Medical therapy for male infertility uses medications to manipulate male hormones (the endocrine system). The goal is to increase the bioavailable testosterone and decrease the estradiol. The medications used to do this are the following:
- Clomiphene citrate or Clomid, which is used off label for male treatment as it is FDA approved only for use in women
- Anastrazole or arimidex
- hCG or hMG
All of these except hCG and hMG, which must given as injections, are taken as oral medications. All of these drugs also have side effects; we will go over the specific side effects of these drugs, should you need them, at the time of your consultation with us.
Clomiphene Citrate/Clomid Clomiphene citrate, or Clomid, works by blocking estrogen’s effect on the pituitary. Normally, estrogen tells the pituitary to produces less LH and FSH, which results in decreased testosterone and poor spermatogenesis or sperm production. Clomiphene citrate blocks this negative feedback, causing the pituitary to increase the LH and FSH it is producing and also the testosterone.
Side effects of clomiphene include, but are not limited to, pectoral (or breast muscle) tenderness, irritability, possible ability to accelerate prostate cancer growth if cancer is present, mild acne, and, very rarely, visual field disturbances caused by pituitary swelling. All of these side effects are reversible if the clomiphene is stopped; please stop taking clomiphene and notify us immediately if you experience any of these side effects.
Most men notice positive side effects from the clomiphene citrate such as improved erections, increased sex drive, increased muscle mass, more energy, and weight loss.
hCG & hMG
A small percentage of men will not respond to clomiphene citrate. We put these men on hCG or hMG. While these drugs are delivered by injection, they have very similar side effect profiles to clomiphene citrate. They work by directly stimulating the testes to make testosterone and improve spermatogenesis. We do not start with these drugs because they require injections, which most patients would rather avoid.
Anastrazole or arimidex is a drug that was originally developed for breast cancer that has become an excellent drug for specific groups of men with male factor infertility. Arimidex blocks the conversion of testosterone to estradiol in the peripheral tissues. Specifically, it blocks the action of aromatase, the enzyme (or biochemical machine) that converts testosterone to estradiol. If estradiol is higher than it should be and the testosterone lower, we will use anastrazole or arimidex to decrease the estradiol and increase the testosterone.
We ask that patients on any of these medications return after two weeks for laboratory testing and a clinic visit to check that the medications are working properly. We then have patients see us every four months for the first year of medication use and then annually.
At each of these visits, we check PSA, hemoglobin, and testosterone levels to check that the medication is working properly and that there are no adverse side effects.
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|Utah Center for Reproductive Medicine||675 Arapeen Dr. Suite 201
Salt Lake City, UT 84108
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Orem, UT 84058
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South Jordan, UT 84095