Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
assisted reproductive techniques (ART)
Men with anti-sperm antibodies are better treated with ART; artificial insemination with sperm wash or IVF with intracytoplasmic sperm injection (ICSI) are better options.
IVF has a higher pregnancy rate than intrauterine insemination (IUI) per cycle of therapy.[79] Multiple pregnancies are a possible complication of IVF. The best way to reduce this complication is through the use of single embryo transfer in young patients with good prognosis.[80][81]
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ART is also linked to a small increased risk of poor pregnancy outcome and birth defects; however, an increased risk related to infertility itself cannot be excluded.[77][82]
Risks of testicular sperm extraction and microsurgical epididymal sperm aspiration include testicular haematoma, pain, and infection. Intracytoplasmic sperm injection has been implicated as a risk factor for Beckwith-Wiedemann and Angelman syndromes and other consequences of abnormal methylation. This association is not well confirmed.
hormonal treatment
Meta-analyses suggest that gonadotrophin treatment for men with idiopathic male subfertility or infertility may improve live birth rate and pregnancy rate; quality of evidence was variable, with high risk of bias.[65][66]
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The American Urological Association (AUA) guidelines recommend consideration for FSH therapy in idiopathic infertility.[29]
Primary options
follitropin alfa: 150 international units subcutaneously three times weekly for 6 months
antioxidants
Additional treatment recommended for SOME patients in selected patient group
Men with idiopathic infertility are likely to benefit from antioxidant therapy.
Antioxidants such as vitamins C and E, L-carnitine, pentoxifylline, and glutathione are used for idiopathic male infertility. These medicines are used empirically. Some observational and in vitro studies showed improvement in sperm parameters. Low-quality evidence has suggested that there is an improvement in pregnancy rates and live birth rates after male treatment with antioxidants.[67][68]
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Pentoxifylline can improve testicular microcirculation, sperm motility, and sperm concentration.[83]
Vitamins C and E, L-carnitine, and glutathione are thought to reduce the reactive oxygen species in the testicular environment. The exogenous administration of coenzyme Q-10 increases the level of the same and ubiquinol in semen and is effective in improving sperm kinetic features in patients affected by idiopathic asthenozoospermia.[84][85][86] Supplemental selenium and acetylcysteine improve semen quality.[87][88]
assisted reproductive techniques (ART)
Studies show that intrauterine insemination (IUI) is superior to timed intercourse in achieving pregnancy for opposite-sex couples with male factor infertility.[69] Controlled ovarian stimulation with IUI might improve pregnancy rates further.
Pregnancy rates with IUI are optimised with post-wash total motile sperm >9 million sperm/mL; however, as there is a gradual decline in pregnancy rates at lower counts, a hard threshold above which IUI ought to be recommended is not available.[71] Double insemination may increase pregnancy rates in cases with male factor infertility, but the evidence is inconsistent.[72]
IVF has a higher pregnancy rate than IUI per cycle of therapy.[79] Multiple pregnancies are a possible complication of IVF. The best way to reduce this complication is through the use of single embryo transfer in young patients with good prognosis.[80][81]
[ ]
[ ]
ART is also linked to a small increased risk of poor pregnancy outcome and birth defects; however, an increased risk related to infertility itself cannot be excluded.[77][82]
Risks of testicular sperm extraction and microsurgical epididymal sperm aspiration include testicular haematoma, pain, and infection.
Intracytoplasmic sperm injection has been implicated as a risk factor for Beckwith-Wiedemann and Angelman syndromes and other consequences of abnormal methylation. This association is not well confirmed.
Donor insemination can be an option for men with severe oligozoospermia/azoospermia who decline ART or men with absent spermatogenesis.
Choose a patient group to see our recommendations
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
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