Effects of testosterone and gonadotropin therapy in men with hypogonadotropic hypogonadism

ABSTRACT

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