Frontiers in hormone therapy for male infertility

Abstract

For a significant number of couples worldwide, infertility is a harsh reality. As specialists in male infertility, much of our armamentarium lacks definitive, evidence-based therapies. For years, we have relied on manipulation of the male hormonal axis to treat those men who help carry the burden of infertility in their partnerships. Indeed, male factor infertility is the sole component of infertility in at least 20% of couples. Further compounding this dilemma is that 25% to 50% of males with infertility have no identifiable etiology and thus present a true management conundrum. This manuscript is an attempt to clarify what therapies exist for the treatment of male factor infertility. We have reviewed the relevant infertility literature honing, our focus on hormonal anomalies and their subsequent impact on fertility. Many of the therapies discussed have been utilized in practice for generations. Thus, this article attempts to provide the evidence-based literature to support the continued use of the current treatment paradigm. Furthermore, we recognize that any review beckons a discussion of what challenges and therapies await on the horizon. For instance, there has been significant interest in restoring spermatogenesis after testosterone replacement therapy (TRT). We explore the adverse long-term spermatogenic outcomes associated with TRT, which with the widespread use of TRT, will inevitably present a great challenge for male infertility specialists. Moreover, we discuss the role of varicocelectomy in the treatment of hypogonadism and infertility, review the association between growth hormone (GH) and male fertility and address the challenges presented by the rising prevalence of obesity.

Colibri® insecticide induces male reproductive toxicity: alleviating effects of Lannea acida (Anacardiaceae) in rats

“…Clomiphene citrate is a selective estrogen receptor modulator and is the common hormonal therapy for idiopathic male infertility [30]. By preventing the negative feedback imposed by estrogen on the hypothalamo-pituitary axis, this molecule increases the secretion of luteinizing hormone (LH) and subsequently testosterone synthesis [31]. The rise observed in testosterone concentration after plant extracts application could strongly justify these increases in body and organ weights.…”

CircRNA expression profile and functional analysis in testicular tissue of patients with non-obstructive azoospermia

“…Infertility is a worldwide reproductive health problem that affects an estimated 70 million people globally [1]. The world Health Organization estimate that 10–15% of couples struggle with infertility issues and male factors account for about half of all infertility cases [2, 3] Unfortunately, nearly 60–75% of male infertility is unexplained or idiopathic, since the molecular mechanisms underlying the defects remain unknown [4, 5]. Non-obstructive azoospermia (NOA) is the most severe manifestation of male infertility which spermatogenesis process is disrupted [6, 7], it affects 1% of males and 10% of those who seek fertility assistance [8].…”

Genetic causes and management of male infertility

“…If FSH/LH is normal and testosterone is low or hypergonadotropic hypogonadism, which is typically found with Klinefelter syndrome, there is minimal benefit in treatment as increasing FSH/LH would not stimulate atrophic testicles. Exogenous testosterone does not confer benefit for spermatozoa production (41). If hypogonadotropic hypogonadism is found, then clomiphene citrate or HCG can be used to correct the abnormality (42).…”