Abstract
CASE HISTORY: A 49-year-old male and a 41-year-old female with a seven-year history of infertility presented to Urology. Despite a successful IVF in 2021, natural conception remained elusive. The male reported fatigue, lethargy, low libido, and unexplained weight gain. A prior scrotal ultrasound detected bilateral varicocele with reverse flow. Both had no significant medical, family, sexually transmitted diseases or significant inherited conditions within their immediate families. The male patient maintains an active lifestyle and avoids tobacco and alcohol consumption. Despite adhering to a healthy diet and exercise regimen during the previous year of infertility treatment with clomiphene (50 mg tablet, ½ tablet 3 times weekly), he gained 15 kilograms of weight. His body fat percentage increased from 24% to 26.2%, and his total weight rose from 107.5 kilograms to 111 kilograms. PHYSICAL EXAM: General appearance: Well-appearing, healthy male in no apparent distress; Mental Status: Alert and oriented, normal affect. Chest: No gynecomastia. Abdomen: Soft, non-tender, no masses or organomegaly. Bladder is not palpable. No evidence of inguinal hernia. Penis: Penis is uncircumcised with no evidence of plaques or induration. Urethral meatus is normal. Scrotum: Scrotum is grossly normal. Testes are descended bilaterally (right 18cc, left 18cc) with no evidence of masses or tenderness. Vas deferens: normal bilaterally. Varicocele: None. DIFFERENTIAL DIAGNOSES: Male factor idiopathic infertility. TESTS & RESULTS: Blood work and sperm analysis were ordered. FINAL DIAGNOSIS: Combined couple infertility. DISCUSSION: Following the initial February 2024 visit, the male patient was prescribed enclomiphene (12.5 mg/d) and anastrozole (1 mg twice/week). His existing thyroid medication (Synthroid 100 mcg/d) remained unchanged. Additionally, the patient underwent a comprehensive lifestyle modification program, incorporating a plant-based Mediterranean diet, increased physical activity, and targeted supplementation. The initial round of medication began with a body fat percentage of 24.4% and a weight of 108 kilograms. After four months, a repeat sperm analysis and blood work revealed the need to double the enclomiphene dosage to 25 mg/d. The decision to increase the enclomiphene dosage was due to suboptimal total testosterone levels – the goal is 450-600 ng/dL. During this period, the patient reported mood changes, joint pain, and delayed recovery from workouts, despite consistent exercise and diet. The patient's supplement regimen included a daily men's multivitamin, omega-3 fatty acid supplements (Omega-3: 375 mg + CoQ10: 50 mg) by Perelel, and an additional omega-3 fish oil supplement (Fish oil: 1250 mg + Omega-3: 1040 mg) by Sports Research. Additionally, a daily Centrum Silver Men's +50 multivitamin was consumed. Despite these efforts, the patient's body fat percentage increased to 31%, and his weight rose to 114 kilograms. OUTCOME OF THE CASE: Patient significantly improved his sperm analysis results, achieving values comparable to those from 2018. Between February and October 2024, he experienced a 33% increase in semen volume, a 54% decrease in total sperm motility, a 233% increase in number of motile sperm, a 53% increase in total of motile sperm count, a 100% increase in testosterone, a 2.5 decease in free testosterone, and a 21.1% increase in estradiol. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Based on these results, the couple underwent a round of IVF, which resulted in a successful pregnancy. The male will follow a testosterone hormone replacement therapy to counteract the side effects of the fertility treatment.
Recommended Citation
Papadakis, Zacharias; Dubin, Justin M.; and Stamatis, Andreas
(2025)
"Pharmaceutical and Lifestyle Solutions for Male Infertility,"
International Journal of Exercise Science: Conference Proceedings: Vol. 2:
Iss.
17, Article 135.
Available at:
https://digitalcommons.wku.edu/ijesab/vol2/iss17/135