Exogenous gonadotropin therapy is recommended only for infertile men with hypogonadotropic hypogonadism (secondary hypogonadism). The Leydig cells can be stimulated with LH for the production of high intratesticular testosterone levels and initiation of spermatogenesis. Such medicine as hCG (Pregnyl or Profasi) 2,000 IU taken three times a week is used to stimulate proper production of testosterone for full virilization. When the patient is virilized and hCG therapy, conducted during 8-12 months, is not effective in sperm production, FSH therapy should be applied. It is used as human menopausal gonadotropin (hMG). Such medicine as Pergonal includes 75 IU of FSH and 75 IU of LH per vial. 1/2 to 1 vial should be taken inside intramuscularly three times every week. Some time is necessary for the appearance of sperm in the ejaculate since the applying of FSH therapy. A sperm count of between 2 and 5 million sperm per ejaculate can be observed and it can lead to impregnation. As soon as a pregnancy is available, the FSH therapy should be stopped. LH and FSH can also be stimulated with GnRH. It should be begun with 25-50 ng/kilogram every two hours conducted by a small infusion pump. The price of the gonadotropins and GnRH is high. GnRH is physiologic gonadotropin stimulation. In the case of Pituitary illness hCG and hMG are also recommended. Patients,who suffer from the fertile eunuch syndrome (partial LH deficiency), should also apply hCG therapy.
Therapy for Immunoloqic Infertility
Detectable antisperm antibodies can hinder treatment. The treatment is held with immunosuppressive medicines such as corticosteroids, its purpose is to abort or change the production of antibodies. It is not still defined if steroid therapy can really reduce the production or the clinical effects of antisperm antibodies in men. It is rather risky. Nevertheless mild and self-limited complications aseptic necrosis of the femur is observed sometimes is connected with yet-unproven therapy. Innovative methods of semen manipulation are also applied. They are immediate dilution and washing of the semen after ejaculation, apply of sperm surface constituencies such as immuno-absorbants that have an ability to get rid of "unbound" antibody, in-vitro dividing of sperm-bound antibodies with proteases, and the absorption of sperm with bound antisperms on indifferent types of columns to make separation and capture of the unbound sperm easier. Most of these techniques are not effective. Most patients finish superovulation with sperm washing and intrauterine insemination. Intrauterine insemination pregnancies for antibodies are not more than 20%. Donor sperm can be used for patients who have male infertility.
Male factor infertility is not treated successfully in most cases, semen processing and intrauterine insemination help to solve the problems of lessened sperm quantity and productiveness. The purpose of semen processing due to in-vitro manipulation of semen is sperm function. It helps to get rid of adverse seminal fluid and to get better and more productive sperm population. Dilution of the semen, centrifugation and resuspension of the sperm pellet are used in many processing methods. Other methods of sperm processing are swim-up procedures, centrifugation through Percoll density gradients, etc. The patients sperm may be productive during procedures and the semen can be tested. Intrauterine inseminations principle indication was the most leading and important factor. It is the most widespread method.