National Men’s Health Month
Treatment Options for Male Infertility: A Brief Review
By: Meaghan Brophy
Director’s Note: It’s National Men’s Health month! Since it takes two to make a baby, today we discuss the important topic of male factor infertility. Meaghan Brophy, a former FACTS elective participant, summarized a 2022 overview of conventional and herbal treatment interventions for male infertility. [1] The brief summary discusses medical and surgical options as well as herbal remedies that may promote spermatogenesis, boost serum testosterone levels, treat erectile dysfunction, and improve sperm quality and quantity. To learn more about male infertility, check out Part B of our online CME course: Special Topics in FABMs for Helping Couples Achieve or Avoid Pregnancy.
Introduction
Infertility affects over 70 million couples worldwide. [1] Most cases of infertility result from a combination of male and female factors, with male fertility a contributing factor in approximately 50% of cases. [1] Male infertility can be due to hereditary or acquired conditions that impair sperm count, motility, and/or morphology; it may also result from idiopathic causes. Modern treatment options for male infertility include hormones, surgery, in-vitro fertilization (IVF), and herbal remedies, with intracytoplasmic sperm injection (ICSI) for IVF being the most common choice. [1]
“Male infertility can be due to hereditary or acquired conditions that impair sperm count, motility, and/or morphology; it may also result from idiopathic causes.”
Hormonal Treatment
Hormonal treatment of male infertility includes a range of options, with gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors among the most frequently used. [1] While it may seem like testosterone could be a viable option, it is to be avoided in the treatment of male infertility. Exogenous testosterone inhibits production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), further preventing spermatogenesis. Exogenous gonadotropins, including FSH and human chorionic gonadotropin (hCG), are administered to replicate the effects of endogenous FSH and LH, respectively. [1] This treatment is specifically therapeutic for infertility due to hypogonadotropic hypogonadism.
“[Testosterone should] be avoided in the treatment of male infertility, [as] exogenous testosterone inhibits production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), further preventing spermatogenesis.”
Surgical Management
Epididymovasostomy is a microsurgical option for male infertility. Designed to open a blocked epididymis, the procedure is often combined with microsurgical epididymal sperm aspiration (MESA) to maximize its effect on fertility rates. [1] Cryopreservation of recovered spermatozoa for ICSI can be combined with MESA if necessary. [1] Another surgical option is percutaneous aspiration of sperm from the epididymis (PESA). [1] If the MESA or PESA procedure fails to produce viable spermatozoa, the next best surgical option is testicular extraction of sperm for ICSI.
Herbal Remedies
Given the expense of assisted reproductive technology and modern medical treatments, some couples turn to herbal alternatives available since ancient times. Indian medicine uses a variety of plants, plant products, and plant extracts to treat several conditions including reproductive health disorders. [1] The herbal remedies work to improve spermatogenesis, and they have a lower likelihood of side effects than most medical and surgical approaches. [1]
Withania somnifera is used to improve spermatogenesis when prescribed as a whole plant. Along with Emblica officials, these herbal remedies have antioxidant properties that suppress lipid peroxidation in sperm cells, a process said to contribute to idiopathic male infertility. [1] Ten separate research studies report an increase in sperm count with Mucuna pruriens. Furthermore, its seeds enhance semen quality, boost several neurotransmitters, and increase serum LH and testosterone. [1]
“Ten separate research studies report an increase in sperm count with Mucuna pruriens. Furthermore, its seeds enhance semen quality, boost several neurotransmitters, and increase serum LH and testosterone.”
The presence of protodioscin in the extract of Tribulus terrestris has been shown to improve spermatogenesis via 5-alpha-reductase activity that converts testosterone to dihydrotestosterone, further stimulating Sertoli cells. [1] Root extracts from herbs named Eurycoma longifolia and Glycyrrhiza glabra are said to boost serum testosterone levels and treat erectile dysfunction, promoting increased libido. [1]
Summary
Male infertility is prevalent around the globe and its incidence varies by country. While the lack of health insurance coverage is a massive obstacle for most couples fighting the uphill battle of infertility, other barriers to adequate healthcare include a lack of education, low socioeconomic status, societal and cultural expectations, religious obligations, and access to specialty-trained urologists. [1] This field of medicine needs to further explore accessible, cost-effective options to support people in achieving their dreams of having their own offspring, even as infertility continues to impact millions of hopeful parents worldwide.
References
[1] Wal, A., Wal, P., Pandey, A., Vig, H., Karunakaran, R., & Dash, B. (2022). Conventional treatment options and herbal remedies for male infertility: An overview. Asian Pacific Journal of Reproduction, 11(4), 158–164. https://doi.org/10.4103/2305-0500.350150.
ABOUT THE AUTHOR
Meaghan Brophy
Meaghan Brophy is a fourth-year medical student at Georgetown University School of Medicine in Washington, DC. She completed her undergraduate education at the College of William and Mary in Williamsburg, VA and proceeded to obtain her master’s degree at Georgetown University prior to medical school. She plans to complete residency in family medicine with the U.S. Navy and is thrilled to enter the world of military medicine. She enrolled in the FACTS elective to learn more about natural family planning methods, including how to share this information effectively with patients. She hopes this will help them feel more empowered over their health and reproductive decisions, particularly while juggling military deployments and ever-changing life circumstances.
