Induction of spermatogenesis in men with hypogonadotropic hypogonadism

Guy C Morris,David J Cahill,Esther Lloyd-Evans

doi:10.1007/s10815-020-02058-0

Abstract

PurposeWe compared our clinical experience to international standards, assessed by response to treatment and pregnancy rates to ensure our results were comparable.MethodsMen presenting with azoospermia related to hypogonadism were recruited into a treatment programme which was managed by one person over 8 years in a secondary care facility. Treatment followed published management plans using urinary gonadotropins. Data were collected on success rates in spermatogenesis, as well as variables which might predict success, and costs. Statistical analysis used non-parametric methods.ResultsOf 16 men with HH, 14 achieved spermatogenesis, and 9 had sperm cryopreserved. Of those 14, 6 were successful in achieving a pregnancy with their partner from assisted conception (including ICSI) and one after natural conception. Factors identified to identify men likely to be successful in treatment were whether testicular volume was larger at onset of gonadotropins (median 10 mL) with a trend towards greater success if the cause developed after puberty. Mean treatment costs per man treated amounted to GP£4379/UD$5377 (figures for September 2020).SummarySuccess rates from this treatment should exceed 70% in most clinical settings. The likelihood of success improves when testicular volume exceeded 10 mL at initiation of treatment and a trend exists whereby success is more likely whereby when hypogonadism developed after puberty. Treatment costs are at a level likely to benefit quality of life, supporting the delivery of this treatment and where necessary and possible, funding it in line with other fertility treatments. This treatment should be available much more widely as a management option for men with hypogonadism, allowing them to father a biological child, rather than using donor sperm.

Highlights

Disorders of sperm function and production are found in 36% of the infertile population [1], but related endocrine causes are rare
Median parameters for the successful and unsuccessful cycles of gonadotropin stimulation of spermatogenesis were analysed for all these outcomes: initial testicular volume, initial LH (IU/L), initial FSH (IU/L), initial semen volume, initial testosterone, initial total sperm count, first testosterone after 4 weeks hCG, change in testosterone post FSH, change in semen volume post FSH, change in total sperm count
This review of the outcomes from our clinical service affirms the importance and effectiveness of spermatogenesis as a treatment and supports the provision of gonadotropin induction of spermatogenesis in a secondary care setting and shows that these patients do not have to be managed in a tertiary fertility unit

Summary

Introduction

Disorders of sperm function and production are found in 36% of the infertile population [1], but related endocrine causes are rare. St Michael’s Hospital, Southwell St, Bristol BS2 8EG, UK 3 St Michael’s Hospital, University of Bristol, Southwell St, Bristol BS2 8EG, UK of the hypothalamic-pituitary axis which result in hypogonadotropic hypogonadism, either are related to anosmia (Kallmann syndrome) or are idiopathic (IHH). In the paper referred to above, hypogonadotropic hypogonadism was the cause of the man’s infertility in only 2 of the 1035 (0.3%) [2]. This condition is rare but amenable to long established, effective treatment, by regular gonadotropin injections, usually selfadministered [3]. What is the cost of this treatment and ... do some clinics shy away from treating men with IHH because of cost?

Methods

Results

Conclusion