Efficacy of Gonadotropin Therapy to Induce Spermatogenesis and Fertility in Men with Pathologic Gonadotropin Deficiency.
Most men with pathologic gonadotropin deficiency treated with hCG/FSH achieve sperm output and fertility within a year, but adverse female fertility factors significantly affect outcomes.
Where it sits
this study against the rest of the hcg (human chorionic gonadotropin) corpusSummary and findings
This study evaluated the efficacy of gonadotropin therapy in inducing spermatogenesis and fertility in men with pathologic gonadotropin deficiency. A total of 99 infertile men were treated with hCG and FSH over a period from 1983 to 2024. The results indicated varying success rates in achieving sperm density thresholds and highlighted the influence of female partner fertility factors on pregnancy outcomes.
Abstract
Context Gonadotropin treatment to induce spermatogenesis for gonadotropin-deficient men is the only medically treatable cause of male infertility. However, time-dependent analyses of fertility outcomes in large cohorts are lacking. We evaluated the time to, and determinants of, fertility outcomes in men with pathologic gonadotropin-deficiency undergoing gonadotropin treatment. Methods Consecutive infertile men (n = 99) with congenital or acquired pathologic gonadotropin deficiency were treated with urinary or recombinant human chorionic gonadotropin and FSH according to a standardized protocol between 1983 and 2024. Kaplan-Meier and multivariate Cox regression analyses examined time to prespecified sperm density thresholds and pregnancy. Results Men aged 35 ± 1 years with female partners 30 ± 1 years underwent 160 treatment cycles. The proportion (%) and median time (months) to achieve sperm thresholds of >0, >2, >5, >10, and >20 million (M) sperm/mL was 78% (5 months), 56% (12 months), 49% (14 months), 37% (21 months), and 24% (not determined), respectively. The major determinant of successful pregnancy was the presence of adverse fertility factors in the female partner (hazard ratio 0.20, 95% confidence interval 0.10-0.40; P < .001), with time to pregnancy also significantly increased by the presence of adverse female factors (15 vs 43 months; P < .0001). The median sperm concentration associated with partner pregnancy was 2.8 (0.2, 52.6) M/mL without and 35.4 (15.1, 52.6) M/mL with adverse female factors. Conclusion Most men with pathologic gonadotropin deficiency treated with hCG/FSH achieve sperm output and fertility within a year, with the greatest impact on fertility outcomes being detrimental female fertility factors.
Background
Not reported in abstract.
Methods
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Results
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Interpretation
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Limitations
Not reported in abstract.