Treatment of Male Infertility

Our insight into the mechanisms of the physiology of reproduction has experienced a swift and constant development these last few years. The advent of more sophisticated diagnostic methods and their relatively easy clinical application allow for the incorporation of that knowledge into the evaluation of the infertile couple. These facts, together with an obvious change in social psychology, have facilitated the development of different specialities dealing with the problems of infertility. It is now possible in medical centers all around the world to undertake a better disposition of the infertile husband to look for advice, to be studied, and treated. Confronted with this situation we are still unable to offer specific therapy in most cases; however, empirically based therapy abounds. Advances in therapy have not kept pace with our increased physio­ logical knowledge and improved diagnostic techniques. Patho­ physiological mechanisms and etiological factors in male infertility are largely unknown. This has significantly hampered both clinical evaluation and advances in treatment allowing for frequent non­ scientific therapeutic incursions into the armamentarium of the an­ drologist. Several factors have given birth to therapeutic "fashions", which are bound to survive as long as this state of lack of knowledge con­ tinues. For example, we may ask whether the treatment of varicocele constitutes a fashion? Though we accept the treatment of varicocele as the best available treatment of male infertility, we do not know its mechanism of action and so we cannot predict a therapeutic result.