Using fertility medications for male infertility – success depends on the pituitary gland.
In order to assess the potential of a male to respond to fertility drugs aimed at stimulating the testicles to produce more spermatozoa and/or male hormone, it is therefore necessary to first measure both FSH and LH which are produced by the pituitary gland, as well as prolactin and the male hormones testosterone, androstenedione, dehydroepiandrosterone, Measurement of these hormones gives an indication as to the likelihood of the man responding to treatment aimed at: 1) inducing increased production of FSH or FSH/LH ( e.g.; clomiphene</p>citrate) or, 2) the direct administration of gonadotropins which comprise of FSH, LH or HCG [e.g. Pergonal, Repronex, Bravelle, Follistim, Gonal F and/ or Profasi (HCG)]
Clomiphene Citrate (The first approach). Clomiphene citrate is a hormone which, through its central action in the brain, stimulates the pituitary gland to produce natural FSH in large amounts. The FSH, in turn, as mentioned above, stimulates spermatogenesis. The treatment is very simple, and involves the administration of 1/2 (25 mg.) of Clomiphene citrate every alternate day for a period of 100 days, to perform a baseline semen analysis, FSH, LH, and male hormone measurements immediately prior to initiating therapy, and then to serially repeat all of these tests throughout the treatment with Clomiphene. The final assessment of response can only be made approximately 100 days after initiating therapy. This administration of Clomiphene is essentially harmless to the man. He may experience some minor side effects such as spots in front of the eyes, dryness of the mouth, headaches, slight changes in mood, and, rarely, hot flashes. These side effects are all reversible upon discontinuation of therapy.
Gonadotropin Therapy. In cases where Clomiphene therapy fails to be successful, or in certain situations where it is not possible for Clomiphene to stimulate the pituitary gland into action, it is possible to administer FSH alone or in combination with LH in the hope of stimulating the testicles directly. This therapy, in certain cases of male infertility, might be combined with the administration of the hormone human chorionic gonadotropin (HCG), which is also a natural hormone, which has a function similar to that of LH. The basis upon which HCG would be administered would be in order to further stimulate the production of male hormones in cases where failed masculinization is associated with reduced sperm production. Administration of these drugs is usually carried out 3 times per week, again for a period of about 100 days, and the same hormonal and sperm assessments as stipulated for Clomiphene therapy would apply. The treatment is, again, relatively harmless, and the minor side effects which might occur are all reversible upon discontinuation of therapy.
Other hormonal therapies: There is very little evidence that the administration of vitamin preparations or specific male hormone administration would be of benefit in the treatment of male infertility. In come cases, there may be systemic conditions affecting other areas of the body which indirectly might impact upon the pituitary gland’s ability to produce the hormones necessary to stimulate testicular function. Rare examples include administration of Thyroid Hormone in cases of involvement of the thyroid gland, severe diabetes mellitus, and collagen diseases amongst others. Sometimes the pituitary gland produces too much prolactin, which in turn inhibits the ability of FSH and LH to act on the testicles. In such cases, it may be necessary to administer a drug called Parlodel (Bromocriptine) to suppress prolactin production, and thereby remove the restraining effect that prolactin might have on the action of FSH upon the testicles. There are, of course, many other such examples of where treatment of unrelated conditions might improve overall male fertility, Testosterone is only mentioned because it is prescribed so often to try and improve sperm function. Such treatment is in fact contraindicated because prolonged use (more than 2-3 months) of testoserone will almost always have the reversed effect, compromising sperm count, motility and even morphology.
If the man is fortunate enough to respond to one of the above treatment modalities for enhancement of sperm production, then it is possible for a number of masturbation specimens of sperm to be collected and frozen in liquid nitrogen in order to be kept for a number of years so that there will always be relatively good quality sperm on hand, even if the fertility treatment is discontinued, and you revert back to a relatively poor production of sperm subsequently. It is, of course, not practical to permanently treat an individual on potent medications such as Clomiphene, or gonadotropins.