Abstract
Gonadotropin therapy, in the form of human chorionic gonadotropin (hCG) and/or human menopausal gonadotropin (hMG), is indicated to restore spermatogenesis in hypogonadotropic hypogonadal (hypo-hypo) males. Recently, recombinant hCG (rec-hCG) become available, but data is limited on its effectiveness to treat men with hypo-hypo. We present the clinical efficacy, safety and tolerability of rec-hCG to restore spermatogenesis and androgenic status in a group of men with hypo-hypo seeking fertility. Case-series. Eleven men with adult-onset hypo-hypo seeking fertility restoration was treated with a single weekly subcutaneous (SC) injection of rec-hCG for a minimum of 12 weeks. All patients presented with clinical signs of hypoandrogenism and were azoospermic. Testis biopsy results revealed peritubular fibrosis and maturation arrest. Mean baseline FSH, LH and testosterone levels were 0.46 ± 0.28 mUI/mL, 0.39 ± 0.32 mUI/mL and 41.3 ± 26.9 ng/dL. All but one man restored spermatogenesis after a mean of 12 treatment weeks. Total motile sperm count at the completion of treatment was 39x106 (range 0.0-156.9x106). Testosterone levels at the 12th treatment weeks were 647.5 ± 219.0 ng/dL, respectively. A marked improvement in virilization, libido and erectile function was also observed. Mean combined testis volume increased from 24 mL before to 33 mL posttreatment. Headache, gynecomastia and increased estradiol levels were observed in one man who did not recover spermatogenesis. All patients reported hCG SC self-administration with mininmal or no local side effects and/or discomfort. In our series, a single weekly injection of rec-hCG was effective to restore spermatogenesis and androgen production in most adult-onset hypo-hypo males. In view of the favorable efficacy, safety and tolerability profile of rec-hCG, it may be considered as an alternative to intramuscular urinary-derived hCG administration to hypo-hypo men seeking fertility.
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