EC Gynaecology

Research Article Volume 12 Issue 3 - 2023

Pregnancy Results with Male Adult-Onset Hypogonadotropic Hypogonadism

Yaprak Engin-Ustun1, Nafiye Yılmaz1, Nilufer Akgun1*, Ayla Aktulay1, Ahmet Deniz Tuzluoğlu2 and Cavidan Gulerman1

1Reproductive Endocrinology Unit, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey

2Urology Unit, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey

*Corresponding Author: Nilufer Akgun, Reproductive Endocrinology Unit, Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey.
Received: November 12, 2022; Published: February 20, 2023

Background: Androgen deficiency and infertility lead to male hypogonadism. The main purpose of this study was to evaluate pregnancy outcomes of a cohort of males with adult-onset hypogonadism (AOHH) after gonadotropin treatment with hCG/hMG.

Methods: This retrospective study included 17 patients from a group of 2,340 men referred to Zekai Tahir Burak Women’s Health Training and Research Hospital for evaluation of azoospermia. Final sperm concentration, serum luteinizing hormone (LH), follicle stimulating hormone (FSH), endogenous testosterone, and pregnancy rates were compared to baseline, and statistical significance was p < 0.05.

Results: The mean LH increased from 0.05 (0 - 0.6) to 0.07 (0.01 - 0.58) IU/liter (p = 0.59), and FSH increased from 0.42 (0 - 2.2) to 2.63 (1.48 - 7.03) IU/liter (p = 0.001). Mean serum endogenous testosterone increased from 714.4 ng per deciliter, and spermatogenesis was induced in all patients. Five patients who want sharing personal data excluded of the study, and of the remaining 12, pregnancy occurred in 42% (n = 5) of their partners, including 17% (n = 2) with spontaneous pregnancy. Nine of the couples (75%) underwent IVF treatment using intracytoplasmic sperm injection (ICSI) and three of these (25%) became pregnant. One pregnancy ended in spontaneous abortion at 9 weeks of gestation and the other four resulted in the delivery of normal offspring.

Conclusion: Spermatogenesis can be improved by gonadotropin treatment in male AOHH, and although semen quality is low after treatment, pregnancy may still occur in a significant portion of cases.

Keywords: Male Adult-Onset Hypogonadotropic Hypogonadism; Pregnancy; In Vitro Fertilization

  1. Kobori Y., et al. “Hormonal therapy (hCG and rhFSH) for infertile men with adult-onset idiopathic hypogonadotropic hypogonadism”. Systems Biology in Reproductive Medicine2 (2015): 110-112.
  2. Nieschlag E., et al. “An open-label clinical trial to investigate the efficacy and safety of corifollitropin alfa combined with hCG in adult men with hypogonadotropic hypogonadism”. Reproductive Biology and Endocrinology1 (2017): 17.
  3. Rohayem J., et al. “Causes of hypogonadotropic hypogonadism predict response to gonadotropin substitution in adults”. Andrology1 (2016): 87-94.
  4. Quaynor SD., et al. “Targeted next generation sequencing approach identifies eighteen new candidate genes in normosmic hypogonadotropic hypogonadism and Kallmann syndrome”. Molecular and Cellular Endocrinology 437 (2016): 86-96.
  5. Fraietta R., et al. “Hypogonadotropic hypogonadism revisited”. Clinics 68 (2013): 81-88.
  6. Nachtigall LB., et al. “Adult-onset idiopathic hypogonadotropic hypogonadism-a treatable form of male infertility”. New England Journal of Medicine6 (1997): 410-415.
  7. Khera M., et al. “Adult-onset hypogonadism”. Paper presented at: Mayo Clinic Proceedings 2016 in Mayo Clinic Proceedings 91.7 (2016): 908-926.
  8. Davidiuk AJ and Broderick GA. “Adult-onset hypogonadism: evaluation and role of testosterone replacement therapy”. Translational Andrology and Urology6 (2016): 824.
  9. Morris G and Cahill DJ. “Fertility treatments for men with hypogonadotropic hypogonadism”. Journal of Cancer2 (2021): 44-50.
  10. Warne DW., et al. “A combined analysis of data to identify predictive factors for spermatogenesis in men with hypogonadotropic hypogonadism treated with recombinant human follicle-stimulating hormone and human chorionic gonadotropin”. Fertility and Sterility2 (2009): 594-604.
  11. Rastrelli G., et al. “Factors affecting spermatogenesis upon gonadotropin‐replacement therapy: a meta‐analytic study”. Andrology6 (2014): 794-808.
  12. Anawalt BD. “Approach to male infertility and induction of spermatogenesis”. The Journal of Clinical Endocrinology and Metabolism9 (2013): 3532-3542.
  13. Dwyer AA., et al. “The long-term clinical follow-up and natural history of men with adult-onset idiopathic hypogonadotropic hypogonadism”. The Journal of Clinical Endocrinology and Metabolism9 (2010): 4235-4243.
  14. Organization WH. WHO laboratory manual for the examination and processing of human semen (2010).
  15. Farhat R., et al. “Outcome of gonadotropin therapy for male infertility due to hypogonadotrophic hypogonadism”. Pituitary2 (2010): 105-110.
  16. Liu PY and Handelsman DJ. “The present and future state of hormonal treatment for male infertility”. Human Reproduction Update1 (2003): 9-23.
  17. Ying M and ZHANG X-h. “Hormonal Treatment of male idiopathic/isolated hypogonadotropic hypogonadism”. Journal of Reproduction and Contraception3 (2010): 179-189.
  18. Bouloux P., et al. “Efficacy and safety of recombinant human follicle-stimulating hormone in men with isolated hypogonadotropic hypogonadism”. Fertility and Sterility2 (2002): 270-273.
  19. Akarsu C., et al. “Pregnancies achieved by testicular sperm recovery in male hypogonadotrophic hypogonadism with persistent azoospermia”. Reproductive Biomedicine Online4 (2009): 455-459.
  20. Yılmazel FK., et al. “A review of hypogonadotropic hypogonadism cases followed up in our clinic in the last decade”. Urologia Journal1 (2021): 50-55.
  21. Rehman K., et al. “Hypogonadotropic hypogonadism: new identification of testicular blood flow and varicocele after treatment with gonadotropins”. Fertility and Sterility3 (2014): 700-704.
  22. Liu PY., et al. “Predicting pregnancy and spermatogenesis by survival analysis during gonadotrophin treatment of gonadotrophin-deficient infertile men”. Human Reproduction3 (2002): 625-633.

Nilufer Akgun., et al.Pregnancy Results with Male Adult-Onset Hypogonadotropic Hypogonadism. EC Gynaecology 12.3 (2023): 21-30.