madman
Super Moderator
Infertility in men: assessment and treatment (2022)
By Ramjan S Mohamed, Danai T Balfoussia & Channa N Jayasena
An overview of the causes and endocrinology of male infertility considering the available treatment options, the role of medicines, and how pharmacists can support patients.
CPD module
After reading this article, test your knowledge by completing the CPD questions and receive a certificate as a record of your learning.
After reading this article, you should be able to:
-Recognise the contribution of medication to male factor infertility;
-Be aware of drugs that are potentially teratogenic and advise patients to seek advice from their specialist team prior to attempting conception;
-Understand the rationale and evidence base of medical treatments for male factor infertility;
-Appreciate the duration and potential side effects of pharmacological treatment of male factor infertility.
Infertility is the inability to conceive after one year of regular unprotected intercourse. It is estimated that infertility affects one in seven heterosexual couples in the UK, with 30% of these cases being attributed to the man[1]. In a quarter of cases, no identifiable cause is found and male factor subfertility is classed as idiopathic[2].
Sperm production is hormonally driven and precisely controlled. In normal physiology, sperm is produced when gonadotrophin-releasing hormone (GnRH), a neuropeptide secreted from specialized neurons of the hypothalamus, stimulates follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion from the anterior pituitary gland. LH in turn stimulates Leydig cells in the testes to synthesize testosterone while FSH acts on Sertoli cells in the testes to promote spermatogenesis. The final maturation of the spermatozoa is dependent on intra-testicular testosterone[3].
Disrupted testicular maturation or hormonal imbalances affecting any stage of spermatogenesis can result in infertility. Male factor subfertility is often medically or surgically treatable and can be connected to the use of certain drugs or medicines.
This article provides an overview of the pathophysiology of male infertility, as well as the diagnosis and assessment, and treatment options, highlighting opportunities for pharmacist involvement.
Causes of male infertility
Causes of male infertility may be classified into four broad groups (see Figure):
1. Impaired sexual function;
2. Primary testicular defects;
3. Endocrinopathies that reduce spermatogenesis;
4. Defects in sperm transportation[4].
Idiopathic primary testicular dysfunction remains the most common cause of male factor infertility[5].
*Impaired sexual function
*Primary testicular defects
*Endocrinopathies
*Congenital causes of hypogonadotropic hypogonadism
*Acquired causes of hypogonadotropic hypogonadism
*Defects in sperm transportation
*Teratogenicity of certain medications
*Clinical features
*Diagnosis and assessment
*Management
*Conservative management
*Medical
*Medical therapy for erectile dysfunction
*Medical therapy for hypogonadotropic hypogonadism
*Medical therapy for oligospermia and non-obstructive azoospermia
*Surgical
Conclusion
Male infertility is relatively common and should be approached in a sensitive manner. Medication can contribute to male factor subfertility through different mechanisms and pharmacists should be vigilant of this. Whilst antioxidants are safe, the evidence base supporting their use as a means of enhancing fertility is limited. The only licensed male medical treatment is for hypogonadotropic hypogonadism. Use of SERMs, AIs, and hCG for oligospermia or prior to surgical sperm retrieval for non-obstructive azoospermia is off-license and with limited evidence to support its use.
By Ramjan S Mohamed, Danai T Balfoussia & Channa N Jayasena
An overview of the causes and endocrinology of male infertility considering the available treatment options, the role of medicines, and how pharmacists can support patients.
CPD module
After reading this article, test your knowledge by completing the CPD questions and receive a certificate as a record of your learning.
After reading this article, you should be able to:
-Recognise the contribution of medication to male factor infertility;
-Be aware of drugs that are potentially teratogenic and advise patients to seek advice from their specialist team prior to attempting conception;
-Understand the rationale and evidence base of medical treatments for male factor infertility;
-Appreciate the duration and potential side effects of pharmacological treatment of male factor infertility.
Infertility is the inability to conceive after one year of regular unprotected intercourse. It is estimated that infertility affects one in seven heterosexual couples in the UK, with 30% of these cases being attributed to the man[1]. In a quarter of cases, no identifiable cause is found and male factor subfertility is classed as idiopathic[2].
Sperm production is hormonally driven and precisely controlled. In normal physiology, sperm is produced when gonadotrophin-releasing hormone (GnRH), a neuropeptide secreted from specialized neurons of the hypothalamus, stimulates follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion from the anterior pituitary gland. LH in turn stimulates Leydig cells in the testes to synthesize testosterone while FSH acts on Sertoli cells in the testes to promote spermatogenesis. The final maturation of the spermatozoa is dependent on intra-testicular testosterone[3].
Disrupted testicular maturation or hormonal imbalances affecting any stage of spermatogenesis can result in infertility. Male factor subfertility is often medically or surgically treatable and can be connected to the use of certain drugs or medicines.
This article provides an overview of the pathophysiology of male infertility, as well as the diagnosis and assessment, and treatment options, highlighting opportunities for pharmacist involvement.
Causes of male infertility
Causes of male infertility may be classified into four broad groups (see Figure):
1. Impaired sexual function;
2. Primary testicular defects;
3. Endocrinopathies that reduce spermatogenesis;
4. Defects in sperm transportation[4].
Idiopathic primary testicular dysfunction remains the most common cause of male factor infertility[5].
*Impaired sexual function
*Primary testicular defects
*Endocrinopathies
*Congenital causes of hypogonadotropic hypogonadism
*Acquired causes of hypogonadotropic hypogonadism
*Defects in sperm transportation
*Teratogenicity of certain medications
*Clinical features
*Diagnosis and assessment
*Management
*Conservative management
*Medical
*Medical therapy for erectile dysfunction
*Medical therapy for hypogonadotropic hypogonadism
*Medical therapy for oligospermia and non-obstructive azoospermia
*Surgical
Conclusion
Male infertility is relatively common and should be approached in a sensitive manner. Medication can contribute to male factor subfertility through different mechanisms and pharmacists should be vigilant of this. Whilst antioxidants are safe, the evidence base supporting their use as a means of enhancing fertility is limited. The only licensed male medical treatment is for hypogonadotropic hypogonadism. Use of SERMs, AIs, and hCG for oligospermia or prior to surgical sperm retrieval for non-obstructive azoospermia is off-license and with limited evidence to support its use.
