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Randomized Controlled Trial
. 2019 Aug;98(31):e16616.
doi: 10.1097/MD.0000000000016616.

Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism

Jianli Lin  1   2 , Jiangfeng Mao  1 , Xi Wang  1 , Wanlu Ma  1 , Ming Hao  1 , Xueyan Wu  1
Affiliations
Randomized Controlled Trial

Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism

Jianli Lin et al. Medicine (Baltimore). 2019 Aug.

Abstract

Background: To compare the efficacies of gonadotropin-releasing hormone (GnRH) pulse subcutaneous infusion with combined human chorionic gonadotropin and human menopausal gonadotropin (HCG/HMG) intramuscular injection have been performed to treat male hypogonadotropic hypogonadism (HH) spermatogenesis.

Methods: In total, 220 idiopathic/isolated HH patients were divided into the GnRH pulse therapy and HCG/HMG combined treatment groups (n = 103 and n = 117, respectively). The luteinizing hormone and follicle-stimulating hormone levels were monitored in the groups for the 1st week and monthly, as were the serum total testosterone level, testicular volume and spermatogenesis rate in monthly follow-up sessions.

Results: In the GnRH group and HCG/HMG group, the testosterone level and testicular volume at the 6-month follow-up session were significantly higher than were those before treatment. There were 62 patients (62/117, 52.99%) in the GnRH group and 26 patients in the HCG/HMG (26/103, 25.24%) group who produced sperm following treatment. The GnRH group (6.2 ± 3.8 months) had a shorter sperm initial time than did the HCG/HMG group (10.9 ± 3.5 months). The testosterone levels in the GnRH and HCG/HMG groups were 9.8 ± 3.3 nmol/L and 14.8 ± 8.8 nmol/L, respectively.

Conclusion: The GnRH pulse subcutaneous infusion successfully treated male patients with HH, leading to earlier sperm production than that in the HCG/HMG-treated patients. GnRH pulse subcutaneous infusion is a preferred method.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Changes in the luteinizing hormone (LH) and follicular-stimulating hormone (FSH) levels (A) and total testosterone (TT) levels (B) in the gonadotropin-releasing hormone group after treatment. Compared with before treatment: ∗∗P < .01 (1/4 month for 1 week).
Figure 2
Figure 2
Comparison of sperm initial time (A) and sperm primary blood total testosterone level (B) in the gonadotropin-releasing hormone (GnRH) and human chorionic gonadotropin (HCG)/human menopausal gonadotropin (HMG) groups. TT: blood total testosterone; compared with the GnRH group. ∗P < .05, ∗∗P < .01.
Figure 3
Figure 3
Influencing factors of spermatogenesis. The values in the chart are the median, mean and standard deviation. (A) The testicular volume of each group was observed 18 months after treatment. (B) Analysis of variance was used to analyze the relationship between treatment methods and sperm density. (C) All successful spermatogenesis patients (n = 88) required the median time to treat different sperm densities. A sperm density >0 × 106/mL was reached after a median treatment period of 9 months. A sperm density >5 × 106/mL was reached after a median treatment period of 13 months, whereas a sperm density >10 × 106/mL was reached after a median treatment period of 18 months. (D) Comparison of the peak value of luteinizing hormone between the successful spermatogenesis group and the nonspermatogenic group. AHH = acquired hypogonadotropic hypogonadism, CHH = congenital hypogonadotropic hypogonadism, GnRH = gonadotropin-releasing hormone, HCG = human chorionic gonadotropin, HMG = human menopausal gonadotropin.
See this image and copyright information in PMC

References

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