The man with a low sperm count presents a very frustrating problem for doctors. Not only is he frustrated that he is " shooting blanks " and cannot get his wife pregnant, but he also expects the doctor to provide a quick solution to his problem.

Most men ( and their wives) naively think that the doctor will be able to prescribe a medicine that will help him to increase his sperm count. After all, isn't a low sperm count a very common problem? And hasn't medical technology advanced so much that we can treat cancers and heart disease? So shouldn't treating a low sperm count be a child's play?

Variety of treatments 

It is true that the conventional treatment of male infertility in the past used a wide array of medicines to try to improve a low sperm count in the infertile man. These included: HMG and HCG injections; Clomid; and testosterone. Unfortunately, none of these work!

Sperm counts tend to vary widely on their own ( even when no treatment is being given); and many of these medicines would actually cause the count to drop rather than to improve, just adding to the patient's frustration!

Read more- Male Infertility Treatment - and why it does not work

Tall claims?

The newest medicine on the block is Proxeed - and many websites and advertisements claim that Proxeed helps to treat male infertility. However, while Proxeed may increase sperm counts in selected men ( and reduce them in others), it hasn't been proven to be effective in increasing pregnancy rates.

The sad truth is that there is no evidence that it works. However, since it's just a simple tablet, and in any case, it " does no harm", many doctors will prescribe it - and many patients will take them.

Many men will observe that their sperm count increases after taking Proxeed and they get very excited when this happens. However, do remember that sperm counts fluctuate all the time - and often the increase is in spite of the medicines, not because of it. In any case, a sperm count is not like a bank account that you should get excited when it increases!

Losing sight of the objective 

The end-point is not an increase in the sperm count or motility - it's a baby! While Proxeed may improve sperm counts in some men on some occasions, double-blind clinical trials have shown they do not help to improve pregnancy rates. This criticism is also true for the currently fashionable Proxeed, which is being marketed very aggressively and cleverly in the USA.

The problem with the medical treatment of a low sperm count is that for most people it simply doesn't work. After all, if the reason for a low sperm count is a microdeletion on the Y-chromosome, then how can medication help?

The very fact that there are so many ways of "treating" a low sperm count itself suggests that there is no effective method available. This is the sad state of affairs today and much needs to be learned about the causes of poor production of sperm before we can find effective methods of treating it.

Read more- The confused infertile man with a low sperm count

Doctors under pressure

However, patients want treatment, so there is pressure on the doctor to prescribe, even if he knows the therapy may not be helpful. When most patients go to a doctor, they expect that the doctor will prescribe a medicine and treat their problem.

Since most people still believe there is a "pill for every ill", they expect that the doctor will give them a medicine ( or an injection) which will increase their sperm count. No patient ever wants to hear the truth that there is really no effective treatment available today for increasing the sperm count.

Hiding the truth 

Since most doctors know this, they are pressurized into prescribing Proxeed for these patients, because they do not want the patient to be unhappy with them. They are worried that if they do not fulfill the patient's expectation of a prescription, the patient will desert them, and go elsewhere, which is why they often do not tell the patient the complete truth.

The doctor also remembers the occasional anecdotal successes (who come back for followup, while the others desert the doctor and are lost to followup) is why patients with low sperm counts are put on every treatment imaginable - with little rational basis - Vitamin E, Vitamin C, high-protein diets, homeopathic pills, and ayurvedic churans. However, the very fact that there are hundreds of medicines itself proves that there is no medicine that works!

The justification

Many doctors justify their prescriptions by saying - " Anyway it can't hurt - and in any case, what else can we do? " However, this attitude can be positively harmful. It wastes time, during which the wife gets older, and her fertility potential decreases.

Patients are unhappy when there is no improvement in the sperm count and lose confidence in doctors. It also stops the patient from exploring effective modes of alternative therapy - such as In Vitro Fertilization and ICSI. Today empiric therapy should be criticized unless it is used as a short term therapeutic trial with a defined end-point.

A word of warning

Medical treatment for male infertility does not have a high success rate and has unpleasant side effects, so don't take it unless your doctor explains his rationale. The treatment is best considered "experimental" and can be tried as a therapeutic trial. Make sure, however, that semen is examined for improvement after three months and then decide whether you want to press on regardless.

It is worth emphasizing how small the list for male infertility treatment is - especially as compared to female treatment. This simply reflects our ignorance about male infertility - we know very little about what causes it, and our knowledge about how to treat it is even more pitiable!

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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