PD07-11 DURATION OF TESTOSTERONE THERAPY AND MALE AGE PREDICT TIME TO RETURN OF NORMAL TOTAL MOTILE SPERM COUNT AFTER HUMAN CHORIONIC GONADOTROPIN THERAPY

Abstract

INTRODUCTION AND OBJECTIVES: Testosterone therapy (TTh) reduces sperm counts in men. For men with testosterone-associated azoospermia and severe oligospermia, treatment includes TTh cessation and human chorionic gonadotropin (hCG) therapy. However, optimal duration of hCG therapy needed for sperm recovery or the expected extent of sperm recovery remains unknown. We identify factors affecting the length of time needed for sperm recovery and for sperm counts to reach >5 million/mL after TTh and subsequent hCG therapy. METHODS: Retrospective chart review of men seen at a single academic andrology clinic between 2004-2015 was performed. All included patients presented with infertility, were on TTh at the time of the visit, and had an initial semen analysis with azoospermia or severe oligospermia. Men ceased TTh and were started on hCG, and had a second semen analysis within 6 months of starting hCG. The number of men with total motile sperm count (TMC) >5 million was determined. Logistic regression analysis evaluated the relationship between the number of men with TCM >5 million and time on TTh, age, T formulation, treatment with or without clomiphene citrate, initial T level, and initial sperm count. RESULTS: A total of 55 men were identified with a mean age of 40.0 (range 27-69) years and a mean duration of TTh of 42.0 (range 0.5-240) months. Of the 55 men, 36 (65.5%) achieved a TMC of >5 million within 6 months of stopping TTh and starting hCG. Two variables had a strong associations with the likelihood of achieving TMC >5 million: age (p 1⁄4 0.04) and time on TTh (p 1⁄4 0.01). T formulation, initial T level, initial sperm count, and clomiphene citrate use were not significantly associated. Multivariate logistic regression demonstrated that both time on TTh (OR1⁄40.781, p1⁄40.016) and patient age (OR1⁄40.941, p1⁄40.050) decrease the probability of achieving a TMC >5 million within 6 months (Figure 1). CONCLUSIONS: Men with infertility associated with TTh can resume sperm production adequate for initiating pregnancy by IUI using hCG combined therapy. The likelihood of achieving sufficient sperm counts within 6 months of TTh cessation and initiation of hCG is related to patient age and duration of TTh. Clinicians should counsel older men or men on long-term TTh that recovery of spermatogenesis may be slower than in other men.