Induction of spermatogenesis with gonadotrophins in Chinese men with hypogonadotrophic hypogonadism

Abstract

The effects of gonadotrophin administration to 17 Chinese patients with hypogonadotrophic hypogonadism (HH) on testicular volume and induction of spermatogenesis were studied. Ten subjects had isolated HH and seven had hypopituitarism. Twelve of the subjects had prepubertal onset of HH and five of them had been treated previously with hCG for induction of puberty. None had a history of cryptorchidism. During hCG treatment for induction of spermatogenesis, all subjects had an increase in serum levels of testosterone into the normal adult male range and their testes increased in size from 3 (1-20) ml to 11.6 (5-20) ml [median(range), p < 0.02]. Six subjects required treatment with hCG alone. However, the remaining 11 subjects, after at least 6 months treatment with hCG, required the addition of human menopausal gonadotrophin (hMG) to induce spermatogenesis. Two subjects remained azoospermic. One had a history of mumps orchitis and the other had isolated elevation of blood FSH levels, suggestive of primary testicular failure in addition to HH. Excluding one subject with fertile eunuch syndrome, the mean duration for first appearance of spermatozoa was 13 (4-52) months. Twelve subjects became fertile and pregnancy was achieved in their partners after 20 (4-78) months. The weekly doses for hCG and hMG were 4000 (3000-10,000) IU and 225 (225-450) IU, respectively. Patients who responded to hCG alone had a significantly larger pretreatment testicular volume, suggesting that they had only partial gonadotrophin deficiency. Prepubertal onset of hypogonadism was not a determining factor for requirement of hMG treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulsatile GnRH or human chorionic gonadotropin/human menopausal gonadotropin as effective treatment for men with hypogonadotropic hypogonadism: a review of 42 cases

“…Our data clearly show that testicular volume at the beginning of therapy is a good predictor for the necessary length of treatment and confirm earlier observations (13). Even in patients with very small initial testicular volume successful therapy is possible.…”

Gonadotrophin replacement for induction of fertility in hypogonadal men

“…One advantage of exogenous gonadotrophin treatment is that it can be effective for hypothalamic as well as pituitary disorders yet this mono-therapy approach has important limitations. Mono-therapy with hCG is best used to stimulate spermatogenesis in those CHH men with larger testicular size [23, 24,28,57]. This includes those CHH men with some degree of spontaneous testicular development as well as those with the so-called fertile eunuch syndrome [58].…”

European Consensus Statement on congenital hypogonadotropic hypogonadism—pathogenesis, diagnosis and treatment

“…In patients with some gonadal development (testicular volume >4 ml) and no history of cryptorchidism, induction of spermatogenesis can be achieved with hCG mono therapy. 194,[206][207][208] If no sperm is present in the ejaculate after 3-6 months of treatment, FSH can be used to stimulate the seminiferous tubules. 198 In the most severely affected men with CHH (testicular volume <4 ml), a sequential treatment has emerged in an attempt to maximize fertility potential.…”