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These are useful in stimulating sperm production in men with hypogonadotropic hypogonadism (men with low FSH and LH levels, because of hypothalamic or pituitary malfunction), but this is a rare condition.
Treatment often takes many months to restore the sperm quality to fertile levels. Combination treatment is required, with HCG stimulating testosterone production; and FSH stimulating sperm production. Initially, the man takes HCG injections thrice a week for about 6 months.
This normally causes the size of the testes to increase and the testosterone to reach normal levels. HMG injections are then added. These can be mixed with the HCG and are also given thrice a week. Once sperm production has been achieved, the HMG can be stopped; and HCG treatment continued alone. While sperm counts achieved are usually low (less than 10 million per ml), a successful pregnancy can be achieved in 50 % of correctly diagnosed patients.
Unfortunately, these expensive injections are often misused as "empiric" therapy in men with low sperm counts - with expectedly disappointing results.
As in the female, this is used to lower unusually elevated levels of prolactin.
Testosterone is given to suppress sperm production in the hope that when medication is stopped (usually after 5-6 months), then the sperm production will "rebound" to higher levels than originally (testosterone rebound). This form of treatment is now seldom used as it may further impair fertility and is hazardous. Testosterone is also be used for the treatment of impotence or diminished libido when blood testosterone levels are low. Testosterone is available as an oily injection and is given intramuscularly, usually once a week. Oral preparations are also available now, but these are more expensive and may not be as effective.
Clomiphene is the most commonly prescribed medicine for infertile men. Its use is largely empirical and very controversial as the results are not predictable. This is usually prescribed as a 25 mg tablet, to be taken once a day, for 25 days per month, for a course of 3 to 6 months. It acts by increasing the levels of FSH and LH, which stimulate the testes to produce testosterone and sperm. However, while clomiphene may increase sperm counts in selected men, it hasn't been proven effective in increasing pregnancy rates.
Just as in the female, antibiotics can resolve a chronic infection in the reproductive tract in the male. Often no specific organism is isolated but improvement in the numbers of normal sperm as well as the reduction in white cells in semen can be seen in some men following several weeks of antibiotics.
There is no supportive evidence that they work, but, sometimes, they are worth a try.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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