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When there are no sperm in the ejaculate, they can often be withdrawn directly from the male reproductive tract using testicular sperm extraction (TESE) or micro epididymal sperm aspiration (MESA).

Most cases of male infertility do not respond to fertility medications and none of the “sperm enhancers” have been proven to significantly increase sperm quality or quantity. One exception is the infertile male who has extremely low levels of FSH and LH a rare condition known as hypogonadotropic hypogonadism. These patients often do well with FSH injections, and sometimes clomiphene, but the treatment period is long and very expensive.