Spermatogenesis by gonadotropin hormone therapy in men with prepubertal-onset hypogonadotropic hypogonadism Eur Urol Suppl 2016;15(3);e826
Lee S.H., Lee J.K., Kim S.W., Paick J-S. Seoul National University of Hospital, Dept. of Urology, Seoul, South Korea INTRODUCTION & OBJECTIVES: Spermatogenesis response to Gonadotropin Combination Therapy (GCT) is considered better in patients with acquired Hypogonadotropic Hypogonadism (HH) than in those with congenital HH. However, in the case of postnatal- and prepubertalonset acquired HH, insufficient data is available to estimate spermatogenesis response to GCT. We report the clinical outcomes of GCT for the treatment of infertility with prepubertal-onset HH. MATERIAL & METHODS: We retrospectively reviewed the medical charts of 32 males with prepubertal-onset HH who visited a medical school affiliated infertility center between 2010-2014. Fifteen males with congenital HH and seventeen males with acquired HH were treated with human Chorionic Gonadotropin (hCG)(2,000 – 2,500 IU) and recombinant Follicle Stimulating Hormone (rFSH)(75 IU) which were administered intramuscularly three times a week. Complete azoospermia was confirmed before treatment. The treatment outcome was considered successful after achievement of one or more sperm appearance. Differences between the two groups were analysed statistically and multivariate logistic regression analysis was used to find significant factors affecting spermatogenesis. RESULTS: The mean age of the congenital group (28 years) was higher than the acquired group (19 years)(p < 0.01). But there was no difference in hormone levels and initial sum of testicular volume. Etiology of the congenital group consisted of 67% (10/15) idiopathic HH and 33% (5/15) Kallmann syndrome. In the acquired group, 94% (16/17) patients were diagnosed with sellar or suparasellar tumors. After GCT, sperm appearance rates were 60% (9/15) in the congenital group and 41% (7/17) in the acquired group (p = 0.29). The mean time to spermatogenesis in the congenital group was 5 months, and in the acquired group 7.5 months, respectively (p = 0.15). Overall sperm quality was similar between the two groups. Multivariate logistic regression analysis showed that only initial sum of testicular volume (odds ratio 1.33, p = 0.04) was a significant factor affecting the spermatogenesis. CONCLUSIONS: Spermatogenesis by the combination of hCG with rFSH therapy could not be restored easily in patients with pre-pubertal onset acquired HH. Initial testicular volume may be the only factor to provide an insight into sperm appearance in response to treatment.