TREATING MALE FACTOR

 

Varicocele: The options are either surgery to close it off, or balloon insertion to block the blood flow.

ICSI: Done in conjunction with IVF. After the eggs are retrieved, a single sperm is injected into each mature egg. Stats on ICSI vary _widely_ from clinic to clinic. It is a good idea to check out the clinic and the embryologist for their ICSI statistics before doing ICSI. A fertilization rate of at least 50-60% should be expected with a good clinic and currently the better clinics have a 35-45% ongoing pregnancy rate. (needle aspiration of sperm, inject in egg, implant egg again, supposed to work even with quite low sperm counts).

For retrograde ejaculation: antihistamines and alpha-sympathomimetics.

For idiopathic oligospermia: Antiestrogens, such as clomiphene citrate (Clomid and Serophene) and tamoxifen can increase sperm density and motility. Sporadic success has been reported with testoractone. hCG has had some positive results, but they aren't solidly reproducible. GnRH (in early stages of investigation).

Of questionable benefit or outmoded: testosterone, arginine, bromocryptine (other than for hyperprolactemia), corticosteroids, thyroxin, oxytocin. (This list from "Male Infertility," by Larry Lipshultz, MD, and Serono Syposium. There seems to be a lot of controversy about which infertility treatments are worthwhile, so some of these may still be being debated.) Note: Larry Lipshultz is a highly regarded urologist who specializes in male infertility. He is located at the Baylor College of Medicine in Houston, Texas.

Coffee and vitamin C are claimed to improve sperm motility. There is conflicting evidence on whether caffeine is good or bad for sperm counts. Caffeine added to washed sperm does help motility, but whether caffeine taken internally will help is questionable. Vitamin C does have a tendency to help other vitamins absorb.

Vitamin E: May help sperm attach better to the egg. Recommended dose is 600 mg per day. An improvement was shown in sperm function on the zona binding test, which may help increases chances of pregnancy.

Vitamins and herbs: Rachel Browne has suggested the following formula which seems to have helped her husband: multi vitamin (without iron but with zinc), 1 mg C, 1000 mg l-arginine, 200 IU E, Bee Pollen and Siberian Ginseng in 500 mg pills, 100 mcg selenium, high potency B-complex, and 250 mg l-carnitine. His multi vitamins have: 10000IU beta carotene, 400 IU D, 150 mg C, 100 IU E, 25 mg B1, 25 mg B2, 25 mg B6, 100 mcg B12, 100 mcg niacinamide, 50 mg pantothenic acid, 300 mcg biotin, 400 mcg folic acid, 25 mg PABA, 25 mg choline bitartate, 25 mg inositol, 25 mg calcium, 7.2 mg magnesium, 5 mg potassium, and 15 mg zinc.

Microsurgical epididymal sperm aspiration (MESA), testicular sperm aspiration or extraction (TESA, TESE) and percutaneous epididymal sperm aspiration (PESA): MESA, TESA,PESA and other forms of retrieving sperm are used when there is no sperm in the ejaculate are used in conjunction with IVF and often with ICSI. Depending on where this is done, it can be done with a needle, a microscopic needle, or surgery. See http://www.ihr.com/bafertil/articles/azoosper.htm or http://www.maleinfertility.org/new-retrieval2.html

Other treatments include surgery to remove blockage, vasectomy reversal (of course), and some kind of gadget which men wear to cool the scrotum area.