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* Gonadotropin treatment has dual roles, including hCG effects on Leydig cell luteinizing hormone (LH) receptors to increase testosterone production and FSH causes proliferative effects on Sertoli cells to support spermatogenesis within the seminiferous tubules [5].

* Treatment‐related increases in testosterone and testicular volume (TV) were not different between hCG and combined hCG/FSH treated patients, although increases in TV were lower in men with CHH compared with those with hypopituitarism.

* Despite similar effects on serum testosterone and TV, combined hCG/FSH appeared more efficacious than hCG alone at inducing spermatogenesis.

[URL unfurl="true"]https://onlinelibrary.wiley.com/doi/10.1111/cen.15151[/URL]

ABSTRACT

Introduction

Hypogonadotropic hypogonadism (HH) is a treatable cause of non obstructive azoospermic male infertility. Gonadotropin treatment can successfully induce spermatogenesis in most patients, although comprehensive quantitative summary data on spermatogenic outcomes like those required to induce pregnancy is lacking in the literature.

Materials and Methods

Systematic review and meta‐analysis of outcomes related to male reproductive function following gonadotropin treatment.

Results

Our search strategy identified 41 studies encompassing 1673 patients with a mean age of 25 (± 5) years. Average sperm concentration achieved after a median of 18 months of gonadotropin treatment was 11.6 M/mL of ejaculate (95% CI 8.4–14.9).S perm concentrations > 0, > 1, > 5, > 10 and > 20 M/mL were achieved by 78%, 55%, 36%, 24% and 15% of patients, respectively. Mean sperm output and the proportion of patients achieving all sperm thresholds were significantly greater following combined hCG/FSH treatment compared with hCG monotherapy. When compared by diagnosis, patients with congenital HH (CHH) had significantly lower mean sperm output compared with patients with hypopituitarism or mixed patient cohorts that did not differentiate between CHH and hypopituitarism. Treatment‐related increases in testosterone and testicular volume (TV) were not different between hCG and combined hCG/FSH treated patients, although increases in TV were lower in men with CHH compared with those with hypopituitarism.

Conclusions

Gonadotropin treatment successfully induced spermatogenesis in most men with pathological gonadotropin deficiency. Sperm outputs more consistent with those typically needed to induce a natural pregnancy were less commonly achieved. Despite similar effects on serum testosterone and TV, combined hCG/FSH appeared more efficacious than hCG alone at inducing spermatogenesis.

* Gonadotropin replacement using human chorionic gonadotropin (hCG) alone or in combination with follicle stimulating hormone (FSH) can induce spermatogenesis in adult men and pubertal adolescents with organic gonadotropin deficiency [4].Gonadotropin treatment has dual roles, including hCG effects on Leydig cell luteinizing hormone (LH) receptors to increase testosterone production and FSH causes proliferative effects on Sertoli cells to support spermatogenesis within the seminiferous tubules [5].

In conclusion, in a proportional meta‐analysis of spermatogenesis outcomes in men with HH undergoing gonadotropin treatment, more than 75% of men achieved some spermatozoa in their ejaculate, but full normalisation of sperm output compared with unselected healthy men was unusual. Only 24% achieved sperm concentrations > 10 M/mL—the sperm output expected to cause pregnancy in partners of this population of men. Combined treatment with hCG and FSH appeared superior to hCG monotherapy; however, due to the study limitations described earlier, randomised controlled studies would berequired to validate this finding.

<blockquote data-quote="madman" data-source="post: 298274" data-attributes="member: 13851">* Gonadotropin treatment has dual roles, including hCG effects on Leydig cell luteinizing hormone (LH) receptors to increase testosterone production and FSH causes proliferative effects on Sertoli cells to support spermatogenesis within the seminiferous tubules [5].* Treatment‐related increases in testosterone and testicular volume (TV) were not different between hCG and combined hCG/FSH treated patients, although increases in TV were lower in men with CHH compared with those with hypopituitarism.* Despite similar effects on serum testosterone and TV, combined hCG/FSH appeared more efficacious than hCG alone at inducing spermatogenesis.[URL unfurl=&quot;true&quot;]https://onlinelibrary.wiley.com/doi/10.1111/cen.15151[/URL]ABSTRACTIntroductionHypogonadotropic hypogonadism (HH) is a treatable cause of non obstructive azoospermic male infertility. Gonadotropin treatment can successfully induce spermatogenesis in most patients, although comprehensive quantitative summary data on spermatogenic outcomes like those required to induce pregnancy is lacking in the literature.Materials and MethodsSystematic review and meta‐analysis of outcomes related to male reproductive function following gonadotropin treatment.ResultsOur search strategy identified 41 studies encompassing 1673 patients with a mean age of 25 (± 5) years. Average sperm concentration achieved after a median of 18 months of gonadotropin treatment was 11.6 M/mL of ejaculate (95% CI 8.4–14.9).S perm concentrations &gt; 0, &gt; 1, &gt; 5, &gt; 10 and &gt; 20 M/mL were achieved by 78%, 55%, 36%, 24% and 15% of patients, respectively. Mean sperm output and the proportion of patients achieving all sperm thresholds were significantly greater following combined hCG/FSH treatment compared with hCG monotherapy. When compared by diagnosis, patients with congenital HH (CHH) had significantly lower mean sperm output compared with patients with hypopituitarism or mixed patient cohorts that did not differentiate between CHH and hypopituitarism. Treatment‐related increases in testosterone and testicular volume (TV) were not different between hCG and combined hCG/FSH treated patients, although increases in TV were lower in men with CHH compared with those with hypopituitarism.ConclusionsGonadotropin treatment successfully induced spermatogenesis in most men with pathological gonadotropin deficiency. Sperm outputs more consistent with those typically needed to induce a natural pregnancy were less commonly achieved. Despite similar effects on serum testosterone and TV, combined hCG/FSH appeared more efficacious than hCG alone at inducing spermatogenesis.* Gonadotropin replacement using human chorionic gonadotropin (hCG) alone or in combination with follicle stimulating hormone (FSH) can induce spermatogenesis in adult men and pubertal adolescents with organic gonadotropin deficiency [4].Gonadotropin treatment has dual roles, including hCG effects on Leydig cell luteinizing hormone (LH) receptors to increase testosterone production and FSH causes proliferative effects on Sertoli cells to support spermatogenesis within the seminiferous tubules [5].In conclusion, in a proportional meta‐analysis of spermatogenesis outcomes in men with HH undergoing gonadotropin treatment, more than 75% of men achieved some spermatozoa in their ejaculate, but full normalisation of sperm output compared with unselected healthy men was unusual. Only 24% achieved sperm concentrations &gt; 10 M/mL—the sperm output expected to cause pregnancy in partners of this population of men. Combined treatment with hCG and FSH appeared superior to hCG monotherapy; however, due to the study limitations&nbsp; described earlier, randomised controlled studies would berequired to validate this finding.</blockquote>

[QUOTE="madman, post: 298274, member: 13851"] [I][B]* Gonadotropin treatment has dual roles, including [U]hCG effects on Leydig cell luteinizing hormone (LH) receptors to increase testosterone production and FSH causes proliferative effects on Sertoli cells to support spermatogenesis within the seminiferous tubules[/U] [5].[/B][/I] [B][I]* Treatment‐related increases in testosterone and testicular volume (TV) were [U]not different between hCG and combined hCG/FSH treated patients[/U], although increases in TV were lower in men with CHH compared with those with hypopituitarism.[/I] * [/B][I][B]Despite similar effects on serum testosterone and TV, [U]combined hCG/FSH appeared more efficacious than hCG alone at inducing spermatogenesis.[/U][/B][/I] [URL unfurl="true"]https://onlinelibrary.wiley.com/doi/10.1111/cen.15151[/URL] [B]ABSTRACT Introduction[/B] [I]Hypogonadotropic hypogonadism (HH) is a treatable cause of non obstructive azoospermic male infertility. Gonadotropin treatment can successfully induce spermatogenesis in most patients, although comprehensive quantitative summary data on spermatogenic outcomes like those required to induce pregnancy is lacking in the literature.[/I] [B]Materials and Methods[/B] [I]Systematic review and meta‐analysis of outcomes related to male reproductive function following gonadotropin treatment.[/I] [B]Results[/B] [I]Our search strategy identified 41 studies encompassing 1673 patients with a mean age of 25 (± 5) years. Average sperm concentration achieved after a median of 18 months of gonadotropin treatment was 11.6 M/mL of ejaculate (95% CI 8.4–14.9).S perm concentrations > 0, > 1, > 5, > 10 and > 20 M/mL were achieved by 78%, 55%, 36%, 24% and 15% of patients, respectively. [B]Mean sperm output and the proportion of patients achieving all sperm thresholds were significantly greater following combined hCG/FSH treatment compared with hCG monotherapy.[/B] When compared by diagnosis, patients with congenital HH (CHH) had significantly lower mean sperm output compared with patients with hypopituitarism or mixed patient cohorts that did not differentiate between CHH and hypopituitarism. [/I][B][I]Treatment‐related increases in testosterone and testicular volume (TV) were not different between hCG and combined hCG/FSH treated patients, although increases in TV were lower in men with CHH compared with those with hypopituitarism.[/I] Conclusions[/B] [I][B]Gonadotropin treatment successfully induced spermatogenesis in most men with pathological gonadotropin deficiency. Sperm outputs more consistent with those typically needed to induce a natural pregnancy were less commonly achieved. Despite similar effects on serum testosterone and TV, combined hCG/FSH appeared more efficacious than hCG alone at inducing spermatogenesis. * Gonadotropin replacement using human chorionic gonadotropin (hCG) alone or in combination with follicle stimulating hormone (FSH) can induce spermatogenesis in adult men and pubertal adolescents with organic gonadotropin deficiency [4].[U]Gonadotropin treatment has dual roles, including hCG effects on Leydig cell luteinizing hormone (LH) receptors to increase testosterone production and FSH causes proliferative effects on Sertoli cells to support spermatogenesis within the seminiferous tubules[/U] [5]. In conclusion, in a proportional meta‐analysis of spermatogenesis outcomes in men with HH undergoing gonadotropin treatment, [U]more than 75% of men achieved some spermatozoa in their ejaculate, but full normalisation of sperm output compared with unselected healthy men was unusual[/U]. [U]Only 24% achieved sperm concentrations > 10 M/mL—the sperm output expected to cause pregnancy in partners of this population of men[/U]. [U]Combined treatment with hCG and FSH appeared superior to hCG monotherapy; however, due to the study limitations [/U][I][B][U]described earlier, randomised controlled studies would berequired to validate this finding[/U].[/B][/I][/B][/I] [/QUOTE]

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TRT Hormone Predictor Widget

Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038