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Chen YK, Huang IS, Chen WJ, Huang CY, Ho CH, Huang EYH, Huang WJ. Reproductive outcomes of microdissection testicular sperm extraction in hypogonadotropic hypogonadal azoospermic men after gonadotropin therapy. J Assist Reprod Genet 2021; 38:2601-2608. [PMID: 33982169 DOI: 10.1007/s10815-021-02211-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Male infertility caused by hypogonadotropic hypogonadism (HH) is not common. The main treatment is gonadotropins for 12 months or longer. If the patient is still azoospermic, conventional or microdissection testicular sperm extraction (mTESE) may further help in sperm retrieval. We aimed to analyze the fertility outcomes of HH men treated at our institute. METHODS From 2008 to 2020, infertile men with hormone profile showing HH were enrolled. Gonadotropin therapy was prescribed if parenthood was being considered. Assisted reproductive technology was available to help patients attain fertility depending on the results of sperm analysis. Patient outcomes, including sperm retrieval, pregnancy and live birth rates, were analyzed. RESULTS Seventeen initially azoospermic patients were administered gonadotropins for an average of 11.1 months, and sperm was subsequently found in the ejaculate of seven patients (41%). mTESE was performed on the other ten (59%) who were still azoospermic. For these 10 patients, they had collectively undergone an average 12.1 months (range 6-23 months) of gonadotropin therapy. Sperm was retrieved in nine (90.0%) cases. After 11 cycles of TESE-ICSI, six (54.5%) successful pregnancies were recorded, resulting in five (55.6%) cases with live-born babies, including two sets of twins, and one case of missed abortion at 9 weeks of gestation. CONCLUSION Gonadotropin therapy reversed azoospermia in a portion of the HH male patients studied. Of men who were still azoospermic after gonadotropin treatment, a majority could still have testicular sperm retrieved by mTESE for use in assisted reproductive technology, subsequently resulting in live births.
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Affiliation(s)
- Yu-Kuang Chen
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.,Department of Urology, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Shu-Tien Urological Science Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Jen Chen
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
| | - Chen-Yu Huang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Hong Ho
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Eric Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.,Department of Urology, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Shu-Tien Urological Science Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.,Department of Urology, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Shu-Tien Urological Science Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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Swee DS, Quinton R. Congenital Hypogonadotrophic Hypogonadism: Minipuberty and the Case for Neonatal Diagnosis. Front Endocrinol (Lausanne) 2019; 10:97. [PMID: 30846970 PMCID: PMC6393341 DOI: 10.3389/fendo.2019.00097] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/01/2019] [Indexed: 12/18/2022] Open
Abstract
Congenital hypogonadotrophic hypogonadism (CHH) is a rare but important etiology of pubertal failure and infertility, resulting from impaired gonadotrophin-releasing hormone secretion or action. Despite the availability of effective hormonal therapies, the majority of men with CHH experience unsatisfactory outcomes, including chronic psychosocial and reproductive sequelae. Early detection and timely interventions are crucial to address the gaps in medical care and improve the outlook for these patients. In this paper, we review the clinical implications of missing minipuberty in CHH and therapeutic strategies that can modify the course of disease, as well as explore a targeted approach to identifying affected male infants by integrating clinical and biochemical data in the early postnatal months.
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Affiliation(s)
- Du Soon Swee
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- *Correspondence: Du Soon Swee
| | - Richard Quinton
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Genetic Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
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Gao Y, Yu B, Mao J, Wang X, Nie M, Wu X. Assisted reproductive techniques with congenital hypogonadotropic hypogonadism patients: a systematic review and meta-analysis. BMC Endocr Disord 2018; 18:85. [PMID: 30453944 PMCID: PMC6245556 DOI: 10.1186/s12902-018-0313-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/05/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND After hormonal replacement therapy (HRT) including androgen replacement or sequential therapy of estrogen and progesterone, The combination of human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) and pulsatile GnRH, is not sufficient to produce sufficient gametes in some patients with Congenital hypogonadotropic hypogonadism (CHH). A Systematic review and meta-analysis was performed to determine that assisted reproductive techniques (ART) can effectively treat different causes of infertility. METHODS To determine the effect of ART on fertility of CHH patients and investigate whether outcomes are similar to infertility due to other causes, we conducted a systematic review and meta-analysis of retrospective trials. Clinical trials were systematically searched in Medline, Embase, and the Cochrane central register of controlled trials databases. The keywords and major terms covered "hypogonadotropic hypogonadism", "kallmann syndrome", "assisted reproductive techniques", "intrauterine insemination", "intracytoplasmic sperm injection", "testicular sperm extraction", "in vitro fertilization", "embryo transplantation" and "intra-Fallopian transfer". RESULTS A total of 388 pregnancies occurred among 709 CHH patients who received ART (effectiveness 46, 95% confidence interval 0.39 to 0.53) in the 20 studies we included. The I2 in trials assessing overall pregnancy rate (PR) per embryo transfer (ET) cycle was 73.06%. Similar results were observed in subgroup analysis by different gender. Regression indicates pregnancy rate decreases with increasing age. Fertilization, implantation and live birth rates (72, 36 and 40%) showed no significant differences as compared to infertility due to other causes. CONCLUSIONS Despite CHH patients usually being difficult to generate gametes, their actual chances of fertility are similar to subjects with other non-obstructive infertility. ART is a suitable option for CHH patients who do not conceive after long-term gonadotropin treatment.
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Affiliation(s)
- Yinjie Gao
- Key laboratory of Endocrinology, Ministry of Health; Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Wang Fu Jing St, Dongcheng district, Beijing, 100730 China
| | - Bingqing Yu
- Key laboratory of Endocrinology, Ministry of Health; Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Wang Fu Jing St, Dongcheng district, Beijing, 100730 China
| | - Jiangfeng Mao
- Key laboratory of Endocrinology, Ministry of Health; Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Wang Fu Jing St, Dongcheng district, Beijing, 100730 China
| | - Xi Wang
- Key laboratory of Endocrinology, Ministry of Health; Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Wang Fu Jing St, Dongcheng district, Beijing, 100730 China
| | - Min Nie
- Key laboratory of Endocrinology, Ministry of Health; Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Wang Fu Jing St, Dongcheng district, Beijing, 100730 China
| | - Xueyan Wu
- Key laboratory of Endocrinology, Ministry of Health; Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Wang Fu Jing St, Dongcheng district, Beijing, 100730 China
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Barbotin AL, Ballot C, Sigala J, Leroy M, Rigot JM, Dewailly D, Robin G, Mitchell V. Pregnancy after intracytoplasmic sperm injection following extended sperm preparation and hormone therapy in an azoospermic man with maturation arrest and microlithiasis: a case report and literature review. Andrologia 2016; 49. [DOI: 10.1111/and.12665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2016] [Indexed: 12/29/2022] Open
Affiliation(s)
- A.-L. Barbotin
- Institut de Biologie de la Reproduction-Spermiologie-CECOS; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - C. Ballot
- Institut de Biologie de la Reproduction-Spermiologie-CECOS; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - J. Sigala
- Institut de Biologie de la Reproduction-Spermiologie-CECOS; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - M. Leroy
- Service de Gynécologie Endocrinienne et de Médecine de la Reproduction; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - J.-M. Rigot
- Service d'Andrologie; Hôpital A. Calmette; Centre Hospitalier Régional Universitaire de Lille; Lille France
- EA4308 Gamétogenèse et qualité du gamète; Université de Lille; Lille France
| | - D. Dewailly
- Service de Gynécologie Endocrinienne et de Médecine de la Reproduction; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - G. Robin
- Service de Gynécologie Endocrinienne et de Médecine de la Reproduction; Centre Hospitalier Régional Universitaire de Lille; Lille France
- Service d'Andrologie; Hôpital A. Calmette; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - V. Mitchell
- Institut de Biologie de la Reproduction-Spermiologie-CECOS; Centre Hospitalier Régional Universitaire de Lille; Lille France
- EA4308 Gamétogenèse et qualité du gamète; Université de Lille; Lille France
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Boehm U, Bouloux PM, Dattani MT, de Roux N, Dodé C, Dunkel L, Dwyer AA, Giacobini P, Hardelin JP, Juul A, Maghnie M, Pitteloud N, Prevot V, Raivio T, Tena-Sempere M, Quinton R, Young J. Expert consensus document: European Consensus Statement on congenital hypogonadotropic hypogonadism--pathogenesis, diagnosis and treatment. Nat Rev Endocrinol 2015; 11:547-64. [PMID: 26194704 DOI: 10.1038/nrendo.2015.112] [Citation(s) in RCA: 486] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder caused by the deficient production, secretion or action of gonadotropin-releasing hormone (GnRH), which is the master hormone regulating the reproductive axis. CHH is clinically and genetically heterogeneous, with >25 different causal genes identified to date. Clinically, the disorder is characterized by an absence of puberty and infertility. The association of CHH with a defective sense of smell (anosmia or hyposmia), which is found in ∼50% of patients with CHH is termed Kallmann syndrome and results from incomplete embryonic migration of GnRH-synthesizing neurons. CHH can be challenging to diagnose, particularly when attempting to differentiate it from constitutional delay of puberty. A timely diagnosis and treatment to induce puberty can be beneficial for sexual, bone and metabolic health, and might help minimize some of the psychological effects of CHH. In most cases, fertility can be induced using specialized treatment regimens and several predictors of outcome have been identified. Patients typically require lifelong treatment, yet ∼10-20% of patients exhibit a spontaneous recovery of reproductive function. This Consensus Statement summarizes approaches for the diagnosis and treatment of CHH and discusses important unanswered questions in the field.
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Affiliation(s)
- Ulrich Boehm
- University of Saarland School of Medicine, Germany
| | | | | | | | | | | | - Andrew A Dwyer
- Endocrinology, Diabetes and Metabolism Sevice of the Centre Hospitalier Universitaire Vaudois (CHUV), du Bugnon 46, Lausanne 1011, Switzerland
| | | | | | | | | | - Nelly Pitteloud
- Endocrinology, Diabetes and Metabolism Sevice of the Centre Hospitalier Universitaire Vaudois (CHUV), du Bugnon 46, Lausanne 1011, Switzerland
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Dwyer AA, Raivio T, Pitteloud N. Gonadotrophin replacement for induction of fertility in hypogonadal men. Best Pract Res Clin Endocrinol Metab 2015; 29:91-103. [PMID: 25617175 DOI: 10.1016/j.beem.2014.10.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Congenital hypogonadotrophic hypogonadism (CHH) is a rare form of infertility caused by deficient secretion or action of gonadotrophin-releasing hormone. There is no consensus regarding the optimal approach to fertility treatment in CHH men. In most cases, appropriate hormonal treatment with human chorionic gonadotrophin with or without follicle stimulating hormone will induce testicular development, spermatogenesis and fertility. Recent studies have examined sequential treatment with FSH pre-treatment to optimize fertility outcomes in severely affected CHH patients. This paper reviews historical and recent literature to summarize the current evidence on therapeutic approaches for CHH men seeking fertility.
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Affiliation(s)
- Andrew A Dwyer
- Endocrinology, Diabetes and Metabolism Service of the Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Taneli Raivio
- Institute of Biomedicine/Physiology, University of Helsinki, Helsinki, Finland; The Children's Hospital, Helsinki University Central Hospital (HUCH), Helsinki, Finland.
| | - Nelly Pitteloud
- Endocrinology, Diabetes and Metabolism Service of the Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland; University of Lausanne, Faculty of Biology & Medicine, Institute of Physiology and the Endocrinology, Diabetes and Metabolism Service of the Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Rastrelli G, Corona G, Mannucci E, Maggi M. Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study. Andrology 2014; 2:794-808. [PMID: 25271205 DOI: 10.1111/andr.262] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 07/03/2014] [Accepted: 07/25/2014] [Indexed: 11/30/2022]
Abstract
A meta-analysis was performed to systematically analyse the results of gonadotropin and GnRH therapy in inducing spermatogenesis in subjects with hypogonadotropic hypogonadism (HHG) and azoospermia. An extensive Medline and Embase search was performed including the following words: 'gonadotropins' or 'GnRH', 'infertility', 'hypogonadotropic', 'hypogonadism' and limited to studies in male humans. Overall, 44 and 16 studies were retrieved for gonadotropin and GnRH therapy, respectively. Of those, 43 and 16 considered the appearance of at least one spermatozoa in semen, whereas 26 and 10 considered sperm concentration upon gonadotropin and GnRH, respectively. The combination of the study results showed an overall success rate of 75% (69-81) and 75% (60-85) in achieving spermatogenesis, with a mean sperm concentration obtained of 5.92 (4.72-7.13) and 4.27 (1.80-6.74) million/mL for gonadotropin and GnRH therapy, respectively. The results upon gonadotropin were significantly worse in studies involving only subjects with a pre-pubertal onset HHG, as compared with studies involving a mixed population of pre- and post-pubertal onset [68% (58-77) vs. 84% (76-89), p = 0.011 and 3.37 (2.25-4.49) vs. 12.94 (8.00-17.88) million/mL, p < 0.0001; for dichotomous and continuous data, respectively]. A similar effect was observed also upon GnRH. No difference in terms of successful achievement of spermatogenesis and sperm concentration was found for different FSH preparations. Previous use of testosterone replacement therapy (TRT) did not affect the results obtained with gonadotropins. Finally, a higher success rate was found for subjects with lower levels of gonadotropins at the baseline and for those using both human chorionic gonadotropin and FSH. Gonadotropin therapy, even with urinary derivatives, is a suitable option in inducing/restoring fertility in azoospermic HHG subjects. Gonadotropins appear to be more efficacious in subjects with a pure secondary nature (low gonadotropins) and a post-pubertal onset of the disorder, whereas previous TRT does not affect outcome.
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Affiliation(s)
- G Rastrelli
- Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Shiraishi K, Oka S, Matsuyama H. Assessment of quality of life during gonadotrophin treatment for male hypogonadotrophic hypogonadism. Clin Endocrinol (Oxf) 2014; 81:259-65. [PMID: 24612103 DOI: 10.1111/cen.12435] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/21/2014] [Accepted: 02/17/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The management of male hypogonadotrophic hypogonadism (MHH) with gonadotrophins is effective in promoting genital development and spermatogenesis. We investigated the changes in SF-36 subscales, including physical, social and psychological QOL, during gonadotrophin or testosterone treatment and analysed the factors that are involved in the outcomes of health-related quality of life (HRQOL) in MHH patients. PATIENTS AND DESIGN Thirty-seven MHH patients (mean age: 26.1 years old) who underwent gonadotrophin (n = 31) or testosterone treatment (n = 6), excluding infertility cases, were asked to respond to a SF-36 questionnaire before and every 6 months during the 2-year treatment period. The changes in SF-36 domains and the associations between improvements and patient factors were examined. RESULTS The scores in all of the SF-36 domains were lower than in the normal Japanese population. In all eight domains, except for bodily pain and social functioning, the mean scores for physical function (PF), role-physical (RP), general health (GH), vitality (VT), role-emotional (RE) and mental health (MH) significantly increased over the course of treatment in patients with gonadotrophin. These changes were particularly noticeable in the psychological domains; GH, VT, RE and MH exhibited large increases 18 months after treatment. Testosterone treatment increased only PF and RP domains. In patients with sperm in their ejaculate, the improvements in GH, VT, RE and MH were significantly greater than those who did not exhibit sperm. CONCLUSION Gonadotrophin treatment for MHH was associated with significant improvements in SF-36 domains. Gonadotrophin treatment could prevent negative physical and psychological sequelae in the management of MHH.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
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Aydogdu A, Bolu E, Sonmez A, Tasci I, Haymana C, Acar R, Meric C, Taslipinar A, Ozgurtas T, Azal O. Effects of three different medications on metabolic parameters and testicular volume in patients with hypogonadotropic hypogonadism: 3-year experience. Clin Endocrinol (Oxf) 2013; 79:243-51. [PMID: 23278834 DOI: 10.1111/cen.12135] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/11/2012] [Accepted: 12/14/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to demonstrate the influences of three different treatment strategies on biochemical parameters and testicular volume (TV) in patients with idiopathic hypogonadotropic hypogonadism (IHH). SUBJECTS DESIGN AND METHODS Seventy-seven never-treated patients with IHH and age and body mass index (BMI)-matched 42 healthy controls were analysed in a retrospective design. Twenty-eight patients were treated with testosterone esters (TE), 25 patients were treated with human chorionic gonadotropin (hCG) and 24 patients were treated with testosterone gel (TG). Biochemical parameters, tanner stages (TS) and TV were evaluated before and after 6 months of treatment. RESULTS Pretreatment TV, TS and biochemical test results were similar among the three treatment subgroup. In the TE-treated group, BMI, haemoglobin, haematocrit, creatinine, triglyceride, total testosterone (TT), TS and TV increased, but HDL-cholesterol (C) and urea level decreased significantly. In the hCG-treated group, triglyceride level decreased, and luteinizing hormone level, TS and TV increased significantly. BMI, TT, TS and TV increased, and leucocyte count, total-C, HDL-C levels decreased significantly in the TG-treated patients. No treatment type resulted in any changes in insulin resistance markers. CONCLUSION hCG treatment resulted in favourable effects particularly on TV and lipid parameters. When TV improvement is considered less important, TG treatment may be a better option for older patients with IHH because of its easy use, neutral effects on triglyceride, haemoglobin and haematocrit, and its beneficial effects on total cholesterol level.
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Affiliation(s)
- Aydogan Aydogdu
- Department of Endocrinology and Metabolism, Gulhane School of Medicine, Ankara, Turkey.
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Fraietta R, Zylberstejn DS, Esteves SC. Hypogonadotropic hypogonadism revisited. Clinics (Sao Paulo) 2013; 68 Suppl 1:81-8. [PMID: 23503957 PMCID: PMC3583156 DOI: 10.6061/clinics/2013(sup01)09] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 06/25/2012] [Indexed: 12/01/2022] Open
Abstract
Impaired testicular function, i.e., hypogonadism, can result from a primary testicular disorder (hypergonadotropic) or occur secondary to hypothalamic-pituitary dysfunction (hypogonadotropic). Hypogonadotropic hypogonadism can be congenital or acquired. Congenital hypogonadotropic hypogonadism is divided into anosmic hypogonadotropic hypogonadism (Kallmann syndrome) and congenital normosmic isolated hypogonadotropic hypogonadism (idiopathic hypogonadotropic hypogonadism). The incidence of congenital hypogonadotropic hypogonadism is approximately 1-10:100,000 live births, and approximately 2/3 and 1/3 of cases are caused by Kallmann syndrome (KS) and idiopathic hypogonadotropic hypogonadism, respectively. Acquired hypogonadotropic hypogonadism can be caused by drugs, infiltrative or infectious pituitary lesions, hyperprolactinemia, encephalic trauma, pituitary/brain radiation, exhausting exercise, abusive alcohol or illicit drug intake, and systemic diseases such as hemochromatosis, sarcoidosis and histiocytosis X. The clinical characteristics of hypogonadotropic hypogonadism are androgen deficiency and a lack/delay/stop of pubertal sexual maturation. Low blood testosterone levels and low pituitary hormone levels confirm the hypogonadotropic hypogonadism diagnosis. A prolonged stimulated intravenous GnRH test can be useful. In Kallmann syndrome, cerebral MRI can show an anomalous morphology or even absence of the olfactory bulb. Therapy for hypogonadotropic hypogonadism depends on the patient's desire for future fertility. Hormone replacement with testosterone is the classic treatment for hypogonadism. Androgen replacement is indicated for men who already have children or have no desire to induce pregnancy, and testosterone therapy is used to reverse the symptoms and signs of hypogonadism. Conversely, GnRH or gonadotropin therapies are the best options for men wishing to have children. Hypogonadotropic hypogonadism is one of the rare conditions in which specific medical treatment can reverse infertility. When an unassisted pregnancy is not achieved, assisted reproductive techniques ranging from intrauterine insemination to in vitro fertilization to the acquisition of viable sperm from the ejaculate or directly from the testes through testicular sperm extraction or testicular microdissection can also be used, depending on the woman's potential for pregnancy and the quality and quantity of the sperm.
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Affiliation(s)
- Renato Fraietta
- Division of Urology, Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
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Application of hormonal treatment in hypogonadotropic hypogonadism: more than ten years experience. Int Urol Nephrol 2011; 44:393-9. [DOI: 10.1007/s11255-011-0065-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Accepted: 09/20/2011] [Indexed: 10/17/2022]
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Oldereid NB, Åbyholm T, Tanbo TG. Spermatogenesis and fertility outcome in male hypogonadotrophic hypogonadism. HUM FERTIL 2010; 13:83-9. [DOI: 10.3109/14647271003639723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A man with hypogonadotropic hypogonadism successfully treated with nasal administration of the low-dose gonadotropin-releasing hormone analog buserelin. Fertil Steril 2009; 92:1169.e1-1169.e3. [PMID: 19591988 DOI: 10.1016/j.fertnstert.2009.05.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 05/24/2009] [Accepted: 05/27/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report a patient with hypogonadotropic hypogonadism of hypothalamic origin successfully treated with nasal administration of a low-dose gonadotropin-releasing hormone (GnRH) analogue. DESIGN Case report. SETTING A reproductive medical center. PATIENT(S) A 37-year-old man with anejaculation and infertility. INTERVENTION(S) Nasal administration of a low-dose GnRH analogue, buserelin. MAIN OUTCOME MEASURE(S) Semen analysis and serum levels of gonadotropins and testosterone after nasal buserelin use. RESULT(S) The patient's laboratory examination showed low serum levels of gonadotropins and testosterone. After being diagnosed with hypogonadotropic hypogonadism, 15 mug of buserelin acetate spray was administrated in each nostril three times a day (total: 90 mug/day). This therapy improved semen parameters and serum gonadotropin and testosterone levels. After approximately 1 year of this treatment, the patient's serum gonadotropin and testosterone levels remained in the normal range and semen analysis showed normozoospermia. The patient and his wife were treated with intracytoplasmic sperm injection, resulting in pregnancy. CONCLUSION(S) A low-dose buserelin nasal spray appears to be an effective and well-tolerated therapeutic option for patients with hypogonadotropic hypogonadism of hypothalamic origin.
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Akarsu C, Caglar G, Vicdan K, Isik AZ, Tuncay G. Pregnancies achieved by testicular sperm recovery in male hypogonadotrophic hypogonadism with persistent azoospermia. Reprod Biomed Online 2009; 18:455-9. [DOI: 10.1016/s1472-6483(10)60119-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pantke P, Diemer T, Marconi M, Bergmann M, Steger K, Schuppe HC, Weidner W. Testicular Sperm Retrieval in Azoospermic Men. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eursup.2008.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bakircioglu ME, Erden HF, Ciray HN, Bayazit N, Bahçeci M. Gonadotrophin therapy in combination with ICSI in men with hypogonadotrophic hypogonadism. Reprod Biomed Online 2007; 15:156-60. [PMID: 17697490 DOI: 10.1016/s1472-6483(10)60703-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate the impact of gonadotrophin therapy in combination with intracytoplasmic sperm injection (ICSI) in men with hypogonadotrophic hypogonadism (HH). Twenty-five azoospermic men were diagnosed with HH due to low FSH, LH and total testosterone concentrations. These patients were treated with human chorionic gonadotrophin for 1 month plus recombinant FSH the following month. Total testosterone concentrations were measured in the first and third months. Semen analyses were performed monthly after the third month of treatment. ICSI was performed when sperm production commenced. Total testosterone concentration and testicular volume were significantly increased after gonadotrophin therapy (P < 0.001). On average, spermatozoa were detected in the ejaculate after 10 months. Spontaneous pregnancies were achieved in four couples. Twenty-two ICSI cycles were performed in 18 couples using ejaculated or testicular spermatozoa, and 12 pregnancies (54.5% per cycle) were achieved. These results showed that HH could be treated successfully with hormonal therapy combined with ICSI using ejaculated spermatozoa. The use of ICSI made it possible to achieve pregnancy when spermatozoa appeared in the ejaculate, and shortened the duration of gonadotrophin therapy.
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Zhaohui Z, Yugui C, Yuanming Z, Xuesong W, Xiaobing J, Zhice X, Guipeng D, Qianle T, Yue J. Effect of acupuncture on pubertal development of rats and rabbits at different developmental stages. Neuropeptides 2007; 41:249-61. [PMID: 17445884 DOI: 10.1016/j.npep.2007.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2006] [Revised: 02/26/2007] [Accepted: 02/27/2007] [Indexed: 11/28/2022]
Abstract
Physiological and endocrine studies on sexual development in animals and effects of acupuncture on sexual development are limited. Therefore, we investigated the effect of electro-acupuncture (EA) on the arcuate nucleus (Arc) and release of gonadotropin-releasing hormone (GnRH) in animals at different developmental stages. In Experiment 1, EA stimulation (30 Hz) was performed for 30 min per day in EA group of rabbits for 48 days, while the control group (mature rabbits) was not given EA. Arc discharges in those two groups were measured after the 48-day treatment. Arc discharge was also measured in the pre-pubertal group (as control) without EA treatment. Then, all three groups were treated with transient EA for 30 min and Arc discharges were determined again. In Experiment 2, EA (3 Hz) at the same acupoints or non-acupoints as that in the rabbits was performed for 20 min per day in different developmental group of Sprague-Dawley rats for 10 days. GnRH mRNA expression in the hypothalamus of rats was determined using RT-PCR and real-time PCR. The serum sexual hormone, sperm count, and body weight was measured. The results showed that the Arc discharge (P<0.01), testosterone (T) (P<0.01) and sperm count (P<0.01) in male rabbits were reduced by repeated EA. However, the body weight of rabbits was not changed after EA compared to the control in Experiment 1. In Experiment 2, GnRH mRNA expression in rats of the early pubertal group (EPG) and adult group (AG) were significantly depressed after repeated EA at acupoints (P<0.01). The sexual hormones were negatively influenced by repeated EA during puberty. Sperm count was reduced significantly after repeated EA at time of puberty (P<0.01). Repeated EA did not influence body weight of rats (P>0.01) and structures of the gonadial tissues during development. The results suggested that repeated EA is a good option that can be considered for regulating the function of the hypothalamus-pituitary-gonad (HPG) axis during puberty.
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Affiliation(s)
- Zhang Zhaohui
- Key Laboratory of Reproductive Medicine, The First Affiliated Hospital to Nanjing Medical University, Nanjing 210029, China
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Amer M, Zohdy W, Abd El Naser T, Hosny H, Arafa M, Fakhry E. Single tubule biopsy: a new objective microsurgical advancement for testicular sperm retrieval in patients with nonobstructive azoospermia. Fertil Steril 2007; 89:592-6. [PMID: 17517404 DOI: 10.1016/j.fertnstert.2007.03.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 03/12/2007] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to measure the diameter of seminiferous tubules (ST) during microdissection testicular sperm extraction (TESE) using a micrometer fixed to one of the eyepieces of the operating microscope to find a correlation between the extracted ST diameter and TESE outcome. DESIGN A prospective comparative study. SETTING Adam International Andrology and Infertility Clinic, Giza, Egypt. PATIENT(S) Two hundred sixty-four patients with nonobstructive azoospermia (NOA) were included. INTERVENTION(S) Patients underwent TESE using the open surgical technique. The STs were measured using the micrometer, and the tubule with the largest diameter was excised and freshly examined under an inverted microscope. If no spermatozoa were found, another sample was taken from the second most dilated tubule area and then at random until sperm were found or a maximum six samples were harvested. If no spermatozoa were detected, the contralateral testis was operated upon. MAIN OUTCOME MEASURE(S) The TESE outcome in relation to ST diameter. RESULT(S) The total sperm recovery rate was 105 out of 264 (39.8%). When ST measured >or=300 microm the sperm retrieval rate was 16 out of 19 (84.2%). When ST diameter was <300 microm, the sperm retrieval rate was 36.3% (89 out of 245). CONCLUSION(S) During microdissection TESE, the best cutoff level of the ST diameter for harvesting testicular spermatoza is 110 microm with sensitivity 86.0% and specificity 74.4% (AUC 0.653, 95% confidence interval 0.608-0.663). When ST diameter is 300 microm or more a single tubule biopsy is usually sufficient to harvest enough testicular spermatozoa for intracytoplasmic sperm injection or sperm freezing with minimal tissue excision.
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Affiliation(s)
- Medhat Amer
- Department of Andrology, Faculty of Medicine, Kaser El Aini, Cairo University Hospital, Cairo, Egypt
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Cao YX, Zhang ZG. A successful pregnancy outcome using testicular sperm from an infertile male pretreated with HCG. ACTA ACUST UNITED AC 2007; 53:1-3. [PMID: 17364455 DOI: 10.1080/01485010600889076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A very rare case of successful pregnancy was reported using testicular sperm from a severely infertile man given the treatment of hCG in advance. Prior to treatment, no sperm were present in the ejaculate and testicle. hCG was administrated to the patient for spermatogenesis. After a period of hCG treatment, a few immature sperm were observed in the minced testicular specimen. A successful pregnancy was established by ICSI using the sperm. Treatment by administration of hCG to generate sperm followed by ICSI for the azoospermia patients was effective and practicable.
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Affiliation(s)
- Y-X Cao
- Reproduction Center, Department of Obstetrics, The First Affiliated Hospital, Anhui Medical University, Hefei, China.
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Affiliation(s)
- Colin M Howles
- Department of Global Product Development, Merck Serono International SA, Geneva Switzerland
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Raivio T, Wikström AM, Dunkel L. Treatment of gonadotropin-deficient boys with recombinant human FSH: long-term observation and outcome. Eur J Endocrinol 2007; 156:105-11. [PMID: 17218732 DOI: 10.1530/eje.1.02315] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Boys with prepubertal onset of hypogonadotropic hypogonadism (HH) are at a risk of poor testis growth and impaired spermatogenesis. One potential cause for this is deficient proliferation of immature Sertoli cells before and during puberty due to the absence of FSH. OBJECTIVE To evaluate the effects of recombinant human FSH (r-hFSH) and human chorionicgonadotropin (hCG) on testicular function and pubertal development in boys with prepubertal onset of HH. DESIGN Retrospective clinical study. SETTING Two university central hospitals, pediatric referral endocrinology outpatient clinics. PATIENTS Fourteen boys (aged, 9.9-17.7 years) with prepubertal (testicular volume (TV) <3 ml) onset of HH (idiopathic HH, n=2; Kallman syndrome, n=2; idiopathic panhypopituitarism, n=4; organic panhypopituitarism, n=6). INTERVENTION Treatment with r-hFSH alone (2 mo-2.8 years) prior to induction of puberty with the combination of FSH and hCG. MAIN OUTCOME MEASURES Progression of puberty, change in serum inhibin B, spermatogenesis. RESULTS r-hFSH alone increased testicular volume twofold, from 0.9+/-0.6 ml (mean+/-s.d.) to 1.8 +/- 1.1 ml (P<0.005), and serum inhibin B threefold, from 27+/-14 to 80+/-57 pg/ml (P<0.01). Three boys with an apparent absence of postnatal hypothalamic-pituitary-testicular axis activation displayed attenuated inhibin B responses to long-term (>or=1 year) r-hFSH (P<0.01). Further significant increase in both TVand inhibin B occurred with induction of puberty with FSH and hCG (P<0.001). Seven boys provided semen samples: one had azoospermia, and others displayed a maximal sperm count range from 2.9 to 92 million/ml (median 8.5 million/ml). CONCLUSIONS (i) r-hFSH induces prepubertal testis growth and increases circulating inhibin B levels, findings suggesting proliferation of immature Sertoli cells. (ii) Puberty was successfully induced with hCG and r-hFSH following r-hFSH priming. (iii) Inhibin B appears useful for monitoring spermatogenetic activity in boys treated with hCG. (iv) Despite the extremely small initial testis volume, six out of seven patients (86%) primed with r-hFSH displayed sperm in the ejaculate suggesting beneficial effect of r-hFSH priming on testicular function later in life.
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Affiliation(s)
- Taneli Raivio
- Hospital for Children and Adolescents, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
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