Thanks to the many breakthroughs in fertility treatment in recent years, today’s women and men have a variety of options to discuss with their doctors. At Michigan Reproductive Medicine, we believe in fully explaining each available option, and then developing a treatment customized and most cost-effective to a couple’s individual diagnosis and circumstances.
To help you get started, here is an overview of the many types of fertility treatments available to meet your medical needs. Should you have any questions, please do not hesitate to set up an appointment for a consultation.
The majority of women and men struggling to overcome infertility in the U.S. (85 to 90 percent), are treated with conventional therapies such as medical or surgical treatment, as opposed to IVF or assisted reproductive technology (ART), according to the American Society of Reproductive Medicine (ASRM). With improved success in ART, surgical treatments are chosen less often.
What this means is that there are a wide range of choices for treatment, both medical and surgical, for you and your physician to discuss. The choice of which treatment to choose should be based on your individual circumstances.
Although you will discuss this more fully with your physician, here is an overview of the medical options for hormone imbalances in men:
Treatment for Sperm Production Disorders
Sperm take about 72 days to complete development from stem cells to a mature sperm ready for release. Any insult to the testicle can impair sperm production and progress to mature sperm having the capacity to successfully fertilize an egg. Physical trauma, chemical and radiation exposure, viruses, heat, various causes of ill health and genetic abnormalities can contribute to abnormally reduced sperm production and function. It can take at least 3 months or greater for recovery of normal sperm production.
Abnormally Low FSH and LH Results in not Turning on the Testicle to Produce Sperm
Men may have abnormally low levels of the essential fertility hormones named follicle stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland that are needed to promote sperm production and development. Testosterone blood levels are usually lower than normal. These men will probably respond well to the gonadotropin, injectable fertility medications that contains FSH, LH and hCG, thereby replenishing the missing hormone and directing the otherwise normal testicles to release an egg. Since clomiphene and tamoxifen will usually stimulate FSH and LH release from a man’s brain, if a man cannot make FSH or LH, then clomiphene and tamoxifen will be ineffective as a fertility medication.The prognosis for successfully having a baby are very high with gonadotropin medications.
Abnormally Low Sperm Concentrations with Normal FSH, LH and Testosterone Levels
When hormone levels are normal, but sperm production is low, use of clomiphene, tamoxifen or Anastraozole (similar to letrozole) may assist in promoting improved sperm production by raising the FSH and LH output by the brain and thus stimulating the testicles to produce sperm in high quantities. A trial of three months is sufficient to assess if this treatment will be of benefit to fertility. Clomiphene and tamoxifen can have depressive effect of a man’s mood as ill side effects.
Abnormally Low Sperm Concentrations with Abnormally High FSH, LH and Testosterone Levels (Diminished testicular reserve)
Men with abnormally high levels of the essential fertility hormones named follicle stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland and abnormally low sperm concentration likely have diminished testicular reserve. In this condition, his brain is already releasing fertility hormones at maximum output. Use of clomiphene, anastrozole and gonadotropins are unlikely to cause an increase in testicular function and yield improved sperm production. IVF therapy with intracytoplasmic sperm injection (ICSI) will likely provide the best opportunity to have a child. Alternative of selection and use of anonymous donor sperm with therapeutic donor sperm insemination (TDI) may need to be considered.
Other Hormonal Disorders Causing Low Sperm Concentration
Men with high levels of prolactin, low thyroid hormone levels (hypothyroidism) and genetic abnormalities that cause adrenal rest tumors to develop can result inlow FSH hormone levels from the pituitary gland in the brain, turns off testicle function with failure to produce sperm. These patients tend to respond very favorably to medications (cabergoline) that lower prolactin secretion and/or replace thyroid hormone with levothyroxine (Synthroid®). Adrenal rest tumors may regress with prednisone steroid therapy, but improvement in semen quality is less certain.
