Treatment for Impotence
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The male reproductive system. |
Pragmatic treatment of
Ejaculation problems
Erection problems
Hormone treatment
Gonadotrofine substitutes
Testosterone treatment
Investigations into male factor infertility have taught us that in a large group of men, no one particular abnormality can be established apart from an abnormal sperm analysis. Clear causes for which there is a specific treatment available are only found in a small minority of cases.
Pragmatic treatment [consultation]If your fertility problem is caused by potency disturbances (impotence, retrograde or premature ejaculation, anejaculation), you would used to have been subjected to an array of investigations aimed at identifying the precise root of cause. Nowadays there is a more empirical approach to treatment.
Ejaculation problems
- Anejaculation. If you can have an erection but are unable to reach ejaculation, psychological therapy may be able to help. If it doesn't, or is not indicated, there is a procedure available and this is addressed under vibro- and electrostimulation. The sperm sample produced can possibly be used in the fertility treatment of you and your partner.
- Retrograde ejaculation. This refers to the condition whereby the ejaculate is directed into the bladder instead of out through the penis. With other words, sperm is released when you have an orgasm but it travels in the wrong direction.
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Information retrograde ejaculation |
If this is suspected to be the problem, your urine will be examined for the presence of sperm cells. Your urine must first be alkalinized, or made less acidic and toxic for the sperm cells, if they are potentially to be used for your fertility treatment. You will be provided with the necessary container for the urine in the andrology lab, after masturbation.
In this information sheet about retrogade ejaculation you can read more about the procedure.
Erection problems
If you have problems with erections, the doctor will ask you a number of questions and examine a few things. Is your blood pressure too high? Do you have high cholesterol? Are you diabetic?
If the answer to these questions is no, it may be suggested that you try sildeafilcitrate, known worldwide as viagra. Sildenafilcitrate is a medication which hinders the break-up of the molecule which causes the penis to swell with blood during an erection. This will enable you to obtain and maintain an erection more easily.
If viagra doesn't help, then an alternative is the injection of prostoglandins into the penis. These hormones are normally produced in the prostate and one of their functions is to ensure you can get an erection and have an orgasm.
- Penis prosthetic. [operation, urology department]
A last resort is the implantation of an inflatable penis prosthetic. You will be able to obtain an erection by squeezing the scrotum.
Hormone treatment [consultation]
Hormone treatment is often carried out with the co-operation of the the Endocrinology department in UZ Brussel. This medical discipline specializes in the study of hormones.
In
theory of fertility, we learned which hormones form the basis of our fertility:
- in the brain: GnRH, LH & FSH. GnRH is regularly secreted from the hypothalamus and ensures that the hypofyse produces LH and FSH. These are Gonadotrophins: hormones which affect the reproductive organs and regulate the ripening process of sperm;
- in the reproductive organs: in the male this is mainly testosterone, the hormone produced in the testicles. If sperm production is low, so are testosterone levels and the hypofyse receives the message to step up production of FSH and LH.
administration of gonadotrophins
In rare cases, such as when the man has Kallman syndrome - there is no production of GnRH in the hypothalamus. As a result, the hypofyse does not produce gondotrophins and there is therefore no sperm production. The testicles are small like those of a pre-pubescent boy.
In order to stimulate the production of sperm, gonadotrophine substitutes are injected at a rate of twice a week. Because the process of sperm production takes around three months, (see
anatomy), a lengthy wait is involved before a satisfactory sperm sample can be obtained for use in IVF/ICSI treatment.
The process also has a number of undesirable side effects and can therefore not be implemented on a permanent basis. For this reason it is generally continued just long enough to produce several good sperm samples which are then banked for later use.
testosterone treatment
As we can conclude from the bodybuilder story (see Theory of infertility, the man,
The central heating principle), the administration of testosterone forms no useful role in fertility treatment. Quite the contrary. This treatment, which can be either in the form of three-weekly injections or topical gel form, is carried out in order to avoid the unpleasant effects of testosterone deficiency, such as low libido and bone calcification.
A specific group of men who have a testosterone deficiency, are those with
Klinefelter syndrome. If a sufferer wishes to father children and he wishes to undergo a
TESE-operation, in order to obtain sperm, he will have to have stopped his testosterone therapy at least three months previously.