Testosterone undecanoate supplementation together with human chorionic gonadotropin does not impair spermatogenesis in males with isolated hypogonadotropic hypogonadism: a retrospective study.

Gonadotropin therapy is commonly used to induce virilization and spermatogenesis in male isolated hypogonadotropic hypogonadism (IHH) patients. In clinical practice, 5.6%-15.0% of male IHH patients show poor responses to gonadotropin treatment; therefore, testosterone (T) supplementation can serve as an alternative therapy to normalize serum T levels and promote virilization. However, treatment with exogenous T impairs spermatogenesis and suppresses intratesticular T levels. This retrospective study aimed to determine whether oral testosterone undecanoate (TU) supplementation together with human chorionic gonadotropin (hCG) would negatively affect spermatogenesis in IHH patients compared with hCG alone. One hundred and seven IHH patients were included in our study. Fifty-four patients received intramuscular hCG and oral TU, and 53 patients received intramuscular hCG alone. The median follow-up time was 29 (range: 12-72) months in both groups. Compared with the hCG group, the hCG/TU group required a shorter median time to normalize serum T levels (P < 0.001) and achieve Tanner stage (III and V) of pubic hair and genital development (P < 0.05). However, there were no significant differences in the rate of seminal spermatozoa appearance, sperm concentration, or median time to achieve different sperm concentration thresholds between the groups. In addition, there were no significant differences in side effects, such as acne and gynecomastia, observed in both groups. This study indicates that oral TU supplementation together with hCG does not impair spermatogenesis in treated IHH patients compared with hCG alone, and it shortens the time to normalize serum T levels and promote virilization.

Effect of adjuvant drug therapy after varicocelectomy on fertility outcome in males with varicocele-associated infertility: Systematic review and meta-analysis.

Varicocele is one of the common correctable causes of male infertility. Recent studies have demonstrated varicocelectomy in males with abnormal semen parameters was associated with better fertility outcome, but the effect of adjuvant drug therapy after varicocelectomy on fertility outcome in patients with varicocele-associated infertility remains undefined. Hence, the present meta-analysis was performed to assess the efficacy of adjuvant drug therapy after varicocelectomy. The protocol was registered with PROSPERO (No. CRD42018093749). Ten randomised controlled trails containing 533 patients with adjuvant drug therapy after varicocelectomy and 368 patients with no medical treatment after varicocelectomy were included. Our analysis revealed that the improvement in pregnancy rate after adjuvant drug therapy was insignificant. (OR = 1.70, 95%CI = 0.99-2.91), but resulted in significant improvements in sperm concentration (MD = 13.71, 95%CI = 5.80-21.63) and motility (MD = 4.77, 95%CI = 3.98-5.56) at 3 months, sperm DNA integrity (SMD = 3.13, 95%CI = 1.50-4.75) and serum FSH level (MD = -1.02, 95%CI = -1.79 to -0.24). Therefore, compared to no medical treatment, the adjuvant drug therapy, especially the use of antioxidants seems to be associated with better fertility outcome. However, more evidences with high-quality studies are necessary to conform its benefits.

[Effect of Naoxintong Capsule on Vascular Remodeling in Type 2 Diabetic Patients with Subclinical Vascular Disease].

Objective To observe the effect of Naoxintong Capsule (NC) on carotid artery vas- cular remodeling (VR) in type 2 diabetes mellitus (T2DM) patients with subclinical vascular disease. Methods A total of 180 T2DM patients with subclinical atherosclerosis (AS) were randomly assigned to the observation group and the control group in the ratio of 1:1 , 90 in each group. All patients took conven- tional hypoglycemic therapy, and the choices of therapeutic drugs and doses were selected according to patients' conditions. Patients in the observation group additionally took NC (3 pills each time, three times per day) , while those in the control group took no interventional drug. The therapeutic course for all was 6 months. The size and nature of bilateral carotid artery plaque were measured before and after treatment using color Doppler ultrasound diagnostic instrument. Bilateral carotid artery intimal-medial thickness (IMT) , plaque area (PA) , total vascular area (TVA) , lumen area (LA) , peak systolic velocity (PSV) , end diastolic velocity (EDV) , vascular resistance index (VRI) , and pulsatility index (PI) were measured. The total plaque score, unstable plaque detection rate, stenosis rate (S) , and refactoring index ( RI) were calculated. Levels of fasting plasma glucose (FPG) , glycated hemoglobin Al c (HbA1 c) , triglyceride (TG) , total cholesterol (TC) , high density lipoprotein cholesterol ( HDL-C) , and low density lipopro- tein cholesterol (LDL-C) were detected. Results Compared with before treatment in the same group, carotid artery IMT and plaque score decreased, levels of TC, TG, LDL-C, FPG, and HbAlc were reduced, PSV, EDV and PI increased, and VRI decreased in both two groups after treatment, with statisti- cal significance (P <0. 05). More obvious effects were shown in decreasing carotid artery IMT, plaque score, PA, and unstable plaque detection rate, reducing levels of TC, LDL-C and VRI, and increasing HDL-C, PSV, and EDV in the observation group, with statistical difference as compared with the control group (P <0. 05). After treatment the reconstruction rate and negative remodeling increased in the control group, with statistical difference as compared with before treatment (P <0. 05). Compared with the control group after treatment, the negative remodeling increased more in the observation group after treatment (X2 =6. 4615, P <0. 05). Conclusion NC could alleviate the carotid artery IMT, reduce and stabilize the plaque, improve blood flow parameters, and delay vascular reconstruction for treating T2DM patients with subclinical vascular disease.