Fertility drugs for men

When do men take fertility drugs?

Just as women need the right balance of hormones to ovulate regularly, men need certain hormones to produce enough healthy sperm to fertilize an egg. About 2 percent of men with infertility have a condition called secondary hypogonadism. It's the only condition in men with infertility that's treatable with fertility drugs.

Secondary hypogonadism happens when the hypothalamus or the pituitary gland doesn't function properly, and the hormone changes prevent normal testosterone and sperm production. Men with this condition have a low sperm count or no sperm at all.

(Men with other causes of infertility who want to conceive can try lifestyle changes, surgery, or assisted reproductive technologies, also called ART.)

Because the same hormones in men and women control reproduction, the same fertility drugs that stimulate ovulation also stimulate sperm production. The catch is that the drugs don't perform nearly as well for men, and only some have been approved by the U.S. Food and Drug Administration (FDA) to treat male infertility. However, a specialist can still prescribe them, even if they're not FDA-approved for this purpose.

How do fertility drugs work in men?

Some of the most commonly prescribed fertility drugs for women – clomiphene citrate, human chorionic gonadotropin (hCG), and human menopausal gonadotropin (hMG) – are used to treat men with secondary hypogonadism.

Clomiphene prompts the pituitary gland to make the hormones that direct the testicles to produce testosterone and more sperm. HCG stimulates the testes to produce testosterone and sperm. And sometimes fertility drugs are used with ART treatment.

How long do men need to take these drugs?

Here's what to expect with each drug:

• Clomiphene: Clomiphene treatment consists of taking one pill three times a week. Each treatment cycle runs for three to six months. As long as hormone levels stay normal, it's safe to take clomiphene in low doses for up to two years.
• Gonadotropins: HCG treatment means getting two to three injections a week. Each treatment cycle runs for up to six months. If the sperm count hasn't improved with hCG after six months, the doctor may suggest adding hMG injections to the regimen. It may take a year or two before treatment with hCG and hMG reaches maximum effectiveness.

Most doctors recommend ART treatment if pregnancy doesn't happen within six to 12 months of sperm first appearing in the semen. And even when using an ART treatment, men usually stay on gonadotropins to continue producing sperm.

What's the chance of pregnancy when using fertility drugs?

For some men, fertility drugs jump-start sperm production, boosting the sperm count closer to 15 million per milliliter of semen. (Anything below that is considered low.) But success is far from guaranteed. Here's what's known about each drug:

• Clomiphene. Studies of clomiphene use in men are small and have mixed results. Some studies find no benefit, and others show only a very slight improvement in pregnancy rates. Doctors don't usually recommend clomiphene for male infertility, but the drug is sometimes prescribed because it's easy to use, safe, and inexpensive.
• Gonadotropins. The benefits are clearer with the gonadotropins hCG and hMG, and experts agree that they're effective in treating secondary hypogonadism. Sperm production improves in up to 90 percent of men, though it may take a while to see results. In one small study of men with secondary hypogonadism and azoospermia (having no sperm), it took an average of seven months of treatment with hCG and hMG for sperm to appear in semen, and it took about 28 months until conception.

What are the side effects of fertility drugs in men?

In men, side effects of clomiphene are usually mild and can include:

• Nausea
• Headache
• Vision changes
• Weight gain
• Changes in sex drive
• Dizziness
• Breast enlargement

Treatment with gonadotropins can cause:

• Soreness at the injection site
• Breast enlargement
• Acne
• Changes in sex drive

How much do fertility drugs cost?

In the United States, expect to spend from $10 to $100 on a month's supply of clomiphene, depending on the dose and whether you choose a brand name or generic drug. You'll probably pay about $180 for a month's worth of hCG. As for hMG, expect to spend up to $2,000 each month.

If your insurance policy doesn't cover these drugs, you'll have to pay the cost up front.

Learn more about handling the cost of fertility treatment.