title: [Male infertility: non-surgical therapy].
abstract: Infertility is defined as the inability of a couple to conceive after 12 months of unprotected intercourse and affects 15% of couples with male component of 50%. The failure of spermatogenesis can result from hypothalamic, pituitary or testicular disorders although in the majority of cases it remains idiopathic. The diagnostic process includes medical history, semen analysis, hormonal studies, genetic studies and radiological evaluation.Targeted hormonal therapies are available for patients whose infertility is caused by altered levels of androgens, prolactin, or TSH. Main treatments aim to restore normal sexual function by administering testosterone and to increase spermatogenesis with pulsatile GnRH.Fertility in men suffering from hypogonadotrophic hypogonadism can be restored through hormone therapy using GnRH or with the use of gonadotropins when there is hypothalamic failure. In the past, treatment options for the factors of idiopathic male infertility were mainly based on the use of anti-estrogens that cause an increased secretion of FSH and LH and therefore of testosterone.Oxytocin promotes the progression of the sperm and increases the conversion of testosterone into dihydrotestosterone. The aromatase's inhibitors decrease the conversion of androgens to estrogens, increasing serum levels of androgens, resulting in an increased release of gonadotropins.Two areas showed interesting future perspectives for the treatment of infertility: gene therapy and transplantation of spermatogonial stem cells.
authors.affiliation: Clinica Urologica, Università Cattolica S. Cuore, Policlinico A. Gemelli, Roma - Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gulino
authors.forename: Marco
authors.initials: M
authors.lastname: Stefanucci
authors.forename: Michele
authors.initials: M
authors.lastname: Antonucci
authors.forename: Marco
authors.initials: M
authors.lastname: Racioppi
authors.forename: Emilio
authors.initials: E
authors.lastname: Sacco
authors.forename: Francesco
authors.initials: F
authors.lastname: Pinto
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Bassi
mesh_terms: D000728:Androgens / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use; D005544:Forecasting; D015316:Genetic Therapy; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006065:Gonadotropins, Pituitary / Q000378:metabolism / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000188:drug therapy; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007248:Infertility, Male / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D008297:Male; D010121:Oxytocin / Q000494:pharmacology / Q000627:therapeutic use; D010903:Pituitary Gland, Anterior / Q000378:metabolism; D013091:Spermatogenesis / Q000187:drug effects; D013093:Spermatogonia / Q000166:cytology; D033581:Stem Cell Transplantation
chemical_list: D000728:Androgens; D000975:Antioxidants; D047072:Aromatase Inhibitors; D020847:Estrogen Receptor Modulators; D006065:Gonadotropins, Pituitary; D007987:Gonadotropin-Releasing Hormone; D010121:Oxytocin