Treatment

Treatment of underlying cause (see Etiology above).

• Modification of lifestyle factors such as alcohol, nicotine, and recreational drug use

• Medical therapy: clomiphene citrate, tamoxifen

• Assisted reproductive technology

  • Intrauterine insemination

  • In vitro fertilization

  • Intracytoplasmic sperm injection

• Surgical treatment of testicular anomalies and/or defects

• Lifestyle modifications: cessation of alcohol, nicotine, and recreational drug use as they contribute to subfertility.

• Treatment of underlying causes (e.g., levothyroxine for hypothyroidism, bromocriptine for hyperprolactinemia, metformin for PCOS)

• Clomiphene citrate

• GnRH (pulsatile): stimulation of FSH and LH release → follicle maturation

• Gonadotropins (e.g., recombinant hCG, recombinant LH): stimulate final oocyte maturation → ovulation

• Tamoxifen (selective estrogen receptor modulator)

• GnRH-antagonists

• In vitro fertilization

  • The most common form of assisted reproduction technology

  • Involves hormonal follicular stimulation followed by a transvaginal follicular puncture for oocyte retrieval with ultrasound monitoring

  • The recovered oocytes are mixed with processed spermatozoa and incubated.

  • Two (in young women) to a maximum of five embryos (in women over 40 years of age) are transferred into the uterus.

• Intracytoplasmic sperm injection:

  • A form of in vitro fertilization.

  • A single spermatozoon is introduced into an oocyte under a microscope using an injection pipette, after which the same procedure is followed as described for in vitro fertilization.

a procedure in which washed and concentrated sperm are introduced directly into the uterine cavity

• Oocyte donation

• Surgery: removal of tubal, cervical, or uterine adhesions, myomas, and/or scar tissue