Treatment of Male Infertility

Our insight into the mechanisms of the physiology of reproduction has experienced a swift and constant development these last few years. The advent of more sophisticated diagnostic methods and their relatively easy clinical application allow for the incorporation of that knowledge into the evaluation of the infertile couple. These facts, together with an obvious change in social psychology, have facilitated the development of different specialities dealing with the problems of infertility. It is now possible in medical centers all around the world to undertake a better disposition of the infertile husband to look for advice, to be studied, and treated. Confronted with this situation we are still unable to offer specific therapy in most cases; however, empirically based therapy abounds. Advances in therapy have not kept pace with our increased physio logical knowledge and improved diagnostic techniques. Patho physiological mechanisms and etiological factors in male infertility are largely unknown. This has significantly hampered both clinical evaluation and advances in treatment allowing for frequent non scientific therapeutic incursions into the armamentarium of the an drologist. Several factors have given birth to therapeutic "fashions", which are bound to survive as long as this state of lack of knowledge con tinues. For example, we may ask whether the treatment of varicocele constitutes a fashion? Though we accept the treatment of varicocele as the best available treatment of male infertility, we do not know its mechanism of action and so we cannot predict a therapeutic result.

I. General Considerations.- Male Infertility: Problems in Assessing Response to Treatment.- II. Medical Treatment.- 1 Inflammation and Infection.- 2 Clomiphene Citrate in the Treatment of Male Infertility.- 3 Tamoxifen.- 4 LHRH and Its Analogs in the Treatment of Idiopathic Normogonadotropic Oligozoospermia.- 5 Hyperprolactinemia in Male Infertility: Treatment with Bromocriptine.- 6 Gonadotropin Therapy in Male Infertility.- 7 Androgen Therapy in Hypogonadism and Infertility.- 8 Mesterolone: a New Androgen for the Treatment of Male Infertility.- 9 Kinin-Releasing Pancreatic Proteinase Kallikrein.- 10 Treatment of Male Infertility with Nucleotides.- 11 Immunological Infertility in Men: Clinical and Therapeutic Considerations.- 12 Nonsurgical Treatment of Varicocele.- 13 Retrograde Ejaculation.- 14 Sexual Dysfunction in the Male.- III. Surgical Treatment.- 15 Varicocele: Its Role in Male Infertility.- 16 Obstruction in the Male Reproductive Tract.- 17 Hydrocele, Spermatocele, and Peyronie's Disease.- IV. Cryopreservation and Insemination.- 18 Cryopreservation and Pooling of Spermatozoa.- 19 Enhancement of Sperm Motility: Selecting Progressively Motile Spermatozoa.- 20 Artificial Homologous Insemination.- 21 In Vitro Fertilization: Future Treatment for Male Infertility.- V. Closing Remarks.- The Last Word-For Now.