of andriol is 120-160 mg / day. A significant advantage of testosterone preparations is the absence of hepatotoxic and other side effects, unlike androgens used parenterally, which allows them to be used for a fairly long time (up to 9 months).
Drug treatment of male infertility involves the use of gonadotropins - human chorionic gonadotropin (pregnyl) at a dose of 500 IU. These drugs are prescribed as monotherapy or in combination with other drugs depending on the nature of the disease. Follitropins are the most effective drugs in the treatment of spermatogenesis disorders (metrodin VCh and puregon). They are prescribed to patients for the purpose of stimulation to improve the quantitative and qualitative indicators of spermatogenesis, as well as in normozoospermia to increase the frequency of pregnancy in married couples using in vitro fertilization. embryo transfer and sperm injection into the egg.
Antiestrogens include clomiphene (50 mg) and tamoxifen (10 mg), the mechanism of action of which is the ability to competitively bind to estrogen receptors in target organs, thereby preventing the penetration of estrogens into cells and increasing the secretion of gonadotropins (prolactin, FSH and LH). Clomiphene at a dose of 25 mg / day is an effective drug in the treatment of oligozoospermia. Treatment for 3-6 months improves sperm count by 20-35% and the pregnancy rate up to 26%.
Treatment of hyperprolactinemia in men is aimed at restoring normal concentrations of prolactin in the blood plasma, improving their fertility and sexual function, and in the presence of prolactinoma, reducing the tumor mass.
Dopaminergic agonists include bromocriptine (2.5 mg). Treatment with bromocriptine usually begins with a low dose, increasing it every 3-4 days until reaching a maximum dose of 7.5 mg/day. One of its side effects is orthostatic hypotension. When the drug is discontinued, suppression of hyperprolactinemia continues for 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 has a positive effect on sperm motility and morphology, increases the volume of ejaculate and increases the number of living cells. The noted positive changes in the ejaculate persist for 3-6 months after treatment.
Pathospermia in varicocele is caused by ischemia, which is proven by the positive effect of using hyperbaric oxygenation. After 5-10 sessions of hyperbaric oxygenation, sperm motility doubles, the number of normal forms of sperm increases, and this level of fertility is maintained for 3-6 months.
Treatment of male infertility: assisted reproductive technologies
The use of assisted reproductive technologies allows achieving pregnancy in 20-25% of cases, and with a combination of several methods of assisted reproductive technologies (artificial insemination with the husband's sperm + in vitro fertilization with embryo transfer + intrapitoplasmic sperm injection) - in 50-60%.
In oligo-, astheno- and teratozoospermia, various capacitation methods are used, allowing to improve sperm fertility indicators and prepare it for insemination and/or preservation. The pregnancy rate when using native sperm during insemination is higher compared to preserved sperm.
In case of obstructive azoospermia and other severe organic lesions of the male reproductive system, it is possible to use in the program of intracytoplasmic injection of epidermal (aspiration of spermatozoa from the epididymis) testicular (aspiration of spermatozoa from the testicle) spermatozoa, as well as spermatids of the late differentiation stage.
Indications for intracytoplasmic sperm injection:
- obstructive azoospermia;
- pathozoospermia with critical sperm quality indicators;
- sperm AR disorders;
- sexual-ejaculatory disorders;
- unsuccessful attempts at in vitro fertilization and embryo transfer without micromanipulation.
It should be noted that by using alternative treatment for male infertility, significant results have been achieved in fundamental research on human gametes and embryos. With the help of assisted reproductive technologies, virtually all known forms of male and female infertility can be effectively overcome.