title: Reversible infertility in a man with 21-hydroxylase deficiency congenital adrenal hyperplasia.
abstract: OBJECTIVE
  To report a case of an azoospermic man diagnosed with 21-hydroxylase deficiency congenital adrenal hyperplasia who successfully conceived with intrauterine insemination (IUI) after hormonal and clomiphene citrate (CC) treatment.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Outpatient practice and academic hospital.
  
  
  METHODS
  A 32-year-old azoospermic man who presented for evaluation of male factor infertility.
  
  
  METHODS
  Semen analysis, ultrasonography, endocrinologic assays, hormonal treatment, CC, and IUI.
  
  
  METHODS
  Semen analysis demonstrating increased sperm count and motility, ultrasonography demonstrating persistent nodules in bilateral testes, endocrinologic assays demonstrating elevated FSH and LH after CC treatment.
  
  
  RESULTS
  Successful intrauterine pregnancy after IUI using the patient's sperm.
  
  
  CONCLUSIONS
  Clomiphene citrate treatment in addition to hormonal manipulation in azoospermic patients with congenital adrenal hyperplasia can be successful in improving sperm count and motility to allow for successful conception using IUI. The presumed adrenal rests in the testes may not involute after adrenal suppression.
authors.affiliation: Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Yang
authors.forename: Richard A
authors.initials: RA
authors.lastname: Fefferman
authors.forename: Charles E
authors.initials: CE
authors.lastname: Shapiro
mesh_terms: D000312:Adrenal Hyperplasia, Congenital / Q000150:complications* / Q000503:physiopathology; D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use; D006801:Humans; D007248:Infertility, Male / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D008297:Male
chemical_list: D002996:Clomiphene