Medical Treatment Options for Male Infertility Include the Use of Clomid for Men to Stimulate Sperm Production
Medical treatment is most often prescribed for men who have hormonal abnormalities. For example, some men with low sperm counts have low levels of the primary male hormone, testosterone. Although the logical approach might be to give a man with a low testosterone level supplemental testosterone, in fact, that is the wrong thing to do.the same clomiphene citrate we give to women to help them ovulate regularly. Clomiphene works essentially the same way in both women and men; in women, it binds to receptors in the brain (specifically the hypothalamus and the pituitary gland) to increase the production of follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones act on the ovarian follicles to induce egg development and ovulation. In men, the increase in FSH leads to an increase in sperm production, whereas the increase in LH leads to an increase in testosterone production.
Due to the complicated design of the endocrine system, giving testosterone to a man can actually decrease the sperm count. A similar situation exists in women, where giving estrogen (like that found in a birth control pill) can prevent egg development and ovulation.
Whereas clomiphene is typically given to women for 5 days early in their cycle, men need to take clomiphene every day (as sperm production occurs every day). It is possible to “overshoot” – i.e. for a man to over-respond to even low dose clomiphene by making too much testosterone. As this can decrease the sperm count, it is very important to re-check the man’s hormone levels a few weeks after he begins taking clomiphene. The typical starting dose for male clomiphene is 25 mg (1/2 pill) per day, but if the repeat testosterone level is too high, this dose can be reduced to ½ pill every other day.
In 1999, we performed a clinical study at TFC that demonstrated the effectiveness of clomiphene when given to men with low FSH, LH, and testosterone levels. In our study, we showed that such men responded with a statistically significant increase in sperm concentration. On some occasions, this increase was so great that couples who initially had no real alternative except IVF were able to conceive with IUI instead.
Another drug occasionally used for men with low sperm concentrations is letrozole. This medication interferes with the natural inter-conversion of estrogen and androgen that occurs in men. This can lead to higher serum testosterone levels and, frequently, sperm counts as well. Regardless of whether a man takes clomiphene or letrozole, it typically takes between 90 and 108 days from the time that a sperm is produced in the testicles until it is eventually ejaculated. Therefore, although an increase in the sperm count may appear within the first month of treatment, you should not be discouraged if this does not happen, and you should not discontinue taking the medication unless there is no improvement by the fourth month of treatment.
Please note that before a man takes either of these medications, it is very important that he have a normal physical examination performed by a urologist. This is critical, as sometimes a low sperm count can indicate a more serious underlying problem, such as a varicocele, an obstruction, or even testicular cancer.