Male Fertility Treatments



 

The drugs and medications used in male fertility treatment are very similar, and sometimes exactly the same as those used in female fertility treatment.

The pituitary hormones FSH and LH are named for their action on the female ovaries, but they are the same hormones that act on the male testes.

There is a good record of inducing fertility in men with KS or HH but certain factors have to be taken into account.

 

Cryptorchidism:

Cryptorchidism, is the medical term for un-descended testes. The testes lie at the base of the abdominal cavity before birth and should drop into the scrotum shortly before or just after birth.

If they do not descended properly a short dose of medication or a simple operation may be required to move them into the correct position.

This condition is not rare affecting around 2 to 3% or all normal male births and usually leads to no lasting effects.

This condition occurs in the majority of a specific form of inherited type of Kallmann's syndrome, called x-linked Kallmann's syndrome, and is a major indicator to having Kallmann's if it is combined with a total lack of sense of smell.

If they remain un-descended after the first year of life it can lead to a increased risk of infertility. The testes need to be outside the body at a cooler temperature than the rest of the body in order to function correctly.

Testicular Biopsy:

A doctor may order a biopsy of one of the testes in order to determine if they still have the capacity to function correctly. A small piece of tissue is removed from one of the testicles and examined under a microscope.

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In male KS or HH the testes will be non-functioning due to lack of stimulation form the pituitary hormones. They will remain small in size, not increasing from childhood size. They will not be producing testosterone or sperm. 

If using testosterone therapy for a period of time the testes may appear to shrink even more and harden. This is because they effectively shut down because they have no active function. If testosterone therapy is stopped and pituitary hormones are given it has be shown that in the majority of cases the testes will start up again and can be induced into producing their own testosterone and sperm. This inducement into sperm production can take anything up to 6 to 18 months to occur.

There might be a reduction in the amount of semen produced, but most of the fluid in semen does not come from the testes. Normal ejaculation is normally possible even though in most cases no viable sperm would be produced.

If the levels of testosterone have been corrected in KS or HH there should be no effects on the ability to have erections or ejaculations.

If a person has KS or HH it is advised that a sperm test is done before assuming that no viable sperm are being produced. There are even rarer forms of HH where a very low level of sperm production is possible, even if it appears there has been no testicular development. If in doubt it might be advisable to use a form of contraception if appropriate.

 





Pituitary Hormones.

 

The anterior pituitary gland releases a range of hormones with various functions around the body.

Luteinising hormone (LH) and Follicle Stimulating Hormone (FSH) are known as gonadotrophins because they act on the gonads (testes or ovaries) to release the sex hormones. The term luteinising hormone and follicle stimulating hormone refers to their actions on the ovaries, but it is the same hormone that affects the testes in men.

The amounts of LH and FSH released by the pituitary are very small. However there is a another natural source of gonadotrophins, which have a very similar structure and almost identical chemical function as FSH and LH.

 

hCG ------- human chorionic gonadotrophin

hMG -------  human menopausal gonadotrophin

 

hCG is secreted by the placenta of pregnant women. It is an early form of LH and is used by the developing foetus. Excess LH is readily excreted into the urine. A highly purified form of hCG can then be obtained from the urine.

Common trade names of hCG include Choragon (UK), Pregnyl (USA / UK), Chorex (USA) and Choron (USA).

 

hMG is sometimes referred to as menotrophin. It is a mixture of LH and FSH in equal quantities and is produced from the urine of menopausal women.

Common trade names of hMG include Menopur (UK) and Menogan (UK).

 

Even though these hormones are obtained from females, they are not 'female' hormones and have the correct function in both males and females.

 

Follitropin is a recombinant form of FSH. This means it is not naturally derived like hMG or hCG but produced synthetically. This means it is more expensive than hMG and hCG, but there is a greater supply of it.

Common trade names of follitropin include Gonal-F (UK), Puregon (UK), Follistim (USA) and Fertinex (USA).

 



In male treatment hCG might be given on its own first. Sometimes this can induce normal puberty if it is a case of delayed puberty rather than KS or HH. 

hCG on its own can stimulate testosterone production, but not sperm production. On its own it can also cause an increase in testicular size and sensitivity as they start to produce their own natural testosterone.

For sperm production, if fertility is required hMG is required or hCG in combination with a FSH medication.

It can take anything from 6 to 18 months for sperm production to commence. There is little indication on how well this type of treatment will work, it might take 12 months to produce any affect and then go suddenly to normal sperm production so natural conception is possible.

If a low level of sperm production is achieved it might not be possible to achieve natural conception but enough sperm could be produced so a form of IVF or other assisted fertilisation programme can be attempted.

 



 



Hypothalamic hormones.

A less common approach, but one that can be effective is the use of the hypothalamic hormone GnRH - gonadotrophin releasing hormone (sometimes called LHRH - luteinising hormone releasing hormone instead).

GnRH is released by the pituitary and acts on the pituitary gland to release its own hormones - LH and FSH.

GnRH is released in a pulsatile manner by the hypothalamus throughout the day in order to stimulate the pituitary gland.

For GnRH treatment to be effective it has to be given in a manner that mimics its normal release as much as possible. In order to do this a pump is normally used that allows for timed release of a set dose of GnRH through out the day. The pump only works for short periods throughout the day, usually at 90 to 120 minute intervals. A very fine needle is inserted into the abdomen and attached to a pump which is worn for most of the day. The pump can be worn around the waist or leg. for more information on the pump go to Question 24.

 

 

Care is needed in changing the needle regularly and cleaning the injection site to prevent the risk of infection. Ampoules of GnRH are replaced in the pump every 10 days or so.

This may be not be the easiest method of delivery but it is one of the most effective and a high success rate has been achieved using this method, usually after 6 months. If effective it will induce near normal levels or sperm production and testosterone by the testes so conception can be achieved naturally. It is also an expensive method of treatment and may not be available everywhere.

A small percentage of HH patients will not respond to this treatment due a problem with the hypothalamus being able to recognise GnRH. Your doctor will probably carry out a very simple GnRH stimulation test first to tell if you are able to respond to this type of treatment.

GnRH is sometimes given in much higher 

GnRH comes in the form of a manufactured drug called gondorelin.

 

Common trade names of gondorelin include Gondorelin (UK), Factrel (USA) and Lutrepulse (USA).