EMPIRIC TREATMENT OF MALE INFERTILITY

 

Most of the studies were performed in vitro. Available data do not confirm any positive effects on sperm parameters and pregnancy rates in vivo in controlled clinical trials. Empiric treatment of male infertility is generally not recommended.

 

 
ClassDrugsEffect
AntiestrogenClomiphene citrate

Tamoxifen

Prevent negative feedback of estrogens to the pituitary and hypothalamus

 

Aromatase inhibitorsTestolactoneBlock the conversion of testosterone to estrogen

 

Mast cell blockers TranilastBlocking release of chemical mediators from mast cells
a-blockers Terazosin? increase the rate of sperm transport from caput to cauda. Increase sperm concentration
Gonadotropins/GnRHHCG/HMG, GnRH,

Recombinant human FSH

Possible effect on spermatogenesis and sperm maturation

 

Pancreatic proteinaseKallikreinCleaves kininogen to produce kinins( regulation of sperm motility)

 

ACE inhibitorsCaptoprilIncrease sperm count
Prostaglandin inhibitorsIndomethacinBlock negative regulatory effect of prostaglandin on testicular and spermatozoal function

 

Phosphodiesterase inhibitorsPentoxyfillineIncrease sperm motility in vitro

 

CorticosteroidsPrednisoneAnti-inflammatory effect

 

ZincZincImprove sperm production

 

VitaminsC, EAntioxidants, decrease level of Reactive Oxygen Species
AminoacidsL-arginineImprove sperm motility

 

 

Selected Bibliography

  1. Wang C., Chan C-W., Wong K-K et al. Comparison of the effectiveness of placebo, clomiphene citrate,mesterolone, pentoxiphylline and testosterone rebound therapy for the treatment of idiopathic oligospermia. Fertil.Steril 1988;49:865
  2. Schill WB. Recent progress in pharmacological therapy of male infertility: a review. Abdrologia 1979;11:77
  3. Schill WB. Treatment of idiopathic oligospermia by kallikrein: result s of double-blind study.Arch Androl 1979;2:163
  4. Baker HWG. Medical treatment for idiopathic male infertility:Is it curative or palliative. Baillieres Clinical Obstetrics & Gynecology1997;11(4):673-689
  5. Schill WB. Survey of medical therapy in andrology. Int J Androl 1995;18 suppl 2: 56-62
  6. Scibona M. Meschini P. Capparelli S. Pecori C. Rossi P. Menchini Fabris GF. L-arginine and male infertility. Minerva Urologica e Nefrologica1994; 46(4):251-3

 

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