Treatment of male infertility

To present various treatment options for male subfertility.

Surgical therapy for varicocele, hormonal therapy, mechanical therapy, e.g., intrauterine insemination, special treatment for antisperm antibodies and low hypoosmotic swelling test scores with protein digestive enzymes, and in vitro fertilization (IVF) with and without intracytoplasmic sperm injection are discussed.

Questions have been raised as to the efficacy of varicocelectomy. Perhaps only a minority of the best of males respond to this therapy. Clomiphene citrate or gonadotropins or hCG may be effective but usually only when serum FSH, LH and/or testosterone levels are low or are in the low normal range. Intrauterine insemination is helpful for oligoasthenozoospermia but is not so beneficial for antisperm antibodies or low hypoosmotic swelling test scores unless first pretreated with chymotrypsin.

Obstructive or non-obstructive azoospermia requires sperm aspiration from the testes or testicular biopsy followed by IVF with intracytoplasmic sperm injection (ICSI). In vitro fertilization with ICSI is needed for extremely low counts or motility. Otherwise less costly or invasive therapy can be tried first but IVF with ICSI can eventually be performed if more conservative therapy fails to achieve a pregnancy.