Empirical medical therapy in idiopathic male infertility: Promise or panacea?

Abstract

Male factors account for 20%-50% of cases of infertility and in 25% of cases, the etiology of male infertility is unknown. Effective treatments are well-established for hypogonadotropic hypogonadism, male accessory gland infection, retrograde ejaculation, and positive antisperm antibody. However, the appropriate treatment for idiopathic male infertility is unclear. Empirical medical treatment (EMT) has been used in men with idiopathic infertility and can be divided into two categories based on the mode of action: hormonal treatment and antioxidant supplementation. Hormonal medications consist of gonadotropins, androgens, estrogen receptor blockers, and aromatase inhibitors. Antioxidants such as vitamins, zinc, and carnitines have also been widely used to reduce oxidative stress-induced spermatozoa damage. Although scientifically acceptable evidence of EMT is limited because of the lack of large, randomized, controlled studies, recent systematic reviews with meta-analyses have shown that the administration of gonadotropins, anti-estrogens, and oral antioxidants results in a significant increase in the live birth rate compared with control treatments. Therefore, all physicians who treat infertility should bear in mind that EMT can improve semen parameters and subsequent fertility potential through natural intercourse.

Association between periodontal status and idiopathic male infertility

“…The estimated prevalence of infertility among couples of reproductive age is 15% (13), and almost half of such cases are attributable to disturbances in male fertility (14). Although the causes of male infertility have been extensively investigated, 25% of male infertility cases are idiopathic (14).…”

“…Although the causes of male infertility have been extensively investigated, 25% of male infertility cases are idiopathic (14). Periodontitis might have a role in subfertility (15).…”

Correlation of Seminal Plasma Total Antioxidant Capacity and Malondialdehyde Levels With Sperm Parameters in Men With Idiopathic Infertility

“…There are several known etiologies of infertility, such as male accessory gland infection, hypogonadotropic hypogonadism, retrograde ejaculation, and positive anti-sperm antibody, but despite technical advances, the exact etiology of male infertility is not clear in 25% of all cases. Idiopathic male infertility is also known as idiopathic oligoasthenospermia, which indicates that the men have an unexplained reduction in semen quality (5).…”

Interventional study to find out effect of human chorionic gonadotropin and antioxidants on idiopathic male infertility

“…1 Affects about 15% of couples. 2 Both male and female contributes to infertility. Male factor is responsible for 30% of cases and contributes to an additional 20% in combination with female factor.…”

“…Thus 50% of cases of infertility can be explained by combined male and female factors. 2,3 When the cause of infertility cannot be identified, the condition is termed idiopathic. It is seen in 25% of men.…”