Male subfertility and the male pill

RA Anderson
Reproductive and Developmental Sciences, University of Edinburgh

Endocrine Nurses Training Course 2005, John MacIntyre Centre, The University of Edinburgh, 18 Holyrood Park Road, Edinburgh EH16 5AY, UK
30 August - 1 September 2005

Normal male function: dual aspects of testicular function
LH-Leydig cells-testosterone
FSH-Sertoli cells-spermatogenesis
Necessity for testosterone for spermatogenesis

Peripheral effects of testosterone and its metabolites E2 and DHT

Male infertility common, male sterility rare
Falling sperm counts, variation across Europe, association with male reproductive developmental defects.

Assessment of male fertility

Clinical examination: general, testes, epididymis, vas
Semen analysis: norms and prognostic value
Hormone analysis: relevance of FSH, LH and testosterone
Chromosome analysis

 

Causes of male infertility
Mostly descriptive, idiopathic.
Rarely endocrine! –hypogonadotrophic hypogonadism
Other diagnoses: chromosomal (Klinefelter’s), varicocele, post-infective, genetic, sexual dysfunction.

Treatments
Rarely a remedial cause

• Expectant management
• Assisted conception revolutionised by ICSI (intracytoplasmic sperm injection)
• Donor insemination
• Psychosexual (artificial insemination)

The male pill

Basis: gonadotrophin suppression
May be achieved by T, progestogen, GnRH analogue
Testosterone required as ‘add-back’ HRT
Contraceptive efficacy demonstrated with several regimens

Most promising at present: T+progestogen
Oral, injectables, implants.

Variable suppression: Caucasian men more resistant than Asian/Chinese men

Long-term effects unknown: possibility for introducing health benefits as for female pill

Revised: 30-Oct-2006