Reversible infertility in a man with 21-hydroxylase deficiency congenital adrenal hyperplasia.
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.
Yang
Ronald M
RM
Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.
Fefferman
Richard A
RA
Shapiro
Charles E
CE
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
D002996:Clomiphene