Hormonal Therapy for the Subfertility of Cryptorchidism

Abstract

Background: The subfertility of cryptorchidism correlates with severely reduced total germ cell counts in prepubertal testicular biopsies of undescended testes. Reduced total germ cell counts are associated with defects in the two prepubertal steps in maturation and proliferation in germ cells: first, the transformation of the fetal stem cell pool (gonocytes) into the adult stem cell pool (adult dark spermatogonia) at two to three months of age and, second, the transformation of adult dark spermatogonia into primary spermatocytes (meiosis) at 4–5 years. The defects in maturation are associated with blunting of the normal surges in gonadotropins and testosterone. Prepubertal treatment with gonadotropin-releasing hormones would theoretically trigger normal germ cell maturation and proliferation and thereby improve total germ cell counts and improve fertility. Prepubertal treatment of cryptorchidism with the GnRH analogue Buserelin has resulted in improved total germ cell counts and improved spermiograms. The purpose of this report is to describe the results of treatment of cryptorchidism with the GnRH analogue Naferelin. Patients: Twelve boys with cryptorchidism, 6 unilateral and 6 bilateral, and severely reduced germ cell counts in testicular biopsies were treated with Naferelin following successful orchidopexy and bilateral testicular biopsies. Response of the total germ cell counts was assessed in follow-up bilateral biopsies within 5 months of completing the hormonal therapy. Results: Eight of the 12 boys (5 of the 6 with unilateral and 3 of the 6 with bilateral cryptorchidism) showed improvement in the total germ cell counts in one or both testes. All 8 had a poor prognosis for fertility pretreatment and a good prognosis for fertility posttreatment. Of the 5 with unilateral cryptorchidism who improved, 2 showed improvement in both testes; and 3, only in the contralateral descended testes. All 3 of the boys with bilateral cryptorchidism who improved showed improvement in both testes. Testes with absence of germ cells and older patients tended to show no improvement. Of the 6 contralateral descended, 5 (83%) improved, and of the 18 undescended testes, 8 (44%) improved. Conclusions: In this preliminary study, Naferelin therapy appears to induce improvement in the total germ cell counts and the prognosis for future fertility in 75% of patients.

Infertility in Cryptorchidism Is Linked to the Stage of Germ Cell Development at Orchidopexy

“…Analyzed in full, at least half of the cryptorchid population is depleted of Ad spermatogonia. The preliminary results of treating cryptorchid boys with low total germ cell count, and lacking Ad spermatogonia, with LH-RH analog are encouraging [16,17,18,19]. Particularly, for boys younger than age seven, having no Ad spermatogonia, as assessed by biopsies performed during orchidopexy, and for whom the total number of germ cells is <0.2 per tubular cross-section, will profit from LH-RHa treatment which will increase the number of germ cells significantly [18].…”

Hormonal Treatment

“…In another study, Huff et al [ 38 ] reported that GnRH treatment after orchidopexy improved total germ cell counts in 75 % of the patients. These results have partly been confi rmed by other groups.…”

Effect of Cordyceps militaris on Testosterone Production in Sprague-Dawley Rats

“…Alternative medicines in plants, fungi, and insects have been studied to enhance sexuality (Crimmelet al, 2001). In fact, the injection of testosterone to restore the reproductive function has been applied to treat men with insufficient testosterone secretion for decades (Huff et al, 2001). The scientific evidence related to the mechanisms or efficacy of these alternatives is scarce or often unconvincing.…”