Withered Yang: a review of traditional Chinese medical treatment of male infertility and erectile dysfunction.

Infertility is a private, social, and economic problem. Infertility is defined as the inability to conceive a pregnancy within 1 year. Twenty-five percent of couples will seek help for infertility at some point during their relationship (Page, 1989), accounting for over 2 million office visits to health care providers annually (The Endocrine Society, 1998). Male factor infertility is contributory in at least 50% of infertile couples (Collins, 1989). Currently, the therapy for male factor infertility focuses on microsurgery to correct varicoceles or obstruction of the male reproductive ductal system. Additionally, there has been a strong shift away from evaluating and treating the man and proceeding directly to expensive artificial reproductive technologies. Prior attempts at medical therapy for male factor infertility have included hormonal therapy (GnRH agonists and antagonists, gonadotropins, anti-estrogens, testosterone, and aromatase inhibitors), antioxidant therapy, antibiotics, corticosteroids, methylxanthines, vitamins, minerals and amino acids (zinc and arginine), and angiotensin-converting enzyme inhibitors. The observation that no medication is approved by the United States Food and Drug Administration for treatment of male infertility confirms the conclusion that adequate controlled studies of potential therapeutic agents are either lacking or failed to elicit a significant improvement in fertility. Male erectile dysfunction can be defined as the inability of a man to obtain penile rigidity sufficient to permit coitus of adequate duration to satisfy himself and his partner. The personal and private nature of this problem has hindered accurate estimates of the true prevalence in the