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Fertility drugs for men
By the BabyCenter editorial staff
Just as women need the right balance of hormones
to ovulate regularly, men need certain hormones to produce healthy
sperm. Surprisingly, the same substances control these reproductive
functions in both men and women — so the same fertility
drugs that stimulate ovulation stimulate sperm production.
The catch is that the drugs don't perform nearly as well for
men (success rates are about a third of those for women), and
the FDA hasn't yet approved them for use in men, though a specialist
can prescribe them. Very few studies have been done on the effects
of fertility drugs on men, and those few agree on just one thing:
The drugs can help only men with specific hormonal imbalances.
The drugs and how they work
The two most popular fertility drugs for women, clomiphene and
human menopausal gonadotropin (hMG) used with human chorionic
gonadotropin (hCG), are also used to treat men with primary hypogonadotropic
hypogonadism — a hormone deficiency in the pituitary gland
or hypothalamus that prevents the testicles from receiving the
signal to make sperm.
Clomiphene (taken daily as a pill) prompts the pituitary gland
to make luteinizing hormone and follicle-stimulating hormone,
which tell the testicles to produce testosterone and possibly
more sperm. HCG (injected two to three times a week, sometimes
with hMG) prompts the testes to produce testosterone and sperm
directly.
Is it for you?
Your doctor may prescribe fertility drugs if you have a hormonal
imbalance (originating in the pituitary gland or hypothalamus)
linked to a low sperm count; sometimes a doctor will also prescribe
them for poor sperm quality and motility (its ability to move).
(To learn about other factors that can cause fertility problems
in men, see our article.)
Length of treatment
For men, a cycle of clomiphene consists of taking one pill a
day for three to six months, and a cycle of hCG means having two
to three injections a week for six months. (If your body doesn't
respond to hCG, your doctor may suggest that you also take hMG.)
Taking fertility drugs for longer periods doesn't improve your
chance of success, so if you take one for more than three months
and your partner doesn't get pregnant, your doctor may increase
the dosage, switch you to another medication, or, most likely,
suggest another kind of treatment. However, as long as your hormone
levels stay normal, you can safely take clomiphene in low doses
for six months to a year.
Success rate
Although success is far from guaranteed, fertility drugs can
help jump-start your sperm production, boosting your count to
20 million or more (anything under 20 million is considered low).
If the medication works, you won't have to think about undergoing
a testicle biopsy to see what else might be wrong with your sperm.
Some studies cite an estimated 20 to 25 percent pregnancy rate
for couples when the man has used fertility drugs. That's low
compared to the rates for women on fertility drugs, which is 20
to 60 percent. But even the latter number loses some of its punch
when you consider that it's about the same rate couples battling
a low sperm count or poor sperm quality can expect for a spontaneous
pregnancy with no treatment at all.
Side effects
In men, both clomiphene and hMG can cause temporary blurred vision,
breast enlargement and tenderness, and weight gain. In rare cases,
clomiphene can cause liver damage.
Cost
In the United States, you should expect to spend about $200 to
$500 on a month's worth of clomiphene, or $120 to $200 on a month's
worth of hCG. If your insurance policy doesn't cover these drugs,
you'll have to pay the cost up front.
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