A Low Sperm Concentration Does Not Preclude Fertility in Men With Isolated Hypogonadotropic Hypogonadism After Gonadotropin Therapy

Objective Gonadotropins (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)) are released from the pituitary gland and stimulate Leydig cells to produce testosterone and initiates spermatogenesis. Little is known about how and when the deterioration of semen quality occurs in patients with adult-onset gonadotropin insufficiency. Design and methods A retrospective study comprising 20 testosterone-deficient men (median age, 29 years) with acquired pituitary disease who delivered semen for cryopreservation before initiation of testosterone therapy. Semen variables and hormone concentrations were compared to those of young healthy men (n = 340). Results Thirteen of 20 patients (65%) and 82% of controls had total sperm counts above 39 million and progressive motile spermatozoa above 32% (P = 0.05). For the individual semen variables, there were no significant differences in semen volume (median (intraquartile range) 3.0 (1.3–6.8) vs 3.2 (2.3–4.3) mL, P = 0.47), sperm concentration 41 (11–71) vs 43 (22–73) mill/mL (P = 0.56) or total sperm counts (P = 0.66). One patient had azoospermia. Patients vs controls had lower serum testosterone 5.4 (2.2–7.6) vs 19.7 (15.5–24.5) nmol/L (P = 0.001), calculated free testosterone (cfT) 145 (56–183) vs 464 (359–574) pmol/L (P < 0.001), LH 1.5 (1.1–2.1) vs 3.1 (2.3–4.0) U/L (P = 0.002) and inhibin b (P < 0.001). Levels of FSH were similar (P = 0.63). Testosterone/LH ratio and cfT/LH ratio were reduced in patients (both P < 0.001). Conclusions Despite Leydig cell insufficiency in patients with acquired pituitary insufficiency, the majority presented with normal semen quality based on the determination of the number of progressively motile spermatozoa. In addition, the data suggest reduced LH bioactivity in patients with pituitary insufficiency.

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Pulsatile gonadotropin-releasing hormone therapy is associated with earlier spermatogenesis compared to combined gonadotropin therapy in patients with congenital hypogonadotropic hypogonadism

Asian Journal of Andrology ◽

10.4103/1008-682x.193568 ◽

2017 ◽

Vol 19 (6) ◽

pp. 680 ◽

Cited By ~ 17

Author(s):

Xue-Yan Wu ◽

Jiang-Feng Mao ◽

Zhao-Xiang Liu ◽

Min Nie ◽

Xi Wang ◽

...

Keyword(s):

Hormone Therapy ◽

Hypogonadotropic Hypogonadism ◽

Gonadotropin Releasing Hormone ◽

Releasing Hormone ◽

Congenital Hypogonadotropic Hypogonadism ◽

Gonadotropin Therapy

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Gonadotropin-Induced Spermatogenesis in CHH Patients with Cryptorchidism

International Journal of Endocrinology ◽

10.1155/2019/6743489 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Zhaoxiang Liu ◽

Jiangfeng Mao ◽

Hongli Xu ◽

Xi Wang ◽

Bingkun Huang ◽

...

Keyword(s):

Confidence Interval ◽

Median Time ◽

Hypogonadotropic Hypogonadism ◽

Sperm Concentration ◽

Congenital Hypogonadotropic Hypogonadism

Congenital hypogonadotropic hypogonadism (CHH) patients with cryptorchidism history usually have poor spermatogenesis outcome, while researches focusing on this population are rare. This study retrospectively evaluated gonadotropin-induced spermatogenesis outcome in CHH patients with cryptorchidism (n = 40). One hundred and eighty-three CHH patients without cryptorchidism were served as control. All patients received combined gonadotropins therapy (HCG and HMG) and were followed up for at least 6 months. The median follow-up period was 24 (15, 33) months (totally 960 person-months). Sperm (>0/ml) initially appeared in semen at a median of estimated 24 months (95% confidence interval (CI) 17.8–30.2). Twenty (20/40, 50%) patients succeeded in producing sperms, and the average time to produce first sperm was 19 ± 8 months. Five pregnancies were achieved in 9 (5/9, 56%) couples who desired for children. Compared with CHH patients without cryptorchidism (n = 183), cryptorchid patients had longer median time for sperm appearance in semen (24 months vs. 15 months, P<0.001), lower rate of spermatogenesis (50% vs. 67%, P=0.032), and lower mean sperm concentration (1.9 (0.5, 8.6) million/ml vs. 11.1(1.0, 25.0) million/ml, P=0.006) at the last visit. In conclusion, CHH patients with cryptorchidism require a longer period for gonadotropin-induced spermatogenesis. The successful rate and sperm concentration were lower than patients without cryptorchidism.

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Gonadotropin Therapy Once a Week for Spermatogenesis in Hypogonadotropic Hypogonadism

Endocrine Practice ◽

10.1016/j.eprac.2021.04.009 ◽

2021 ◽

Author(s):

Wanlu Ma ◽

Jiangfeng Mao ◽

Min Nie phD ◽

Xi Wang ◽

Junjie Zheng ◽

...

Keyword(s):

Hypogonadotropic Hypogonadism ◽

Gonadotropin Therapy

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Clinical and Laboratory Findings during Gonadotropin Therapy of Post Pubertal Hypogonadotropic Hypogonadism

Andrologia ◽

10.1111/j.1439-0272.1974.tb01613.x ◽

2009 ◽

Vol 6 (2) ◽

pp. 147-154 ◽

Cited By ~ 7

Author(s):

K.D. SMITH ◽

M. FICHER ◽

E. STEINBERGER

Keyword(s):

Hypogonadotropic Hypogonadism ◽

Laboratory Findings ◽

Gonadotropin Therapy

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Induction of Spermatogenesis and Fertility during Gonadotropin Treatment of Gonadotropin-Deficient Infertile Men: Predictors of Fertility Outcome

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2008-1648 ◽

2009 ◽

Vol 94 (3) ◽

pp. 801-808 ◽

Cited By ~ 125

Author(s):

Peter Y. Liu ◽

H. W. Gordon Baker ◽

Veena Jayadev ◽

Margaret Zacharin ◽

Ann J. Conway ◽

...

Keyword(s):

Semen Analysis ◽

Sperm Concentration ◽

Previous Treatment ◽

Prognostic Indicator ◽

Time To Event ◽

Androgen Therapy ◽

Infertile Men ◽

Predictors Of Response ◽

Testis Volume ◽

Gonadotropin Therapy

Abstract Background: The induction of spermatogenesis and fertility with gonadotropin therapy in gonadotropin-deficient men varies in rate and extent. Understanding the predictors of response would inform clinical practice but requires multivariate analyses in sufficiently large clinical cohorts that are suitably detailed and frequently assessed. Design, Setting, and Participants: A total of 75 men, with 72 desiring fertility, was treated at two academic andrology centers for a total of 116 courses of therapy from 1981–2008. Outcomes: Semen analysis and testicular examination were performed every 3 months. Results: A total of 38 men became fathers, including five through assisted reproduction. The median time to achieve first sperm was 7.1 months [95% confidence interval (CI) 6.3–10.1]) and for conception was 28.2 months (95% CI 21.6–38.5). The median sperm concentration at conception for unassisted pregnancies was 8.0 m/ml (95% CI 0.2–59.5). Multivariate correlated time-to-event analyses show that larger testis volume, previous treatment with gonadotropins, and no previous androgen use each independently predicts faster induction of spermatogenesis and unassisted pregnancy. Conclusions: Larger testis volume is a useful prognostic indicator of response. The association of slower responses after prior androgen therapy suggests that faster pregnancy rates might be achieved by substituting gonadotropin for androgen therapy for pubertal induction, although a prospective randomized trial will be required to prove this.

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