madman
Super Moderator
024 Dual Therapy with rFSH and HCG Results in a Significantly Shorter Time to Return of Spermatogenesis than Combination HCG and Clomiphene (2021)
K. Campbell, J. Sullivan, R. Valero Carrion, J. Kraus, B. Stocks, A. Lawrence, L. Lipshultz
Introduction: The use of testosterone replacement therapy (TRT) for hypogonadism continues to grow and more younger men are now receiving treatment. With the use of exogenous TRT, the hypothalamic-pituitary-gonadal axis becomes quiescent and endogenous testosterone production ceases. In addition, in most men, there is a halting of sperm production by the testis. In men who have previously taken TRT and now desire fertility, various pharmacological agents are employed to “reboot” endogenous T and restore spermatogenesis. It has previously been reported that human chorionic gonadotropin (hCG) in addition to selective estrogen receptor modulators (SERMs) such as clomiphene citrate has been shown to result in the return of sperm to the ejaculate in testosterone-induced azoospermia. Additionally, recombinant follicle-stimulating hormone (rFSH) has been used to potentiate Sertoli cell function recovery and sperm production. Studies have also shown the effectiveness of adding rFSH to HCG as a substitute for Clomiphene.
Objective: To assess the efficacy of using either FSH or clomiphene citrate in conjunction with hCG, in restoring sperm production in azoospermic men who have been treated with TRT for hypogonadism.
Methods: The study population consisted of men presenting to a single tertiary referral men’s health clinic with the following profiles: 1) desire to “reboot” and recover natural spermatogenesis, 2) previous exogenous TRT, and 3) evidence of azoospermia on initial presenting semen analysis. A retrospective chart review was performed of 40 patients prescribed high-dose hCG and clomiphene and 40 patients using hCG and FSH. Patients were identified by the type of reboot protocol used, initial total motile sperm count, and time to recovery of spermatogenesis. Demographic characteristics, relevant medical comorbidities, previous reboot cycle, and serum hormonal profiles were included. Exclusion criteria included lack of initial semen parameters and/or hormonal panel, non-testosterone-induced hypogonadism, and concomitant therapy.
Results: Once exclusion criteria had been applied, azoospermic patients undergoing reboot protocol with FSH (5) were noted to have a faster return of sperm to the ejaculate than those on clomiphene (5). The results were 5.5 months and 14.8 months, respectively. Additionally, a review of all patients who previously had failed reboot on clomiphene and underwent a second reboot on FSH revealed a 100% pregnancy rate (5/5).
Conclusions: Our results reiterate that FSH in combination with hCG may be considered as an alternative to combination hCG and clomiphene in the treatment of testosterone-induced azoospermia. FSH and hCG dual therapy may result in the more rapid recovery of sperm to the ejaculate being three times faster in the FSH group. Additionally, patients who have failed dual therapy with hCG and clomiphene should be considered for subsequent FSH.
K. Campbell, J. Sullivan, R. Valero Carrion, J. Kraus, B. Stocks, A. Lawrence, L. Lipshultz
Introduction: The use of testosterone replacement therapy (TRT) for hypogonadism continues to grow and more younger men are now receiving treatment. With the use of exogenous TRT, the hypothalamic-pituitary-gonadal axis becomes quiescent and endogenous testosterone production ceases. In addition, in most men, there is a halting of sperm production by the testis. In men who have previously taken TRT and now desire fertility, various pharmacological agents are employed to “reboot” endogenous T and restore spermatogenesis. It has previously been reported that human chorionic gonadotropin (hCG) in addition to selective estrogen receptor modulators (SERMs) such as clomiphene citrate has been shown to result in the return of sperm to the ejaculate in testosterone-induced azoospermia. Additionally, recombinant follicle-stimulating hormone (rFSH) has been used to potentiate Sertoli cell function recovery and sperm production. Studies have also shown the effectiveness of adding rFSH to HCG as a substitute for Clomiphene.
Objective: To assess the efficacy of using either FSH or clomiphene citrate in conjunction with hCG, in restoring sperm production in azoospermic men who have been treated with TRT for hypogonadism.
Methods: The study population consisted of men presenting to a single tertiary referral men’s health clinic with the following profiles: 1) desire to “reboot” and recover natural spermatogenesis, 2) previous exogenous TRT, and 3) evidence of azoospermia on initial presenting semen analysis. A retrospective chart review was performed of 40 patients prescribed high-dose hCG and clomiphene and 40 patients using hCG and FSH. Patients were identified by the type of reboot protocol used, initial total motile sperm count, and time to recovery of spermatogenesis. Demographic characteristics, relevant medical comorbidities, previous reboot cycle, and serum hormonal profiles were included. Exclusion criteria included lack of initial semen parameters and/or hormonal panel, non-testosterone-induced hypogonadism, and concomitant therapy.
Results: Once exclusion criteria had been applied, azoospermic patients undergoing reboot protocol with FSH (5) were noted to have a faster return of sperm to the ejaculate than those on clomiphene (5). The results were 5.5 months and 14.8 months, respectively. Additionally, a review of all patients who previously had failed reboot on clomiphene and underwent a second reboot on FSH revealed a 100% pregnancy rate (5/5).
Conclusions: Our results reiterate that FSH in combination with hCG may be considered as an alternative to combination hCG and clomiphene in the treatment of testosterone-induced azoospermia. FSH and hCG dual therapy may result in the more rapid recovery of sperm to the ejaculate being three times faster in the FSH group. Additionally, patients who have failed dual therapy with hCG and clomiphene should be considered for subsequent FSH.
