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Medical Management of Male Infertility

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Read the article to understand how male infertility has been managed recently and what its future looks like.

Medically reviewed by

Dr. Ramesh Mohanlal Maheshwari

Published At May 3, 2023
Reviewed AtMay 3, 2024

Introduction:

Management of male infertility usually depends on the underlying factor causing infertility. Management of male infertility usually depends on the underlying factor causing infertility. Most problems can be fixed with medical and surgical intervention, which will allow conception through regular sexual intercourse. Management of male infertility is divided into three categories; non-surgical therapy, surgical therapy, and managing the unknown causes.

What Are the Non-surgical Therapies Used in Certain Causative Factors of Male Infertility?

Management of Anejaculation:

Anejaculation is when no semen is released after a man attains sexual climax. It is not a common condition and is caused by spinal cord injury, prior surgery, diabetes, multiple sclerosis, abnormalities found at birth, and other emotional, mental, or unknown reasons.

Medicines usually manage this condition. If medicines do not resolve the person's condition, several other options, like a rectal probe electroejaculation or penile vibratory stimulation, are recommended to induce ejaculation.

Rectal Probe Electroejaculation - This technique is usually performed under anesthesia. It retrieves sperm in ninety out of a hundred men. Many sperm can be collected. However, sperm shape and movement can lower fertility.

Penile Vibratory Stimulation - This is a non-invasive technique where the tip and penis shaft will undergo vibrations to help the person achieve a natural climax. However, it does not work in severe cases as well as a rectal probe electroejaculation.

In men with anejaculation, the sperm will be weak in men with an impaired sperm cell, and the semen fluid transportation will be weak out of the body. In such cases, assisted reproductive techniques like intracytoplasmic sperm injection and in vitro fertilization will be of great value to men with anejaculation. Another technique called testicular sperm aspiration is used to retrieve sperm directly from the testicles using a needle.

Management of Genital Tract Infection:

A genital tract infection is rarely connected to infertility. This is found in about two out of a hundred men having fertility issues. Semen tests usually diagnose this problem. It is detected through the presence of white blood cells. White blood cells create too many reactive oxygen species (ROS), which damages the sperm and lowers its chances of fertilizing an egg. For example, a severe infection of the testis and epididymis can cause epididymal duct blockage and testicular shrinkage. The infection does not necessarily have to be sudden to cause issues.

Antibiotics usually manage infections. However, they are not used for fewer inflammation cases because antibiotics can cause harm to the functioning or production of sperm. So in case of less inflammation, non-steroidal anti-inflammatory drugs like ibuprofen are often used. Information that occurs from causes other than infection also affects fertility. For example, chronic prostatitis blocks the ejaculatory ducts in rare cases.

Management of Hyperprolactinemia:

Hyperprolactinemia occurs when the pituitary gland produces too much prolactin hormone. Prolactin hormone plays a role in erectile dysfunction and infertility. The management of this condition depends on the underlying factor causing the increase of hormones. If pituitary tumors are present, they can be managed by drugs or surgery.

Management of Hypogonadotropic Hypogonadism:

Hypogonadotropic hypogonadism is when the testicles do not produce enough sperm as the pituitary hormones poorly stimulate them. This is due to problems that exist in the hypothalamus or pituitary gland. This condition is the cause of a very small percentage of infertility. The condition usually arises from birth (congenital) and becomes more apparent when the person goes through puberty. It can also arise later in life (acquired). If hypogonadotropic hypogonadism Is suspected, the doctor will recommend magnetic resonance imaging (MRI). A blood test will also be done to check the prolactin levels. Both blood tests and an MRI will help evaluate pituitary tumors.

High levels of prolactin are found with no tumor in the pituitary gland then the doctor will try to lower the prolactin levels first. Then the next step of treatment would be gonadotrophic replacement therapy. During the treatment, semen and blood testosterone level will be checked. The sperm that results from the treatment will be normal, and the pregnancy chances will improve.

Management of Retrograde Ejaculation:

Retrograde ejaculation is when the semen starts flowing back instead of going out through the penis. It is caused by diabetes, antidepressants, prostate and bladder surgery, spinal cord injuries, medications used to manage prostate enlargement, and certain antihypertensives. This condition is usually found when urine is checked for sperm count under a microscope after the person ejaculates. Retrograde ejaculation is usually treated with over-the-counter medications, and if the medications do not work, the person might require other assisted reproductive techniques.

What Are the Surgical Therapies Used in Certain Causative Factors of Male Infertility?

Management of Varicocele - Varicocele can be managed by a minor outpatient surgery called varicocelectomy. Fixing the swollen veins will help in the movement, numbers, and structure of the sperm.

Management of Azoospermia - Azoospermia is a condition when the semen lacks sperm because of any kind of blockage. This condition is managed by surgical intervention along with assisted reproduction. . Microsurgical Vasovasostomy - Vasovasostomy is a treatment performed to reverse a vasectomy. It uses microsurgery to join the two parts cut from the vas deferens in the testicle.

Assisted Reproductive Techniques (ART) - If infertility treatments fail, other ways, like assisted reproductive techniques, are used. They include:

  • Intrauterine Insemination (IUI) - In this method, the provider will place the sperm through a tube into the partner's uterus. IUI works well for low sperm count, retrograde ejaculation, movement problems, and other underlying causes of infertility.

  • Invitro Fertilization (IVF) - In this method, the eggs of a female partner are combined with sperm in a petri dish in the laboratory. The ovaries have to be stimulated to produce enough eggs during this procedure. This is usually done with drugs that are given as daily injections, and it will allow the mature eggs to be retrieved, and after three to five days, the fertilized embryo will be put into the uterus.

  • Intracytoplasmic Sperm Injection (ICSI) - ICSI is another form of IVF. This statement has revolutionized the management of severe cases of male fertility. A single sperm is injected into the egg using a tiny needle. Once the egg gets fertilized, it is inserted into the partner's uterus. This method is used if very poor semen quality is found or when no sperm is found in the semen due to a testicular failure or block which cannot be fixed.

What Is the Future of the Management of Male Infertility?

  • An orderly diagnosis is required to recognize the ideal treatment to manage male infertility, which will help pinpoint the causative factor.

  • However, many infertility cases lack a specific diagnosis after an evaluation.

  • The advancements in genetic testing have shown promising results in identifying the new etiology of male infertility.

  • The future use of array-based comparative genomic hybridization (aCGH), next-generation sequencing (NGS), or gene panels can establish an appropriate diagnosis, offer prognostic value for testicular sperm extraction and clinical pregnancy and assess any potential risks for future offspring.

Conclusion:

Infertility refers to the inability to produce a pregnancy and failing to do it even after trying for about six to twelve months. Male infertility is a common problem in recent times. However, with technological advancement, about 90 % of male infertility cases can be resolved with the potential of conceiving a child. Managing male infertility is mainly done by understanding the underlying causative factor causing infertility and treating those factors.

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Dr. Ramesh Mohanlal Maheshwari
Dr. Ramesh Mohanlal Maheshwari

Sexology

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