The causes of male infertility are varied and thus their treatment also varies. While previously, most cases of male infertility were treated with surgery, now the focus is on identifying the exact cause of infertility and treating it accordingly using male infertility medicines. With more and more research, there has been an increase in the number of male infertility pills in the market.

Pharmacotherapy of male infertility:

Hypogonadotropic hypogonadism: In this condition, the pituitary gland is the one at fault. Due to decreased release of gonadotropin releasing hormones (GnRH) , there is reduced stimulation of the testes to produce testosterone. This condition is treated by using the hormone, Human Chorionic Gonadotropin (HCG) and recombinant Follicle Stimulating Hormone (FSH). Pulsatile therapy with GnRH is also available using a potable pump to be administered subcutaneously. The therapy lasts for about 8 to 12 months.
Hperprolactinemia: Increased levels of prolactin occur mainly due to a secretory tumor in the pituitary gland. Male infertility here is due to decrease in the GnRH and testosterone. This condition once diagnosed can be treated with the use of bromocryptine which helps in reducing the size of the tumor and improves fertility.
Congenital adrenal hyperplasia (CAH): Pharmacotherapy in male infertility due to CAH is treated using corticosteroids like dexamethasone in doses of 0.5 to .075 mg per day.
Antiestrogens like clomiphene citrate and tamoxifen have also been tried successfully to improve male fertility in subjects with high estrogen levels. This therapy increases the pituitary release of FSH and LH which increases the secretion testosterone and improves spermatogenesis.
Use of alpha sympathomimetics: These drugs are useful in the treatment of retrograde ejaculation as they improve the contractibility of the bladder neck. It is likely to be less effective in patients who have the hypogastric nerve plexus have been involved.
Immunologic disease: Medical therapy is used for the treatment antisperm antibodies using steroids like prednisolone.
Infections: Infections of the prostate are very common in males and can be diagnosed if the male is having recurrent episodes of urinary tract infection and the couple is unable to conceive despite repeated attempts. Prostatitis causes decrease motility of the sperms and also decreases the levels of zinc and acid phosphatase, all of which contribute to reducing the fertility. Leucocytes release reactive oxygen species in large amounts which also decreases the fertility by affecting sperm functions like acrosome activation, zona binding etc. Treatment is usually with broad spectrum antibiotics for prolonged periods like 6 to 8 weeks.
Alternative therapy: Antioxidants like N-acetylcysteine, vitamin C and vitamin E are used as antioxidants which help improve sperm function. Folic acid is a micronutrient which helps in DNA and RNA synthesis. Supplementation with zinc is known to improve male fertility as it improves spermatogenesis and also the motility of sperm.

Zinc is a co-factor in a large number of metalloenzymes. Some of these enzymes play an important role in conversion of testosterone into its more active forms 5-alpha –dihydrotestosterone which explain its role in improving male fertility. L-Carnitine is very important agent for sperm metabolism and supplementation with this agent has also been studied in the treatment of male fertility.