Hormonal Therapies in Male Infertility Management
Summary
Hormonal therapies have emerged as a cornerstone in the management of male infertility by targeting the endocrine regulation of spermatogenesis and androgen production. Central to this approach is the modulation of the hypothalamic–pituitary–gonadal axis, where follicle-stimulating hormone (FSH) and luteinising hormone (LH) govern Sertoli and Leydig cell function, respectively. In men with hypogonadotropic hypogonadism, replacement with gonadotropins or pulsatile gonadotropin-releasing hormone restores intratesticular testosterone and supports sperm production. Empirical use of selective oestrogen receptor modulators such as clomiphene citrate aims to elevate endogenous gonadotrophin release by blocking negative oestrogen feedback, while aromatase inhibitors like letrozole can shift the testosterone- oestradiol balance in favour of androgens. Recent investigations have explored recombinant human chorionic gonadotropin and human menopausal gonadotrophin combinations in non-obstructive azoospermia to stimulate dormant spermatogenic pathways. Despite encouraging case series and small trials reporting improved semen parameters and occasional spontaneous pregnancies, heterogeneity in patient selection, dosage regimens and outcome measures has impeded consensus. Ongoing research seeks to refine indications, optimise dosing strategies and identify biomarkers predictive of response, thereby translating hormonal modulation into predictable and effective fertility restoration.
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Hormonal Therapies in Male Infertility Management publication trend
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Technical terms
Hypogonadotropic hypogonadism: A condition characterised by insufficient secretion of gonadotrophins (FSH and LH) leading to reduced testosterone production and impaired spermatogenesis.
Non-obstructive azoospermia (NOA): Absence of sperm in the ejaculate due to intrinsic testicular failure rather than physical blockage of the reproductive tract.
Gonadotropins: Pituitary hormones (FSH and LH) or their analogues that stimulate Sertoli cells for sperm maturation and Leydig cells for testosterone synthesis.
Selective oestrogen receptor modulator (SERM): A compound that selectively inhibits oestrogen receptors in the hypothalamus and pituitary to increase gonadotrophin release.
Intracytoplasmic sperm injection (ICSI): An assisted reproductive technique in which a single sperm is directly injected into an oocyte to achieve fertilisation.
References
- Aromatase inhibitors in men: effects and therapeutic options. Reproductive Biology and Endocrinology (2011).
- Does hormonal therapy improve sperm retrieval rates in men with non-obstructive azoospermia: a systematic review and meta-analysis. Human Reproduction Update (2022).
- Recombinant gonadotropin therapy to improve spermatogenesis in nonobstructive azoospermic patients – A proof of concept study. International braz j urol (2022).
- Clomiphene Citrate for Male Hypogonadism and Infertility: An Updated Review. Androgens Clinical Research and Therapeutics (2020).
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