Treatment Counselling Sometimes certain ‘lifestyle’ factors may be responsible for poor semen quality: for example, heavy smoking, alcohol abuse, use of anabolic steroids, extreme sports (marathon training, excessive strength sports), and an increase in scrotal temperature through thermal underwear, sauna or hot tub use, or occupational exposure to heat sources. A considerable number of drugs can affect the spermatogenesis.
Medical (hormonal) treatment No studies have confirmed that hormonal therapies, such as human menopausal gonadotrophin (HMG)/human chorionic gonadotrophin (HCG), androgen, anti-oestrogens (clomi- phene and tamoxifen), prolactin inhibitors (bromocriptine), and steroids, have improved pregnancy rates in men with idiopathic OAT. However, some primarily endocrinological pathologies can be treated medically, including:
Low testosterone: testosterone substitution, however, can have a negative effect on the spermatogenesis. Anti- estrogen therapy may be a better alternative for substitu- tion, f.i. Tamoxifen 10 mg 2dd.
Hypogonadotrophic hypogonadism: start HCG 1500 IU sc. 3 times per week and add HMG or rFSH 75-150 IU im 3 times per week after 6 months if azoospermia persists.
Hyperprolactinaemia, with dopamine agonists.
In patients with sperm autoantibodies, high-dose corticoster- oids could be effective, but are not recommended because of serious side-effects.
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