Maintenance of spermatogenesis in hypogonadotropic hypogonadal men with human chorionic gonadotropin alone

Abstract

Objective: It is generally accepted that both gonadotropins LH and FSH are necessary for initiation and maintenance of spermatogenesis. We investigated the relative importance of FSH for the maintenance of spermatogenesis in hypogonadotropic men. Subjects and methods: 13 patients with gonadotropin deficiency due to idiopathic hypogonadotropic hypogonadism (IHH), Kallmann syndrome or pituitary insufficiency were analyzed retrospectively. They had been treated with gonadotropin-releasing hormone (GnRH) ðn ¼ 1Þ or human chorionic gonadotropin/human menopausal gonadotropin (hCG/hMG) ðn ¼ 12Þ for induction of spermatogenesis. After successful induction of spermatogenesis they were treated with hCG alone for maintenance of secondary sex characteristics and in order to check whether sperm production could be maintained by hCG alone. Serum LH, FSH and testosterone levels, semen parameters and testicular volume were determined every three to six months. Results: After spermatogenesis had been successfully induced by treatment with GnRH or hCG/hMG, hCG treatment alone continued for 3 -24 months. After 12 months under hCG alone, sperm counts decreased gradually but remained present in all patients except one who became azoospermic. Testicular volume decreased only slightly and reached 87% of the volume achieved with hCG/ hMG. During treatment with hCG alone, FSH and LH levels were suppressed to below the detection limit of the assay. Conclusion: Once spermatogenesis is induced in patients with secondary hypogonadism by GnRH or hCG/hMG treatment, it can be maintained in most of the patients qualitatively by hCG alone, in the absence of FSH, for extended periods. However, the decreasing sperm counts indicate that FSH is essential for maintenance of quantitatively normal spermatogenesis.

Gonadotrophin replacement for induction of fertility in hypogonadal men

“…If the couple desires to conceive again quickly, hCG alone can be continued. This can effectively maintain spermatogenesis yet sperm counts tend to progressively fall over time [90]. Importantly, Liu and colleagues noted that a prior gonadotrophin treatment resulted in a 2e3 fold shorter time to the appearance of first sperm on subsequent gonadotrophin treatment regimens [31].…”

Factors affecting spermatogenesis upon gonadotropin‐replacement therapy: a meta‐analytic study

“…HHG, hypogonadotropic hypogonadism; LL, lower limit of confidence interval; UL, upper limit of confidence interval. small testis size in pre-pubertal HHG more likely reflects a failure of puberty-associated testicular and Sertoli cell development (Matsumoto & Bremner, 1987;Schaison et al, 1993;Tachiki et al, 1995Tachiki et al, , 1998Depenbusch et al, 2002;Matthiesson et al, 2006), as described above. In addition, the accuracy of measurement of testis volume with Prader orchidometer, as in usual clinical practice, is limited possibly producing an underestimation of the actual prognosis impact of testis volume.…”

Treatment of hypogonadotropic male hypogonadism: Case-based scenarios

“…hCG alone can only maintain spermatogenesis for a short period of time. In a small case series directed by Depenbusch et al [24] , thirteen azoospermic men with hypogonadotropic hypogonadism were initially administered hCG and human menopausal gonadotropin (hMG) to induce spermatogenesis. hCG was then administered 5002500 IU hCG subcutaneously biweekly alone for up to two years (range 324 mo).…”