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Medical treatment of male infertility

In most cases, the cause of male infertility is unknown. Sperm parameters have been shown to sometimes improve using certain hormonal medications, ie. gonadotropins (FSH, LH, hCG), aromatase inhibitors (letrozol or anastrozole) or selective estrogen receptor modulators (clomiphene citrate or tamoxifen). Testicular and hypophyseal function should be assessed by measuring serum hormone levels to identify the men that benefit most from the medical treatment.

Hormonally treatable conditions include:

  • Hypogonadotropic hypogonadism, a condition with FSH, LH and testosterone level, either congenital or acquired
  • Normogonadotropic hypogonadism (low testosterone level)
  • Previous use of anabolic androgens or testosterone with strong withdrawal symptoms
  • Preparing for surgical sperm retrieval (TESA or micro-TESE), and testosterone level is low to intermediate

The medication may be administered orally or as subcutaneous injections. Due to the long process of spermatogenesis, the effect of the medication on the sperm parameters will take at least 4 to 6 months to show. The treatment will also be monitored following serum testosterone and LH levels. 

It should be noted that testosterone and anabolic androgens are highly detrimental on sperm production, and all of these products should be discontinued when trying to achieve a pregnancy!