Clin Exp Reprod Med.  2014 Sep;41(3):108-114. 10.5653/cerm.2014.41.3.108.

Empirical medical therapy in idiopathic male infertility: Promise or panacea?

• Jung JH
• Seo JT

• KMID: 1805492
• DOI: http://doi.org/10.5653/cerm.2014.41.3.108

Abstract

Male factors account for 20%-50% of cases of infertility and in 25% of cases, the etiology of male infertility is unknown. Effective treatments are well-established for hypogonadotropic hypogonadism, male accessory gland infection, retrograde ejaculation, and positive antisperm antibody. However, the appropriate treatment for idiopathic male infertility is unclear. Empirical medical treatment (EMT) has been used in men with idiopathic infertility and can be divided into two categories based on the mode of action: hormonal treatment and antioxidant supplementation. Hormonal medications consist of gonadotropins, androgens, estrogen receptor blockers, and aromatase inhibitors. Antioxidants such as vitamins, zinc, and carnitines have also been widely used to reduce oxidative stress-induced spermatozoa damage. Although scientifically acceptable evidence of EMT is limited because of the lack of large, randomized, controlled studies, recent systematic reviews with meta-analyses have shown that the administration of gonadotropins, anti-estrogens, and oral antioxidants results in a significant increase in the live birth rate compared with control treatments. Therefore, all physicians who treat infertility should bear in mind that EMT can improve semen parameters and subsequent fertility potential through natural intercourse.

Keyword

Drug therapy; Infertility, male; Pregnancy outcome; Semen analysis

MeSH Terms

Androgens
Antioxidants
Aromatase Inhibitors
Drug Therapy
Ejaculation
Estrogens
Female
Fertility
Gonadotropins
Humans
Hypogonadism
Infertility
Infertility, Male*
Live Birth
Male
Pregnancy
Pregnancy Outcome
Semen
Semen Analysis
Spermatozoa
Vitamins
Zinc
Androgens
Antioxidants
Aromatase Inhibitors
Estrogens
Gonadotropins
Vitamins
Zinc