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Therapy with human chorionic gonadotrophin alone induces spermatogenesis in men with isolated hypogonadotropic hypogonadism long-term follow-up (1992)
E. VICARI, et al
Summary
The effects of long-term (14-120 months) hCG-treatment of 17 male patients affected by isolated hypogonadotropic hypogonadism (IHH) on testicular volume, plasma testosterone levels, and sperm concentration were assessed. Mean testicular volume increased from 3.8 ± 0.2 (Mean ± SEM) ml to a maximal of 14.9 ± 1.1 ml after 22.2 ± 2.3 months of hCG treatment. Maximal testicular volume correlated positively with the volume recorded before the patients had undergone any previous treatment. Testicular growth was also analyzed by sorting the patients into two subgroups according to whether their initial testicular volume was <4 ml (small testis subset, STS) or 34 ml (large testis subset, LTS), supposedly indicating complete or partial gonadotropin deficiency, respectively. Testicular volumes in the LTS group were always greater than those of the STS. Plasma testosterone levels reached adulthood values during hCG treatment and no statistically significant difference was detected between LTS and STS patients with IHH. Thirteen patients (70%) became sperm-positive during treatment with hCG alone; five out of eight (60%) were STS patients and eight out of nine (90%) were LTS. In addition, LTS patients always had a greater sperm output than did STS patients. Sperm concentration correlated positively with maximal testicular volume, but not with patient age, length of treatment, or initial testicular volume. The administration of hMG to eight of these patients caused an increase in testicular volume in two patients but the mean volume was not statistically different from that recorded at the end of treatment with hCG alone. Similarly, sperm concentration improved in three patients but again it did not differ significantly from that achieved in the course of hCG treatment. It is noteworthy that one patient became sperm-positive after the addition of hMG to his therapeutic regimen. Among sperm-positive patients attempting conception, seven out of 10 succeeded, two of whom were from the STS group.
In summary, this study indicates that hCG alone is an effective treatment to induce complete spermiogenesis in IHH patients regardless of their initial testicular volume. However, a number of IHH patients may benefit from the addition of hMG in terms of testicular volume, sperm output, and pregnancy outcome.
Introduction
Isolated hypogonadotropic hypogonadism (IHH) is a congenital disorder in which pituitary gonadotrophin secretion is deficient. Male patients affected by IHH are characterized clinically by delayed sexual maturation, inability to achieve the adult testicular size and a more or less marked impairment of germ cell maturation. In these patients, virilization can be induced by administering androgens, whereas sperm production can only be achieved by treatment with gonadotrophins or gonadotrophin-releasing hormone.
We have reported previously that the administration of human chorionic gonadotrophin (hCG) to patients with IHH is capable of stimulating spermatogenesis in proportion (D’Agata et al., 1982). More recently, two other groups have reported similar results (Finkel et al., 1985; Burris et al., 1988). However, we have also shown that the addition of human menopausal gonadotrophin (hMG) to the therapeutic regimen of some IHH patients was necessary to complete spermatogenesis and to achieve an adequate sperm output (Vicari et al., 1984). Thus, although the efficacy of gonadotrophin treatment for the induction of spermatogenesis in these patients is well established, the relative contribution of hCG and hMG is not clear.
In this retrospective clinical report, we present the outcome of long-term (14 -120 months) follow-up of 17 male patients with IHH who had been treated with hCG alone for initiation of spermatogenesis and completion of spermiogenesis.
In conclusion, our experience in the management of patients with IHH suggests that hCG alone is an effective treatment to complete spermiogenesis in patients with IHH, regardless of their initial testicular volume. However, additional treatment with hMG may increase testicular volume, potentiate sperm output in some of these patients, and may improve the pregnancy rate. Thus combined treatment with hCG + hMG seems a better choice in patients with IHH desiring pregnancies. After treatment, male patients with IHH are fertile even though some of them may have a very low sperm count.
E. VICARI, et al
Summary
The effects of long-term (14-120 months) hCG-treatment of 17 male patients affected by isolated hypogonadotropic hypogonadism (IHH) on testicular volume, plasma testosterone levels, and sperm concentration were assessed. Mean testicular volume increased from 3.8 ± 0.2 (Mean ± SEM) ml to a maximal of 14.9 ± 1.1 ml after 22.2 ± 2.3 months of hCG treatment. Maximal testicular volume correlated positively with the volume recorded before the patients had undergone any previous treatment. Testicular growth was also analyzed by sorting the patients into two subgroups according to whether their initial testicular volume was <4 ml (small testis subset, STS) or 34 ml (large testis subset, LTS), supposedly indicating complete or partial gonadotropin deficiency, respectively. Testicular volumes in the LTS group were always greater than those of the STS. Plasma testosterone levels reached adulthood values during hCG treatment and no statistically significant difference was detected between LTS and STS patients with IHH. Thirteen patients (70%) became sperm-positive during treatment with hCG alone; five out of eight (60%) were STS patients and eight out of nine (90%) were LTS. In addition, LTS patients always had a greater sperm output than did STS patients. Sperm concentration correlated positively with maximal testicular volume, but not with patient age, length of treatment, or initial testicular volume. The administration of hMG to eight of these patients caused an increase in testicular volume in two patients but the mean volume was not statistically different from that recorded at the end of treatment with hCG alone. Similarly, sperm concentration improved in three patients but again it did not differ significantly from that achieved in the course of hCG treatment. It is noteworthy that one patient became sperm-positive after the addition of hMG to his therapeutic regimen. Among sperm-positive patients attempting conception, seven out of 10 succeeded, two of whom were from the STS group.
In summary, this study indicates that hCG alone is an effective treatment to induce complete spermiogenesis in IHH patients regardless of their initial testicular volume. However, a number of IHH patients may benefit from the addition of hMG in terms of testicular volume, sperm output, and pregnancy outcome.
Introduction
Isolated hypogonadotropic hypogonadism (IHH) is a congenital disorder in which pituitary gonadotrophin secretion is deficient. Male patients affected by IHH are characterized clinically by delayed sexual maturation, inability to achieve the adult testicular size and a more or less marked impairment of germ cell maturation. In these patients, virilization can be induced by administering androgens, whereas sperm production can only be achieved by treatment with gonadotrophins or gonadotrophin-releasing hormone.
We have reported previously that the administration of human chorionic gonadotrophin (hCG) to patients with IHH is capable of stimulating spermatogenesis in proportion (D’Agata et al., 1982). More recently, two other groups have reported similar results (Finkel et al., 1985; Burris et al., 1988). However, we have also shown that the addition of human menopausal gonadotrophin (hMG) to the therapeutic regimen of some IHH patients was necessary to complete spermatogenesis and to achieve an adequate sperm output (Vicari et al., 1984). Thus, although the efficacy of gonadotrophin treatment for the induction of spermatogenesis in these patients is well established, the relative contribution of hCG and hMG is not clear.
In this retrospective clinical report, we present the outcome of long-term (14 -120 months) follow-up of 17 male patients with IHH who had been treated with hCG alone for initiation of spermatogenesis and completion of spermiogenesis.
In conclusion, our experience in the management of patients with IHH suggests that hCG alone is an effective treatment to complete spermiogenesis in patients with IHH, regardless of their initial testicular volume. However, additional treatment with hMG may increase testicular volume, potentiate sperm output in some of these patients, and may improve the pregnancy rate. Thus combined treatment with hCG + hMG seems a better choice in patients with IHH desiring pregnancies. After treatment, male patients with IHH are fertile even though some of them may have a very low sperm count.
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