[Current status of drug therapy in male fertility disorders]

Recent advances in the medical treatment of male fertility disturbances by specific and empirical approaches are discussed. Specific approaches follow a pathophysiological concept and require critical patient selection. In contrast, empirical approaches do not allow patient selection, and a predictability of the success is not possible. Therefore, the response of the patients towards one of the available medical compounds has to be checked on an individual basis. Specific treatment includes replacement therapy of hormone-deficient men by human gonadotropins, inhibition of hyperprolactinemia by bromocriptine, antibiotic-antiinflammatory therapy of male genital tract infections and immunosuppressive treatment in cases of autoantibodies against spermatozoa. In addition, special medical approaches are available for disturbances of sperm transport and the retrograde ejaculation using sympathicomimetic or anticholinergic agents. Empirical treatment comprises the use of antiestrogens, human gonadotropins, androgens, kininogenases, and methylxanthines. As supporting therapy psychopharmacological compounds and spasmolytic agents should be mentioned here. The overall result of treatment is moderate. However, considering all possibilities of treatment conception rates between 30% and 50% will be obtained which differ from the spontaneous conception rates of between 10% and 20%.