There exists in the man a cyclical production of spermatozoa where the duration of spermatogenesis from takes approximately 90 days. It follows that, any treatment aimed at enhancing sperm production requires approximately a period of 3 months. Since the enhancement of testicular function must of necessity be mediated through FSH and LH it follows that in order to assess response to testicular stimulatory drugs it is necessary to get a baseline FSH, LH and testosterone as well as a semen analysis and then to re-measured these parameters during and following a 3 month course of treatment There are a few basic approaches to the hormonal enhancement of sperm production:
- Clomiphene Citrate: Clomiphene citrate is a hormone which, through its central action on the brain, stimulates the pituitary gland to produce natural FSH in large amounts. The FSH, in turn, as mentioned above, stimulates spermatogenesis. The treatment is very simple, and involves the administration of 1/2 (25 mg.) of Clomiphene citrate daily for a period of 90 days, to perform a baseline semen analysis, FSH, LH, and male hormone measurements immediately prior to initiating therapy, and then to serially repeat all of these tests throughout the treatment with Clomiphene. The final assessment of response can only be made approximately 90 days after initiating therapy. This administration of Clomiphene is essentially harmless to the man. He may experience some minor side effects such as spots in front of the eyes, dryness of the mouth, headaches, slight changes in mood, and, rarely, hot flashes. These side effects are all reversible upon discontinuation of therapy.
- Letrozole: Like clomiphene, Letrozole is also an oral agent that causes FSH and LH to be released. The mechanism of action by which it does so is similar to clomiphene. The FSH then promotes Sertoli cell activity and spermatogenesis. Thus Letrozole can supplant clomiphene for promoting spermatogenesis. The duration of treatment is the same as with clomiphene.
- Gonadotropin Therapy: In cases where clomiphene/letrozole therapy fails or in certain situations where it is not possible for such treatment to stimulate the pituitary gland, FSH can be administered directly, alone combined with human chorionic gonadotropin (hCG). The hCG , functions similar to LH to further enhance the production of male hormones These hormones should be administered 3 times per week, for a period of about 90 days, whereupon hormonal and sperm assessments are repeated to determine effect. Such treatment is, relatively harmless and side effects are minor and reversible upon discontinuation of therapy.
- Other Therapies: I always advise the use of male fertility blends such as Proxeed or Proceptin which are rich in important vitamins and antioxidants. This having been said, there is only anecdotal evidence that the administration of such preparations is of real benefit in the treatment of male infertility. In some cases, there may be systemic conditions affecting other areas of the body which indirectly might impact upon the pituitary gland’s ability to produce the hormones necessary to stimulate testicular function. Rare examples include administration of thyroid hormone in cases of involvement of the thyroid gland, severe diabetes mellitus, and collagen diseases amongst others. Sometimes the pituitary gland produces too much prolactin, which in turn inhibits the ability of FSH and LH to act on the testicles. In such cases, it may be necessary to administer a drug called Bromocriptine (Parlodel) to suppress prolactin production, and thereby remove the restraining effect that prolactin might have on the action of FSH upon the testicles. There are, of course, many other such examples of where treatment of unrelated conditions might improve overall male fertility. The use of temperature lowering devices on the testicles and prevention of exposure to dangerous chemicals, et cetera, are reported as examples of preventative and even curative approaches. In our opinion they are of dubious value.