Treating Male Infertility

A wide variety of treatment options are available for the many causes of male infertility.  Simple lifestyle changes, like abstaining from alcohol, tobacco, and illicit drugs can improve male fertility.  A healthy diet, sufficient exercise (but not excessive exercise), and proper amounts of vitamin B12, vitamin C, and zinc also improve fertility.

Treating Hormonal Problems:

Several drugs are available to treat pituitary and hormonal imbalances:
· If LH and FSH levels are low and the hypothalamus and pituitary gland are functional, the drug
  clomiphene citrate (Serophene, Clomid) is able to stimulate the hypothalamus to release GnRH at
  regular intervals and restore fertility.
· If the pituitary is malfunctioning and not manufacturing the necessary sex hormones, hormone
  replacement therapy can restore fertility.  Injections of hCG (human chorionic gonadotropin)
  increases the LH supply and can stimulate the testes to produce testosterone and sperm.
· If unresponsive to hCG, the drug Pergonal (a combination of LH and FSH) can stimulate sperm
  production.
·  The drug Parlodel (bromocriptine) can correct hyperprolactinemia.
· Cortisone replacement therapy can lower abnormally high androgen levels and allow the pituitary
  to function normally to restore fertility.
· Hormone replacement therapy usually works in about 4 months.

Treating Physical Problems:

Varicocele:  Are most successfully repaired by microsurgery.  Surgical repair improves the semen in 70 percent of men and results in pregnancy in 60 percent of couples.  Surgery involves the interruption of the damaged testicular veins.  Men who are infertile due to varicoceles can also achieve fertilization via intrauterine insemination, in-vitro fertilization (IVF--more on this technique later), and treatment with the drug clomid.

Blocked Ducts:  As mentioned earlier, the path through which sperm pass from the testicle to outside of the penis can become interrupted or blocked by several conditions.  In the case of voluntary or accidental vasectomy, a vasectomy reversal can be performed which reconnects the testicle to the vas deferens.  Tubal scarring due to an STD or tuberculosis can also be fixed by microsurgical techniques.  In the cases of a congenital absence of the vas deferens, failed vasectomy reversals, and other irreparable obstructions, menís sperm can be retrieved via three methods.  Once sperm is retrieved, the sperm are used to fertilize the egg of a woman who has undergone a typical IVF cycle.
Sperm retrieval methods are:
· Micro Epididymal Sperm Aspiration (MESA)--involves a delicate surgical technique that utilizes
  a microscope to get a sperm sample from a location proximal to the tubal obstruction.
· Percutaneous Epididymal Sperm Aspiration (PESA)--a small needle is used to aspirate sperm
  from a location proximal to the tubal obstruction.
· Testicular Sperm Biopsy (TESE)--a small biopsy of testicular tissue is taken and a sperm sample is
  removed from the biopsy.

Ejaculatory Disfunction:  Men who suffer from conditions that render them unable to ejaculate (neurologic disease, traumatic injury, or surgical complication), can achieve ejaculation by two currently used techniques.
· Vibratory stimulation employs a custom designed mechanical vibrator to stimulate the underside of
  the glans penis to induce a reflex ejaculation.  This technique only works in patients with an intact
  ejaculatory reflex arc.
· For men for which vibratory stimulation is ineffective, a procedure called electroejaculation can be
  used to induce ejaculation. A specially designed electric probe is inserted into the rectum next
to the prostate.  A current generated by the
  device stimulates the nerves of the pelvic muscles to induce a contraction and cause an ejaculation.
  Retrograde ejaculation can be treated with decongestant medication (which causes the bladder
  sphincter to close and allows semen to pass to the penis) or by tubal constructive surgery.

Treating Psychological/Physical Problems:

Erectile Dysfunction:  Treatment for ED can be divided into four broad categories, pharmacological, mechanical, surgical, and psychological.
· Pharmacological treatment:  Involves the delivery of medications that restore erections.  Several
  drugs are currently used to treat ED.  Sildenafil (Viagra) is taken orally to increase penile blood
  flow; it is highly effective.  Caverject is a drug injected directly into the penis to cause an
  erection; it is highly effective.  Papaverine is another injectible drug that is highly effective.
  Yohimbine is a dietary supplement taken orally that is moderately effective.  Testosterone
  replacement therapy is highly effective for men with low testosterone levels.

· Mechanical Treatment:  Involves the use of a vacuum erection device with a constriction ring.
  The vacuum device vacuums the penis into an erection and the constriction ring keeps blood from
  exiting the spongy bodies of the penis to maintain the erection.  This treatment is effective but
  obviously cumbersome.

· Surgical Treatment:  Involves the use of implants or the correction of vascular damage/blockage
  to restore erectile capacity.  Penile implants work excellently:  there are 2 types.  A semi-rigid
  implant keeps the penis in a perpetual semi-rigid state.  Inflatable implants allow the man to
   ďpumpĒ his penis into an erection.  Arterial and venous reconstructive surgery works moderately
  well and may restore a manís ability to achieve an erection.
· Psychological therapy is useful in the cases of ED which are a direct result of psychological
  causes. These patients may also benefit from pharmacological or combination therapy.

Treating Premature Ejaculation:
Premature ejaculation can be treated by the squeeze technique in which a man is stimulated until close to orgasm and then his frenulum is squeezed by his partner.  This procedure is repeated until the penis becomes desensitized and longer intercourse becomes feasible.  Premature ejaculation can also be treated by collecting the ejaculate and using artificial insemination to fertilize the egg.

Treating Ejaculatory Incompetence:
Ejaculatory incompetence can be treated by behavioral therapy in some cases.  With behavioral therapy, ejaculation may be stimulated by combining masturbation and manual stimulation with eventual penile insertion into the vagina.  If this therapy does not work, artificial insemination with an ejaculate obtained through masturbation can be used to overcome infertility.

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