Male infertility
Encyclopedia
Male infertility refers to the inability of a male to achieve a pregnancy
in a fertile female. In humans it accounts for 40-50% of infertility
. Male infertility is commonly due to deficiencies in the semen
, and semen quality is used as a surrogate measure of male fecundity.
Radiation therapy
to a testis decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes.
:
will be required. The provider may order blood tests to look for hormone imbalances, medical conditions, or genetic issues.
The history should include prior testicular or penile insults (torsion
, cryptorchidism
, trauma
), infections (mumps
orchitis
, epididymitis
), environmental factors (excessive heat, radiation
, medications, and drug use (anabolic steroids, alcohol
, smoking
).
Sexual habits, frequency and timing of intercourse, use of lubricant
s, and each partner's previous fertility experiences are important.
Loss of libido
and headaches or visual disturbances may indicate a pituitary tumor.
The past medical or surgical history may reveal thyroid or liver disease (abnormalities of spermatogenesis), diabetic neuropathy
(retrograde ejaculation
), radical pelvic or retroperitoneal surgery (absent seminal emission secondary to sympathetic nerve injury), or hernia repair (damage to the vas deferens or testicular blood supply).
A family history
may reveal genetic problems.
may suggest androgen
deficiency.
Usually, the patient disrobes completely and puts on a gown. The physician will perform a thorough examination of the penis, scrotum, testicles, anus and rectum.
The scrotal contents should be carefully palpated with the patient standing. As it is often psychologically and physically uncomfortable for men to be examined, one helpful hint is to make the examination as efficient and as matter of fact as possible.
The peritesticular area should also be examined. Irregularities of the epididymis, located posterior-lateral to the testis, include induration, tenderness, or cysts.
Semen deficiencies are often labeled as follows:
There are various combinations of these as well, e.g. Teratoasthenozoospermia, which is reduced sperm morphology and motility.
Low sperm counts are often associated with decreased sperm motility and increased abnormal morphology, thus the terms "oligoasthenoteratozoospermia" or "oligospermia" can be used as a catch-all.
and testosterone
levels. A blood sample can reveal genetic causes of infertility, e.g. Klinefelter syndrome, a Y chromosome microdeletion
, or cystic fibrosis
.
Pre-testicular conditions can often be addressed by medical means or interventions.
Testicular-based male infertility tends to be resistant to medication. Usual approaches include using the sperm for intrauterine insemination (IUI), in vitro fertilization (IVF), or IVF with intracytoplasmatic sperm injection
(ICSI). With IVF-ICSI even with a few sperm pregnancies can be achieved.
Obstructive causes of post-testicular infertility can be overcome with either surgery or IVF-ICSI. Ejaculatory factors may be treatable by medication, or by IUI therapy or IVF.
The off-label use
of Clomiphene citrate, an anti-estrogen drug designed as a fertility medicine for women, is controversial. Vitamin E
helps counter oxidative stress, which is associated with sperm DNA damage and reduced sperm motility. A hormone-antioxidant combination may improve sperm count and motility.
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
in a fertile female. In humans it accounts for 40-50% of infertility
Infertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
. Male infertility is commonly due to deficiencies in the semen
Semen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...
, and semen quality is used as a surrogate measure of male fecundity.
Pre-testicular causes
Pre-testicular factors refer to conditions that impede adequate support of the testes and include situations of poor hormonal support and poor general health including:- Hypogonadotropic hypogonadism due to various causes
- ObesityObesityObesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
increases the risk of hypogonadotropic hypogonadism. Animal models indicate that obesity causes leptin insensitivity in the hypothalamusHypothalamusThe Hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions...
, leading to decreased Kiss1 expression, which, in turn, alters the release of gonadotropin-releasing hormoneGonadotropin-releasing hormoneGonadotropin-releasing hormone , also known as Luteinizing-hormone-releasing hormone and luliberin, is a tropic peptide hormone responsible for the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary. GnRH is synthesized and released from neurons within...
(GnRH).
- Obesity
- DrugsDRUGSDestroy Rebuild Until God Shows are an American post-hardcore band formed in 2010. They released their debut self-titled album on February 22, 2011.- Formation :...
, alcoholAlcoholIn chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms.... - Strenuous riding (bicycle riding, horseback riding)
- Medications, including those that affect spermatogenesis such as chemotherapyChemotherapyChemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
, anabolic steroids, cimetidineCimetidineCimetidine INN is a histamine H2-receptor antagonist that inhibits the production of acid in the stomach. It is largely used in the treatment of heartburn and peptic ulcers. It is marketed by GlaxoSmithKline under the trade name Tagamet...
, spironolactoneSpironolactoneSpironolactone , commonly referred to as simply spiro, is a diuretic and is used as an antiandrogen.It is a synthetic 17-lactone drug that is a renal competitive aldosterone antagonist in a class of pharmaceuticals called...
; those that decrease FSH levels such as phenytoinPhenytoinPhenytoin sodium is a commonly used antiepileptic. Phenytoin acts to suppress the abnormal brain activity seen in seizure by reducing electrical conductance among brain cells by stabilizing the inactive state of voltage-gated sodium channels...
; those that decrease sperm motility such as sulfasalazine and nitrofurantoinNitrofurantoinNitrofurantoin is an antibiotic which is marketed under the following brand names; Furadantin, Macrobid, Macrodantin, Nitrofur Mac, Nitro Macro, Nifty-SR, Martifur-MR, Martifur-100 , Urantoin, and Uvamin . It is usually used in treating urinary tract infection... - Genetic abnormalities such as a Robertsonian translocationRobertsonian translocationRobertsonian translocation is a common form of chromosomal rearrangement that in humans occurs in the five acrocentric chromosome pairs, namely 13, 14, 15, 21, and 22. Other translocations occur but do not lead to a viable fetus. They are named after the American biologist William Rees Brebner...
Tobacco smoking
Male smokers also have approximately 30% higher odds of infertility. There is increasing evidence that the harmful products of tobacco smoking kill sperm cells. Therefore, some governments require manufacturers to put warnings on packets. Smoking tobacco increases intake of cadmium, because the tobacco plant absorbs the metal. Cadmium, being chemically similar to zinc, may replace zinc in the DNA polymerase, which plays a critical role in sperm production. Zinc replaced by cadmium in DNA polymerase can be particularly damaging to the testes.Testicular factors
Testicular factors refer to conditions where the testes produce semen of low quantity and/or poor quality despite adequate hormonal support and include:- Age
- Genetic defects on the Y chromosomeY chromosomeThe Y chromosome is one of the two sex-determining chromosomes in most mammals, including humans. In mammals, it contains the gene SRY, which triggers testis development if present. The human Y chromosome is composed of about 60 million base pairs...
- Y chromosome microdeletionY chromosome microdeletionY chromosome microdeletion is a family of genetic disorders caused by missing gene in the Y chromosome. Many men with YCM exhibit no symptoms and lead normal lives. However, YCM is also known to be present in a significant number of men with reduced fertility...
s
- Y chromosome microdeletion
- Abnormal set of chromosomes
- Klinefelter syndrome
- Neoplasm, e.g. seminoma
- IdiopathicIdiopathicIdiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...
failure - CryptorchidismCryptorchidismCryptorchidism is the absence of one or both testes from the scrotum. It is the most common birth defect regarding male genitalia. In unique cases, cryptorchidism can develop later in life, often as late as young adulthood. About 3% of full-term and 30% of premature infant boys are born with at...
- VaricoceleVaricoceleVaricocele , also known as varicoscele or varicose seal, is an abnormal enlargement of the vein that is in the scrotum draining the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis...
(14% in one study) - TraumaPhysical traumaTrauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
- HydroceleHydroceleA hydrocoele denotes a pathological accumulation of serous fluid in a body cavity. It can also be noted as a minor malformation of newborns due to high levels of lead in the mother's blood during pregnancy....
- MumpsMumpsMumps is a viral disease of the human species, caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide...
- MalariaMalariaMalaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
- Testicular cancerTesticular cancerTesticular cancer is cancer that develops in the testicles, a part of the male reproductive system.In the United States, between 7,500 and 8,000 diagnoses of testicular cancer are made each year. In the UK, approximately 2,000 men are diagnosed each year. Over his lifetime, a man's risk of...
- Defects in USP26USP26USP26 is a peptidase enzyme.Recent research has suggested that defects in USP26 may be involved in some cases of male infertility....
in some cases - Acrosomal defects affecting egg penetration
- Idiopathic oligospermiaOligospermiaOligospermia, also oligozoospermia, refers to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility...
- unexplained sperm deficiencies account for 30 % of male infertility.
Radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
to a testis decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes.
Post-testicular causes
Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculationEjaculation
Ejaculation is the ejecting of semen from the male reproductory tract, and is usually accompanied by orgasm. It is usually the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. In rare cases ejaculation occurs because of prostatic disease...
:
- Vas deferensVas deferensThe vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....
obstruction - Lack of Vas deferensVas deferensThe vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....
, often related to genetic markers for Cystic FibrosisCystic fibrosisCystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine... - InfectionInfectionAn infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
, e.g. prostatitisProstatitisProstatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:... - Retrograde ejaculationRetrograde ejaculationIn the human male reproductive system, retrograde ejaculation occurs when semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least...
- Ejaculatory duct obstructionEjaculatory duct obstructionEjaculatory duct obstruction is a congenital or acquired pathological condition which is characterized by the obstruction of one or both ejaculatory ducts. Thus, the efflux of semen is not possible....
- HypospadiasHypospadiasHypospadias is a birth defect of the urethra in the male that involves an abnormally placed urinary meatus...
- Impotence
Diagnosis
The diagnosis of infertility begins with a medical history and physical exam by a physician, preferably a specialist with experience or who specializes in male infertility. Typically two separate semen analysesSemen analysis
A semen analysis evaluates certain characteristics of a male's semen and the sperm contained in the semen. It may be done while investigating a couple's infertility or after a vasectomy to verify that the procedure was successful. It is also used for testing donors for sperm donation, in stud...
will be required. The provider may order blood tests to look for hormone imbalances, medical conditions, or genetic issues.
Medical history
The cornerstone of the male partner evaluation is the history. It should note the duration of infertility, earlier pregnancies with present or past partners, and whether there was previous difficulty with conception.The history should include prior testicular or penile insults (torsion
Testicular torsion
Testicular torsion is when the spermatic cord to a testicle twists, cutting off the blood supply. The most common symptom is acute testicular pain and the most common underlying cause is a congenital malformation known as a "bell-clapper deformity". The diagnosis is often made clinically but if it...
, cryptorchidism
Cryptorchidism
Cryptorchidism is the absence of one or both testes from the scrotum. It is the most common birth defect regarding male genitalia. In unique cases, cryptorchidism can develop later in life, often as late as young adulthood. About 3% of full-term and 30% of premature infant boys are born with at...
, trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
), infections (mumps
Mumps
Mumps is a viral disease of the human species, caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide...
orchitis
Orchitis
Orchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection.-Symptoms:Symptoms of orchitis are similar to those of testicular torsion...
, epididymitis
Epididymitis
Epididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...
), environmental factors (excessive heat, radiation
Radiation
In physics, radiation is a process in which energetic particles or energetic waves travel through a medium or space. There are two distinct types of radiation; ionizing and non-ionizing...
, medications, and drug use (anabolic steroids, alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
, smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
).
Sexual habits, frequency and timing of intercourse, use of lubricant
Lubricant
A lubricant is a substance introduced to reduce friction between moving surfaces. It may also have the function of transporting foreign particles and of distributing heat...
s, and each partner's previous fertility experiences are important.
Loss of libido
Libido
Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...
and headaches or visual disturbances may indicate a pituitary tumor.
The past medical or surgical history may reveal thyroid or liver disease (abnormalities of spermatogenesis), diabetic neuropathy
Diabetic neuropathy
Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves in addition to macrovascular conditions that can culminate in diabetic neuropathy...
(retrograde ejaculation
Retrograde ejaculation
In the human male reproductive system, retrograde ejaculation occurs when semen, which would normally be ejaculated via the urethra, is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least...
), radical pelvic or retroperitoneal surgery (absent seminal emission secondary to sympathetic nerve injury), or hernia repair (damage to the vas deferens or testicular blood supply).
A family history
Family history
Family history is the systematic narrative and research of past events relating to a specific family, or specific families.- Introduction :...
may reveal genetic problems.
Physical examination
A complete examination of the infertile male is important to identify general health issues associated with infertility. For example, the patient should be adequately virilized; signs of decreased body hair or gynecomastiaGynecomastia
Gynecomastia or Gynaecomastia, , is the abnormal development of large mammary glands in males resulting in breast enlargement. The term comes from the Greek γυνή gyné meaning "woman" and μαστός mastós meaning "breast"...
may suggest androgen
Androgen
Androgen, also called androgenic hormone or testoid, is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics in vertebrates by binding to androgen receptors...
deficiency.
Usually, the patient disrobes completely and puts on a gown. The physician will perform a thorough examination of the penis, scrotum, testicles, anus and rectum.
The scrotal contents should be carefully palpated with the patient standing. As it is often psychologically and physically uncomfortable for men to be examined, one helpful hint is to make the examination as efficient and as matter of fact as possible.
The peritesticular area should also be examined. Irregularities of the epididymis, located posterior-lateral to the testis, include induration, tenderness, or cysts.
Sperm sample
The volume of the semen sample, approximate number of total sperm cells, sperm motility/forward progression, and % of sperm with normal morphology are measured. This is the most common type of fertility testing.Semen deficiencies are often labeled as follows:
- OligospermiaOligospermiaOligospermia, also oligozoospermia, refers to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility...
or Oligozoospermia - decreased number of spermatozoa in semen - AspermiaAspermiaAspermia is the complete lack of semen . Naturally, it is associated with infertility....
- complete lack of semen - HypospermiaHypospermiaHypospermia is the medical term when a man has an unusually low ejaculate volume, it is the logical opposite of Hyperspermia. It should not be confused with Oligospermia, which means low sperm count....
- reduced seminal volume - AzoospermiaAzoospermiaAzoospermia is the medical condition of a male not having any measurable level of sperm in his semen. It is associated with very low levels of fertility or even sterility, but many forms are amenable to medical treatment...
- absence of sperm cells in semen - TeratospermiaTeratospermiaTeratospermia or teratozoospermia is a condition characterized by the presence of sperm with abnormal morphology that affects fertility in males.-Causes:The causes of teratospermia are unknown in most cases...
- increase in sperm with abnormal morphology - AsthenozoospermiaAsthenozoospermiaAsthenozoospermia is the medical term for reduced sperm motility. Complete asthenozoospermia, that is, 100% immotile spermatozoa in the ejaculate, is reported at a frequency of 1 of 5000 men...
- reduced sperm motility
There are various combinations of these as well, e.g. Teratoasthenozoospermia, which is reduced sperm morphology and motility.
Low sperm counts are often associated with decreased sperm motility and increased abnormal morphology, thus the terms "oligoasthenoteratozoospermia" or "oligospermia" can be used as a catch-all.
Blood sample
Common hormonal test include determination of FSHFSH
FSH may refer to:* Follicle-stimulating hormone* Fox Sports Houston, a regional Fox Sports Net affiliate station for the Houston, Texas area* Facioscapulohumeral muscular dystrophy* International Civil Aviation Organisation code for Flash Airlines...
and testosterone
Testosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
levels. A blood sample can reveal genetic causes of infertility, e.g. Klinefelter syndrome, a Y chromosome microdeletion
Y chromosome microdeletion
Y chromosome microdeletion is a family of genetic disorders caused by missing gene in the Y chromosome. Many men with YCM exhibit no symptoms and lead normal lives. However, YCM is also known to be present in a significant number of men with reduced fertility...
, or cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...
.
Prevention
Some strategies suggested or proposed for avoiding male infertility include the following:- Avoiding smokingSmokingSmoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
as it damages sperm DNA - Avoiding heavy marijuana and alcoholAlcoholIn chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
use. - Avoiding excessive heat to the testes.
- Sperm counts can be depressed by daily coital activity and sperm motility may be depressed by coital activity that takes place too infrequently (abstinence 10–14 days or more).
- When participating in contact sports, wear an Protective Cup and JockstrapJockstrapA jockstrap is an undergarment designed for supporting the male genitalia during sports or other vigorous physical activity...
to protect the testicles. Sports such as BaseballBaseballBaseball is a bat-and-ball sport played between two teams of nine players each. The aim is to score runs by hitting a thrown ball with a bat and touching a series of four bases arranged at the corners of a ninety-foot diamond...
, FootballFootballFootball may refer to one of a number of team sports which all involve, to varying degrees, kicking a ball with the foot to score a goal. The most popular of these sports worldwide is association football, more commonly known as just "football" or "soccer"...
, CricketCricketCricket is a bat-and-ball game played between two teams of 11 players on an oval-shaped field, at the centre of which is a rectangular 22-yard long pitch. One team bats, trying to score as many runs as possible while the other team bowls and fields, trying to dismiss the batsmen and thus limit the...
, LacrosseLacrosseLacrosse is a team sport of Native American origin played using a small rubber ball and a long-handled stick called a crosse or lacrosse stick, mainly played in the United States and Canada. It is a contact sport which requires padding. The head of the lacrosse stick is strung with loose mesh...
, HockeyHockeyHockey is a family of sports in which two teams play against each other by trying to maneuver a ball or a puck into the opponent's goal using a hockey stick.-Etymology:...
, SoftballSoftballSoftball is a bat-and-ball sport played between two teams of 10 to 14 players. It is a direct descendant of baseball although there are some key differences: softballs are larger than baseballs, and the pitches are thrown underhand rather than overhand...
, PaintballPaintballPaintball is a sport in which players compete, in teams or individually, to eliminate opponents by tagging them with capsules containing water soluble dye and gelatin shell outside propelled from a device called a paintball marker . Paintballs have a non-toxic, biodegradable, water soluble...
, RodeoRodeoRodeo is a competitive sport which arose out of the working practices of cattle herding in Spain, Mexico, and later the United States, Canada, South America and Australia. It was based on the skills required of the working vaqueros and later, cowboys, in what today is the western United States,...
, Motorcross, WrestlingWrestlingWrestling is a form of grappling type techniques such as clinch fighting, throws and takedowns, joint locks, pins and other grappling holds. A wrestling bout is a physical competition, between two competitors or sparring partners, who attempt to gain and maintain a superior position...
, Soccer, KarateKarateis a martial art developed in the Ryukyu Islands in what is now Okinawa, Japan. It was developed from indigenous fighting methods called and Chinese kenpō. Karate is a striking art using punching, kicking, knee and elbow strikes, and open-handed techniques such as knife-hands. Grappling, locks,...
or other Martial ArtsMartial artsMartial arts are extensive systems of codified practices and traditions of combat, practiced for a variety of reasons, including self-defense, competition, physical health and fitness, as well as mental and spiritual development....
or any sport where a ball, foot, arm, knee or bat can come into contact with the groin.
Treatment
Treatments vary according to the underlying disease and the degree of the impairment of the male fertility. Further, in an infertility situation, the fertility of the female needs to be considered.Pre-testicular conditions can often be addressed by medical means or interventions.
Testicular-based male infertility tends to be resistant to medication. Usual approaches include using the sperm for intrauterine insemination (IUI), in vitro fertilization (IVF), or IVF with intracytoplasmatic sperm injection
Intracytoplasmic sperm injection
Intracytoplasmic sperm injection is an in vitro fertilization procedure in which a single sperm is injected directly into an egg.-Indications:...
(ICSI). With IVF-ICSI even with a few sperm pregnancies can be achieved.
Obstructive causes of post-testicular infertility can be overcome with either surgery or IVF-ICSI. Ejaculatory factors may be treatable by medication, or by IUI therapy or IVF.
The off-label use
Off-label use
Off-label use is the practice of prescribing pharmaceuticals for an unapproved indication or in an unapproved age group, unapproved dose or unapproved form of administration...
of Clomiphene citrate, an anti-estrogen drug designed as a fertility medicine for women, is controversial. Vitamin E
Vitamin E
Vitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols. There are many different forms of vitamin E, of which γ-tocopherol is the most common in the North American diet. γ-Tocopherol can be found in corn oil, soybean oil, margarine and dressings...
helps counter oxidative stress, which is associated with sperm DNA damage and reduced sperm motility. A hormone-antioxidant combination may improve sperm count and motility.