Evaluation of semen quality in 1808 university students, from Wuhan, Central China

Effects of long and short ejaculatory abstinence on sperm parameters: a meta-analysis of randomized-controlled trials

Purpose

This study aimed to investigate the effects of ejaculatory abstinence on sperm parameters.

Methods

This analysis was registered in PROSPERO (CRD42023472124). We performed a search on PubMed using the following text terms: (("sperm parameters" OR "sperm analysis" [Mesh]) AND ("sperm DNA fragmentation" OR "DNA fragmentation" [Mesh]) AND ("sexual abstinence" [Mesh] OR "abstinence")) and an advanced search in Scopus using the terms ("sperm parameters" OR "sperm parameters" OR "DNA fragmentation") AND ("abstinence"). The sperm parameters that were investigated were sperm volume, total sperm motility, progressive sperm motility, sperm concentration, sperm morphology, and sperm DNA fragmentation (SDF). A two-day cut-off as a "short" or "long" abstinence period has been defined.

Results

Thirteen studies published between 2013 and 2022 were included in this meta-analysis. A total of 2,315 patients, ranging from 6 to 836 from each cohort, were enrolled in the study. We showed that longer abstinence time was associated with greater sperm concentration (mean difference [MD]: 8.19; p <0.01), sperm volume (MD: 0.96; p <0.01), and higher SDF (MD: 3.46; p <0.01), but lower progressive sperm motility (MD: -1.83; p <0.01). Otherwise, no statistically significant difference was observed in patients with longer vs. shorter abstinence times regarding total sperm motility (MD: -1.83; p = 0.06). Meta-regression analysis showed that days of abstinence were positively and linearly related to sperm concentration (slope: 3.74; p <0.01) and SDF (slope: 0.65; p = 0.044).

Conclusions

According to our data, short ejaculatory abstinence is associated with better sperm quality. Indeed, a higher percentage of progressive sperm motility and lower levels of SDF have been reported in a short abstinence cohort. In contrast, the long abstinence group reported a higher sperm concentration.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023472124.

Frequency, morbidity and equity - the case for increased research on male fertility

Currently, most men with infertility cannot be given an aetiology, which reflects a lack of knowledge around gamete production and how it is affected by genetics and the environment. A failure to recognize the burden of male infertility and its potential as a biomarker for systemic illness exists. The absence of such knowledge results in patients generally being treated as a uniform group, for whom the strategy is to bypass the causality using medically assisted reproduction (MAR) techniques. In doing so, opportunities to prevent co-morbidity are missed and the burden of MAR is shifted to the woman. To advance understanding of men's reproductive health, longitudinal and multi-national centres for data and sample collection are essential. Such programmes must enable an integrated view of the consequences of genetics, epigenetics and environmental factors on fertility and offspring health. Definition and possible amelioration of the consequences of MAR for conceived children are needed. Inherent in this statement is the necessity to promote fertility restoration and/or use the least invasive MAR strategy available. To achieve this aim, protocols must be rigorously tested and the move towards personalized medicine encouraged. Equally, education of the public, governments and clinicians on the frequency and consequences of infertility is needed. Health options, including male contraceptives, must be expanded, and the opportunities encompassed in such investment understood. The pressing questions related to male reproductive health, spanning the spectrum of andrology are identified in the Expert Recommendation.

Impact of Seasonal Variations on Semen Parameters: A Retrospective Analysis of Data from Subjects Attending a Tertiary Care Fertility Centre

Background

Seasonal variations in semen parameters have been detected in many previous studies, mostly conducted in the West and Mediterranean countries. Located in a tropical region, we have only three seasons - summer, winter and rainy season. Literature search did not reveal studies from Indian subcontinent.

Aims

Our objective was to find if our climate produced seasonal variations in semen parameters such as sperm concentration (SC), total motile SC, morphology and vitality, which may have implications in fertility management.

Settings and Design

This is a descriptive study, conducted at a tertiary level hospital. Semen analysis reports of male partners of all infertile couples during the 4-year period from 2019 to 2022 were analysed.

Materials Methods

The data were collected from records of all infertile couples registered for the treatment in the department during the study period. Semen analysis reports of male partners of all infertile couples attending outpatient department of the Reproductive Medicine Department during the 4-year period from January 2019 to December 2022 were collected. The data of azoospermic and severe oligospermic (<5 million/mL) men and those receiving hormone treatment were excluded.

Statistical Analysis Used

Data were analysed using SPSS 23 and variables expressed as mean and standard deviation. Changes in mean values over years and over seasons were evaluated using F-test. Post hoc analysis was done using Sidak method. P < 5% was considered statistically significant.

Results

The data of 2326 patients were analysed. SC was lowest during summer but was not statistically significant. Sluggishly motile sperm per cent was maximum in rainy season (P = 0.002). Post hoc analysis showed significant variations in summer samples compared to both rainy and winter seasons. Head defect (HD) and tail defects showed a significant seasonal variation (P = 0.011 and P = 0.024, respectively), lowest HD seen in rainy season.

Conclusion

Semen parameters showed seasonal variations, with favourable features in colder climates, and may need to be considered in infertility management, especially if the male is oligospermic.

Diurnal rhythm of human semen quality: analysis of large-scale human sperm bank data and timing-controlled laboratory study

STUDY QUESTION

Can we identify diurnal oscillations in human semen parameters as well as peak times of semen quality?

SUMMARY ANSWER

Human semen parameters show substantial diurnal oscillation, with most parameters reaching a peak between 1100 and 1500 h.

WHAT IS KNOWN ALREADY

A circadian clock appears to regulate different physiological functions in various organs, but it remains controversial whether diurnal rhythms occur in human semen parameters.

STUDY DESIGN, SIZE, DURATION

The medical record of a provincial human sperm bank (HSB) with 33 430 semen samples collected between 0800 and 1700 h from 1 March 2010 to 8 July 2015 was used to analyze variation in semen parameters among time points. A laboratory study was conducted to collect semen samples (n = 36) from six volunteers at six time points with identical time intervals (2 days plus 4 h) between 6 June and 8 July in 2019, in order to investigate the diurnal oscillation of semen parameters in vivo, with a strictly controlled abstinence period. Therefore, the sperm bank study with a large sample size and the in vivo study with a strictly controlled abstinence period in a 24-h time window could be compared to describe the diurnal rhythms in human semen parameters.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Samples were obtained from potential HSB donors and from participants in the laboratory study who were volunteers, recruited by flyers distributed in the community. Total sperm count, sperm concentration, semen volume, progressive motility and total motility were assessed using computer-aided sperm analysis. In addition, sperm chromatin integrity parameters (DNA fragmentation index and high DNA stainability) were assessed by the sperm chromatin structure assay, and sperm viability was measured with flow cytometry in the laboratory study.

MAIN RESULTS AND THE ROLE OF CHANCE

The 33 430 samples from the HSB showed a temporal variation in total sperm count, sperm concentration, semen volume, progressive motility and total motility (all P < 0.001) between 0800 and 1700 h. Consequently, the eligibility of semen samples for use in ART, based on bank standards, fluctuated with time point. Each hour earlier/later than 1100 h was associated with 1.14-fold risk of ineligibility. Similarly, the 36 samples taken during the 24-h time window showed diurnal oscillation. With the pre-collection abstinence period strictly controlled, most semen parameters reached the most favorable level between 1100 and 1500 h.

LIMITATIONS, REASONS FOR CAUTION

Some of the possible confounding factors, such as energy intake, which might influence semen quality or diurnal rhythms, were not adjusted for in the analyses. In addition, the findings should be considered with caution because the study was conducted in a specific population, time and place, while the timing of oscillations could differ with changing conditions.

WIDER IMPLICATIONS OF THE FINDINGS

The findings could help us to estimate semen quality more precisely and to obtain higher quality sperm for use in ART and in natural conception.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the National Natural Science Foundation of China (81871208) and National Key R&D Program of China (2017YFC1002001). There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Decline in semen quality of North African men: a retrospective study of 20,958 sperm analyses of men from different North African countries tested in Tunisia over a period of 6 years (2013-2018)

BACKGROUND

According to numerous studies from around the world, semen quality seems to have declined dramatically over the last years. However, the data investigated on male fertility status and semen quality in North Africa is limited.

AIM

To investigate on the status of semen quality in North-African men and to understand its variations.

SUBJECTS & METHODS

20,958 Sperm-analyses (Spermogram - Spermocytogram) of North-African men (19-77 years old) consulting for infertility, performed in a private laboratory of medical analyses (Tunis, Tunisia) over a period of six years (2013 - 2018), were investigated. All patients had at least one year of unprotected intercourse with their partners before the test. Statistical analyses were performed using SPSS 22.0 software for windows.

RESULTS

Libyan men presented a clear decline in all sperm parameters. A continuous decline in sperm morphology quality was shown in Tunisian and Algerian men. Mauritanian men presented a significant increase in sperm vitality with pseudo-stability in the rest of sperm parameters during the whole study period.

CONCLUSION

North-African men presented remarkable decreases of their semen quality over the last decade. This data could confirm possible global common-causes that need to be identified in order to limit their negative impact on sperm quality, and consequently on male-fertility.

Regional and ethnic differences in semen quality and reproductive hormones in Russia: A Siberian population-based cohort study of young men

Background

This is the first large‐scale Russian study describing semen quality and reproductive hormone levels among young men.

Objectives

The aim of the study was to compare semen quality and reproductive hormone levels in young men of four cities and three ethnic groups living in the Siberian region of Russia and to find out ethnic or environmental reasons for regional differences.

Materials and methods

The study population consisted of 1291 young men from Novosibirsk, Kemerovo, Ulan‐Ude, and Yakutsk, including 1013 men of three most numerous ethnic groups: Slavs, Buryats, and Yakuts. Each participant provided one sperm and blood sample, information about lifestyle and ethnicity. Anthropometric parameters, semen quality and reproductive hormone levels, were evaluated.

Results

Significant regional and ethnic differences were detected for semen and reproductive hormone parameters. Median sperm concentrations in Novosibirsk, Kemerovo, Ulan‐Ude, and Yakutsk were 54.6, 39.9, 34.7, 33.1 × 10⁶/ml; total sperm counts—202.5, 138.7, 97.9, 93.4 × 10⁶; percentages of morphologically normal spermatozoa—7.8%, 6.5%, 6.3%, 5.0%, respectively. Median sperm concentrations in Slavs, Buryats, and Yakuts were 43.7, 37.0, 30.6 × 10⁶/ml; total sperm counts—150.0, 102.3 and 74.8 × 10⁶; percentages of morphologically normal spermatozoa—6.8%, 6.8%, 4.8%, respectively.

Discussion

The young men in Novosibirsk and Kemerovo, populated by Slavs, had a higher semen quality compared to Ulan‐Ude and Yakutsk, populated by Buryats and Yakuts, apparently due to the higher testicular function in Slavic compared to Asian ethnicity. Impaired spermatogenesis in young men in Kemerovo compared to Novosibirsk, located in the same climatic zone and having a socio‐cultural and ethnic identity, may be due to the influence of a polluted environment.

Conclusion

The findings suggest that ethnic composition and environment may be responsible for regional differences in semen and reproductive hormone parameters.

Physical activity and sedentary time in relation to semen quality in healthy men screened as potential sperm donors

STUDY QUESTION

Is physical activity or sedentary time associated with semen quality parameters?

SUMMARY ANSWER

Among healthy men screened as potential sperm donors, higher self-reported physical activity was associated with increased progressive and total sperm motility.

WHAT IS KNOWN ALREADY

Despite the claimed beneficial effect of moderate physical activity on semen quality, results from epidemiological studies have been inconclusive. Previous studies were mostly conducted among endurance athletes or male partners of couples who sought infertility treatment.

STUDY DESIGN, SIZE, DURATION

Healthy men screened as potential sperm donors were recruited at the Hubei Province Human Sperm Bank of China. Between April 2017 and July 2018; 746 men completed the long-form International Physical Activity Questionnaire (IPAQ) and provided repeated semen samples (n = 5252) during an approximately 6-month period.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Total metabolic equivalents (METs), moderate-to-vigorous METs and sedentary time were abstracted from the IPAQ. Sperm concentration, total sperm count, progressive motility and total motility in repeated specimens were determined by trained clinical technicians. Mixed-effect models were applied to investigate the relationships between physical activity and sedentary time and repeated measures of semen quality parameters.

MAIN RESULTS AND THE ROLE OF CHANCE

After adjusting for multiple confounders, total METs and moderate-to-vigorous METs were both positively associated with progressive and total sperm motility. Compared with men in the lowest quartiles, those in the highest quartiles of total and moderate-to-vigorous METs had increased progressive motility of 16.1% (95% CI: 6.4, 26.8%) and 17.3% (95% CI: 7.5, 27.9%), respectively, and had increased total motility of 15.2% (95% CI: 6.2, 24.9%) and 16.4% (95% CI: 7.4, 26.1%), respectively. Sedentary time was not associated with semen quality parameters.

LIMITATIONS, REASONS FOR CAUTION

The IPAQ was reported only once from study participants; measurement errors were inevitable and may have biased our results. Furthermore, although we have adjusted for various potential confounders, the possibility of unmeasured confounding cannot be fully ruled out.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings suggest that maintaining regular exercise may improve semen quality parameters among healthy, non-infertile men. Specifically, we found that higher self-reported total and moderate-to-vigorous METs were associated with improved sperm motility, which reinforces the existing evidence that physical activity may improve male reproductive health.

STUDY FUNDING/COMPETING INTEREST(S)

Y.-X.W was supported by the Initiative Postdocs Supporting Program (No. BX201700087). A.P. was supported by the National Key Research and Development Program of China (2017YFC0907504). C.-L.X. was supported by the National Key Research and Development Program of China (2016YFC1000206). The authors report no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Effect of chronic stress on expression and secretion of seminal vesicle proteins in adult rats

Chronic stress (CS) is known to affect men's health especially fertility by reducing semen quality. Although the effects of CS on testicular function and sperm parameters are documented, changes of substances and secreting proteins in the seminal vesicle (SV) have never been reported. This study aimed to demonstrate the alterations of contents and expressions of proteins in seminal vesicle fluid (SVF) under CS. Fourteen adult rats were divided into control and CS groups (n = 7/each). Control rats were not exposed to stressor, while the CS animals were immobilised by restraint cage (4 hr/day) and followed by forced swimming (15 min/day) for consecutive 60 days. Biochemical substances and malondialdehyde (MDA) level in SVF were examined. Expressions of heat-shock protein 70 (Hsp70), caspases (Casp) 3 and 9, and tyrosine-phosphorylated (TyrPho) proteins were investigated in seminal vesicle tissue (SVT) and SVF. It was found that CS caused reductions of seminal epithelial height and secreted substance levels. Significantly, MDA levels in SVF and expressions of Hsp70, Casp and TyrPho proteins were increased in of CS animals. It was concluded that CS affected seminal secretion. Low quality of CS seminal plasma may associate with increase of MDA and expressions of secreted proteins.

Sleep duration and quality in relation to semen quality in healthy men screened as potential sperm donors

BACKGROUND

Short sleep duration and poor sleep quality are increasingly prevalent in modern society and may be associated with impaired semen quality, yet studies are inconclusive.

OBJECTIVES

To investigate the reproducibility of semen quality parameters among 842 healthy men screened as potential sperm donors and explore the associations of sleep duration and quality with repeated measures of semen quality parameters.

METHODS

We assessed sleep duration (night sleep and daytime napping) and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) among 842 healthy men screen as potential sperm donors. We examined sleep characteristics in relation to repeated measurements (n = 5601) of semen parameters using linear mixed-effects models.

RESULTS

High degrees of within-individual variability were found for total and progressive sperm motility with intraclass correlation coefficient (ICC) of 0.20 and 0.22, respectively; while fair-to-good reproducibilities were observed for sperm volume, concentration, and total count (ICC = 0.54, 0.62, and 0.50, respectively). Compared to men with total sleep duration of 8.0-8.5 h/day (h/d), men who slept less than 6.0 h/d and higher than 9.0 h/d had lower sperm volume of 12% [95% confidence interval (CI): -22%, -0.68%] and 3.9% (95% CI: -7.3%, -0.44%), respectively. Compared to men with night sleep duration of 7.5-8.0 h/d, men who slept less than 6.0 h/d had lower total and progressive sperm motility of 4.4% (95 CI:-8.4%, -0.24%) and 5.0% (95% CI: -9.2%, -0.48%), respectively. Compared to men who reported good sleep quality (total PSQI score ≤5.0), those reporting poor sleep quality (total PSQI score >5.0) had lower total sperm count, total motility, and progressive motility of 8.0% (95% CI: -15%, -0.046%), 3.9% (95% CI: -6.2%, -1.5%), and 4.0% (95% CI: -6.5%, -1.4%), respectively.

CONCLUSIONS

Both long and short sleep duration and poor sleep quality were associated with impaired semen quality parameters. The high within-individual variability of total and progressive sperm motility suggests that a single measurement may result in a moderate degree of classification error.

Decline in semen concentration of healthy Chinese adults: evidence from 9357 participants from 2010 to 2015

The present study aims to analyze sperm concentration trends among young and healthy Chinese adults in Wuhan, Central China, from 2010 to 2015. Semen analysis data from 9357 participants were collected and analyzed using a general linear model and the Cochran–Armitage trend test. A significant decline was observed in sperm concentration (β [standard deviation]: −1.53 [0.16]; P < 0.001). In addition, a decline in sperm density was observed by stratifying student versus nonstudent sperm donors and by analyzing the year of birth or birth year cohort of the participants. Furthermore, the percentage of participants with sperm densities of over 40 × 10⁶ ml⁻¹ significantly decreased with year. Notably, a dramatic decline in sperm density was recorded over the first 5 years of study. This research reported a decline in sperm concentration among young adults in Wuhan, Central China, in 2010–2015.

Exposed Biologies and the Banking of Reproductive Vitality in China

The looming figures of smog-choked cities, cancer villages and contaminated food have become iconic of a modernising China: the tragic, perhaps unavoidable, side effects of a voracious economy. In this article, I examine how the sperm bank—jingzi ku—in China has emerged quite literally as a sanctuary of vitality amidst concerns around food safety, air and water pollution, rising infertility and declining population quality. As a twist on Margaret Lock’s concept of ‘local biologies’, I argue that ‘exposed biologies’ have become a matter of concern in China in ways that have corroborated a place for hi-tech sperm banks within China’s restrictive reproductive complex. Exposed biologies are a side effect of modernisation processes, as industrially manufactured chemicals are increasingly held culpable for a range of pathologies, from cancers to metabolic diseases, disorders of sex development and infertility. Amidst concerns that pollution and modern lifestyles are deteriorating sperm quality in China, the sperm bank stands out as a repository of screened, purified and quality-controlled vitality, and as such sperm banking can be seen as a form of reproductive insurance, not only for individuals but also for the nation.

JG. Influence of the abstinence period on human sperm quality: analysis of 2,458 semen samples

OBJECTIVE

The aim of this study was to evaluate the influence of different periods of abstinence on conventional semen parameters as well as functional parameters in human semen, including mitochondrial function, chromatin packing and sperm DNA fragmentation.

METHODS

We recruited a cohort of 2,458 men undergoing infertility investigation. Semen analyses were performed according to WHO guidelines/morphology-motile sperm organelle morphology examination/MSOME. For DNA integrity analysis, the percentages of DNA fragmentation (TUNEL), abnormal chromatin packaging/underprotamination (chromomycin A3/CMA3), abnormal mitochondrial membrane potential (MMP/MitoTracker Green), and apoptosis (annexin-V) were recorded. Associations between the sexual abstinence period and sperm parameters were assessed using Spearman correlation. For group comparisons, the subjects were categorized according to the sexual abstinence period (SAP) into three groups: SAP <2 days, SAP 2-5 days, and SAP >5 days.

RESULTS

The duration of abstinence had a statistically significant positive influence on sperm concentration and volume, the number of leukocytes and a statistically significant negative influence on sperm motility and vitality. The percentages of DNA fragmentation and MMP (mitochondrial damage) worsened with the increased duration of abstinence. The percentage of sperm protamination was statistically significantly increased with abstinence.

CONCLUSION

Increase in the sexual abstinence period influences sperm quality. This study reinforces the importance of the duration of ejaculatory abstinence on semen parameter variation. It highlights the deleterious effect of increased abstinence on DNA damage, which is most likely associated with ROS (mitochondrial damage/number of leukocytes). The increase in chromatin packaging can represent a protective feature for DNA.

Decline of semen quality among Chinese sperm bank donors within 7 years (2008-2014)

Semen from 5210 sperm bank donors was analyzed and trends in semen quality were evaluated at Shandong Human Sperm Bank between 2008 and 2014. After 2-7 days of abstinence, semen samples were collected. Measurements of semen volume, sperm concentration, sperm forward motility, and total sperm count were performed. There were significant declining trends in semen volume, sperm concentration, sperm forward motility, and total sperm count. Our results indicate that the quality of semen in this cohort of sperm donors had decreased during the study period.

Decline in semen quality among 30,636 young Chinese men from 2001 to 2015

OBJECTIVE

To provide information of semen quality among young Chinese men in the past 15 years.

DESIGN

Retrospective cross-sectional study.

SETTING

Sperm bank.

PATIENT(S)

A total of 30,636 young adult men who applied to be sperm donors at the Hunan Province Human Sperm Bank of China in 2001-2015 were included in the study.

INTERVENTION(S)

Physical examination and analysis of blood and semen samples.

MAIN OUTCOME MEASURE(S)

Semen parameters, such as semen volume, sperm concentration, total sperm count, progressively motile sperm count, sperm progressive motility, sperm morphology, and round cells.

RESULT(S)

Many of the semen parameters showed a decreasing trend over the 15-year observation period. The sperm concentration and percentage of sperm with normal morphology decreased from 68 × 10⁶/mL to 47 × 10⁶/mL and from 31.8% to 10.8%, respectively. Although sperm progressive motility showed irregular variation, the progressively motile sperm count decreased from 34 × 10⁶ to 21 × 10⁶ over the 15-year period. Furthermore, the rate of qualified donors fell from 55.78% in 2001 to 17.80% in 2015, and the rate for 2015 was approximately threefold lower than the corresponding rates in 2001.

CONCLUSION(S)

The semen quality among young Chinese men has declined over a period of 15 years, especially in terms of sperm concentration, total sperm count, sperm progressive motility, and normal morphology.

Abstinence Time and Its Impact on Basic and Advanced Semen Parameters

OBJECTIVE

To assess the effect of ejaculatory abstinence (EA) periods on routine and advanced sperm tests.

METHODS

Men with normozoospermia provided semen samples after 1, 2, 5, 7, 9, and 11 days of abstinence. A standard semen analysis was performed on all samples. Each specimen was assessed for levels of reactive oxygen species (ROS) and sperm DNA fragmentation. Comparison was also made by grouping EA periods into short (1 day), recommended by World Health Organization (WHO) (2-7 days), and long (9-11 days).

RESULTS

Semen volume (P < .001), sperm concentration (P < .001), and total sperm count (P < .001) increased significantly with abstinence length. Sperm DNA fragmentation was associated with the length of EA (P < .001). Both 1 and 2 days of EA had the least amount of DNA fragmentation (P < .001). Significant increase was seen in volume, pH, viscosity, total count, total motile sperm, and DNA fragmentation between short and recommended EA (P < .05), and between recommended and long EA (P < .05). Short EA had no detrimental impact on semen characteristics according to the 2010 WHO thresholds.

CONCLUSION

Shortening of EA time is not detrimental to sperm quality in men with normozoospermia and is proposed as a method for reducing sperm DNA fragmentation. This strategy could help optimize sperm quality and the chances of natural and assisted conception. Accurate abstinence time should be considered when managing men with infertility problems with semen analyses even when it is within the recommended range.

Efficacy and Outcome Predictors of Gonadotropin Treatment for Male Congenital Hypogonadotropic Hypogonadism: A Retrospective Study of 223 Patients

Gonadotropin induces masculinization and spermatogenesis in men with congenital hypogonadotropic hypogonadism (CHH). However, large cohort studies for the efficacy and reliable predictors of this therapy need to be conducted. The aim of this study was to investigate the efficacy of gonadotropin treatment in a large cohort of male CHH patients and analyze putative predictors for successful spermatogenesis. This retrospective study included 223 CHH azoospermic patients without puberty development treated between 2005 and 2014. All patients received combined human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG) and were followed up for >6 months (5109 person-months). Serum total testosterone level, testicular size, spermatogenesis, and pregnancy outcome were recorded at each visit. After gonadotropin therapy, testicular size was enlarged from 2.1 ± 1.6 to 8.1 ± 4.6 mL (P < 0.001) and serum total testosterone was elevated from 0.9 ± 0.5 to 15.1 ± 8.2 nmol/L (P < 0.001). Spermatogenesis (>0/mL) occurred at a median period of 15 months (95% confidence interval 13.5-16.5). Larger basal testicular volume (P = 0.012) and noncryptorchidism history (P = 0.028) are independent predictors for earlier sperm appearance. Sixty four percent (143/223) of patients succeeded in producing sperms and the average time for initial sperm detection was 14 ± 8 months. However, their sperm concentrations (11.7 [2.1, 24.4] million/mL) and sperm progressive motility (A + B 36.9% ± 20.2%) are significantly lower than World Health Organization standards. Of the 34 patients who desired for fathering children, 19 patients impregnanted their partners during the treatment. Gonadotropin therapy induces spermatogenesis in male CHH patients. A larger basal testicular size and noncryptorchidism history are favorable indicators for earlier spermatogenesis.

Congenital combined pituitary hormone deficiency patients have better responses to gonadotrophin-induced spermatogenesis than idiopathic hypogonadotropic hypogonadism patients

STUDY QUESTION

Do patients with congenital combined pituitary hormone deficiency (CCPHD) have different responses to gonadotrophin-induced spermatogenesis compared with those with idiopathic hypogonadotropic hypogonadism (IHH)?

SUMMARY ANSWER

CCPHD patients have a better response to gonadotrophin therapy than IHH patients.

WHAT IS KNOWN ALREADY

Gonadotrophins are effective in inducing spermatogenesis in patients with hypogonadotropic hypogonadism.

DESIGN, SIZE AND DURATION

This retrospective cohort study included 75 patients, 53 of whom had IHH and 22 CCPHD. They were diagnosed, treated and followed up between January 2008 and December 2013.

PARTICIPANTS/MATERIALS, SETTING AND METHODS

Combined gonadotrophin therapy, consisting of human chorionic gonadotrophin and human menopausal gonadotrophin, was administered for 24 months. The success rate of spermatogenesis (≥1 sperm in ejaculate), serum total testosterone level, testicle size and sperm concentration during the treatment, as well as the first time sperm were detected in the ejaculate, were compared between the two diagnostic groups. All patients were treated in Peking Union Medical College Hospital.

MAIN RESULTS AND THE ROLE OF CHANCE

Spermatogenesis was successfully induced in 85% of IHH patients and 100% of CCPHD patients after 24-month combined gonadotrophin treatment (P = 0.03). In comparison with IHH, CCPHD patients had larger mean testicle sizes during the gonadotrophin treatment at 6, 12, 18 and 24 months (all P < 0.05). The initial time for sperm appearance in IHH group (n = 45) and CCPHD group (n = 22) was 13.2 ± 5.9 versus 10.4 ± 3.8 months (P = 0.045). Generally, CCPHD patients had higher sperm counts [median (quartiles)] than IHH patients during the treatment, but the difference was only statistically significant at 12 months of treatment, 3.3 (1.8, 12.0) versus 1.0 (0.0, 4.6) million/ml, P = 0.001. There was a higher level of serum total testosterone [mean (SD)] in the CCPHD group than the IHH group (676 ± 245 versus 555 ± 209 ng/dl, P = 0.035).

LIMITATIONS, REASONS FOR CAUTION

First, the inherent nature of a retrospective designed study was a main shortcoming. Secondly, pathological gene mutations in IHH and CCPHD patients should be further investigated. Clarification of the underlying mechanisms between cryptorchidism and mutated genes may provide more information for the divergent therapeutic responses between two groups. Only a minority of patients were actively seeking to have children so information about fertility is limited.

WIDER IMPLICATIONS OF THE FINDINGS

CCPHD patients had a lower incidence of cryptorchidism and a better response to gonadotrophin therapy than IHH patients, reflecting multiple defects on the different levels of reproduction axis in IHH. Furthermore, growth hormone is not indispensable for spermatogenesis in CCPHD patients.

STUDY FUNDING/COMPETING INTERESTS

The study was supported by Natural Science Foundation of China (No: 81100416). None of the authors has any conflicts of interest to declare.