Approach to male infertility treatment

Most males seeking treatment for infertility (85 to 90%) require assisted reproductive technology  (ART), because sperm number or quality is too low to achieve unassisted conception. Sperm may be collected from semen, but in some cases testicular biopsy is necessary or donated sperm is required. ART is the treatment of choice for individuals with abnormal semen analysis of unknown cause. A range of other therapies has been tried but none consistently improves fertility, so they are not recommended. These include hormones and hormone antagonists (gonadotrophins, antiestrogens), nutritional supplements, anti-inflammatory drugs, antibiotics and physical therapies (testicular cooling).

ART is also the treatment of choice for infertility after vasectomy reversal. Factors affecting the decision to use ART following reversal include time since reversal, intraoperative findings and partner age.

Gonadotrophin therapy  can induce spermatogenesis and fertility in some males with hypogonadotrophic hypogonadism. If this is not successful, ART can be offered as second-line treatment.

Individuals with erectile dysfunction need investigation for underlying medical conditions before starting treatment.