Volume 113, Issue 6, Page 1120
Mark Sigman, M.D.
Despite significant advances in reproductive medicine, a substantial portion of men are diagnosed with idiopathic male infertility—abnormal semen parameters with no identifiable cause. We have a good understanding of many of the requirements needed for spermatogenesis, such as a functioning hypothalamic pituitary axis. We also have data indicating that an excess of certain compounds, such as reactive oxygen species, may be detrimental to fertility. For over 50 years, clinicians have used this knowledge as a basis for empiric therapy of the infertile male. The concept is quite simple: if a little of something is good for fertility, more of it must be better. Conversely, if something is bad for fertility, less of it may improve fertility. This simple paradigm has been applied to empiric hormonal medical therapy, the use of antioxidants and vitamins, and recommendations for change lifestyle patterns such as avoiding heat, cell phones, or laptop computers.