Gonadotropin administration after gonadotropin-releasing-hormone agonist: a therapeutic option in severe testiculopathies.
OBJECTIVE
To evaluate the effect of recombinant human follicle-stimulating hormone (FSH) plus human chorionic gonadotropin (hCG) on seminal parameters and pregnancy rate in severe testiculopathies after high FSH plasma concentrations have been suppressed.


METHODS
Prospective, controlled, randomized clinical study.


METHODS
Infertility center at a university hospital.


METHODS
Eighty-seven men affected by severe testiculopathy.


METHODS
We treated 57 men with a gonadotropin-releasing hormone agonist (GnRH-a) and then with recombinant human FSH and hCG, and 30 patients did not receive any treatment. Seminal parameters and sperm aneuploidies were evaluated during and after the treatment period. Couples did not achieve a spontaneous pregnancy received assisted reproduction treatment.


METHODS
Seminal parameters, sperm aneuploidies, testicular cytologic analysis, FSH, luteinizing hormone, testosterone, inhibin B concentrations, and pregnancy rate.


RESULTS
After the therapy period, the treated group showed statistically significant improvement in sperm parameters and sperm aneuploidies. No changes were observed in the untreated group. A trend toward an increase in pregnancy rate also was observed among treated couples (cumulative pregnancy rates 31.6% treated vs. 20.0% untreated), although the increase was not statistically significant. The improvement of seminal parameters in the treated group allowed some patients to undergo in vitro fertilization-embryo transfer instead of intracytoplasmic sperm injection.


CONCLUSIONS
Results from this controlled, randomized clinical trial show that FSH therapy improves sperm parameters in severe male factor infertility when endogenous high FSH plasma levels are suppressed. In cases of severely impaired testicles, a rational treatment of male infertility is mandatory to improve the outcome of assisted reproduction techniques.
Foresta
Carlo
C
Section of Clinical Pathology and Centre for Male Gamete Cryopreservation, Department of Histology, Microbiology, and Medical Biotechnologies, University of Padova, Padova, Italy. Electronic address: carlo.foresta@unipd.it.
Selice
Riccardo
R
Section of Clinical Pathology and Centre for Male Gamete Cryopreservation, Department of Histology, Microbiology, and Medical Biotechnologies, University of Padova, Padova, Italy.
Moretti
Afra
A
Section of Clinical Pathology and Centre for Male Gamete Cryopreservation, Department of Histology, Microbiology, and Medical Biotechnologies, University of Padova, Padova, Italy.
Pati
Mauro Antonio
MA
Section of Clinical Pathology and Centre for Male Gamete Cryopreservation, Department of Histology, Microbiology, and Medical Biotechnologies, University of Padova, Padova, Italy.
Carraro
Marina
M
Section of Clinical Pathology and Centre for Male Gamete Cryopreservation, Department of Histology, Microbiology, and Medical Biotechnologies, University of Padova, Padova, Italy.
Engl
Bruno
B
Obstetrics and Gynaecology Unit, Brunico, Italy.
Garolla
Andrea
A
Section of Clinical Pathology and Centre for Male Gamete Cryopreservation, Department of Histology, Microbiology, and Medical Biotechnologies, University of Padova, Padova, Italy.
D000328:Adult; D000782:Aneuploidy; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000819:agonists*; D006062:Gonadotropins / Q000008:administration & dosage*; D006801:Humans; D007248:Infertility, Male / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D011247:Pregnancy; D011994:Recombinant Proteins / Q000008:administration & dosage; D055101:Semen Analysis; D012720:Severity of Illness Index; D012729:Sex Chromosome Aberrations; D013733:Testicular Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D024182:Uniparental Disomy
D006063:Chorionic Gonadotropin; D004338:Drug Combinations; D006062:Gonadotropins; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D005640:Follicle Stimulating Hormone