Male infertility, often a consequence of various medical therapies, presents a challenging intersection of hormonal balance, sexual function, and reproductive health.

Understanding the impact of commonly prescribed medications on male fertility is crucial for healthcare professionals, particularly in the context of increasing survival rates due to advancements in medical treatments.

This article delves into the intricate relationship between medical therapies and their potential iatrogenic effects on male reproductive health.

The Delicate Balance of Male Reproductive Health

Assessing and treating male infertility requires a nuanced understanding of the interconnectedness of hormones, anatomy, sexual function, and spermatogenesis.

Medications that impact one aspect of this system invariably affect others, making a comprehensive approach essential in the evaluation and treatment of male infertility.

Common Medications Impacting Male Fertility

Chemotherapy and Radiation

Advances in cancer treatments, such as chemotherapy and radiation, have significantly improved survival rates. However, they also pose risks to male reproductive health, including:

  • Radiation: Doses ≤0.8 Gray can lead to oligospermia, while doses >2.0 Gray may cause azoospermia.
  • Chemotherapy: Alkylating agents like Busulfan and cyclophosphamide present a high risk of oligospermia and azoospermia. Platinum-based drugs like Cisplatin and carboplatin, Anthracyclines, and plant alkaloids also pose varying threats to sperm production.

Androgen Deprivation Therapy

Used in prostate cancer and gender affirmation treatments, Androgen Deprivation Therapy (ADT) can significantly impact sexual function and fertility.

The resulting hypogonadism leads to a range of side effects, including sexual dysfunction and changes in body composition.

5-Alpha Reductase Inhibitors

These inhibitors, used for benign prostatic hyperplasia and androgenic alopecia, can lead to persistent sexual dysfunction, impacting erectile function and overall sexual health.

Selective Serotonin Receptor Inhibitors

Commonly used for depression and anxiety, SSRIs can cause sexual dysfunction, including poor libido, erectile dysfunction, and anorgasmia. They may also impact spermatogenesis and increase sperm DNA fragmentation.

Opioids

Chronic opioid use leads to hypogonadism and can negatively affect semen parameters, including sperm concentration, morphology, and motility.

Exogenous Testosterone

Used in hypogonadism treatment, exogenous testosterone suppresses natural spermatogenesis, posing a challenge for male fertility.

Fertility Preservation and Management Strategies

Given the potential iatrogenic effects of these therapies on fertility, it is imperative to counsel patients on fertility preservation strategies before treatment.

Options include sperm cryopreservation, penile vibratory stimulation, and electroejaculation. For prepubertal boys, experimental approaches like onco-testicular sperm extraction offer hope for future fertility.

Addressing Sexual Dysfunction

Addressing Sexual Dysfunction - Safe Therapeutics

Treating sexual dysfunction secondary to medical therapies requires a multifaceted approach. Phosphodiesterase-5 inhibitors, vacuum erectile devices, and penile implants are viable options. Exercise regimens and psychological support can also play a crucial role in managing the side effects of therapies like ADT.

The Importance of Holistic Care

In treating male infertility, it’s essential to consider the impact on the patient’s partner and the couple’s relationship. Couples’ counseling and comprehensive sexual health discussions should be integral parts of the treatment plan.

For transgender individuals, fertility preservation should be discussed before initiating gender-affirming treatments.

Conclusion

The intersection of medical therapies and male infertility is a complex arena that requires careful navigation. Healthcare providers must be vigilant in understanding the potential impacts of various treatments on male reproductive health.

Collaborative care involving oncologists, urologists, and fertility specialists is critical to providing effective treatment while preserving fertility and sexual function.

As advancements in medical therapies continue, ongoing research and updated guidelines will be crucial in optimizing patient care and quality of life.