title: Nonsurgical treatment of male infertility: specific and empiric therapy.
abstract: Management of male infertility is always a difficult task, and the pathologic process is often poorly understood. Even though modern assisted reproduction techniques (ART) can help overcome severe male factor infertility, the application of these methods in all infertile couples would definitely represent over-treatment. Several conditions can interfere with spermatogenesis and reduce sperm quality and production. A careful diagnostic work-up is necessary before any andrological treatment can be initiated so that adequate treatment options can be selected for individual patients. Most hormonal imbalances can be readily identified and successfully treated nonsurgically. However, the treatment of men with unexplained idiopathic infertility remains a challenge. In the absence of a correctable etiology, patients are managed with either empirical medical therapy or ART. Empiric medical therapy continues as a viable option. However, physicians and patients must understand that the success rates with any of the pharmacological therapies remain suboptimal.
authors.affiliation: Reproductive Research Center, Glickman Urological & Kidney Institute and Department of Obstetrics-Gynecology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Marcello
authors.initials: M
authors.lastname: Cocuzza
authors.forename: Ashok
authors.initials: A
authors.lastname: Agarwal
references.citation: J Androl. 1985 Mar-Apr;6(2):127-35
references.pmid: 3838741
references.citation: Fertil Steril. 1997 Jul;68(1):112-7
references.pmid: 9207594
references.citation: Int J Androl. 1984 Jun;7(3):188-97
references.pmid: 6480140
references.citation: Br Med J. 1974 Dec 14;4(5945):617-21
references.pmid: 4613417
references.citation: Int J Androl. 1980 Oct;3(5):479-86
references.pmid: 6777310
references.citation: Fertil Steril. 1994 May;61(5):799-811
references.pmid: 8174713
references.citation: Contraception. 2002 Apr;65(4):279-81
references.pmid: 12020778
references.citation: Andrologia. 2003 Oct;35(5):309-13
references.pmid: 14535861
references.citation: J Clin Endocrinol Metab. 1969 May;29(5):638-49
references.pmid: 5781777
references.citation: Fertil Steril. 1995 Jun;63(6):1143-57
references.pmid: 7750580
references.citation: Br J Urol. 1982 Dec;54(6):780-4
references.pmid: 6817845
references.citation: Fertil Steril. 1982 Nov;38(5):591-9
references.pmid: 7128845
references.citation: Cochrane Database Syst Rev. 2000;(2):CD000151
references.pmid: 10796497
references.citation: Hum Reprod. 1993 Oct;8(10):1657-62
references.pmid: 8300824
references.citation: J Urol. 2002 Feb;167(2 Pt 1):624-9
references.pmid: 11792932
references.citation: Fertil Steril. 1988 Aug;50(2):343-7
references.pmid: 3135208
references.citation: J Androl. 1984 Jul-Aug;5(4):294-6
references.pmid: 6432759
references.citation: J Androl. 1994 Jul-Aug;15(4):343-52
references.pmid: 7982803
references.citation: Fertil Steril. 1983 Sep;40(3):358-65
references.pmid: 6411497
references.citation: J Endocrinol. 1977 Apr;73(1):171-8
references.pmid: 323393
references.citation: Fertil Steril. 1993 Dec;60(6):1052-6
references.pmid: 8243685
references.citation: Exp Clin Immunogenet. 1993;10(2):65-72
references.pmid: 8251181
references.citation: Urol Clin North Am. 1998 Nov;25(4):703-13, x
references.pmid: 10026776
references.citation: J Androl. 2005 Nov-Dec;26(6):654-60
references.pmid: 16291955
references.citation: Urol Clin North Am. 2002 Nov;29(4):949-63
references.pmid: 12516764
references.citation: Free Radic Res Commun. 1990;9(1):1-32
references.pmid: 2159941
references.citation: Urol Clin North Am. 1994 Aug;21(3):531-48
references.pmid: 8059506
references.citation: Hum Reprod Update. 1999 Sep-Oct;5(5):399-420
references.pmid: 10582780
references.citation: Fertil Steril. 1987 Jul;48(1):113-7
references.pmid: 3297810
references.citation: Eur J Obstet Gynecol Reprod Biol. 1996 Nov;69(2):129-34
references.pmid: 8902446
references.citation: Andrologia. 1999 Sep;31(5):297
references.pmid: 10526640
references.citation: Hum Reprod. 1999 Sep;14 Suppl 1:1-23
references.pmid: 10573021
references.citation: Int J Androl. 1992 Aug;15(4):299-307
references.pmid: 1516979
references.citation: J Clin Endocrinol Metab. 1995 Jun;80(6):1941-7
references.pmid: 7539819
references.citation: Int J Androl. 1986 Apr;9(2):91-8
references.pmid: 3539821
references.citation: Fertil Steril. 1990 Jul;54(1):175-7
references.pmid: 2358086
references.citation: Urol Clin North Am. 2002 Nov;29(4):873-94
references.pmid: 12516759
references.citation: Fertil Steril. 2004 Jun;81(6):1578-84
references.pmid: 15193480
references.citation: Int J Fertil. 1989 Mar-Apr;34(2):120-2
references.pmid: 2565314
references.citation: Br J Urol. 1998 Sep;82(3):331-41
references.pmid: 9772867
references.citation: J Reprod Fertil. 1992 Mar;94(2):451-62
references.pmid: 1317451
references.citation: Fertil Steril. 1984 Sep;42(3):406-11
references.pmid: 6088300
references.citation: Fertil Steril. 1978 Mar;29(3):320-7
references.pmid: 640052
references.citation: Hum Reprod. 1997 Jan;12(1):24-8
references.pmid: 9043896
references.citation: Hum Reprod Update. 1999 Sep-Oct;5(5):421-32
references.pmid: 10582781
references.citation: Eur Urol. 1981;7(5):283-7
references.pmid: 7250160
references.citation: Prostaglandins Leukot Essent Fatty Acids. 2000 Sep;63(3):159-65
references.pmid: 10991774
references.citation: Urol Clin North Am. 2002 Nov;29(4):841-53
references.pmid: 12516756
references.citation: Arch Biochem Biophys. 1993 Feb 1;300(2):535-43
references.pmid: 8434935
references.citation: Drugs Exp Clin Res. 1995;21(4):157-9
references.pmid: 8529529
references.citation: J Androl. 2001 Jul-Aug;22(4):575-83
references.pmid: 11451354
references.citation: Fertil Steril. 1982 Apr;37(4):557-64
references.pmid: 6896033
references.citation: Fertil Steril. 1992 May;57(5):1034-43
references.pmid: 1572471
references.citation: J Androl. 1996 Sep-Oct;17(5):530-7
references.pmid: 8957697
references.citation: Arch Androl. 2000 Nov-Dec;45(3):125-30
references.pmid: 11111859
references.citation: J Steroid Biochem. 1978 Dec;9(12):1257-9
references.pmid: 745424
references.citation: Fertil Steril. 2002 Dec;78(6):1203-8
references.pmid: 12477513
references.citation: Fertil Steril. 2003 Feb;79(2):292-300
references.pmid: 12568837
references.citation: Fertil Steril. 1990 Mar;53(3):528-36
references.pmid: 2407566
references.citation: Am J Obstet Gynecol. 1990 Nov;163(5 Pt 2):1752-8
references.pmid: 2122732
references.citation: Urology. 1979 Nov;14(5):500-3
references.pmid: 388805
references.citation: Fertil Steril. 1983 May;39(5):700-3
references.pmid: 6404663
references.citation: J Assist Reprod Genet. 1995 Feb;12(2):70-4
references.pmid: 7545483
references.citation: Proc Soc Exp Biol Med. 2000 Jul;224(3):123-32
references.pmid: 10865226
references.citation: J Urol. 1997 Jun;157(6):2140-6
references.pmid: 9146602
references.citation: Fertil Steril. 1986 Feb;45(2):249-54
references.pmid: 3949025
references.citation: J Reprod Fertil. 1973 Jan;32(1):167-70
references.pmid: 4573450
references.citation: Reprod Biomed Online. 2004 Jun;8(6):616-27
references.pmid: 15169573
references.citation: Fertil Steril. 1988 May;49(5):865-70
references.pmid: 3129318
references.citation: Fertil Steril. 1997 Jun;67(6):1115-20
references.pmid: 9176453
references.citation: Fertil Steril. 1986 Aug;46(2):334-7
references.pmid: 3732542
references.citation: Hum Reprod. 1999 Apr;14(4):1028-33
references.pmid: 10221237
references.citation: J Urol. 2001 Mar;165(3):837-41
references.pmid: 11176482
references.citation: Andrologia. 1994 May-Jun;26(3):155-9
references.pmid: 8085668
references.citation: Int J Androl. 1992 Feb;15(1):14-8
references.pmid: 1544695
references.citation: N Engl J Med. 1985 May 23;312(21):1371-5
references.pmid: 3990735
references.citation: Eur J Biochem. 1993 Jul 15;215(2):213-9
references.pmid: 7688300
references.citation: Hum Reprod Update. 2003 Jan-Feb;9(1):9-23
references.pmid: 12638778
references.citation: Clin Endocrinol (Oxf). 1987 Sep;27(3):363-71
references.pmid: 3427794
references.citation: J Urol. 1989 Sep;142(3):752-5
references.pmid: 2671415
references.citation: J Am Coll Surg. 2001 Dec;193(6):651-9
references.pmid: 11768682
references.citation: Hum Reprod. 1994 Nov;9(11):2044-50
references.pmid: 7868672
references.citation: Endocrinol Metab Clin North Am. 1999 Mar;28(1):143-69, vii
references.pmid: 10207689
references.citation: Fertil Steril. 1995 Oct;64(4):868-70
references.pmid: 7672165
references.citation: Indian J Exp Biol. 2005 Nov;43(11):963-74
references.pmid: 16315393
references.citation: Urol Clin North Am. 2002 Nov;29(4):939-48
references.pmid: 12516763
references.citation: Br J Urol. 1986 Dec;58(6):715-20
references.pmid: 3801833
references.citation: Urology. 2000 Nov 1;56(5 Suppl 1):20-2
references.pmid: 11074198
references.citation: Cancer Metastasis Rev. 1986;5(2):125-38
references.pmid: 3549032
references.citation: Int J Androl. 1991 Apr;14(2):87-90
references.pmid: 1869318
references.citation: Drugs. 1991 Jan;41(1):60-8
references.pmid: 1706988
references.citation: Fertil Steril. 1995 Jan;63(1):142-7
references.pmid: 7805903
references.citation: Hum Reprod. 1998 Mar;13(3):596-603
references.pmid: 9572419
references.citation: J Androl. 2007 Jul-Aug;28(4):613-20
references.pmid: 17409462
references.citation: Acta Endocrinol (Copenh). 1988 Feb;117(2):265-7
references.pmid: 3132792
references.citation: J Clin Endocrinol Metab. 1987 Dec;65(6):1081-7
references.pmid: 3119647
references.citation: Hum Reprod. 1995 Oct;10 Suppl 1:15-21
references.pmid: 8592032
references.citation: Int J Fertil. 1991 Jul-Aug;36(4):243-51
references.pmid: 1680827
references.citation: Fertil Steril. 1978 Nov;30(5):572-6
references.pmid: 720646
references.citation: Minerva Endocrinol. 1990 Jan-Mar;15(1):91-4
references.pmid: 2274020
references.citation: Lancet. 1977 Oct 15;2(8042):815-6
references.pmid: 71615
references.citation: Am J Clin Pathol. 1959 Oct;32:357-63
references.pmid: 14440176
references.citation: Drugs. 2002;62(12):1741-53
references.pmid: 12149044
references.citation: Fertil Steril. 1997 Sep;68(3):519-24
references.pmid: 9314926
references.citation: Fertil Steril. 1988 Mar;49(3):497-504
references.pmid: 3342902
references.citation: Int J Fertil Womens Med. 1998 May-Jun;43(3):165-70
references.pmid: 9692540
references.citation: Recent Prog Horm Res. 1985;41:473-531
references.pmid: 3931190
references.citation: Reprod Biomed Online. 2004 Apr;8(4):376-84
references.pmid: 15149558
references.citation: J Urol. 1978 Apr;119(4):507-10
references.pmid: 25971
references.citation: J Clin Endocrinol Metab. 1985 Nov;61(5):868-72
references.pmid: 3930553
references.citation: Lancet. 1990 Jan 13;335(8681):85-8
references.pmid: 1967425
references.citation: Fertil Steril. 1995 Oct;64(4):825-31
references.pmid: 7672157
references.citation: J Clin Endocrinol Metab. 1972 Dec;35(6):836-9
references.pmid: 4634484
references.citation: J Androl. 2001 Mar-Apr;22(2):316-22
references.pmid: 11229806
references.citation: Indian J Exp Biol. 2002 Nov;40(11):1233-9
references.pmid: 13677624
references.citation: J Urol. 1979 Apr;121(4):432-4
references.pmid: 439212
references.citation: Clin Reprod Fertil. 1986 Dec;4(6):359-66
references.pmid: 3594346
references.citation: Fertil Steril. 2006 Oct;86(4):878-85
references.pmid: 17027357
references.citation: J Androl. 2007 Jul-Aug;28(4):528-32
references.pmid: 17287456
references.citation: Fertil Steril. 2005 Mar;83(3):635-42
references.pmid: 15749492
references.citation: Hum Reprod. 2001 Nov;16(11):2338-42
references.pmid: 11679516
references.citation: J Clin Endocrinol Metab. 1999 Jul;84(7):2518-22
references.pmid: 10404830