Effects of testosterone and gonadotropin therapy in men with hypogonadotropic hypogonadism

Limited data is available on the treatment of male infertility in patients with hypogonadotropic hypogonadism [HH]. The aim of this study was to evaluate the impact of therapy with testosterone and gonadotropins on the development of sexual characteristics and fertility in men with HH. In this study, conducted between 1992 and 2009, 102 male patients with HH were investigated. Patients who did not have secondary sexual characteristics were treated by testosterone until normalization of public hair and full appearance of sexual characteristics and 41 patients, who wanted fertility received treatment with human chronic gonadotropin [hCG], followed by human menopausal gonadotropin [hMG]. Testicular volume, sperm production and fertility were assessed, before and after treatment. Mean age at presentation was 22.7 +/- 6.3 years. Means for pubic hair and genital stages were 1.8 +/- 0.9 and 2.0 +/- 1.3, respectively. Testicular volume was 3.4 +/- 1.9 mL and 96% had azospermia. Levels of serum testosterone of 40 +/- 60 ng/dL, LH 0.5 +/- 1.0 IU/l and FSH 1.0 +/- 1.2 IU/I, were all in prepubertal ranges. Treatment with hMG/hCG in 32 men who completed >1 year of therapy, resulted in 24 conceptions [75%], 5 abortions and 19 pregnancies, with 18 singletons and one twin. Since treatment with gonadotropins resulted in conception in 75% and live births in 59% of the cases, it seems that in male patients with hypogonadotropic hypogonadism, this regimen is the treatment of choice

effects of pregnancy: induced hypertension on umbilical artery blood flow in the third trirnester

Doppler ultrasound of umbilical vessels is a method of evaluating fetoplacental blood flow which is very important in high risk pregnancies and can predict both the duration of maternal hospitalization and fetal mortality rates in IUGR. Pregnancy induced hypertension is one of the most important causes of high-risk pregnancies. In this study, the rate of blood flow through umbilical artery as well as its degree of resistance were measured, using Doppler ultrasound in the patients with pregnancy induced hypertension. This is a cross-sectional study which was carried out on 35 pregnant women with pregnancy induced hypertension in the year of 2004. All of the cases were studied during their third trimester. 61 pregnant women in their third trimester were selected as the control group. They all had normal blood pressure. Doppler ultrasound of umbilical artery was performed for both the case and the control groups. Then, Peak Systolic Velocity [PSV], End Diastolic Velocity [EDV] and mean velocity were measured, based of which Resistive Index [RI], Pulsatility Index [PI] and Systolic to Diastolic ratio [S/D ratio] were calculated. Finally the statistical analysis was performed on the obtained recorded data, using SPSS software. The results indicate a measure of 0.77 for RI; 1.39 for PT and 4.88 for S/D ratio in the case group while in the control group, such measurements were calculated as 0.64; 1.08 and 2.97, respectively. As a whole, the comparison of the mean values of the mentioned indices revealed a significant difference between the two groups [P<0.01]. The case group were significantly rated higher in terms of the above mentioned indices. In patients with pregnancy induced hypertension without having other risk factors [such as diabetes, mellitus and IUGR], Doppler ultrasound should be used for evaluating the degree of fetoplacental blood flow in order to decrease the risk of pregnancy complications