Review articleA new look at the medical management of infertility
Section snippets
Hypogonadotropic hypogonadism
Gonadotropin deficiency may occur in the absence of other pituitary dysfunction. Congenital hypogonadotropic hypogonadism is associated with Kallmann's syndrome. Anosmia is a characteristic finding in these patients. Cleft palate, deafness, renal anomalies, cryptorchidism, and micropenis also may be found. The primary hormonal defect is a failure of gonadotropin-releasing hormone (GnRH) secretion by the hypothalamus [2]. Acquired hypogonadotropic hypogonadism may be caused by pituitary tumors,
Nonspecific treatment
For at least one quarter of men with infertility, no causal factor can be found. These men are classified as having idiopathic male infertility. The history, physical examination, including testicular size and consistency, and hormonal evaluation are normal, yet semen samples from these men demonstrate a wide range of abnormalities. Often referred to as idiopathic oligospermia or asthenospermia, a majority of these men have abnormalities of all semen parameters or oligoasthenoteratospermia.
In
Future prospects
A variety of approaches have been used in attempts to improve male infertility. Success has been hampered by a lack of understanding of the etiology of many cases of male infertility. During the last decade, significant advances have taken place in understanding the genetics of spermatogenesis. The ability to generate transgenic and gene knock-out mouse models has resulted in the identification of approximately 100 genes that seem to have a role in spermatogenesis [134]. The ability to perform
Summary
Effective therapies are available for the treatment of infertility owing to specific causes. Most hormonal imbalances can be readily identified and successfully treated. The treatment of men with unexplained idiopathic infertility remains difficult. The availability of a multitude of agents ranging from hormones to nutritional supplements emphasizes the fact that none are consistently effective. There is no good way to predict which patients will respond to a specific treatment. Idiopathic
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