[Therapy of male subfertility]

The possibilities of treating male subfertility are still limited. Approaches at medical therapy include stimulation of spermatogenesis at the testicular level, improvement of epididymal function (sperm maturation), influence on sperm transport and activation of sperm metabolism with improvement of sperm motility. Causal therapy has been most successful in patients with hormonal insufficiency and male adnexitis, while microsurgical reconstructive measures have yielded best results in cases of occlusion within the efferent seminal ducts. New therapeutic approaches include the use of mast cell blockers and alpha blockers as well as vitamin C/E as an antioxidative treatment to reduce reactive oxygen species. If medical or surgical therapy has failed, methods for improvement of sperm quality in vitro must be considered (swim-up technique, glass wool filtration, migration/sedimentation technique, density gradient centrifugation). In cases of severe male sterility factor, intracytoplasmic sperm injection (ICSI) has been a breakthrough in the therapy of childlessness. A further progress is the collection of spermatozoa from the epididymis (MESA = microsurgical epididymal sperm aspiration) or testis (TESE = testicular sperm extraction). Finally, pressure in terms of time and organization can now be avoided by the use of cryopreserved spermatozoa from the ejaculate, epididymis or testicular tissue so that microinjection may be planned independently of the partner. In any case, a close cooperation between gynecologist and andrologist is of utmost importance.