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Survey of medical therapy in andrology.

Despite considerable basic research effort, the therapeutic possibilities to improve impaired male fertility are still limited. This is partly because the cause of reduced fertility is unknown in many cases and, consequently, no specific therapy is available. Approaches to andrological therapy at different levels include stimulation of spermatogenesis, improvement of epididymal function or sperm transport within the male genital tract, and stimulation of sperm metabolism. Medical therapy of male fertility disturbances has to distinguish between specific and empirical treatment procedures. Specific treatment is based on a pathophysiological concept and implies accurate patient selection; the therapeutic success is predictable. In contrast, empirical treatment involves no patient selection according to specific criteria; thus, the therapeutic success is unpredictable. Hormonal treatment is the main choice in andrological therapy, including pulsatile administration of gonadotrophin-releasing hormone (GnRH), human gonadotrophins, anti-oestrogens and testosterone. Non-hormonal treatment is carried out using different pharmaceutical compounds such as alpha-sympathomimetics, antibiotics, antiphlogistics, corticosteroids, mast cell blockers, pentoxifylline, kallikrein, captopril, vitamins and zinc. In patients with severe male factor who are resistant to therapy, procreation problems may be solved by the method of intracytoplasmic sperm injection (ICSI).