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Meta-Analysis
. 2020 May-Jun;22(3):309-316.
doi: 10.4103/aja.aja_42_19.

FSH dosage effect on conventional sperm parameters: a meta-analysis of randomized controlled studies

Rossella Cannarella  1 , Sandro La Vignera  1 , Rosita A Condorelli  1 , Laura M Mongioì  1 , Aldo E Calogero  1
Affiliations
Meta-Analysis

FSH dosage effect on conventional sperm parameters: a meta-analysis of randomized controlled studies

Rossella Cannarella et al. Asian J Androl. 2020 May-Jun.

Abstract

Follicle-stimulating hormone (FSH) represents a therapeutic option in normogonadotropic patients with idiopathic oligozoospermia. The aim of this review was to evaluate the possible dose- and drug-dependent efficacy of FSH treatment on conventional sperm parameters. We performed a comprehensive systematic review via a meta-analysis of all available randomized controlled trials, in which FSH administration was compared with placebo or no treatment when administered to normogonadotropic patients with idiopathic oligozoospermia. Of the 971 articles that were retrieved, 5 were finally included, including a total of 372 patients and 294 controls. Overall, FSH treatment was effective in ameliorating the sperm concentration, total count, progressive motility, but not normal forms. On the basis of the weekly dosage, the studies were classified into those using low (175-262.5 IU per week), intermediate (350-525 IU per week), and high (700-1050 IU per week) doses. At low doses, FSH improved only sperm motility. At intermediate doses, FSH ameliorated sperm concentration and morphology. Total sperm count and progressive motility showed a trend toward the increase. At high doses, FSH increased sperm concentration, total sperm count, and progressive motility. Sperm morphology showed a trend toward the increase. Finally, both highly purified FSH (hpFSH) and recombinant human FSH (rhFSH) improved sperm concentration, total sperm count, progressive motility, but not morphology. No different efficacy was observed between these two preparations. This meta-analysis provides evidence in favor of high FSH doses. The FSH efficacy was not related to the preparation type (recombinant vs highly purified). Further studies are needed to evaluate the effectiveness of long-standing treatment regimes.

Keywords: follicle-stimulating hormone; male infertility; oligozoospermia; sperm concentration; sperm count.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Flowchart of the studies included in the meta-analysis. We identified 971 papers, 27 of which were assessed for eligibility. Based on the inclusion criteria of the present study, five studies were finally included in this meta-analysis.
Figure 2
Figure 2
Dose-dependent effect of FSH therapy on sperm concentration and total count. Treatment with FSH improved the (a) sperm concentration and (b) total sperm count in men with idiopathic oligozoospermia compared with controls. (a) At low doses, FSH therapy did not ameliorate the sperm concentration; at intermediate and high doses, FSH administration increased the sperm concentration in a dose-dependent manner. (b) At low doses, FSH did not improve the total sperm count; at intermediate doses, the total sperm count showed a trend toward the increase; and at high doses, FSH ameliorated the total sperm count. FSH: follicle-stimulating hormone; CI: confidence interval; s.d.: standard deviation; a–d: study subgroups; IV: Inverse Variance methods; df: degree of freedom.
Figure 3
Figure 3
Dose-dependent effect of FSH therapy on progressive sperm motility and morphology. Treatment with FSH improved (a) the progressive sperm motility but not (b) the sperm morphology in men with idiopathic oligozoospermia compared with controls. (a) At low and high doses, FSH therapy ameliorated the progressive sperm motility; at intermediate doses, FSH administration did not increase this parameter. (b) At low doses, FSH did not improve the sperm morphology; at intermediate doses, it was ameliorated; and at high doses, the sperm morphology showed a trend toward the increase. FSH: follicle-stimulating hormone; CI: confidence interval; s.d.: standard deviation; std: standard; a–d: study subgroups; IV: Inverse Variance methods; df: degree of freedom.
Figure 4
Figure 4
Effects of different FSH preparations on sperm concentration and total sperm count. Both hpFSH and rhFSH improved (a) the sperm concentration and (b) the total sperm count. FSH: follicle-stimulating hormone; hpFSH: highly purified FSH; rhFSH: recombinant human FSH; CI: confidence interval; s.d.: standard deviation; a–d: study subgroups; IV: Inverse Variance methods; df: degree of freedom.
Figure 5
Figure 5
Effects of different FSH preparations on progressive sperm motility and morphology. (a) Both hpFSH and rhFSH increased the progressive sperm motility. (b) Neither of them improved the sperm morphology. FSH: follicle-stimulating hormone; hpFSH: highly purified FSH; rhFSH: recombinant human FSH; CI: confidence interval; s.d.: standard deviation; std: standard; a–d: study subgroups; IV: Inverse Variance methods; df: degree of freedom.
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