Dr Kaylen Silverberg - How can you treat male infertility?
Medical Treatment Options for Male Infetility Include the Use of Clomid to Stimulate Sperm Production
Medical treatment is most often prescribed for
men who have hormonal abnormalities. For example, some men with low
sperm counts have low levels of the primary male hormone,
testosterone. Although the logical approach might be to give a man
with a low testosterone level supplemental testosterone, in fact,
that is the wrong thing to do.
Due to the complicated design of the
endocrine system, giving testosterone to a man can actually
decrease the sperm count. A similar situation exists in
women, where giving estrogen (like that found in a birth control
pill) can prevent egg development and ovulation.
Medical therapy can be very effective when the
right medication is given in the correct dose to men with low
hormone levels. The most commonly prescribed male fertility
medication is clomiphene citrate or Clomid – the same clomiphene citrate we
give to women to help them ovulate regularly. Clomiphene works
essentially the same way in both women and men; in women, it binds
to receptors in the brain (specifically the hypothalamus and the
pituitary gland) to increase the production of follicle stimulating
hormone (FSH) and luteinizing hormone (LH). These hormones act on
the ovarian follicles to induce egg development and ovulation. In
men, the increase in FSH leads to an increase in sperm production,
whereas the increase in LH leads to an increase in testosterone
production.
Whereas clomiphene is typically given to women
for 5 days early in their cycle, men need to take clomiphene every
day (as sperm production occurs every day). It is possible to
“overshoot” – i.e. for a man to over-respond to even low dose
clomiphene by making too much testosterone. As this can decrease
the sperm count, it is very important to re-check the man’s hormone
levels a few weeks after he begins taking clomiphene. The typical
starting dose for male clomiphene is 25 mg (1/2 pill) per day, but
if the repeat testosterone level is too high, this dose can be
reduced to ˝ pill every other day.
Another drug occasionally used for men with low
sperm concentrations is letrozole. This medication interferes with
the natural inter-conversion of estrogen and androgen that occurs in
men. This can lead to higher serum testosterone levels and,
frequently, sperm counts as well. Regardless of whether a man takes
clomiphene or letrozole, it typically takes between 90 and 108 days
from the time that a sperm is produced in the testicles until it is
eventually ejaculated. Therefore, although an increase in the
sperm count may appear within the first month of treatment, you
should not be discouraged if this does not happen, and you should
not discontinue taking the medication unless there is no improvement
by the fourth month of treatment.
Please note that before a man takes either of
these medications, it is very important that he have a normal
physical examination performed by a urologist. This is critical, as
sometimes a low sperm count can indicate a more serious underlying
problem, such as a varicocele, an obstruction, or even testicular
cancer.
