Outcome of gonadotropin therapy for male hypogonadotropic hypogonadism at university affiliated male infertility centers: a 30-year retrospective study.
OBJECTIVE
Hypogonadotropic hypogonadism (HH) is an uncommon cause of male infertility. Even specialized centers see small numbers of patients and have little experience in restoring fertility in these patients. To explore the phenotypic heterogeneity and treatment outcome of HH, we summarized our 30-year experience.


METHODS
Medical charts of 36 male patients (age range 11 to 42 years) with HH (81% primary, 19% secondary) treated at university affiliated male infertility centers were reviewed. Pubic hair stage, genital stage, testicular volume (TV), sexual function and sperm production were determined before and after human chorionic gonadotropin/human menopausal gonadotropin (hCG/hMG) treatment. Differences were analyzed statistically.


RESULTS
The population was stratified according to initial TV into a small testis subset (TV less than 4 ml in 23) and a large testis subset (TV 4 ml or greater in 13). Comparison of these 2 subsets revealed significant differences in the incidence of cryptorchidism (39% vs 8%) and Kallmann's syndrome (22% vs 0%), pubic hair stage (1.3 +/- 0.5 vs 3.5 +/- 1.4), genital stage (1.2 +/- 0.4 vs 3.9 +/- 0.9) and TV (1.6 +/- 0.9 vs 7.5 +/- 3.5 ml). Long-term administration of hCG/hMG for 12 to 240 months (average 56 +/- 11) resulted in sperm production in only 36% of the small testis subjects but in 71% of the large testis subjects.


CONCLUSIONS
Initial TV values provide insight into phenotypic variables such as time of onset and severity in patients with primary or secondary HH, and may predict sperm output in response to hCG/hMG therapy.
Miyagawa
Yasushi
Y
Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Tsujimura
Akira
A
Matsumiya
Kiyomi
K
Takao
Tetsuya
T
Tohda
Akira
A
Koga
Minoru
M
Takeyama
Masami
M
Fujioka
Hideki
H
Takada
Shingo
S
Koide
Takuo
T
Okuyama
Akihiko
A
D000293:Adolescent; D000328:Adult; D002648:Child; D006063:Chorionic Gonadotropin / Q000627:therapeutic use*; D018740:Genetic Heterogeneity; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D017436:Kallmann Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D008134:Long-Term Care; D008297:Male; D008596:Menotropins / Q000627:therapeutic use*; D009929:Organ Size / Q000187:drug effects; D010641:Phenotype; D012189:Retrospective Studies; D012741:Sexual Maturation / Q000187:drug effects; D013091:Spermatogenesis / Q000187:drug effects; D013737:Testis / Q000187:drug effects; D016896:Treatment Outcome
D006063:Chorionic Gonadotropin; D008596:Menotropins