Empirical medical therapy for idiopathic male infertility

Hatim Thaker; Edmund Y Ko; Edmund S Sabanegh; Robert E Brannigan; Joseph P Alukal; Mary K Samplaski

doi:10.1016/j.xfre.2020.04.003

Empirical medical therapy for idiopathic male infertility

F S Rep. 2020 Apr 25;1(1):15-20. doi: 10.1016/j.xfre.2020.04.003. eCollection 2020 Jun.

Authors

Hatim Thaker¹, Edmund Y Ko², Edmund S Sabanegh³, Robert E Brannigan⁴, Joseph P Alukal⁵, Mary K Samplaski⁶

Affiliations

¹ Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
² Department of Urology, Loma Linda University, Loma Linda, California.
³ Department of Urology, Cleveland Clinic, Cleveland, Ohio.
⁴ Department of Urology, Northwestern University, Chicago, Illinois.
⁵ Department of Urology, Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
⁶ Institute of Urology, University of Southern California, Los Angeles, California.

Abstract

Objective: To determine if there has been a change in empirical medical therapy (EMT) practices since a 2010 American Urological Association survey reported that 25% of urologists treated infertile men who were pursuing a pregnancy with testosterone (T).

Design: Survey-based cohort study of AUA members.

Setting: Practice patterns were evaluated of urologists in academic and nonacademic hospital centers.

Patients: Practice patterns were evaluated in the treatment of men with idiopathic infertility.

Interventionss: None.

Main outcome measures: Subgroup analysis by means of univariate analysis between means (Fisher exact test) and descriptive proportions was used to compare male infertility fellowship-trained urologists (RUs) to general urologists (non-RUs).

Results: A total of 191 urologists responded (4.7%). Excluding trainees, 164 responses (85.9%) were analyzed: 134 (82.3%) were from non-RUs and 29 from (17.7%) RUs. Over all, 65.9% treated male infertility with a combination of EMT and surgery (93.1% of RU vs. 60.4% of non-RUs). The most common medications used by RUs were clomiphene (100%), anastrozole (85.7%), and hCG/LH (82.1%). Non-RUs used these less frequently. Overall, 24.4% of the urologists reported that they would use T to treat male infertility: 14.4% (n = 4) of RUs and 24.4% (n = 30) of non-RUs.

Conclusions: A total of 65.9% of urologists would treat male infertility with the use of EMT and surgery. The most common EMTs were clomiphene, anastrozole, and hCG/LH. Of concern, 24.4% of urologists considered T to treat male infertility, a medication with known contraceptive potential. This is unchanged from the 2010 survey, and confirms the need for reproductive medicine guidelines that include the topic of EMT use in infertile men.

Keywords: Male infertility; clomiphene citrate; empirical medical therapy; sperm analysis; testosterone.