Pharmaceutical And Lifestyle Solutions For Male Infertility

HISTORY: A 49-year-old male and a 41-year-old female presented to the urology department in February 2024 with a seven-year combined infertility history. Despite previous in vitro fertilization (IVF) success in 2021, they have been unable to conceive naturally. The male patient reported fatigue, lethargy, low libido, and unexplained weight gain. Male’s scrotal ultrasound revealed varicocele with reverse flow on both sides of the pampiniform plexus. He maintains an active healthy lifestyle, avoiding tobacco and alcohol. While taking clomiphene (50 mg tablet, ½ tablet 3 times weekly) in 2021, his body fat percentage increased from 24.5% to 26.2%. PHYSICAL EXAMINATION: He appeared healthy, alert, and oriented, with no abnormal findings on physical examination. DIFFERENTIAL DIAGNOSIS: Male factor idiopathic infertility. TEST AND RESULTS: Ordered blood work and sperm analysis. FINAL DIAGNOSIS: He was prescribed enclomiphene and anastrozole (1 mg twice/week), without altering his thyroid medication (Synthroid 100 mcg/d). He also underwent a comprehensive lifestyle modification program, incorporating a plant-based Mediterranean diet, increased physical activity, and targeted supplementation. After four months, repeat testing revealed suboptimal testosterone levels (goal: 450-600 ng/dL), leading to a doubling of the enclomiphene dosage to 25 mg/d. Despite consistent exercise and diet, he experienced mood changes, joint pain, and delayed recovery from workouts. He took omega-3 fatty acid (375 mg + CoQ10: 50 mg), an omega-3 fish oil (Fish oil: 1250 mg + Omega-3: 1040 mg), and a daily Centrum Silver Men's + 50 multivitamin. Despite these efforts, his body fat percentage increased to 31.1%. FINAL WORKING DIAGNOSIS: His sperm analysis significantly improved, comparable to 2018 levels. Between February and October 2024, he saw a 33% increase in semen volume, a 54% decrease in total sperm motility, a 233% increase in motile sperm, a 53% increase in total motile sperm count, a 100% increase in testosterone, a 2.5% decrease in free testosterone, and a 21.1% increase in estradiol. TREATMENT AND OUTCOMES: The couple underwent IVF, resulting in a successful pregnancy. He will take testosterone hormone replacement therapy to counteract IVF side effects.