Abstract
Congenital hypogonadotropic hypogonadism (CHH) patients with cryptorchidism history usually have poor spermatogenesis outcome, while researches focusing on this population are rare. This study retrospectively evaluated gonadotropin-induced spermatogenesis outcome in CHH patients with cryptorchidism (n = 40). One hundred and eighty-three CHH patients without cryptorchidism were served as control. All patients received combined gonadotropins therapy (HCG and HMG) and were followed up for at least 6 months. The median follow-up period was 24 (15, 33) months (totally 960 person-months). Sperm (>0/ml) initially appeared in semen at a median of estimated 24 months (95% confidence interval (CI) 17.8–30.2). Twenty (20/40, 50%) patients succeeded in producing sperms, and the average time to produce first sperm was 19 ± 8 months. Five pregnancies were achieved in 9 (5/9, 56%) couples who desired for children. Compared with CHH patients without cryptorchidism (n = 183), cryptorchid patients had longer median time for sperm appearance in semen (24 months vs. 15 months, P < 0.001), lower rate of spermatogenesis (50% vs. 67%, P=0.032), and lower mean sperm concentration (1.9 (0.5, 8.6) million/ml vs. 11.1(1.0, 25.0) million/ml, P=0.006) at the last visit. In conclusion, CHH patients with cryptorchidism require a longer period for gonadotropin-induced spermatogenesis. The successful rate and sperm concentration were lower than patients without cryptorchidism.
Highlights
Congenital hypogonadotropic hypogonadism (CHH), caused by GnRH deficiency or dysfunction, is characterized by delayed or absent puberty, development, and infertility
International Journal of Endocrinology study, we report the fertility and paternity outcomes in 40 CHH patients with cryptorchidism treated with gonadotropins (HCG/human menopausal gonadotropin (HMG))
One hundred and eightythree CHH patients without cryptorchidism treated with human chorionic gonadotropin (HCG)/HMG were served as control. e diagnosis of CHH was made according to the criteria reported previously [13]
Summary
Congenital hypogonadotropic hypogonadism (CHH), caused by GnRH deficiency or dysfunction, is characterized by delayed or absent puberty, development, and infertility. Pulsatile GnRH infusion or combined human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG) therapy can be used for spermatogenesis. Cryptorchidism ( bilateral) has a significant negative impact on fertility potential [1, 2]. Testosterone and insulin-like factor 3 (INSL3) secreted by Leydig cells are primary regulators for testicular descent [6]. The normal procedure of testicular descent is disturbed due to a low level of testosterone and impaired Leydig cell function in CHH patients [7]. Erefore, it is recommended that cryptorchidism should be treated within one year after birth, hoping to maximally preserve the spermatogenic potentiality [9]. International Journal of Endocrinology study, we report the fertility and paternity outcomes in 40 CHH patients with cryptorchidism treated with gonadotropins (HCG/HMG)
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