Retrospective Monocentric Clinical Study on Male Infertility: Comparison between Two Different Therapeutic Schemes Using Follicle-Stimulating Hormone.

Rosita A Condorelli,Federica Barbagallo,Andrea Crafa,Antonio Aversa,Sandro La Vignera,Laura M Mongioì,Emanuela Greco,Aldo E Calogero,Rossella Cannarella

doi:10.3390/jcm10122665

Abstract

Follicle-stimulating hormone (FSH) is a therapeutic option in patients with idiopathic oligozoospermia and normal FSH serum levels. However, few studies have evaluated which dose of FSH is more effective. The aim of this study was to compare the clinical efficacy of the two most frequently used FSH treatment regimens: 75 IU daily vs. 150 IU three times a week. Patients were retrospectively assigned to two groups. The first group (n = 24) was prescribed highly purified FSH (hpFSH) 75 IU/daily (Group A), and the second group (n = 24) was prescribed hpFSH 150 IU three times a week (Group B) for three months. Before and after treatment, each patient underwent semen analysis, evaluation of the percentage of DNA-fragmented spermatozoa, assessment of testicular volume (by ultrasonography), and measurement of FSH and total testosterone (TT) serum levels. Treatment with hpFSH significantly improved conventional sperm parameters. In detail, sperm concentration increased significantly after treatment only in Group A, whereas total sperm count, percentage of spermatozoa with progressive motility, normal morphology, or alive improved significantly in both groups. Interestingly, the percentage of sperm DNA fragmentation decreased significantly in both groups after treatment with hpFSH. FSH serum levels were expectably higher at the end of the treatment than before hpFSH was administered to both groups. Remarkably, TT serum levels only increased significantly in Group A. Finally, testicular volume was significantly higher in Group A after treatment, while it did not change significantly compared to baseline in Group B. The percentage of FSH responders did not differ significantly between the two groups (8/24 vs. 6/24). The daily administration of hpFSH 75 IU seems more effective than using 150 IU three times a week. However, this therapeutic scheme implies a higher number of injections and slightly higher costs.

Highlights

On the basis of the proteomic analysis, the authors concluded that α-follitropin can be used in hypospermatogenesis due to insufficient hypogonadotropic stimulus, or to induce spermatogenesis in puberty, β-follitropin could improve spermiation or could be used in case of spermatidic arrest, and urofollitropin could be useful in treating idiopathic infertility in normogonadotropic patients [4]
At higher doses (700–1050 IU per week), Follicle-stimulating hormone (FSH) increased sperm concentration, total sperm count, and progressive motility, while sperm morphology showed an upward trend [3]. These findings suggest that FSH seems to act with a dose-dependent mechanism to ameliorate spermatogenesis
FSH within the normal range represents a valid therapeutic strategy supported by scientific evidence [15]