Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism

[madman]

Abstract

Background: To compare the efficacies of gonadotropin-releasing hormone (GnRH) pulse subcutaneous infusion with combined human chorionic gonadotropin and human menopausal gonadotropin (HCG/HMG) intramuscular injection have been performed to treat male hypogonadotropic hypogonadism (HH) spermatogenesis.

Methods: In total, 220 idiopathic/isolated HH patients were divided into the GnRH pulse therapy and HCG/HMG combined treatment groups (n=103 and n=117, respectively). The luteinizing hormone and follicle-stimulating hormone levels were monitored in the groups for the 1st week and monthly, as were the serum total testosterone level, testicular volume and spermatogenesis rate in monthly follow-up sessions.

Results: In the GnRH group and HCG/HMG group, the testosterone level and testicular volume at the 6-month follow-up session were significantly higher than were those before treatment. There were 62 patients (62/117, 52.99%) in the GnRH group and 26 patients in the HCG/HMG (26/103, 25.24%) group who produced sperm following treatment. The GnRH group (6.2±3.8 months) had a shorter sperm initial time than did the HCG/HMG group (10.9±3.5 months). The testosterone levels in the GnRH and HCG/ HMG groups were 9.8±3.3 nmol/L and 14.8±8.8 nmol/L, respectively.

Conclusion: The GnRH pulse subcutaneous infusion successfully treated male patients with HH, leading to earlier sperm production than that in the HCG/HMG-treated patients. GnRH pulse subcutaneous infusion is a preferred method.








5. Conclusion

Our study suggested that GnRH pulse infusion therapy simulates the physiologic secretion of the human GnRH pulse, which is more consistent with the physiologic state. Compared with the combined treatment of HCG/HMG, GnRH pulse subcutaneous infusion can promote spermatogenesis faster. Therefore, GnRH pulse subcutaneous infusion is an optimal choice for the treatment of spermatogenesis in patients with HH.

 

[Sides]

Interesting study, but terrible protocol in the HCG/HMG group. 5000-10000iu HCG once or twice a week!? I would like to see what the results would have been with a different protocol, say 500iu HCG and 150iu HMG every other day.

T + HCG + HMG/FSH worked for me in restoring my fertility after 27 years on testosterone, and enabled me to go from azoospermia to getting my wife pregnant at the age of 51. It worked for me, and would work for many other people as well, using a reasonable protocol.

"2.2.3. HCG/HMG treatment scheme. Then, 5000 IU HCG (5000 IU/ampoule, Shanghai First Biochemical Pharmaceutical Co., Ltd., Shanghai, China; H31020865) and 75 IU HMG (75 IU/ ampoule, Li Zhu Pharmaceutical Factory, Guangdong, China; SFDA No. H10940097) were used simultaneously. The reference dose of HMG was 75 to 150 IU intramuscular injection once or twice a week. HCG reference dose 5000 to 10,000 IU intramuscular injection once or twice a week. The drugs were mixed with 2mL sterile water for injection, and then, a 5-mL syringe was used to draw the required volume of the drugs. This solution was injected into the gluteal muscles 2 times a week. The blood TT level 48 to 72 hours following the injection was measured, and the dose of HCG and HMG was adjusted according to the TT level and the production of spermatogenesis (the level of TT was maintained at 10–15 nmol/L)."