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Other Male Fertility Treatments
Hormones and Other Drugs
Hormone therapy has been effective for women with infertility problems but has been disappointing in men except in a few specific cases. Gonadotropin–releasing hormone (GnRH) is very useful for men with gonadotropin deficiency and hypogonadism. Sperm production occasionally responds to low doses of estrogen and testosterone or testosterone alone, menotropins (Pergonal, Repronal), clomiphene citrate (Clomid), human chronic gonadotropin (HCG), or human follicle stimulating hormone (r–hFSH). A few other drugs may be helpful for specific cases. Bromocriptine (Parlodel) counteracts excess prolactin manufactured by the pituitary. Infections and leukocytospermia (an excess of white blood cells) are treated with antibiotics.
Treatment for Retrograde Ejaculation and Failure of Emission
Men with retrograde ejaculation and failure of emission caused by surgery, severe disease, or spinal cord injury are treated with various methods. Retrograde ejaculation can be managed by first having the man take sodium bicarbonate four times a day to reduce the acidity of the urine. After ejaculation, the man urinates or has a catheter (a tube) inserted to withdraw urine, which is then submitted for washing techniques to separate out the sperm. Using any of these methods, the sperm are collected for intrauterine insemination or assisted reproductive techniques.
Techniques for Men with Spinal Cord Injury
Procedures that assist ejaculation are helping men with spinal cord injury conceive children. Ejaculation was achieved in all men in one study group with the use of vibratory or electronic stimulation. The sperm was then inserted into the women using self–insemination, IUI, IVI, or ICSI. Nearly a third of the couples achieved pregnancy, a success rate that approaches natural conception.
For men who wish to conceive after vasectomy, they may try ART procedures or reversal surgery (vasovasostomy). For men who have failed vasovasostomy, however, a repeat procedure appears to be less expensive than embarking on fertility treatments at that time.
In vasovasostomy (reversal surgery) the severed ends of the vas deferens are reconnected to re–establish the flow of sperm. The reversal procedure is difficult, it involves sewing together the two ends of both tubes, each with pinhead sized openings. Laser surgery is being investigated and may prove to require lesser skills, reduce operating time, and result in fewer complications. The chances for pregnancy increases with shorter the duration between vasectomy and the reversal operation..
A vasoepididymostomy is used to clear obstruction in the epididymis, which is a common reason, by reversal surgery (Obstruction can also occur as birth defect). Vasoepididymostomy is a very difficult operation involving the tiny tubules of the epididymis, which are 1/300 of an inch wide with a wall thickness of 1/1000 of an inch, and requires great surgical skill. Pregnancy rates are around 20% after this procedure.
Treating Antisperm Autoantibodies
ART is the best approach at this time for men with evidence of antisperm auto antibodies due to vasectomy or other causes. High doses of corticosteroids may be useful in conjunction with intrauterine insemination. Their effectiveness however, is not proven and they have potentially serious side effects with prolonged use. Interesting research is testing a factor called fertilization antigen (FA–1), which may be able to remove auto antibodies from the sperm surface. Some experts believe however, immune factors are not significant in causing infertility, and that many men can still conceive despite antibodies to their sperm.