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Sperm and Infertility - Drug Therapies

The sperm production process is extremely complex. It takes place over about ten weeks and involves the expression of at least 100 genes. It is no surprise that there is no single medication that can fix most sperm problems.

There have been a number of candidates for drugs to fix the sperm count. One important issue related to research in sperm counts is that sperm counts vary much from day to day and some men with normal sperm counts will have low sperm counts on occasion. This means that it takes several (two or three) semen analyses to determine if men have truly low sperm counts. In addition, using men as their own controls (or comparison group), cannot provide valid results. Generally, if you select men on the basis of having a single low sperm count and then do anything to them, the average sperm count will go up (since some men did not truly have a low sperm count).

The most widely used medication used to improve sperm counts is clomiphene citrate. I am only aware of one controlled study that looked at the effect of clomiphene on improving sperm count. It was not effective. Given the widespread popularity of this therapy, one wonders if this therapy might work in some subset of patients. However, I have not seen any good way to define that subset of patients.

Testosterone has also been used to improve sperm counts. Generally, testosterone suppresses the sperm count. After stopping testosterone, some men have a rebound increased count. Some men will continue to have a suppressed sperm count. Thus, this is not a good therapy for men wishing to achieve pregnancy.

There are several studies looking at using FSH containing medications, gonadotropins, in men with low sperm counts. Treatment resulted in "better quality" sperm as judged by better results with IVF, but not an improved sperm count. With the widespread availability of ICSI, there does not seem to be much value in this treatment since most programs use ICSI when there is any question about the quality of the sperm.

There is one recent drug therapy for a subset of the men with a low sperm count that has been shown to be effective. Aromataze inhibitors have been shown to improve the sperm counts in men with low sperm counts and low testosterone to estradiol ratios.

Acupuncture has also been advocated for improving low sperm counts. Information is still preliminary, but one carefully done study did not show an improvement in sperm count, but did show an improvement in morphology as judged by electron microscopy. The clinical significance of this paper is unclear, but is provocative.