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This chapter discusses a number of specific therapeutic modalities aimed at the management of defined causes of male infertility. Androgen replacement therapy is gaining significant attention as a possible treatment for ailments ranging from lack of libido to increased body fat to depression and decreased mental acuity. Hyperprolactinemia is a cause of male infertility that is often amenable to non-surgical therapy. Elevated levels of prolactin may impair male fertility based on multiple pathways. A particularly interesting application of pharmacotherapy in the management of male infertility is the use of clomiphene citrate before testis biopsy in the management of azoospermic men suffering from primary testicular failure. Substances, including antiestrogen agents, aromatase inhibitors, gonadotropins, L-carnitine, antioxidants, and a variety of other compounds have been employed for years with little conclusive evidence that they consistently improve either semen quality or pregnancy rates.
This chapter discusses the sites of genitourinary tract infections, infectious organisms, the numerous ways in which leukocytes may impair male reproduction, and the diagnosis and treatment of leukocytospermia and bacteriospermia. Infections of the urethra are most common due to sexually transmitted pathogens, and they are separated into two broad categories: gonococcal urethritis (due to Neisseria gonorrhoeae ) and nongonococcal urethritis (Chlamydia trachomatis, Mycoplasma species, Trichomonas vaginalis). Immunohistology employs monoclonal antibodies (mAb) targeted against white blood cell (WBC) surface markers. Flow cytometry, when used in conjunction with monoclonal antibodies, can provide rapid analysis of scant WBC subpopulations without purification procedures. Leukocytes, monocytes, and granulocytes are differentiated by using the light-scatter properties of the WBCs and the density of the leukocyte marker antibody, CD45. The chapter suggests that abnormal concentrations of leukocytes are a common finding in the semen of men with spinal cord injury (SCI).
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