Assisted reproductive technics for the treatment of male factor infertility.

Abstract

Several treatment choices remain for the couple with male factor infertility due to idiopathic male infertility or in couples in which specific therapy has failed. Empiric medical therapy continues as a viable option; however, the physician and patient must understand that the success rates with any of the pharmacological therapies remain suboptimal. In addition, this therapy should only be used for patients with idiopathic male infertility. It is not indicated for other classes of infertile males. Another option is that of IVF and related technologies. These technics continue to improve and we can expect more specific technics to be developed to optimize fertilization and pregnancy rates in those couples with male factor infertility. At the present time, the pregnancy rates achieved with this technology in male factor couples are less than those in non-male factor patients. In addition, all of these technics entail considerable expense, often not covered by insurance. The third alternative for the patient with idiopathic male infertility is that of therapeutic insemination with the husband's sperm. Recent studies combining ovarian hyperstimulation with IUI suggest a clear advantage of this technic over other insemination approaches. As this treatment is significantly less expensive and time-consuming than the prior therapies, it should be considered when choosing therapy. Additional choices the couple with male factor infertility should consider are adoption and therapeutic donor insemination. It is only after careful consideration of all the available options that an appropriate decision can be made. This will vary, depending on the particular clinical characteristics of the couple as well as their social and financial situation.