Male infertility and gonadotropin treatment: What can we learn from real-world data?

Esteves, Sandro C.; Achermann, Arnold Peter Paul; Simoni, Manuela; Santi, Daniele; Casarini, Livio

doi:10.1016/j.bpobgyn.2022.102310

Cited by 17 publications

(21 citation statements)

References 180 publications

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“…The potential FSH efficacy in idiopathic infertility has been confirmed by recent real-world data analyses, 11 18 providing new relevant information directly from the clinical practice. 44 A recent study from our group 18 showed a positive FSH effect both in terms of pregnancy rate (one pregnancy in every four men treated), and in terms of sperm quality improvement (particularly referred to sperm number).…”

Section: Empirical Application Of Gonadotropins In Malesmentioning

confidence: 90%

“…Despite these challenges, the efficacy of FSH administration in male idiopathic infertility has been evaluated in 23 clinical trials so far. 10 11 18 The comprehensive evaluation of this approach was performed by four different meta-analyses, confirming a significant increase in pregnancy rate, both natural and after ART, in those couples in whom the man was treated with FSH. 40 41 42 However, the number needed to treat (NNT) calculated on available data is too high to justify the extensive use of FSH, at least at the dosages used so far.…”

Section: Empirical Application Of Gonadotropins In Malesmentioning

confidence: 94%

“…83 In this complex scenario, the genetic variability, involving the FSHB gene and FSHR single nucleotide polymorphisms (SNPs), should be considered to understand the different FSH efficacy observed in clinical practice. 7,11 It is well known that some SNPs in either FSHB or FSHR genes influence FSH production, FSHR expression, and its sensitivity. 84 Although this aspect is demonstrated in females, 85 only few studies evaluated the SNP's role in hormonal treatment of male infertility.…”

Section: Should We Consider a Follicle-stimulating Hormone Stimulator...mentioning

confidence: 99%

“…10 The rationale behind the use of hormonal treatment in male infertility comes from evidence-based use of replacement therapies in the endocrinological setting. 11,12 Hormonal restoration of the integrity of the hypothalamicpituitary-gonadal (HPG) axis is known to be effective in restoring the fertility of patients with hypogonadotropic hypogonadism. 11 In this clinical condition, pulsatile administration of gonadotropin-releasing hormone (GnRH) is the most physiological approach to promote gonadotropin production in an intact pituitary gland.…”

mentioning

confidence: 99%

“…11,12 Hormonal restoration of the integrity of the hypothalamicpituitary-gonadal (HPG) axis is known to be effective in restoring the fertility of patients with hypogonadotropic hypogonadism. 11 In this clinical condition, pulsatile administration of gonadotropin-releasing hormone (GnRH) is the most physiological approach to promote gonadotropin production in an intact pituitary gland. 13 However, because of management complexity and high cost, its use in clinical practice is limited, while direct administration of exogenous gonadotropins is generally preferred.…”

mentioning

confidence: 99%

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Gonadotropins in the Management of Couple Infertility: Toward the Rational Use of an Empirical Therapy

Romeo,

Donno,

Spaggiari

et al. 2023

Semin Reprod Med

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Although epidemiology shows that both men and woman can experience infertility, the female partner usually experiences most of the diagnostic and therapeutic burden. Thus, management of couple infertility is a unique example of gender inequality. The use of exogenous gonadotropins in assisted reproductive technology (ART) to induce multifollicular growth is well consolidated in women, but the same is not done with the same level of confidence and purpose in infertile men. Indeed, the treatment of idiopathic male infertility is based on an empirical approach that involves administration of the follicle-stimulating hormone (FSH) in dosages within the replacement therapy range. This treatment has so far been attempted when the endogenous FSH serum levels are within the reference ranges. According to the most recent evidence, a “substitutive” FSH administration may not be effective enough, while a stimulatory approach could boost spermatogenesis over its basal levels without adverse extragonadal effects. This article aims to describe the rationale behind the empirical application of gonadotropins in couple infertility, highlighting the need for a change in the therapeutic approach, especially for the male partner.

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Section: Empirical Application Of Gonadotropins In Malesmentioning

confidence: 90%

Section: Empirical Application Of Gonadotropins In Malesmentioning

confidence: 94%

Section: Should We Consider a Follicle-stimulating Hormone Stimulator...mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Gonadotropins in the Management of Couple Infertility: Toward the Rational Use of an Empirical Therapy

Romeo,

Donno,

Spaggiari

et al. 2023

Semin Reprod Med

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Are they functional hypogonadal men? Testosterone serum levels unravel male idiopathic infertility subgroups

Spaggiari,

Costantino,

Dalla Valentina

et al. 2024

Endocrine

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Purpose To evaluate total testosterone distribution in male idiopathic infertility. Methods A retrospective, real-world case-control clinical study was conducted. Cases consisted of men evaluated for couple infertility, specifically those with alterations in semen parameters and normal gonadotropin levels, and after excluding all known causes of male infertility. Controls were male subjects who underwent semen analysis for screening purposes, without any abnormality detected. The total testosterone distribution was evaluated in cases and controls. Further analyses were performed subgrouping cases according to total testosterone reference threshold suggested by scientific societies (i.e., 3.5 ng/mL). Results Cases included 214 idiopathic infertile men (mean age 38.2 ± 6.2 years) and controls 224 subjects with normozoospermia (mean age 33.7 ± 7.5 years). Total testosterone was not-normally distributed in both cases and controls, with positive asymmetric distribution slightly shifted on the left in cases. The rate of subjects with testosterone lower than 3.5 ng/mL was higher in cases (23.8%) than controls (4.5%) (p < 0.001). In cases with testosterone lower than 3.5 ng/mL, a significant direct correlation between testosterone and the percentage of normal morphology sperms was highlighted, also applying multivariate stepwise linear regression analysis (R = 0.430, standard error = 0.3, p = 0.020). Conclusion Although idiopathic infertile men show by definition altered semen analysis and gonadotropins within reference ranges, testosterone serum levels are widely variable in this population. Approximately a quarter of these patients present some sort of functional hypogonadism. Our data support the need to better classify idiopathic male infertility and total testosterone serum levels could be a supportive parameter in tracing the patient’s therapeutic profile.

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Endocrine and paracrine regulation of mammalian spermatogenesis

Zirkin,

Papadopoulos,

Huhtaniemi

2024

Hormones and Reproduction of Vertebrates

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Male infertility and gonadotropin treatment: What can we learn from real-world data?

Cited by 17 publications

References 180 publications

Gonadotropins in the Management of Couple Infertility: Toward the Rational Use of an Empirical Therapy

Gonadotropins in the Management of Couple Infertility: Toward the Rational Use of an Empirical Therapy

Are they functional hypogonadal men? Testosterone serum levels unravel male idiopathic infertility subgroups

Endocrine and paracrine regulation of mammalian spermatogenesis

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