Treatments for male factor include medical treatment, surgical treatment, or assisted reproduction.
Medical treatment consists of the administration of certain drugs to improve seminal quality. Clomiphene citrate, aromatase inhibitors, tamoxifen, gonadotropin injections, antibiotics, and steroids are commonly used.
If there is a mild decrease in the sperm count or motility, the urologist may prescribe Clomiphene citrate, a fertility pill commonly used to treat women who fail to ovulate. Clomiphene (also called Clomid or Serophene) mildly stimulates the pituitary to make hormones that stimulate sperm production. Sperm counts should be re-analyzed 3-6 months after initiation of the medication to evaluate the effectiveness of this treatment. If the sperm count is very poor to begin with, this strategy is less likely to be successful.
Surgical treatment consists of ligation or varicoceles, vasectomy reversal, or retrieval of sperm to be inserted in eggs. If a varicocele is found, sometimes surgery to ligate (tie off) the abnormally dilated veins is recommended. If the varicocele is of significant size (Grade II or Grade III), about two thirds of men undergoing the surgery will see some improvement in the sperm quality.
The reported pregnancy rates following surgery is approximately 40%, but most pregnancies occur 6-9 months following surgery. Because of this, the age of the female partner needs to be a major consideration. If the initial sperm count and motility are in the severe male factor category, it is unlikely that this surgery will improve sperm counts enough to enable the couple to conceive without assistance.
If the male patient has undergone a vasectomy, surgical options include vasectomy reversal or IVF-ICSI with epididymal or testicular sperm extraction. Age of the female partner and length of time since the vasectomy are important factors in decision-making.
It can sometimes take 6-9 months to recover adequate sperm counts following vasectomy reversal. The greater the length of time between the vasectomy and the reversal, the greater the chances are that the surgery will be unsuccessful or that anti-sperm antibodies will form, preventing the recovered sperm from penetrating the eggs without IVF-ICSI. Any man undergoing vasectomy reversal should request that any sperm seen at the time of the reversal be frozen in case subsequent scarring or re-obstruction occurs.
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Fort Worth, TX 76104 USA
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