The alpha-sympathomimetic midodrin as a tool for diagnosis and treatment of sperm transport disturbances.

The present study was performed to determine the usefulness of the alpha-sympathomimetic midodrin for diagnosis and treatment of functional sperm transport disturbances. 140 andrological patients consulting due to severe oligozoospermia, hypospermia or partial/complete retrograde ejaculation were included. Ejaculates were examined 30 min after intravenous injection of 5-15 mg midodrin. Sperm concentration, motility and alpha-glucosidase as a marker of both epididymal function and sufficient passage through the vasa deferentia and the ejaculatory duct were measured and the values compared to those in the ejaculates obtained before therapy. In 23 of 140 patients, sperm concentration or total sperm count was improved by more than 10 million spermatozoa ml-1 or 20 million spermatozoa per ejaculation. Alpha-glucosidase in the seminal plasma increased in two cases. The present study demonstrates that severe oligozoospermia may be caused by functional transport disturbance of semen from the epididymis to the efferent duct system. In these cases, midodrin is of diagnostic and therapeutic value; however, it should be emphasized that its effectiveness cannot be predicted individually.