Gonadotropins for testicular descent in cryptorchid congenital hypogonadotropic hypogonadism males beyond infancy

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shreya Sharma ◽  
Ravikumar Shah ◽  
Virendra Patil ◽  
Anurag R. Lila ◽  
Vijaya Sarathi ◽  
...  
Keyword(s):  
Semen Analysis ◽  
Hypogonadotropic Hypogonadism ◽  
Sperm Concentration ◽  
Inhibin B ◽  
Testicular Descent ◽  
Total Testosterone ◽  
Human Menopausal Gonadotropin ◽  
Beneficial Effects ◽  
Congenital Hypogonadotropic Hypogonadism

Abstract Objectives To study the effect of combined gonadotropin therapy (CGT) on testicular descent ± spermatogenesis in congenital hypogonadotropic hypogonadism (CHH) patients with cryptorchidism beyond infancy. Methods This retrospective cohort study included CHH patients with cryptorchidism [bilateral (n=5) or unilateral (n=1)] treated with CGT for testicular descent ± pubertal induction. All participants were treated with CGT [human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG)] with hMG pretreatment in three and monitored for changes in testicular volume (TV), serum total testosterone (T), serum inhibin-B, and sperm concentration. Results Complete testicular descent to the scrotal position was achieved in 5/6 patients (10/11 testes) after 4.7 ± 1.6 months of treatment. There was 44 ± 18%, 97.5% (IQR: 44–195), 10-fold (IQR: 3–19.6), and two-fold (IQR: 1.7–9.3) increase in stretched penile length, ultrasound measured TV, T level, and serum inhibin-B from baseline, respectively. In two pediatric cases, testicular descent occurred with isolated hMG therapy. At the last follow up (median: 23.5, IQR: 10.5–38.7 months), all the descended testes remained in scrotal position. In four pubertal/postpubertal age patients, continuous CGT (18–60 months) yielded T and inhibin-B levels of 16.64 ± 1.46 nmol/l and 106 ± 32.6 pg/mL, respectively. All the three patients with available semen analysis had sperm concentration of ≥5 million/mL and one of them achieved paternity. Conclusions A trial of CGT before orchiopexy may be considered in CHH males with cryptorchidism even beyond the narrow age-window of infancy. CGT may also have beneficial effects on future spermatogenesis and fertility outcomes in these patients.

scholarly journals Gonadotropin-Induced Spermatogenesis in CHH Patients with Cryptorchidism

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
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.

scholarly journals The Pulsatile Gonadorelin Pump Induces Earlier Spermatogenesis Than Cyclical Gonadotropin Therapy in Congenital Hypogonadotropic Hypogonadism Men

2018 ◽  
Vol 13 (1) ◽  
pp. 155798831881828 ◽  
Author(s):  
Luyao Zhang ◽  
Ke Cai ◽  
Yu Wang ◽  
Wen Ji ◽  
Zhen Cheng ◽  
...  
Keyword(s):  
Hypogonadotropic Hypogonadism ◽  
Serum Testosterone ◽  
High Serum ◽  
Serum Testosterone Level ◽  
Common Side Effect ◽  
Human Menopausal Gonadotropin ◽  
Luteinizing Hormone Level ◽  
Contributing Factors ◽  
Congenital Hypogonadotropic Hypogonadism ◽  
Serum Luteinizing Hormone

The objective of this study was to compare the effect of pulsatile gonadorelin pump (PGP) and cyclical gonadotropin (human chorionic gonadotropin [HCG]/human menopausal gonadotropin [HMG]) therapy (CGT) on spermatogenesis in congenital hypogonadotropic hypogonadism (CHH) men. Twenty-eight azoospermic CHH males were included in this nonrandomized study. Ten received PGP and 18 received CGT. The primary endpoint was the earliest time spermatogenesis occurred during 24 months of treatment. Spermatogenesis time was significant earlier in the PGP group than the CGT group (median of 6 and 14 months, respectively, χ2 = 6.711, p = .01). Spermatogenesis occurred in 90% of the PGP group and 83.3% of the CGT group and showed statistically insignificant difference in the superiority analysis and the no-inferior test. Contributing factors significant for spermatogenesis were previous HCG/or testosterone treatment and the peak serum luteinizing hormone level of triptorelin stimulation test at baseline. Although testis volume and penile length increased significantly from baseline, the differences between the two therapies were not significant. There was a tendency for high serum testosterone level, associated with more facial acne and breast tenderness in the CGT group. Skin allergic erythema scleroma was a common side effect of the PGP. In summary, PGP resulted in earlier spermatogenesis and more desirable testosterone levels than CGT.

scholarly journals FSH stimulated inhibin B (FSH-iB): A novel marker for the accurate prediction of pubertal outcome in delayed puberty

2021 ◽  
Author(s):  
Shakun Chaudhary ◽  
Rama Walia ◽  
Anil Bhansali ◽  
Devi Dayal ◽  
Naresh Sachdeva ◽  
...  
Keyword(s):  
Validation Cohort ◽  
Hypogonadotropic Hypogonadism ◽  
Inhibin B ◽  
Stimulation Test ◽  
Delayed Puberty ◽  
P Value ◽  
Healthy Children ◽  
Group 2 ◽  
Group 1

Abstract Background Clinicians have long been struggling to find an effective tool to predict onset of puberty. Objective To explore stimulability of inhibin B after exogenous FSH and it’s potential role for prediction of onset of puberty. Design and participants Study subjects were enrolled into “exploratory cohort”(n=42) and “validation cohort”(n=19). “Exploratory cohort” was further divided into Group-1(Healthy children with spontaneous puberty: SP, n=26) and Group-2 (Patients of hypogonadotropic hypogonadism: HH, n=16). “Validation cohort” included children who presented with complaints of delayed puberty. Intervention and outcome Participants were subjected to FSH stimulation test and GnRHa stimulation test. Cut-offs derived from “exploratory cohort” for basal and FSH stimulated inhibin B(FSH-iB) were applied on “validation cohort” .Basal LH, GnRHa stimulated LH, basal inhibin B and FSH-iB were compared with clinical outcome on prospective follow-up for prediction of onset of puberty. Results There was statistically significant increment in inhibin B after exogenous FSH in Group 1(SP) in both male(188.8 pg/ml;p-value-0.002) and female (1065 pg/ml;p-value-0.023) subjects. The increment was not statistically significant in Group 2(HH) in both genders. FSH-iB at a cut-off of 116.14 pg/ml in male and 116.50 pg/ml in female had 100% sensitivity and specificity for labelling entry into puberty. On application of these cut-offs on “validation cohort”, FSH-iB had 100% PPV, NPV and diagnostic accuracy for prediction of onset of puberty. Conclusion Inhibin B was stimulable in both male and female subjects. FSH-iB can be considered as novel and promising investigation for prediction of onset of puberty. Future studies are required for further validation.

scholarly journals Treatment With Cholecalciferol Leads to Increase Of Selected Semen Parameters in Young Infertile Males: Results of a 6-month Interventional Study

2021 ◽  
pp. S99-S107
Author(s):  
I. Bartl ◽  
M. Ondrušová ◽  
M. Kužma ◽  
P. Jackuliak ◽  
A. Gažová ◽  
...  
Keyword(s):  
Vitamin D ◽  
Semen Analysis ◽  
Sperm Concentration ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
Sperm Parameters ◽  
Semen Parameters ◽  
Serum Vitamin D ◽  
Vitamin D Levels

High incidence of infertility along with low vitamin D levels was detected in otherwise healthy young men. The aim is to observe the effect of vitamin D supplementation on semen parameters as assessed by semen analysis in infertile men. In total, 45 men (mean age 36.6 years) in consecutive order were included, of whom 34 finished the study. Subjects were supplemented by vitamin D (cholecalciferol) 2500 IU/day. Vitamin D levels were assessed by HPLC. Semen analysis was performed strictly following 2010 WHO guidelines. Study periods were baseline and month 6. During follow-up, 20 %, 7.4 %, 22 % and 0.7 % increase in serum vitamin D levels, progressive sperm motility, sperm concentration and sperm morphology, respectively, were observed (all p<0.05). At follow-up end, 9 patients (26 %) reached normal sperm parameters of whom 2 fertilized their partner. There was no correlation between vitamin D and semen parameters observed. This study proves that vitamin D supplementation is possibly a modulator of sperm parameters in vitamin D deficient, otherwise healthy men. Although a direct relationship between vitamin D and sperm parameters was not observed obtaining adequate vitamin D levels could likely play a role in the male factor of infertility.

scholarly journals Semen quality among Danish and Finnish men attempting to conceive. The Danish First Pregnancy Planner Study Team

2000 ◽  
Vol 142 (1) ◽  
pp. 47-52 ◽  
Author(s):  
TK Jensen ◽  
M Vierula ◽  
NH Hjollund ◽  
M Saaranen ◽  
T Scheike ◽  
...  
Keyword(s):  
Semen Quality ◽  
Sperm Count ◽  
Semen Analysis ◽  
Sperm Concentration ◽  
Cohort Effect ◽  
World Health ◽  
Follow Up Studies ◽  
Health Organization ◽  
Selection Of

OBJECTIVE: To assess differences in semen quality between similar populations from Denmark and Finland. DESIGN: Comparison of semen quality between 221 Finnish men (of whom 115 had no proven fertility) and 411 Danish men with no proven fertility in two follow-up studies among normal couples trying to conceive. METHODS: In Finland male partners of couples without experienced infertility attempting to conceive were recruited through advertisements in local newspapers from 1984 to 1986. From 1992 to 1995 Danish men who lived with a partner and who had not attempted to achieve a pregnancy previously were recruited through their union when they discontinued birth control. All semen analyses were performed in accordance with the World Health Organization guidelines. RESULTS: Median sperm concentration, total sperm count and the percentage of morphologically normal spermatozoa were significantly higher among the Finnish men without proven fertility (104.0 million/ml, 304.0 million and 58% respectively) compared with the Danish men (53.0 million/ml, 140.8 million, and 41% respectively). Sperm concentration was 105.7% (95% confidence interval (CI) 58.1%-167.6%) and total sperm count was 127.4% (95% CI 71.4%-201.6%) higher among Finnish men without proven fertility than among Danish men after control for confounders. CONCLUSIONS: Some, but hardly all, of the observed difference in semen quality may be explained by differences in recruitment procedures, selection of the men and by methodological differences in semen analysis between the two countries. Also a birth cohort effect may explain some of the differences between countries as the Finnish men were recruited 11 years before the Danish men. Therefore, follow-up studies with identical recruitment and selection of men from the two countries are needed.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Reversible hypogonadotropic hypogonadism

2016 ◽  
Vol 174 (6) ◽  
pp. R267-R274 ◽  
Author(s):  
Andrew A Dwyer ◽  
Taneli Raivio ◽  
Nelly Pitteloud
Keyword(s):  
Hypogonadotropic Hypogonadism ◽  
Steroid Treatment ◽  
Treatment Withdrawal ◽  
Close Monitoring ◽  
Epigenetic Factors ◽  
Endocrine Disease ◽  
Congenital Hypogonadotropic Hypogonadism ◽  
Reproductive Axis ◽  
Periodic Treatment

Congenital hypogonadotropic hypogonadism (CHH) is characterized by lack of puberty and infertility. Traditionally, it has been considered a life-long condition yet cases of reversibility have been described wherein patients spontaneously recover function of the reproductive axis following treatment. Reversibility occurs in both male and female CHH cases and appears to be more common (~10–15%) than previously thought. These reversal patients span a range of GnRH deficiency from mild to severe and many reversal patients harbor mutations in genes underlying CHH. However, to date there are no clear factors for predicting reversible CHH. Importantly, recovery of reproductive axis function may not be permanent. Thus, CHH is not always life-long and the incidence of reversal warrants periodic treatment withdrawal with close monitoring and follow-up. Reversible CHH highlights the importance of environmental (epigenetic) factors such as sex steroid treatment on the reproductive axis in modifying the phenotype. This review provides an overview and an update on what is known about this phenomenon.

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